• Users Online: 498
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
Year : 2018  |  Volume : 18  |  Issue : 2  |  Page : 45-50

Prediction of low back pain among school-aged adolescents using parental sociodemographic variables in a Nigerian City

1 Department of Medical Rehabilitation, Faculty of Basic Medical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile Ife, Nigeria
2 Department of Physiotherapy, Faculty of Basic Medical and Allied Health Sciences, College of Health Sciences, Bowen University, Iwo, Nigeria

Date of Submission05-Dec-2019
Date of Decision14-Apr-2020
Date of Acceptance04-May-2020
Date of Web Publication23-Mar-2022

Correspondence Address:
Dr. A O Ojoawo
Department of Medical Rehabilitation, Faculty of Basic Medical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile Ife
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/njhs.njhs_30_19

Rights and Permissions

Background: Low back pain (LBP) is the most prevalent musculoskeletal disorder among adults, but how parental sociodemographic factors associated with the prevalence of LBP among adolescents is still under investigation.
Materials and Methods: Eight schools were selected randomly; from each school, 100 students were consecutively selected amounting to 800 participants for the study. LBP questionnaire from a study of Chiwaridzo and Naidoo was adopted for the research. The Likert scale questionnaire was administered to each participant and collected as soon as it was completed. Descriptive and inferential statistics were used to analyse the data. Alpha level was set at 0.05.
Results: The results showed that 710 questionnaires, which were 88.7% of the total, were analysable. More than 46% of the participants recorded LBP in the last 1 year. There was significant association between occurrence of LBP and each of family history of LBP (χ[2] = 13.357, P = 0.000), fathers' occupation (χ[2] = 13.357, P = 0.000) and education (χ[2] = 13.357, P = 0.000); mothers' occupation (χ[2] = 13.357, P = 0.000) and education (χ[2] = 13.357, P = 0.000). Prediction equation for the occurrence of LBP is: Y = K + B (Occupation) + C (Education) + D (LBP in the family). The r[2] value was 0.473 interpreting that the percentage contribution of these factors to the prediction of LBP among adolescents was 47.3%.
Conclusion: The study showed that prevalence of pain at low back was 46% among 10–14 years' adolescents. Some parental sociodemographic variables may contribute to the occurrence of LBP among adolescents.

Keywords: Adolescents, education, family, low back pain, occupation

How to cite this article:
Ojoawo A O, Enokeran H O, Fatoyinbo E F, Akinola O T. Prediction of low back pain among school-aged adolescents using parental sociodemographic variables in a Nigerian City. Niger J Health Sci 2018;18:45-50

How to cite this URL:
Ojoawo A O, Enokeran H O, Fatoyinbo E F, Akinola O T. Prediction of low back pain among school-aged adolescents using parental sociodemographic variables in a Nigerian City. Niger J Health Sci [serial online] 2018 [cited 2023 Sep 27];18:45-50. Available from: http://www.https://chs-journal.com//text.asp?2018/18/2/45/340544

  Introduction Top

Low back pain (LBP) is the most prevalent musculoskeletal condition and the most common cause of disability in developed nations.[1] The lifetime prevalence rate of 40% in the United Kingdom[2] and 34.5% in the United States of America[3] has been documented. The prevalence of LBP has also been reported in low-income countries; 58% in South Africa[4] and 25% in Nigeria.[5] In clinical settings, LBP in children and adolescents is often perceived to be uncommon; most research studies on LBP have focused on adults.[6],[7] The prevalence rate for children and adolescents is lower than that seen in adults but is rising.[8] The 1-year prevalence rate of LBP in children has been reported from 7% to 58%.[9] The likelihood of a child from a family with positive family history of LBP of having LBP is almost two times more than those without positive history of back pain.[1] Children with LBP in childhood are at higher risk of LBP in adulthood.[10] The period of adolescence has been described as a critical stage of spinal development characterised by rapid growth until early adulthood.[11],[12] During this period of rapid growth, the adolescent spine is thought to be vulnerable to stress.[11],[12],[13] A study has reported adverse effects on muscles with prolong sitting, which subject the muscles of the back to prolonged low-level static loading.[13] Prolonged activity leads to impaired oxygenation of the muscle tissues and has been implicated as a cause of back pain.[14] Therefore, prolonged sitting will end up in pain and limiting the spinal movements.[15] The red flags associated with LBP include osteoporosis, previous or current cancer, focal neurological deficit, unexplained fever and immunosuppression.[16] Modifiable risk factors of developing LBP can be classified as lifestyle (physical inactivity, smoking, obesity and poor muscle strength) and occupational (heavy lifting, twisting, bending, prolonged sitting, stooping, awkward posture at work and poor ergonomics).[17],[18] Sitting, especially prolonged sitting, is generally accepted as a risk factor in developing LBP. [19] In general, most students (60%) spend on average of 20 h per week sitting, for prolonged hours in class or front of technology (computer or television),[20] which may predispose them to LBP. Long periods of sitting and lack of spinal motion may increase the stress of the back, neck, and legs and may put an extra pressure to the back muscles and the supporting tissues, leading to muscle tension and fatigue, joint strain and spinal disc compression.[21] Relatively, little has been done to understand the prevalence of LBP among adolescents and how parental sociodemographic factors such as education and occupation associate with the prevalence of LBP among adolescents.[9] The study therefore determined the prevalence of LBP among school-aged adolescents and its association with parental sociodemographic variables in Ile Ife, Nigeria.

