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Chiropr Man Therap. 2019 Mar 20;27:10. doi: 10.1186/s12998-018-0231-x. eCollection 2019.

The natural course of low back pain from childhood to young adulthood - a systematic review.

Author information

1Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark.
2Health Sciences Research Centre, University College Lillebaelt, Odense, Denmark.
3Department of Orthopaedics, Sydvestjysk Sygehus Esbjerg, Esbjerg, Denmark.



Taking the natural course of recurrent and fluctuating low back pain (LBP) seen in longitudinal studies of adults into consideration, the aetiology and development of LBP in children and adolescents also needs to be reflected in a long-term course. Therefore, a systematic critical literature review was undertaken to assess the natural course of LBP in the general population from childhood through adolescence to young adulthood.


A systematic literature search was conducted in MEDLINE, EMBASE, CINAHL and PsycINFO with synonyms of search terms for 1) low back pain; 2) natural course; 3) cohort study and 4) children. Records in English, German, French, Danish, Swedish, and Norwegian were included. To assess the methodological quality of the studies, the NIH quality assessment checklist for cohort studies was adapted and risk of bias was assessed on a study level. Two authors independently reviewed selected studies, assessed quality, and extracted data. A synthesis of results in relation to the natural course of LBP was created.


Totally, 3373 records were identified, eight articles were included for quality assessment, and finally, four studies of good to fair quality were included for synthesis of results. Indication of three common patterns of LBP were identified across studies and labelled as 1) ´children and adolescents with no LBP or low probability of LBP´ (49 to 53%), 2) ´children and adolescents with fluctuation of LBP´ (16 to 37%) and 3) ´children and adolescents with repeated reporting of LBP´ (< 1 to 10%).


Although methodological heterogeneity, mainly due to different age ranges, an indication of a natural course of LBP was seen across studies. The majority of children and adolescents repeatedly reporting no or low probability of LBP. With recall periods between one week to three months and sampling rates ranging from one to four years, a very low rate repeatedly reported LBP, and approximately one-fifth to one-third of children and adolescents had fluctuating reports of LBP. A need of future research of LBP trajectories with short reporting period lengths and narrower sampling windows in a long-term perspective is emphasized in order to study childhood influences on the development of LBP throughout life.


Children and adolescence; Low back pain; Natural course

Conflict of interest statement

This article was commissioned, and peer reviewed by the Journal of Chiropractic & Manual Therapies (CMT). The authors PK and NW were author and co-author on one of the manuscripts included in the current systematic review.TJ designed and directed the project, searched the databases, assessed the eligibility of potential studies, did quality assessment and data extraction for analysis of the results and wrote the manuscript. NW, EB and PK contributed to the design of the research, to the assessment of the eligibility of potential studies, to quality assessment and data extraction for analysis of the results and read and approved the final manuscript.Not applicable.Not applicable.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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