Pain distribution in school aged children

While studies and statistics on musculoskeletal pain in adulthood abound, data on schoolchildren seems somewhat scarcer. With an increasingly sedentary population, and with extended time sitting being noted as a public health concern, it warrants collecting data on this particular group. Recently, some researchers undertook this task and analyzed pain distribution on 1,000 Danish Schoolchildren aged 8-16, and the results are very interesting [1].

The report, referenced below, was carried in the Journal of Chiropractic and Manual Therapies and aimed to expand the available data on the topic according to age, sex, and the number and length of episodes of pain. For the purposes of the report, pain was defined as at least one week of pain during a school year. While we know that “pain can start early in life and increases throughout adolescence [1],” it is the specifics offered up by this study that make it noteworthy.

Other concerns that accompany childhood and adolescent pain include negative impacts on “sports participation and physical activity in childhood” as well as “psychological distress, poor relations with peers, absence from school, puberty and decreased quality of life [1].” To this end, it is important for both parents and clinicians to know when and how to bring in interventions. For the purpose of the study, researchers:

  • Categorized children into eight subgroups. These were; no pain, spinal pain only, upper extremity pain only, lower extremity pain only, spinal and upper extremity, spinal and lower extremity, upper and lower extremity, and pain in all regions.
  • Determined the age, sex, number of weeks with pain, mean number of episodes and mean length of episodes for the groups.
  • The sample was taken from pupils attending public primary schools in Svendborg, Denmark (which is comparable to the rest of Denmark in terms of the demographic data, and 84% of children attend public schools so all socioeconomic statuses could be well represented).

Participants took part in the study via SMS. To be eligible, they had to stay engaged with the study for at least 51 weeks, but could stay in the program for up to three years (making the study an interesting one in terms of the timeline). The researchers kept exclusion criteria based on the number of text messages responded to, and during the three-year period, 296 children dropped out leaving 1,169 participants. With a 96% average weekly response rate, the data capture was indeed impressive.

What the study found

While the full study did provide statistical analysis on the entire cohort (available at the open-access journal referenced below), there were some noteworthy takeaways from the study [1].

  • The percentage of children who did not experience pain during the school year was just 28.5%. 71.5% of children did experience at least one episode of pain lasting one week.
  • Of this percentage, 60% experienced lower extremity pain, 28.7% experienced spinal pain and the upper extremities came in last at 22.6%.
  • 2% of participants reported pain in more than one region, and of these, the most common was spinal and lower extremity pain (13.2%).
  • Twice as many girls reported pain in all three sites compared to boys (10% vs. 5%).
  • There were with no other statistically significant sex or age differences observed.
  • When pain was defined as at least 3 weeks with pain during a school-year, 40% reported pain with similar patterns to those for the more lenient pain definition of 1 week.

Among the observations made by the researchers was the following: “Danish schoolchildren often experienced pain at more than one pain site during a school-year, and a significantly larger proportion of girls than boys reported pain in all three regions. This could indicate that, at least in some instances, the musculoskeletal system should be regarded as one entity, both for clinical and research purposes.”

The study did have limitations, one being that parents reported the pain states. When the children themselves were asked, they often had other pain to report. Thus, these estimates are likely conservative and indicative of greater intensity pain.


What it means for chiropractic

While the study did not comment on the types of interventions pertinent for the sample group, or what this might mean clinically for the wider population, it is certainly interesting to note their suggestion that the musculoskeletal system be regarded as one entity. This sits well within a chiropractic context as we tend to look at the body as a whole system, with each part interconnected to the others.

The data certainly proves thought-provoking. As we nurture these young lives and aim to support them through a healthy and well-rounded childhood, this study certainly offers some interesting insights. 



  1. Fuglkaer S, Vach W, Hartvigsen J, Boe Dissing K, Junge T and Hestbaek L (2020), “Musculoskeletal pain distribution in 1,000 Danish Schoolchildren aged 8-16 years,” Chiropractic and Manual Therapies, 45(2020),


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