Sedentary behaviour and spinal pain in adolescents

Spinal pain in adolescents is a significant public health concern, and adolescent sedentary behaviour is a proposed modifiable risk factor for spinal pain. Whether sedentary behaviour recommendations in international public health guidelines are relevant for adolescent spinal pain is unknown. This thesis reports a systematic review exploring associations between sedentary behaviours and spinal pain in adolescents. It also reports a secondary cross-sectional analysis, of a population-based cohort of young adolescent Danes, to investigate the association between sedentary behaviour (as per public health guidelines) and non-trivial spinal pain. Cross-sectional multinominal logistic regression investigated associations between sedentary behaviour, by duration and type, and spinal pain, by region and triviality, adjusted for age and sex. The systematic review found there was no meaningful association between sedentary behaviour and adolescent spinal pain; however, the evidence base is inconsistent and at high risk of bias. The cross-sectional analysis demonstrated there was no association between exceeding two hours per day of sedentary behaviour and spinal pain. The collective thesis findings suggest that sedentary behaviour is not a meaningful risk factor for adolescent back pain. Therefore, we challenge existing public and clinical beliefs that sedentary behaviour is causally associated with spinal pain in adolescents.