From: Rehabilitation of back pain in the pediatric population: a mixed studies systematic review
First Author, Country, Study Design | Year | Total participants | Clinical condition | Age (years) | Female sex No, (%) | Interventions | ||
---|---|---|---|---|---|---|---|---|
Mean/ median | SD/ range | Intervention | Comparison | |||||
Spinal manipulation | ||||||||
 Evans (United States) RCT [33] | 2018 | 185 | Adolescents (12–18 years) with nonspecific LBP with or without leg pain, VAS ≥ 3/10; subacute/recurrent (current episode 2–12 weeks duration with at least one similar episode in the past year) or chronic (current episode ≥ 12 weeks duration) | I: 15.5 C: 15.3 | I: 1.6 C: 1.8 | I: 65 (70%) C: 62 (67%) | Type: SMT + Exercise SMT: provided by chiropractors; techniques: high velocity low amplitude (preferred), low velocity low amplitude mobilization, flexion-distraction or drop-table assisted; up to a few minutes of ice/heat or soft tissue massage as needed Duration: 12 weeks Frequency: 1–2 x/week (20-min sessions); 8–16 sessions total Setting: clinic Exercise: provided by chiropractors or exercise therapists; self-care education; supervised sessions; components: aerobic, stretching, strengthening; home exercises accompanied by 20–40 min of aerobic activity Duration: 12 weeks Frequency: Supervised exercises: 1-2x/week (45-min sessions), 8–16 sessions total; Home exercises: 2x/week Setting: clinic/home | Type: Exercise (provided by chiropractors or exercise therapists; self-care education; supervised sessions; components: aerobic, stretching, strengthening; home exercises accompanied by 20–40 min of aerobic activity) Duration: 12 weeks Frequency: Supervised exercises: 1-2x/week (45-min sessions), 8–16 sessions total; Home exercises: 2x/week Setting: clinic/home |
 Selhorst (United States) RCT [22] | 2015 | 35 | Adolescents (13–17 years) with nonspecific LBP < 90 days duration | 14.88 | 1.27 | 21 (62%) | Type: SMT + Exercise SMT: provided by physical therapists; technique: side-posture lumbar manipulation performed on symptomatic side Duration: 1 week Frequency: 2x/week Setting: Clinic Exercise: provided by physical therapist; components: lumbar stabilization, range of motion, postural training, core strengthening, stretching, addition of high-level functional exercises as indicated to promote return to activity Duration: 4 weeks Frequency: 2x/week Setting: Clinic | Type: Sham SMT + Exercise Sham SMT: provided by physical therapists; technique: patient side-lying, therapist passively flexed both hips to achieve slight lumbar flexion at patient’s most painful vertebral level, equal and opposite force applied to spinous process with both hands without inducing motion Duration: 1 week Frequency: 2x/week Setting: Clinic Exercise: provided by physical therapist; components: lumbar stabilization, range of motion, postural training, core strengthening, stretching, addition of high-level functional exercises as indicated to promote return to activity Duration: 4 weeks Frequency: 2x/week Setting: Clinic |
Group-based exercise | ||||||||
 Fanucchi (South Africa) RCT [34] | 2009 | 72 | Children (12–13 years) with low back pain in the previous three months | 12.3 | 0.7 | I: 15 (38.5%) C: 18 (54.6%) | Type: Progressive exercise (instruction provided by PT; 10–15 min educational session about the importance of exercise, core musculature, posture and spinal alignment; weekly home exercise program including class-taught exercises; continuation of normal physical education classes, sports, and physical activity) Duration: 8 weeks Frequency: 1x/week (40–45 min sessions) Setting: School | Type: Control (no intervention; continuation of normal physical education classes, sports, and physical activity) Duration: 8 weeks Frequency: N/A Setting: N/A |
 Harringe (Sweden) Cohort study [40] | 2007 | With and without LBP: 51 (I: 33; C: 18) With LBP: 24 (I: 15; C: 4) | Female top level national gymnasts (11–16 years) with LBP (pain between the 12th rib and gluteal folds) more than 1 day during a 4-week baseline period | I: 13 C: 14 | I: 11–15 C: 12–16 | I: 15 (100%) C: 4 (100%) | Type: Specific segmental muscle control exercises (group training program provided by PT; abdominal hollowing with progression: prone, four-point kneeling, prone with diagonal elevation of arm and leg, standing on balance board, in a basic trampette jump; 10 repetitions using 10-s holds; pressure biofeedback unit used initially to ensure correct muscle contraction) Duration: 8 weeks Frequency: 3–4 times/week Setting: Gymnasium | Type: Control (visits provided by PT; given time for questions regarding injuries; provided advice and regime) Duration: 8 weeks Frequency: 3–4 times/week Setting: Gymnasium |
2007 | 62 | Adolescents (Grade 9 and 10 students) with recurrent nonspecific LBP as determined using a standardized questionnaire | I: 14.6 C: 14.6 | I: 0.6 C: 0.5 | Not reported | Type: Exercise rehabilitation (group-based; progressive program of strengthening and stabilization, range of motion, and aerobic exercises for the back and lower extremity; standardized with respect to number of exercises, repetitions, progression and schedule) Duration: 8Â weeks Frequency: 2 x/week (30-min sessions) Setting: school (home exercise encouraged) | Type: Control (continue normal daily activities) Duration: 8Â weeks Frequency: N/A Setting: N/A | |
