In Response to: Low Back Pain in Benign Joint Hypermobility Syndrome: Do not Forget the Adolescents

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Dear Editor-in-Chief:
We read with great interest the remarkable article by Pasanen et al1 about the prevalence and risk factors of low back pain (LBP) in young basketball and floorball players. In this study, the prevalence of LBP in young players between 12 and 21 years of age was reported to be 44% of basketball players and 61.9% of floorball players. This study reported that age and family history of musculoskeletal disorders were risk factors for LBP symptoms in young basketball and floorball players.1 We would like to mention another neglected but important contributing factor regarding the prevalence of LBP in these adolescents: benign joint hypermobility syndrome (BJHS).
Benign joint hypermobility syndrome is a disorder associated with musculoskeletal symptoms that results from an abnormality of the structure of type-1 collagen, and its incidence decreases with age.2 In our previous study of 115 patients with BJHS who were more than 18 years of age, the prevalence of LBP was determined to be 32.2%.2 It is reported that up to 64.6% of children and adolescents have hypermobile joints.3 Therefore, the presence of BJHS may be a risk factor in terms of LBP in children and adolescents. The diagnosis of BJHS is based entirely on clinical evaluation. Because the study of Pasanen et al1 was based on self-reported questionnaire data rather than a clinical examination, BJHS may have been overlooked.
In conclusion, clinicians who investigate the prevalence and risk factors of LBP in adolescents should keep BJHS in mind as a predisposing factor. The questionnaire may be sufficient to assess the prevalence of LBP. However, clinical evaluation is required to determine the risk factors for low back pain.
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