  Materials and Methods Top


Junior secondary school (JSS) 1–3 students from selected schools in Ife Central Local Government of the State of Osun, Nigeria, participated in this study.

Inclusion criteria

Apparently healthy male and female pupils between the ages of 10 and 14 years in JSS 1–3 who volunteered to participate in the study.

Exclusion criteria

Students of the age bracket but unwilling to participate from the study or the parent did not give the consent.


The LBP study questionnaire used by Chiwaridzo and Naidoo was adapted for the study.[22] The choice of a questionnaire as a survey tool was based on the fact that pain is a highly subjective phenomenon best evaluated by self-report.[23] In addition, self-administered questionnaires have been reported to yield similar results as compared to other self-report methods such as face-to-face interviews.[24] Section A of the questionnaire evaluated the primary outcome measures of the prevalence of recurrent LBP. A mannequin was used with an arrow pointing to a posterior view of the lumbar region to assist the respondents in identifying the lower back. As the study sought information on LBP, respondents were specifically instructed to report on back pain localised to the identified region of a spine but not on pain related to the experience of menses. Pain intensity was evaluated based on the visual analogue scale (VAS) from 0 (no pain) to 10 (maximum pain). Section B captured information regarding the highest level of education of parents, occupation of the parent and family history of LBP. Participants were thoroughly tutored on the meaning of LBP as the pain that is situated at the level of first lumbar vertebrae to the sacral region; a picture was shown to describe the location of the pain. The family history was limited to the nuclear family, father, mother and siblings, and each participant was educated on how to assess the pain intensity using VAS.

Research design

The study was a cross-sectional study.

Determination of sample size

Using the formula for determining sample size from a population that is >10,000 sample formula:

n = z[2] pq/d[2]


n = the desired sample size.

z = the standard normal deviate, usually set at 1.96 (or more simply 2.0), which corresponds to the 95% confidence level.

p = the proportion in the target population estimated to have a particular characteristic. If there is no reasonable estimate, 50% is used.

q = 1.0 – p

d = degree of accuracy desired, usually set at 0.05 or occasionally at 0.02.[25]

The calculated sample size for this study would then be:

n = (1.96)[2] (0.5) (0.5)/(0.05)[2]

= 384.2

Therefore, the minimum sample size for this study was approximated to 384, but 800 participants were recruited for the study to make the sample size appreciably large.

Sampling technique

Simple random sampling using the fishbowl technique was used to select a total of eight secondary schools from Ife Central Local Government. Using consecutive sampling technique, 100 students were selected in each school from JSS 1–3 making 800 participants in all from the eight schools for the study. Approval was obtained from the Local Inspector of Education, Ife Central Local Government Area, Ile-Ife.


Ethical approval for this study was obtained (IPHOAU/12/914) from the Health Research and Ethics Committee, Institute of Public Health, Obafemi Awolowo University, Ile-Ife. Letters of introduction from the Department of Medical Rehabilitation was taken to the management of selected schools in the study area (Ile-Ife), seeking for permission from the principals to conduct the study in such schools. Informed consent and assent were obtained from the parents and participants, respectively. Participants were fully informed about the study before data collection. Participants were given a copy of the questionnaire to fill. The questionnaire was explained to each of the participants. The questionnaire was collected as soon as participant completed it. The children provided information about the parents' level of education, occupation and family history of LBP.