 Vitman (Israel) RCT [39] | 2022 | 33 | Children and adolescents (10 – 18 years) with LBP | I: not reported C: not reported | I: not reported C: not reported | Not reported | Type: Weekly physiotherapy + monthly physiotherapy and home exercise Weekly physiotherapy: 45-min group session with two physiotherapists, 21-exercise group therapy program Duration: 12 weeks Frequency: 1x/week Setting: Clinic Monthly physiotherapy and home exercise: same as the comparison group | Type: Monthly physiotherapy (i.e., personally-tailored comprehensive training) and home exercises Physiotherapy: 40-min session consisting of personally tailored training for muscle endurance, flexibility, and strength, as well as instructions on body awareness and application of biomechanical and ergonomic principles Home exercises: 5–6 individualized exercises, 1 set 10 repetitions (10–15 min/day). Diary kept of home practice to monitor Duration: 12 weeks Frequency: 1x/monthy Setting: Clinic |
Whole-body vibration | ||||||||
 Jung (Korea) RCT [37] | 2020 | 50 | Adolescents (10 – 19 years) with LBP ≥ 3 months, VAS ≥ 3/10 and able to perform sit-to-stand movements without assistance | I: 18 C: 18 | I: 0.65 C: 0.68 | I: 10 (40%) C: 12 (48%) | Type: Whole-body vibration + trunk stabilization exercise Six exercises (squat, bridge, single bridge and knee flex, side bridge, plank) performed on whole-body vibration machine (15 Hz and 2 mm amplitude). Exercise duration was 60 s for single bridge, bridge and knee flex, and plank or 90 secs for squat, bridge, side bridge, performed for 2 sets with 30 s break in between Duration: 12 weeks Frequency: 3x/week Setting: Clinic (supervised by physiotherapist) | Type: Trunk stabilization exercise Six exercises (squat, bridge, single bridge and knee flex, side bridge, plank). Exercise duration was 60 s for single bridge, bridge and knee flex, and plank or 90 secs for squat, bridge, side bridge, performed for 2 sets with 30 s break in between Duration: 12 weeks Frequency: 3x/week Setting: Clinic (supervised by physiotherapist) |
Cognitive functional therapy | ||||||||
 Ng (Australia) RCT [38] | 2015 | 36 | Adolescent male rowers (14–19 years) with nonspecific LBP, VAS > 3/10 | I: 16.3 C: 15.2 | I: 1.5 C: 1.5 | 0 (0%) | Type: Cognitive functional approach (provided by a physiotherapist; components: education, discussion about factors contributing to back pain, movement training and body awareness, functional integration, conditioning) Duration: 8 weeks Frequency: 1x/week for first two weeks, 1x/2 weeks for remainder (1 h initial; 30-min subsequent); total 5 sessions Setting: local rowing club or university laboratory | Type: Control (no intervention; free to seek treatment from other providers) |
Multimodal care | ||||||||
 Ahlqwist (Sweden) RCT [32] | 2008 | 45 | Adolescents (12–18 years) with nonspecific LBP (lumbar pain in a defined area); referred by a physician or nurse; VAS > 2/10 | I: 15 C: 14 | I: 13–18 C: 12–17 | I: 15 (65%) C: 16 (73%) | Type: Individualized physical therapy and exercise + standardized home exercise + education Individualized physical therapy and exercise: exercises supervised by a physical therapist (15 reps/exercise; general and specific exercises including conditioning, active and passive mobility, strengthening and coordination; resistance gradually increased); individualized therapy (manual therapy, mechanical diagnostic therapy) Duration: 12 weeks Frequency: 1x/week Setting: clinic Standardized home exercise: body weight for resistance; 2 sets of 10 reps/exercise Duration: 12 weeks Frequency: 2x/week Setting: home Education: functional anatomy, ergonomics, pain management Frequency: 1 session Setting: clinic | Type: standardized home exercise + education Self-training: conditioning exercises (brisk walks, jogging, bicycling, swimming) Duration: 12 weeks Frequency: 3x/week Setting: home; follow-up in clinic at 1 week; follow-up by telephone at 6 weeks Standardized home exercise: body weight for resistance; 2 sets of 10 reps/exercise Duration: 12 weeks Frequency: 3x/week Setting: home Education: functional anatomy, ergonomics, pain management Frequency: 1 session Setting: clinic |
 Selhorst (United States) Cohort study [41] | 2021 | 16 | Adolescent (12 – 19 years) athletes (participating in sport activity ≥ 2 times/week prior to the onset of LBP) who reports acute LBP (< 3 months) that increases during lumbar extension | I: 14.5 C: 15.5 | I: 12.1 C: 1.4 | I: 5 (62%) C: 3 (38%) | Type: Physical therapist guided functional progression program (PT First) No advanced imaging was obtained at the beginning of the treatment PT First Program 3-phase program: Participants were on rest from their sport Phase I: core strengthening in neutral spine, directional preference if identified, hip strengthening, peri-scapular strengthening, flexibility exercises, manual therapy as needed, modalities for pain (sparingly) Phase II: core strengthening in functional range, hip and peri-scapular strengthening, flexibility exercises, manual therapy (sparingly), light running, jumping Phase III: Return to sport activity with focus on functional return to all aspects of sport Patients who fail to progress after 5 weeks either were treated as a presumed spondylolysis or had advanced imaging. They received two months of rest except for daily activities and home exercise program, following this, they completed physical therapy before returning to sport Duration: Variable Frequency: 2x/week Setting: Clinic | Type: Biomedical model Advanced imaging was obtained to diagnose the injury and participants diagnosed with non-specific LBP or spondylolisthesis Patients with non-specific LBP: physical therapy and progressed to sport immediately Patients with a bony or spondylolytic injury: preliminary 2–3 month rest from activity, bracing if indicated, followed by 4–6 weeks of physical therapy. Physical therapy was individualized based on patient’s presentation Physical therapy: Duration: 4–6 weeks Frequency: 2x/week Setting: Clinic |