title: Physical Activity Level and Sport Participation in Relation to Musculoskeletal Pain in a Population-Based Study of Adolescents: The Young-HUNT Study.
abstract: BACKGROUND
  Prevalence of musculoskeletal pain among adolescents is high, and pain in adolescence increases the risk of chronic pain in adulthood. Studies have shown conflicting evidence regarding associations between physical activity and musculoskeletal pain, and few have evaluated the potential impact of sport participation on musculoskeletal pain in adolescent population samples.
  
  
  OBJECTIVE
  To examine the associations between physical activity level, sport participation, and musculoskeletal pain in the neck and shoulders, low back, and lower extremities in a population-based sample of adolescents.
  
  
  METHODS
  Cross-sectional study; Level of evidence 4.
  
  
  METHODS
  Data from the Nord-Trøndelag Health Study (Young-HUNT3) were used. All 10,464 adolescents in the Nord-Trøndelag county of Norway were invited, of whom 74% participated. Participants were asked how often they had experienced pain, unrelated to any known disease or acute injury, in the neck and shoulders, low back, and lower extremities in the past 3 months. The associations between (1) physical activity level (low [reference], medium or high) or (2) sport participation (weekly compared with no/infrequent participation) and pain were evaluated using logistic regression analyses, stratified by sex, and adjusted for age, socioeconomic status, and psychological distress.
  
  
  RESULTS
  The analyses included 7596 adolescents (mean age, 15.8 years; SD, 1.7). Neck and shoulder pain was most prevalent (17%). A moderate level of physical activity was associated with reduced odds of neck and shoulder pain (OR = 0.79 [95% CI, 0.66-0.94]) and low back pain (OR = 0.75 [95% CI, 0.62-0.91]), whereas a high level of activity increased the odds of lower extremity pain (OR = 1.60 [95% CI, 1.29-1.99]). Participation in endurance sports was associated with lower odds of neck and shoulder pain (OR = 0.79 [95% CI, 0.68-0.92]) and low back pain (OR = 0.77 [95% CI, 0.65-0.92]), especially among girls. Participation in technical sports was associated with increased odds of low back pain, whereas team sports were associated with increased odds of lower extremity pain. Strength and extreme sports were related to pain in all regions.
  
  
  CONCLUSIONS
  We found that a moderate physical activity level was associated with less neck and shoulder pain and low back pain, and that participation in endurance sports may be particularly beneficial. Our findings highlight the need for health care professionals to consider the types of sports adolescents participate in when evaluating their musculoskeletal pain.
authors.affiliation: Communication and Research Unit for Musculoskeletal Disorders, Oslo University Hospital, Oslo, Norway.; Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Maren Hjelle
authors.initials: MH
authors.lastname: Guddal
authors.affiliation: Communication and Research Unit for Musculoskeletal Disorders, Oslo University Hospital, Oslo, Norway.; Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.
authors.forename: Synne Øien
authors.initials: SØ
authors.lastname: Stensland
authors.affiliation: Communication and Research Unit for Musculoskeletal Disorders, Oslo University Hospital, Oslo, Norway.; Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
authors.forename: Milada Cvancarova
authors.initials: MC
authors.lastname: Småstuen
authors.affiliation: Communication and Research Unit for Musculoskeletal Disorders, Oslo University Hospital, Oslo, Norway.; Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Marianne Bakke
authors.initials: MB
authors.lastname: Johnsen
authors.affiliation: Communication and Research Unit for Musculoskeletal Disorders, Oslo University Hospital, Oslo, Norway.; Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: John-Anker
authors.initials: JA
authors.lastname: Zwart
authors.affiliation: Communication and Research Unit for Musculoskeletal Disorders, Oslo University Hospital, Oslo, Norway.; Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Kjersti
authors.initials: K
authors.lastname: Storheim
keywords: adolescents; epidemiology; musculoskeletal pain; overuse problems; physical activity; sport participation