Data analysis

The data were analyzed using Statistical Packages for Social Sciences (SPSS) version 17 (Illinois, Chicago). Descriptive and inferential statistics were used to summarise the data. Chi-square test was used to evaluate the association between the occurrence of LBP and each of the following: occurrence of back pain in the family, educational level of the parent and occupation of the parent. Logistic regression was used to examine the degree of prediction of the prevalence of LBP by the variables. Alpha level of 0.05 was set as level of significance.

  Results Top

Sociodemographic parameters of the participants and their parents

[Table 2] presents the sociodemographic parameters of the participants and their parents. The study showed that 358 (50.4%) of the participants were male. A large number (432, 60.8%) of the participants' father attained the tertiary level of education. It was observed that 350 (49.3%) of the participant's father were civil servant and 299 (42.1%) of the participant's mother were business women. Further, 412 (58%) of the participant's mother had tertiary education.
Table 2: Sociodemographic parameters of the participants and parents (n=710)

Click here to view

Prevalence of low back pain among participants and family members

[Table 2] presents the prevalence of LBP among participants and family members. It was observed that 292 (41.1%) of the participants had LBP. In addition, it was observed that 325 (45.8%) of the participant's family members had LBP with the mother accounting for more than 141 (19%).
Table 2: Prevalence of low back pain among participants and family members (n=710)

Click here to view

[Table 3] summarises the Chi-square analysis of the association between parental occupation and prevalence of LBP. There was significant association between the prevalence of LBP and each of father's (χ[2] = 14.353, P = 0.000) and mother's (χ[2] = 12.257, P = 0.000) occupation.
Table 3: Association between parental occupation and prevalence of low back pain (n=292)

Click here to view

[Table 4] summarises the Chi-square analysis of the association between parental educational level and prevalence of LBP. There was significant association between prevalence of LBP and each of father's (χ[2] = 11.357, P = 0.000) and mother's (χ[2] = 10.358 P = 0.000) education and prevalence of LBP among adolescents of 10–14 years' old.
Table 4: Association between parental education and prevalence of low back pain (n=292)

Click here to view

[Table 5] summarises the Chi-square analysis of the association between family history of LBP and prevalence of LBP. There was significant association between the family history and prevalence of LBP among the participants.
Table 5: Association between family history of low back pain and prevalence of low back pain (n=292)

Click here to view

[Table 6] presents the logistic regression for the prediction of prevalence of LBP with parental sociodemographic variables. Tables reveal that mother's occupation, education and history of pain in the family were more significant contributors to the prevalence of LBP. The r[2] value from the analysis was 0.473, showing that the percentage contribution to the prediction was close to 50%. Prediction equation for the occurrence of LBP using parental sociodemographic variables was: Y = K + B (Occupation) + C (Education) + D (Pain in the family). K = Constant; B, C, and D are categorical variables [Table 6].
Table 6: Logistic regression for the prediction of prevalence of low back pain form parental sociodemographic variables

Click here to view

  Discussion Top

The primary objectives of the study were to determine the prevalence of LBP and the association of parental sociodemographic factors with the prevalence. The results of the study showed a LBP prevalence rate of more than 40% among school-aged adolescents. This was more than the prevalence rate of 18.5%, being 15.5% in boys and 21.6% in girls among students in Brazil, aged 10–14 years reported by Okamoto et al.[26] In addition, the results of the study by Fernandes et al.,[27] in adolescents aged 11–14 years in the Northwest of England, revealed a prevalence of LBP of 24%. The differences may be due to that factors which may be associated to Nigeria as a country. In Nigeria, children are made to do strenuous activities such as hawking on the street, farm work and bending down for long hour to do house chores; cleaning of school compound which may include cutting of grasses. They were involved in manual carrying of some loads at home which may result in to twisting of the spine. These may be some factors that may make the prevalence in our study more than other sited researchers. Other predisposing factors including chairs in the school which may not be ergonomically compliance, long hours of sitting and bad sitting posture have been linked to the development of back pain. The study reported that long sitting has significant effect on the low back due to unnecessary stress on the spine which when occurs repeatedly can cause micro-trauma to the spine.[28] Prolonged sitting in bad position leads to slackening of the abdominal muscles and curvature of the spine. In bad sitting posture, the lumbar lordosis tends to flatten and the pelvis rotates posteriorly. This kyphotic posture places increased stress on the posterior elements of the spine and raises intra-discal pressure.[29]

