Eur Spine J (2015) 24:425–433
DOI 10.1007/s00586-014-3571-9

ORIGINAL ARTICLE

Association between home posture habits and low back pain
in high school adolescents
Ney Meziat Filho • Evandro Silva Coutinho •Gulnar Azevedo e Silva

Received: 10 September 2013 / Revised: 2 September 2014 / Accepted: 4 September 2014 / Published online: 12 September 2014
Ó Springer-Verlag Berlin Heidelberg 2014

Abstract
Purpose To investigate the prevalence of low back pain
(LBP) and the association with home posture habits while
watching TV and using the computer in adolescents.
Methods This is a cross-sectional study with high school
adolescents in Rio de Janeiro, Brazil. Students answeredquestions regarding sociodemographic variables, lifestyle,posture (illustration), time watching TV, time using computer, time playing video game and the presence andimpact of LBP. Multivariate logistic regression was used toinvestigate the association between home posture habits
and LBP.
Results The prevalence of LBP was 46.8 % (18.2 %chronic low back pain [CLBP] and 28.6 % acute low backpain [ALBP]). As LBP consequence, 23 % (n = 253) of
the students took medication, 9.1 % (n = 100) missedclasses and 8.2 % (n = 90) sought a physician. Slump
postures while watching TV and using the desktop computer were associated with CLBP (OR 3.22, 95 % CI
1.38–7.5 and OR 1.7, 95 % CI 1.06–2.73, respectively).

N. Meziat Filho (&)
Departamento de Epidemiologia, Programa de Pós-Graduaçãoem Saúde Coletiva, Instituto de Medicina Social, Universidade
do Estado do Rio de Janeiro, R. São Francisco Xavier, 524,
Pavilhão João Lyra Filho, 7° andar, Bloco E, Maracanã,
Rio de Janeiro, RJ CEP 20550-900, Brazil
e-mail: neymeziat@gmail.com
E. S. Coutinho  G. Azevedo e Silva
Departamento de Epidemiologia, Instituto de Medicina Social,
Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ,
BrazilE. S. Coutinho
Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz,
Rio de Janeiro, Brazil

Participants who watched TV seated in bed yielded an ORof 2.14 (95 % CI 1.06–4.32) for ALBP and who used thenotebook lying belly down in bed yielded an odds ratio(OR) of 2.26 (95 % CI 1.02–5.01) for ALBP. Amongconfounding factors, female sex was associated with CLBP
and ALBP, work (no) was a protective factor associatedwith ALBP.
Conclusion Our findings support the high prevalence andthe substantial impact of LBP in late adolescence and add
the association with inappropriate home postural habits.
Keywords Low back pain  Adolescence  Posture Prevalence

Introduction
Low back pain is the first cause of years lived with disability all over the globe [1]. The lifetime prevalence of
LBP is documented to be as high as 80 %, and the point
prevalence of chronic low back pain (CLBP) is about 20 %[2]. In Brazil back pain is the first cause of disability
retirement and in many countries the costs with disability
pension make LBP the most expensive public healthproblem [3, 4]. The prevalence of LBP in teenagers is ashigh as in adults and when LBP starts in adolescence there
is a fourfold increase in risk of developing CLBP inadulthood [5].
O’Sullivan et al. [6] reported a point prevalence of
CLBP as 20 % in 17-year-old adolescents and the pain was
associated with seeking professional help, using medication, school absenteeism, reduced activity levels andreduced health-related quality of life. The same author also
found a cluster of 17-year-old adolescents with highprobability of associated spinal pain (low back and

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shoulder/neck pain) [7]. Onofrio et al. [8] reported aprevalence of acute low back pain (ALBP) as 13.7 % in
13–19-year-old adolescents in South Brazil.
Increase in age, female sex, smoking and high and low
levels of physical activity are also risk factors for LBP inadolescence [9, 10]. Mechanical predictors are scarce, butthere is a concern about the time spent watching TV, andusing the computer. The first was associated with LBP incross-sectional studies [11]. There is a lack of studies
investigating how the home postural habits of the teenagers
are while in passive activities at home and if such habits
are associated with low back pain.
This study investigated the prevalence of LBP and its
association with home posture habits (by posture illustrations) while watching TV and using computer (desktop or
notebook) in high school adolescents.

