Monday, 27 June 2011

Young People Get Low Back Pain Too?!?!

When I was asked by Anthony to cover the lower back and low back pain in one of my talks at The 21 Convention one of my first thoughts was whether or not the audience would really be that interested. After meeting and speaking directly with many of the attendees at this year's convention in London, I was pleasantly surprised at how interested many of them were. A number of them had specific questions regarding exercise to help strengthen the lumbar extensors and prevent occurrence of LBP and a number also spoke to me about the back pain they themselves experienced. Most of the attendees were probably aged between 18-30 years old.

The 21 Convention Official Cinematic Trailer

An official trailer for The 21 Convention was released last week including footage from one of my talks (on Objectivism, not my low back talk). I recommend checking it out and not just because it has me in. It's epic to say the least.

A comment was left on Anthony's blog regarding the speakers featured in the trailer and what impact their 'popularity' would have.

Well, I'll briefly comment that it seems more likely to me that Anthony chose not specifically those speakers he wanted in the trailer but more the idea's expressed in their talks that best exemplified each aspect that the convention aims to cover.

What I wanted to do in this post was to respond to the assertion made by MikeG.

"...wont sell tickets, neither will a guy specializing on “low back pain” guys in their early twenties don't have back pain (blahblahblah at whatever counterpoint you have to having a low back specialist speaking)..."

Anecdotal as it is, I'm fairly certain already that this assertion is false by the number of people who informed me they had LBP at the convention and the ages they were. In addition based on the interest noted at the convention it seems that there is some demand for the information.

But more importantly, had MikeG attempted a brief search of the academic literature, say even a google scholar or pubmed search (you can get free access, so no excuse really), it would have brought up enough evidence to show how ridiculous and socially conditioned this concept is.

High prevalence of LBP from ages 10~20 y/o

Here's a small sample of studies showing prevalence of LBP in adolescents and young adults and some associated factors.

To be fair it wouldn't matter whether the prevalence was high or not. Any observation of LBP in these ages would refute MikeG's claim. But interestingly some of these studies found very high prevalence.

  • Kujala et al. 1992 - 10.3-13.3 y/o - Athlete's and non-athletes had similar LBP prevalence, but duration of training in last 12 months was a risk factor for 12 month prevalence.

  • Salminen et al. 1992 - 15 y/o - 38 symptomatic and 38 asymptomatic participants selected from population of 1503 (not clear whether this means that there was only 38 with LBP or only 38 participated). Decreased sagittal mobility and trunk muscle strength associated with LBP.

  • Salminen et al. 1995 - 15 y/o - Follow up from previous study. LBP at baseline and follow up characterised by decreased spinal function i.e mobility and strength. Disc degeneration worse at follow up in the with LBP.

  • Loboeuf-Yde & Kyvik, 1998 - By age 18 (females) and 20 (males) more than 50% had experienced LBP. 1 year prevalence began at 7% in 12 y/o and reached 56% & 67% by 41 y/o with a steady increase over that period.

  • Salminen et al. 1999 - 15 y/o with 9 year follow up - 35% reported LBP persistently between 14-23 y/o. Early disc degeneration was predictive of future LBP recurrence.

  • Kovacs et al. 2003 - 13-15 y/o - Lifetime prevalence of LBP 50.9% (males) and 69.3% (females). Numerous associated factors, though causality can't be inferred. Interesting though is the association of greater frequency of sport participation in light of the first cited study. (Overtraining from high impact activities??)

  • Brennan et al. 2007 - 20.9 y/o - Overall prevalence of LBP was 32%. Two associated factors were age and time spent engaged in personal training physical activity (again with the overtraining). Participation in sports was the only other factor that approached significance (p=0.068) (potentially high impact). The authors suggest that age (despite a difference of only 1 year between groups) was associated likely due to an increased duration of exposure.

So what to make of this? It seems that LBP is common even in adolescents and young adults. Sorry MikeG you were wrong.

It's interesting also that Salminen's studies indicated decreased trunk strength as associated with LBP, and also a temporal relationship between it (characterised at baseline) and further development of disc degeneration (at follow up in LBP group) suggesting the potential of one being caused (or at least influenced) by the other.

These studies are interesting because although chronic LBP is usually characterised as a degenerative disease and part of the aging process this evidence demonstrates that's not necessarily the case. Age related degeneration will undoubtedly have an impact, however it seems that lumbar spine dysfunction may be the more important factor.


  1. The speakers were chosen for the trailer by 2 means.

    1. Who expressed the cornerstones/pillars of T21C best.
    2. Who I wanted to see succeed most.

    Doug McGuff and his chosen quote were an easy pick in both regards.

    Jason Savage was a tough call over Steve Mayeda, but ultimately Steve was promoted in the last trailer a lot, so I gave Jason the spot, who had an excellent quote.

    My quote hit the nail on the head for self-actualization and becoming more of yourself.

    And you, heh, I want to see you succeed in your endeavors James. The quote, great (and custom made) as it was, was second to this. You're also extremely in tune with my ideas and T21C, so it made excellent sense in my mind to have you included in there.

    -- Anthony

  2. Man is a rational animal. Like I said to you when we first met, it's not coincidence that the two of us have come to the same conclusions and have the same values. It's the consistent acceptance of reason as an absolute. In that sense you're right in your reason for including me. As arrogant as that sounds to most, to anyone who applies reason it shows my confidence that it's true.

    Thanks Anthony.

  3. I've noticed that if I wear normal shoes for a while, my entire back, knees, hips, and sometimes shoulders get sore. I make an effort to rest and wear my Vibrams as much as I can. And I'm only 18 yrs/o. This is anecdotal, but it still disproves MikeG.

    Another anecdote: A few years ago, i was squatting in Nike Shox shoes. After a few weeks of heavy squatting, I developed an intense pain in my knees and couldn't do even light squats. My form was always pretty good. I don't remember any unusual back pain, but the knee pain went away when I switched to flat shoes. I've been more or less barefoot/minimal shoes ever since.

    I really wish I could have seen your talks in London. I'm going to the July event though. Seriously can't wait.

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