The study observed further that more than 60% of the participants' parents with LBP had tertiary education. This was in support of the report by Hestbaek et al.[30] that parental education status, which is an indicator of socioeconomic status of the family, is considered as a factor that has been associated with LBP in adolescents. Parents with tertiary education probably may be a civil servant with car and a good home amenity. In this case, such a parent will endeavour to carry his/her child to school and bring such child from the school. Even at home, such children will be busy doing assignments. All this activity involved sitting posture. Couple with the long sitting hour in the school, such child is highly prone to LBP. As a rider to this, the only time for exercise or increase physical activity may be on weekend which may be grossly inadequate for the strengthening of the back muscles. In addition, the type of food and this sedentary life style by these children will most likely result in overweight, another factor that may likely promote the development of or initiate LBP. The study noticed a significant association between family history of LBP and occurrence of LBP. This supports the research result conducted by Masiero et al.,[31] which reported a positive association between the presence of LBP among adolescents and family history of LBP. Further, Leboeuf-Yde[32] noted that there is evidence of a relatively strong genetic component in the development of LBP, both in the young and in adult. From the results, the predictability of prevalence of LBP by parental socioeconomic parameters was about 47%, which was shown in the r[2] to be 0.47. It can be understood from this that there are other factors that have their contributions to the prevalence. Researches established that there is association between LBP and the link between school bag weight in adolescents.[33],[34] Onofrio et al. documented a significant association between backpack weight and adolescent LBP prevalence.[35] On the other hand, neither satchel weight nor the mode of its carriage was found to be associated with adolescent LBP among Tunisian adolescents.[24]

  Conclusion Top

There was high prevalence of LBP among adolescents aged between 10 and 14 years, and parental occupation, education and family history of pain were found to be associated with the prevalence of back pain among adolescents.

Limitation of the study

There were some limitations from the study. One of them was that the education, family history of LBP and occupation of the parents were reported from the children (participants). It is assumed that this information was true and correct for each family. Further, pain is highly subjective; it was assumed that the pain reported by the participants was the true picture of their feelings.