Methods
Participants
Study population was 1,102 high school students from themorning shift from a cross-sectional study conducted from
August 2012 to July 2013, developed in a public highschool from the city of Rio de Janeiro.
Measures
The adolescents completed a self-reported questionnaire
containing 41 questions in classroom with the presence ofthe researcher and the teacher. A pretest was conducted toadapt the questionnaire and to ensure understanding by theparticipants. A pilot study was conducted as a ‘‘dress
rehearsal’’ of the whole process of the field research,
including the test–retest reliability of the questionnaire.
Low back pain The below questions were based on theÓSullivan study and on the Nordic Questionnaire [6, 12].
The low back was showed on a body map above the correspondent question. We also used the following questions
to assess the mid back and the neck. ‘‘Has your low backbeen painful at any time in the previous month?’’ and ‘‘Has
your low back pain ever lasted for more than 3 months?’’
Subjects were classified as CLBP participants when theyanswered ‘‘yes’’ in the first and in the second question.
When the answer was ‘‘yes’’ only in the first, they wereclassified as ALBP participants.
Low back pain impact The following questions werebased on the ÓSullivan study [6] and on the pretest. ‘‘Have
you ever sought a doctor due to the low back pain?’’,‘‘Have you ever taken medicine due to the low back pain?’’and ‘‘Have you ever missed school due to the low backpain?’’

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Home posture habits were represented by illustrations(Tables 3, 4 and 5). Posture watching TV, using thedesktop computer, and using notebook computer wereassessed by the three following questions. ‘‘Which is yourmost frequent position while watching TV? Please, choose
only one of the eight options below’’, ‘‘Which is your mostfrequent position while using the desktop computer?
Please, choose only one of the six options below’’ and‘‘Which is your most frequent position while using thenotebook computer? Please, choose only one of the nine
options below’’. The response options (illustrations andtwo written options) are showed in the Tables 3 and 4. The
time spent on each of the above activities was asked by thefollowing questions from PENSE (National Research of
Schoolchildren Health) [13]. ‘‘How many hours in a regular day do you spend watching TV?’’, ‘‘How many hours
in a regular day do you spend using a computer?’’ The nine
response options ranged from none to 7 h. As the question
about time in the computer did not differentiate notebook
from desktop, we used the following question to know
which was the most used. ‘‘Do you spend more time using
notebook or desktop?’’ The response options were ‘‘notebook’’, ‘‘desktop’’ or ‘‘I don’t use any of them above’’.
Sociodemographic characteristics Age (14–15, 16–17
and 18–20-year-old) sex, maternal education (first grade
incomplete, high school incomplete, high school complete,college, I don’t know), work (yes or no) and if the participant have any children (yes or no).
Lifestyle Physical activity was assessed by questions
from PENSE, including commuting, recreational andphysical education [14]. Adolescents were classified as
active if performing [300 min/week of physical activity,
insufficiently active \300 min/week or inactive (less than
10 min/week) [14]. Smoke status was assessed by thequestion from PENSE ‘‘On the past 30 days, how manydays did you smoke a cigarette?’’ with eight options tochoose [13]. When the students answered ‘‘never smoke’’or ‘‘didn’t smoke any day on the past 30 days’’ wereclassified as nonsmoker.
Institute for Social Medicine ethics Committee of the
University of the State of Rio de Janeiro granted ethicalapproval according to the National Council of Health.
Statistical analysis
Low back pain prevalence, subgroup prevalence andrespective 95 % confidence intervals were calculated.
Logistic models were fitted to investigate the association
between LBP and home posture habits. We assumed home
posture habits as an independent variable for LBP because(1) the population was in a steady state over the study
period, (2) no selective survival was allowable, (3) the
exposure did not seem to influence the survival or recovery

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427

Six models for acute and chronic low back pain werefitted including interaction terms between home postural
habits (TV posture, desktop posture, notebook posture) and
exposure time (less or more than 2 h). Variables with,
p \ 0.2 in the univariate analysis were also included. The
variable related to the use of notebook or desktop use wasinserted in the 4 multivariate models of the exposures

probabilities, (4) reverse causality was not likely, and (5)temporal directionality from the exposure to the outcome
was sustainable, either theoretically or by means of athorough data collection procedure. Under these assumptions the exponential of the logistic regression coefficient
can estimate the incidence density ratio (IDR) when these
conditions are met [15, 16].

