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breaks could involve active neck and back extension, flexion, lateral bending and rotation (Fig. 3), and rolling the shoulders to relax the upper spine muscles such as the trapezius muscle (Fig. 4). Excessive daily use of screen media and prolonged sitting should be avoided. n Low-impact aerobic exercises such as walking and cycling may be useful ways of reducing adolescent spinal pain, and these could be incorporated into the school journey. n Adolescent employment, particularly white-collar work, may be a risk factor. n School bags should not be perceived by the adolescent as overly heavy.

References 1. Hakala PT, Rimpelä AH, Saarni LA, Salminen JJ. Frequent computer-related activities increase the risk of neck-shoulder and low back pain in adolescents. European Journal of Public Health 2006;16:536–541 2. Auvinen J, Tammelin T, Taimela S, Zitting P, Karppinen J. Neck and shoulder pains in relation to physical activity and sedentary activities in adolescence. Spine 2007;32:1038–1044 3. Ho SMY, Lee TMC. Computer usage and its relationship with adolescent lifestyle in Hong Kong. Journal of Adolescent Health 2001;29:258–266 4. Ramos EMA, James CA, Bear-Lehman J. Children’s computer usage: are they at risk of developing repetitive strain injury? Work 2005;25:143–154 5. Sjolie AN. Associations between activities and low back pain in adolescents. Scandinavian Journal of Medicine and Science in Sports 2004;14:352–359 6. Diepenmaat AC, van der Wal MF, de Vet HC, Hirasing RA. Neck/ shoulder, low back, and arm pain in relation to computer use, physical activity, stress, and depression among Dutch adolescents. Pediatrics 2006;117:412–416 7. Harreby M, Nygaard B, Jessen T, Larsen E, et al. Risk factors for low back painin a cohort of 1389 Danish school children: an epidemiologic study. European Spine Journal 1999;8:444–450 8. Straker L, O’Sullivan PB, Smith A, Perry MC. Computer use and habitual spinal posture in Australian adolescents. Public Health Reports

2007;122:634–643 9. Straker LM, O’Sullivan PB, Smith AJ, Perry MC. Relationships between prolonged neck/shoulder pain and sitting spinal posture in male and female adolescents. Manual Therapy 2008;[Epub ahead of print]. 10. Sheir-Neiss GI, Kruse RW, Rahman T, Jacobson LP, Pelli JA. The association of backpack use and back pain in adolescents. Spine 2003;28:922–930 11. Briggs A, Straker L, Greig A. Upper quadrant postural changes of school children in response to interaction with different information technologies. Ergonomics 2004;47:790–819 12. Niemi S, Levoska S, Kemila J, Rekola K, Keinanen-Kiukaanniemi S. Neck and shoulder symptoms and leisure time activities in high school students. Journal of Orthopedic and Sports Physical Therapy 1996;24:25–29 13. Vikat A, Rimpela M, Salminen JJ, Rimpela A, et al. Neck or shoulder pain and low back pain in Finnish adolescents. Scandinavian Journal of Public Health 2000;28:164–173 14. Salminen JJ, Erkintalo M, Laine M, Pentti J. Low back pain in the young: a prospective three-year follow up study of subjects with and without low back pain. Spine 1995;20:2101–2108 15. Nelson MC, Gordon-Larsen P, Adair LS, Popkin BM. Adolescent physical activity and sedentary behavior patterning and long-term maintenance. American Journal of Preventative Medicine 2005;28:259–266 16. Ehrmann-Feldman D, Shrier I, Rossignol M, Abenhaim L. Risk factors for the development of neck and upper limb pain in adolescents. Spine 2002;27:23–28 17. Mikkelsson LO, Nupponen H, Kaprio J, Kautiainen H, et al. Adolescent flexibility endurance strength and physical activity as predictors of adult tension neck low back pain and knee injury: a 25 year follow up study. British Journal of Sports Medicine 2006;40:107–113

18. Szpalski M, Gunzburg R, Balagué F, Nordin M, Mélot C. A 2-year prospective longitudinal study on low back pain in primary school children. European Spine Journal 2002;11:459–464 19. Wedderkopp N, Leboeuf-Yde C, Andersen LB, Froberg K, Hansen HS. Back pain in children: no association with objectively measured level of physical activity. Spine 2003;28:2019–2024 20. Ehrmann-Feldman D, Shrier I, Rossignol M, Abenhaim L. Work is a risk factor for adolescent musculoskeletal pain. Journal of Occupational and Environmental Medicine 2002;44:956–961 21. Brackley H, Stevenson J. Are children’s backpack weight limits enough? A critical review of the relevant literature. Spine 2004;29:2184–2190 22. Haselgrove C, Straker L, Smith A, O’Sullivan P, et al. Perceived school bag load, duration of carriage, and method of transport to school are associated with spinal pain in adolescents: an observational study. Australian Journal of Physiotherapy 2008;54:193–200

23. Grimmer K, Williams M. Gender–age environmental associates of adolescent low back pain. Applied Ergonomics 2000;31:343–360 24. Van Gent C, Dols JJ, de Rover CM, Hira Sing RA, de Vet CW. The weight of schoolbags and the occurrence of neck, shoulder, and back pain in young adolescents. Spine 2003;28:916–921 25. Watson KD, Papageorgiou AC, Jones GT, Taylor S, et al. Low back pain in schoolchildren: the role of mechanical and psychosocial

factors. Archives of Disease in Childhood 2003;88;12–17. THE AUTHOR TH

Mark Perry practiced as a charted physiotherapist for several years before moving full-time into biomedical research. PhD evaluated the effects of muscle tremor on falling in older people, and he carried out his post-doctoral work in Western Australia, working on a large-scale cohort study

ving full-time into biomedical research. His

into the causes of spinal pain in adolescents. He is now supervising undergraduate and postgraduate research projects at Barts and the London School of Medicine and Dentistry. He has published 15 articles in peer-reviewed journals and has presented his research findings internationally. He is a keen Masters track athlete, recently winning a national title and an international vest by selection.

16 sportEX medicine 2009;41(Jul):12-19

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