We acknowledged the support of the Head of Department, Prof R. A. Adedoyin for the completion of the study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ 2003;81:646-56.  Back to cited text no. 1
Sjolie AN. Low-back pain in adolescents is associated with poor hip mobility and high body mass index. Scand J Med Sci Sports 2004;14:168-75.  Back to cited text no. 2
Jones MA, Stratton G, Reily T, Unnithan VB. A school based survey of recurrent nonspecific low back pain prevalence and consequences in children. Health Edu Res 2004;19:284-9.  Back to cited text no. 3
Jordan R, Kruger M, Stewart AV, Becker PJ. The association between low back pain, gender, and age in adolescents. S Afr J Physiother 2005;61:15-20.  Back to cited text no. 4
Ayanniyi O, Mbada CE, Muolokwu CA. Prevalence and profile of back pain in Nigerian adolescents. Med Princ Pract 2011;20:368-73.  Back to cited text no. 5
Omokhodion FO, Sanya AO. Risk factors for low back pain among office workers in Ibadan, Southwest Nigeria. Occup Med (Lond) 2003;53:287-9.  Back to cited text no. 6
Rotgoltz J, Derazne E, Froom P, Grushecky E, Ribak J. Prevalence of low back pain in employees of a pharmaceutical company. Isr J Med Sci 1992;28:615-8.  Back to cited text no. 7
Taimela S, Kyjala UM, Salminen JJ, Viljanen T. The prevalence of LBP among children and adolescents a nationwide cohort-based questionnaire survey in Finland. Spine 1997;22:1132-6.  Back to cited text no. 8
Smith DR, Leggat PA. Back pain in the young. A review of studies conducted among school children and university students. Cur pediatric Rev 2007;3:69-77.  Back to cited text no. 9
Hestbaek L, Leboeuf-Yde C, Kyvik KO, Manniche C. The course of low back pain from adolescence to adulthood: Eight-year follow-up of 9600 twins. Spine (Phila Pa 1976) 2006;31:468-72.  Back to cited text no. 10
Grimmer K, Williams M. Gender-age environmental associates of adolescent low back pain. Appl Ergon 2000;31:343-60.  Back to cited text no. 11
Dockrell S, Kane C, Keeffe EO. School bag weight and the effects of school bag carriage on secondary school students. Physiotherapy Ireland 2006;17:1-6.  Back to cited text no. 12
Nancy C, Selby BS, John J, Triano DC. Office chair, posture and driving ergonomics. Spine Health 2018.  Back to cited text no. 13
Wan JJ, Qin Z, Wang PY, Sun Y, Liu X. Muscle fatigue: General understanding and treatment. Exp Mol Med 2017;49:e384.  Back to cited text no. 14
Lis AM, Black KM, Korn H, Nordin M. Association between sitting and occupational LBP. Eur Spine J 2007;16:283-98.  Back to cited text no. 15
Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, et al. Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007;147:478-91.  Back to cited text no. 16
Chon J, Kim SW, Kim SS, Kim YG, Choi HJ. Risk factors of low back pain in a general population. J Korean Acad Rehabil Med 2000;24:981-7.  Back to cited text no. 17
Pill RM, Jones-Elwyn G, Stott NC. Opportunistic health promotion: Quantity or quality? J R Coll Gen Pract 1989;39:196-200.  Back to cited text no. 18
Levangie PK. Association of low back pain with self-reported risk factors among patients seeking physical therapy services. Phys Ther 1999;79:757-66.  Back to cited text no. 19
Marie L, Mark D American Heart Association. Many Teen Spend 30 Hours A Week On Screen Time During High School. Science Daily; 2008  Back to cited text no. 20
Danoff R. Sitting Pain-Back Pain. Available from: https://www.healthline.com/health/lower-back-pain-when-sitting#. [Last assessed on 2018 Jun 07].  Back to cited text no. 21
Chiwaridzo M, Naidoo N. Prevalence and associated characteristics of recurrent non-specific low back pain in Zimbabwean adolescents: A cross-sectional study. BMC Musculoskelet Disord 2014;15:381.  Back to cited text no. 22
Haraldstad K, Sørum R, Eide H, Natvig GK, Helseth S. Pain in children and adolescents: Prevalence, impact on daily life, and parents' perception, a school survey. Scand J Caring Sci 2011;25:27-36.  Back to cited text no. 23
Bejia I, Abid N, Bensalem K, Touzi M, Bergaoui N. Reproducibility of a low back pain questionnaire in Tunisian adolescents. Clin Rheumatol 2006;25:715-20.  Back to cited text no. 24
Eng J. Sample size estimation: How many individuals should be studied? Radiology 2003;227:309-13.  Back to cited text no. 25
Okamoto K, Ohsuka K, Shiraishi T, Hukazawa E, Wakasugi S, Furuta K. Comparability of epidemiological information between self- and interviewer-administered questionnaires. J Clin Epidemiol 2002;55:505-11.  Back to cited text no. 26
Fernandes JA, Genebra CV, Maciel NM, Fiorelli A, Conti MH. Low back pain in schoolchildren: A cross-sectional study in a western city of São Paulo State, Brazil. Acta Ortop Bras 2015;23:235-38.  Back to cited text no. 27
Watson KD, Papageorgiou AC, Jones GT, Taylor S, Symmons DP, Silman AJ, et al. Low back pain in schoolchildren: The role of mechanical and psychosocial factors. Arch Dis Child 2003;88:12-7.  Back to cited text no. 28
Beach TA, Parkinson RJ, Stothart JP, Callaghan JP. Effects of prolonged sitting on the passive flexion stiffness of the in vivo lumbar spine. Spine J 2005;5:145-54.  Back to cited text no. 29
Hestbaek L, Korsholm L, Leboeuf-Yde C, Kyvik KO. Does socioeconomic status in adolescence predict low back pain in adulthood? A repeated cross-sectional study of 4,771 Danish adolescents. Eur Spine J 2008;17:1727-34.  Back to cited text no. 30
Masiero S, Carraro E, Celia A, Sarto D, Ermani M. Prevalence of nonspecific low back pain in schoolchildren aged between 13 and 15 years. Acta Paediatr 2008;97:212-6.  Back to cited text no. 31
Leboeuf-Yde C. Back pain-individual and genetic factors. J Electromyogr Kinesiol 2004;14:129-33.  Back to cited text no. 32
Adegoke BO, Odole AC, Adeyinka AA. Adolescent low back pain among secondary school students in Ibadan, Nigeria. Afr Health Sci 2015;15:429-37.  Back to cited text no. 33
Anderson GB. The epidemiology of spinal disorders in fry. In: Moyer JW, editor. The Adult Spine Principles and Practice. Philadelphia: Lippincott-Raven; 1997. p. 93-141.  Back to cited text no. 34
Onofrio AC, da Silva MC, Domingues MR, Rombaldi AJ. Acute low back pain in high school adolescents in Southern Brazil: Prevalence and associated factors. Eur Spine J 2012;21:1234-40.  Back to cited text no. 35


  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Materials and Me...
Article Tables

 Article Access Statistics
    PDF Downloaded99    
    Comments [Add]    

Recommend this journal