Table 1 Prevalence of LBP and 95 % CI by sociodemographic, lifestyle, time watching TV, time using computer and time playing video-gamevariablesnOverall%

Chronic low back pain

Acute low back pain%

95 % CI

%

95 % CI

1,102

–

18.2

15.9–20.5

28.6

25.9–31.2

Male

515

46.7

14.4

11.4–17.4

21.2

17.7–24.7

Female

587

53.3

21.7

18.4–25.0

35.1

31.2–38.9

14–15

387

35.1

19.4

15.5–23.3

28.5

24.0–32.9

16

320

29.0

19.1

14.8–23.4

33.1

27.9–38.3

17

282

25.6

17.0

12.6–21.4

24.5

19.5–29.5

18–20

112

10.2

15.2

8.6–21.8

26.8

18.5–35.0

311
192

28.2
17.4

20.6
15.1

16.1–25.1
10.0–20.2

28.3
29.7

23.3–33.3
23.2–36.2

Sex

Age group (years)bMother scholaritya
1st grade incomplete
High school incomplete
High school complete

332

30.1

18.1

13.9–22.2

30.8

25.8–35.8

College

101

9.2

18.8

11.2–26.4

24.8

16.4–33.2

Yes

237

21.5

18.6

13.7–23.6

32.9

26.9–38.9

No

864

78.4

18.1

15.5–20.7

27.5

24.5–30.5

Workb

Smokeb
Smoker

32

2.9

31.2

15.1–47.3

12.5

1.0–23.9

1,069

97.0

17.9

15.6–20.2

29.1

26.4–31.8

Active

437

39.7

17.4

13.8–20.9

26.4

22.2–30.5

Insufficiently active

486

44.1

18.1

14.7–21.5

31.7

27.6–35.8

Inactive

179

16.2

20.8

14.9–26.7

25.7

19.3–32.1

817
284

74.1
25.8

17.8
19.7

15.2–20.4
15.1–24.3

28.8
26.3

25.1–32.5
21.8–33.8

Nonsmoker
Physical activity

Time watching TVb
2 h or more per dayLess than 2 h per day
Time using computerb
2 h or more per day

889

80.7

18.9

16.3–21.5

29.1

26.1–32.1

Less than 2 h per day

212

19.2

15.6

10.7–20.4

26.9

20.9–32.9

Never use computer

56

5.1

21.4

10.7–32.1

28.6

16.8–40.4

Desktop computer

718

65.2

17.6

14.8–20.4

27.3

24.0–30.6

Notebook

328

29.8

19.2

14.9–23.5

31.4

26.4–36.4

2 h or more per day

246

22.3

15.4

10.9–19.9

25.9

20.4–31.4

Less than 2 h per day

854

77.5

19.1

16.5–21.7

29.6

26.5–32.7

Computer type preferenceTime playing video-gamebaThere were 15.1 % of the participants reporting not knowing their mother scholarityb

Missing data were 0.2 % or less

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posture/time using notebook and posture/time using desktop because the exposure time variable did not differentiate
between these two devices. Statistical analysis was performed with R-project 2.10 for Windows.

Results
The proportions of male and female participants were
almost the same (46.7 and 53.3 %, respectively). The
average age of the participants was 16.8 years, only 2.9 %of the participants were smokers and more than half wereinsufficiently active (44.1 %) or inactive (16.2 %). The
majority of the students (74.1 %) reported 2 h or more ofwatching TV per day, 80.7 % reported 2 or more hours
while using the computer (desktop or notebook), 65.2 %commonly used desktop computer and 22.3 % played
video game for 2 h or more per day.
The reliability of the questionnaire, evaluated by test–
retest method was moderate ([0.4) or substantial ([0.6) forthe majority of the answers [17]. For TV postures the
Kappa coefficient was 0.59 (95 % CI 0.45–0.72), fordesktop postures 0.53 (95 % CI 0.38–0.67) and 0.52
(0.38–0.68) for notebook postures.
The prevalence of chronic or acute low back pain was
46.8 % (18.2 % CLBP and 28.6 % ALBP). Female
reported chronic low back pain more frequently than males(Table 1). Participants with chronic neck pain (CNP) andchronic mid back pain (CMBP) reported an increased
prevalence of CLBP (Table 2). The same occurred for
ALBP. Table 2 also shows the specific impact of low backpain. As a consequence of LBP, 23 % of the students took
medication, 9.1 % missed classes and 8.2 % sought aphysician. CLBP participants went more to the doctor andmissed more classes than ALBP participants. The proportion of medication use was the same for both types (37.
3 % for CLBP and 35.2 % for ALBP).
Table 3 presents the proportions of different postures
watching TV. The majority of students frequently changed
their position while watching TV and did not have a preferred position (32.8 %). Table 4 shows the proportions ofdifferent postures using desktop or notebook computer.
Among the participants, 24.9 % frequently changed theirposition while using desktop computer and did not have apreferred position and 25.4 % said that the neutral postureis the usual. Almost half of the students (43 %) did not use
notebook computer, 15.4 % of the participants frequently
changed their position and did not have a preferred position
and 13.2 % used the notebook computer sitting on bed.
For the CLBP models, univariate analysis showedfemale sex and smoking associated to the outcome(p \ 0.2). For the ALBP, the associated confounding factors were female sex, age, physical activity status, work
status and smoking status.
Table 3 shows the adjusted independent OR for posturewhile watching TV on the risk of reporting CLBP (model1) and ALBP (model 2). The interaction term was notstatistically significant for any model. As compared withthose who watched TV adopting the neutral posture, participants who watched it in the slump posture yielded an
odds ratio (OR) of 3.22 (95 % CI 1.38–7.5) for CLBP.
Participants who watched it seated on bed yielded an OR of
2.14 (95 % CI 1.06–4.32) for ALBP.
Table 4 shows the adjusted independent effects of posture while using the desktop or notebook computer on therisk of reporting CLBP (model 3) and ALBP (model 4). As

Table 2 Presence of other spinal pain areas and specific LBP impacts
Other spinal pain areas

Overall (n = 1,102)

Chronic low back pain

Acute low back painn%

95 % CIn%

95 % CI201

18.2

15.9–20.5

315

28.6

25.9–31.2

Other spinal pain areas
No CMBP or CNP

77

9.7

7.6–11.8

240

30.3

27.1–33.5

CMBP or CNP

124

40.1

34.6–45.6

75

24.3

19.5–29.1

CMBP and CNP

39

54.2

42.7–65.7

13

18.1

9.2–26.9

No AMBP or ANP

122

20.6

15.4–21.2

123

20.8

17.5–24.1

AMBP or ANP
AMBP and ANP

79
9

15.6
8.4

12.4–18.8
0.0–26.5

192
45

37.7
42.1

33.5–41.9
32.7–51.5

Sought physician care (n = 90 of 1,102—8.2 %)

39

19.4

11.2–27.6

21

6.7

1.5–11.9

Took medication (n = 253 of 1,102—23 %)

75

37.3

31.3–43.3

111

35.2

29.3–41.1

Missed schoola (n = 100 of 1,102—9.1 %)

45

22.4

14.2–30.6

32

10.2

4.3–16.1

Specific LBP impacts

CMBP chronic midback pain, AMBP acute midback pain, CNP chronic neck pain, ANP acute neck painaMissing data were 0.2 % or less123Eur Spine J (2015) 24:425–433

429

Table 3 Proportions of thedifferent postures watching TV
and adjusted OR for acute andchronic low back pain

Posture watching TV

Overall

–

n

%

1,102

Acute low backpain(model 1)aChronic low backpain (model 2)bAdjustedOR

95 % CIc

AdjustedOR

95 % CIc
–

–

–

–

25

2.3

1.31

0.43–3.97

2.42

0.69–8.50

172

15.6

1.74

0.88–3.44

1.7

0.7–4.12

196

17.8

1.78

0.91–3.47

3.22

1.38–7.5

122

11.1

2.14

1.06–4.32

2.1

0.85–5.21

76

6.9

1.34

0.6–2.98

2.09

0.79–5.55

78

7.1

1

1

1

1

I frequently change my position
while watching TV, I do nothave a preferred position

351

31.9

1.56

0.82–2.95

1.98

0.86–4.55

My preferred position while
watching TV is very different
from the options above

82

7.4

1.85

0.87–3.96

1.25

0.45–3.5%

Acute low back pain(model 3)aChronic low backpain (model 4)b

AdjustedOR

95 % CI

AdjustedOR

95 % CI–I do not watch TVaModel for acute low back pain
adjusted for sex, age, work
status, physical activity status
and smoke statuscbModel for chronic low backpain was adjusted for sex andsmoke. Interaction term was not
significant for acute and chronic
low back painc

Neutral posture was thereference

Table 4 Proportions of thedifferent postures using desktop
computer and adjusted OR for
acute and chronic low back pain

Posture using desktop computer

Overall

–

n

1,102

–

–

–

–

169

15.3

0.83

0.5–1.36

1.19

0.67–2.13

200

18.1

1.23

0.82–1.86

1.7

1.06–2.73

91

8.3

0.99

0.57–1.73

0.88

0.44–1.76

280

25.4

1

1

1

1

I frequently change my position
while using the computer, I do
not have a preferred position

274

24.9

1.14

0.78–1.66

1.3

0.83–2.04

My preferred position while
using the computer is very
different from the options
above

88

8.0

1.08

0.63–1.87

1.16

0.61–2.21

I do not use desktop computeraModel for acute low back pain
was adjusted for sex, age, work,
physical activity status, smoke
status and computer typepreferencecbModel for chronic low backpain was adjusted for sex,
smoke and computer typepreferencecNeutral posture was thereference. Interaction term was
not significant for acute or
chronic low back pain

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Table 5 Proportions of thedifferent postures using
notebook computer and adjusted
OR for acute and chronic low
back painn

Posture using notebook
computera

Overall–%

Acute low back pain(model 5)bChronic low backpain (model 6)c

AdjustedOR

95 % CI

AdjustedOR

95 % CI
–

1,102

–

–

–

–

474

43.0

1.24

0.6–2.56

1.04

0.47–2.29

26

2.4

2.18

0.75–6.29

1.54

0.48–4.93

94

8.5

2.26

1.02–5.01

1.12

0.46–2.71

146

13.2

1.89

0.89–4.04

1.04

0.45–2.4

22

2.0

2.19

0.73–6.6

0.76

0.18–3.12

82

7.4

1.41

0.61–3.26

1.23

0.5–3.02

58

5.3

1

1

1

1

I frequently change my position
while using the notebook, I do
not have a preferred position

170

15.4

1.88

0.89–3.96

1.01

0.44–2.29

My preferred position while
using the notebook is very
different from the options
above

27

2.5

0.82

0.25–2.69

1.10

0.33–3.70

I do not use notebookaMissing data of notebook
posture were 0.3bModel for acute low backpain was adjusted for sex, age,
work status, physical activity
status, smoke status andcomputer type preferencecModel for chronic low backpain adjusted for sex, smoke andcomputer type preference.
Interaction term was not
significant for acute or chronic
low back paind

Neutral posture was thereferencedcompared with those who used the desktop computer
adopting the neutral posture, participants who used it in theslump posture yielded an OR of 1.7 (95 % CI 1.06–2.73)
for CLBP. Participants who used notebook lying belly
down, yielded an odds ratio (OR) of 2.26 (95 % CI
1.02–5.01) for ALBP (Table 5). The inclusion of theinteraction term was not statistically significant for any
model.
Among variables inserted in the models as confounding
factors, female sex was associated with CLBP and ALBP,
work (no) was a protective factor associated with ALBP.

Discussion
According to our knowledge this is the first study assessing
the association of home posture habits and LBP by use ofillustrations of the usual positions in the sagittal plane
while watching TV and using the computer. The association between slump posture watching TV, using the desktop computer and CLBP is predictable. The slump sitting is123

the most relaxed posture for the spine, with high demandsin the posterior passive tissues of the low back and very
low muscle activation [18, 19]. Staying seated in bed while
watching TV and lying belly down while using the notebook also produce elevated stress in the passive tissue but
in opposite directions. Regarding these two last postures,
hip joints are at the end range of movement. While seatedin bed, the end range of hip flexion naturally produces atendency of an excessively flexed low back. Otherwise,
while lying belly down in bed, the hip joints are at the end
range of extension. So there is a tendency to keep the lowback excessively extended.
The absence of interaction between posture and time wasprobably because the majority of the students spend many
hours watching TV and using the computer and becausesome bad postures need little time to be provocative.
The posture illustration offered in the questionnaire a
range of different positions commonly adopted by theparticipants while watching TV and using the computer(desktop and notebook). There were two more answering
options. The first was ‘‘I frequently change my position

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while watching TV (or using the desktop/notebook), I don’t
have a preferred position’’, it may represent the dynamic
sitting that facilitates spinal motion and trunk muscle
activation. Dynamic sitting was not effective as a standalone management approach for LBP [20, 21]. This answer
was so far the most frequent answer regarding posture, butthere were no protective association with chronic or acutelow back pain. The second was ‘‘My preferred position
while watching TV (or using the desktop/notebook) is very
different from the options above’’, it may represent themore asymmetrical postures in the frontal plane. The
decision to include the two questions above with the posture illustration options was based on the pretest when thestudents were free to give their opinions about thequestionnaire.
The prevalence of chronic low back pain was almost thesame as in the O’Sullivan study [22] that used similar
methodology, but the prevalence of acute low back pain
was very high when compared with the same study. The
considerable impact of low back pain reinforces the findings of ÓSullivan [22]. CLBP also caused more missedclasses and physician sought than acute low back pain, but
CLBP and ALBP did not differ regarding medication use.
The relatively low physician sought and probable high self
medication, were probably related to the difficulty to see a
doctor in the public health system of Rio de Janeiro.
Prevalence of CLBP was very high in participants reporting other chronic spinal pain (CNP and CMBP). The same
phenomenon was found for ALBP. The possible explanation is the psychological tendency that differ acute andchronic pain patients. As an example, ALBP patients withhigher levels of pain catastrophizing and kinesiophobia
used to have an elevated risk of becoming CLBP patientsand chronic pain patients used to have widespread pain [23,24]. The way the patients cope with the LBP is probably
the same as when they suffer of neck and mid back pain,increasing or decreasing the probability of becoming achronic pain patient.
This study has not shown LBP prevalence differences
regarding physical activity levels. In Brazil, there is alack of competitive sports practice in the majority of thehigh schools. Although 40 % of the study sample isphysically active, almost all the participants lived far
from the school, used to go to school by bus andremained frequently seated while in the physical education classes. The physically active participants are probably much less active than the adolescents from highincome countries. The observed association between
home postural habits and LBP could be a reflex of a
population that spends much time in inappropriate passive postures at home without the counterbalance of amoderate physical activity level.

431

This study supports the assumption that LBP in adolescence is a public health issue. There is too little attention
paid to this problem both at school and also at home. The
advantage of assess posture by home habits is that it iseasier to modify when comparing to posture itself. The
questionnaire with posture illustrations would be a simpler
tool to epidemiological research and also for the clinicaluse. Screening the home posture habits through a questionnaire applied at school could contribute to the implementation of prevention measures.
Limitations
Our findings should be interpreted with certain limitations.
The population of the study does not represent a sample of
Public High School adolescents of Rio de Janeiro. However, considering the distribution of exposure variables, theprevalence of the outcomes and the plausibility of theassociation, an inference to other adolescents may bepossible. Another problem is the classification of acute lowback pain as pain in the last month of any intensity and any
duration tends to overestimate such prevalence. One would
state that the lack of self-conscious in adolescence invalidates the assessment of home posture habits by illustrations
in a questionnaire, but if there was information bias it
would probably counteract the association. Even with amoderate reliability of the questionnaire, it was possible tofind relevant associations. Other possibilities of position
illustrations as more asymmetrical postures in the frontal
plane could be inserted in the questionnaire, but there isevidence that the sagittal changes in the low back are moreassociated with LBP [25].
Although cross-sectional design is not the ideal one forcausal inference, home posture habits probably precede
LBP. Considering habits as a recurrent, often unconscious
pattern of behavior that is acquired through frequent repetition, someone with good posture habits would hardly
change such habit to a worst one after the onset of LBP,
although antalgic changes in the posture itself can happen.
The possibility of spontaneously changing a posture habit
in chronic low back pain is remote. Reverse causality isalso unlikely in the case of the association between staying
seated in bed while watching TV or lying belly down while
using the notebook and acute low back pain. As acute pain
was considered pain in the previous month, there was notime to change a posture habit.

Conclusion
Our findings support that low back pain is common andcauses a substantial impact in late adolescence. This is the

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Eur Spine J (2015) 24:425–433

first study to find an important association between inappropriate home posture habits and low back pain.
Acknowledgments The authors thank Prof. Michael Eduardo Reichenheim Ph.D for the idea of the posture Illustrations, Prof. Washington Junger for helping with R-project for Statistical Computing,
Leonardo Batista de Leão for drawing the figures of postures, Luiz
Fernando Martins Ribeiro and Marcela Teixeira, teachers of the State
High School for the help in data collection, Gisela Meziat for the
English revision, Vivian Correa, Maria de Fátima Andrade, Roberta
Mendonça and Leonardo Paolino for helping with the field researchand Carlos Vicente Rodrigues for helping with data tabulation. There
was no research funding. The first author received a monthly doctoral
scholarship of CAPES (Coordination for the Improvement of Higher
Level—or Education—Personnel). ESFC was partially supported by
the National Council for Scientific and Technological Development(CNPq), process no 306575/2011-6. This study was presented at
CIRNE 2013 (International Congress on Sports and Neuromusculoskeletal Rehabilitation).
Conflict of interest

None.

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