Effectiveness of physiotherapy interventions for back care and the prevention of non-specific low back pain in children and adolescents: a systematic review and meta-analysis.

Low back pain in children and teenagers has become more common in recent years, which raises the question of whether preventive physiotherapy programmes in schools or clinics actually help before problems set in. This review pooled twenty controlled trials, mostly involving exercise, postural hygiene education, and physical activity programmes, comparing children and adolescents who received these interventions against those who did not. Across the studies, the programmes were associated with improvements in back-care knowledge and behaviour, along with modest gains in trunk muscle endurance, posture, and hamstring flexibility. Some of these benefits persisted at follow-up assessments up to several months later.

What makes this interesting is that it suggests structured back-care education and exercise can shift how young people move and think about their spines. However, the authors rated the underlying evidence as ranging from very low to moderate quality, meaning these encouraging patterns should be read with some caution rather than as settled proof.

If you're a parent or work with children, you may wonder whether teaching kids about posture and back exercises in school actually makes a difference. This review looked at twenty studies of children and teenagers, mostly under 18, who took part in programmes involving exercise, posture education, and physical activity aimed at preventing low back pain. The combined results showed improvements in how much children knew about caring for their backs and in behaviours like sitting and lifting habits, along with modest improvements in muscle endurance, posture, and flexibility of the hamstring muscles.

Some of these improvements were still present when children were checked again months later. These findings are encouraging, but the researchers rated the quality of the evidence behind them as ranging from very low to moderate. That means the results point in a positive direction, but they aren't yet strong, settled proof that these programmes will prevent back pain from developing.

More consistent, higher-quality research would help confirm how reliable these benefits really are.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This review addresses a question many paediatric and school-based physiotherapists face: does preventive back-care education or exercise actually change children's back-related knowledge, behaviour, and physical measures, or is the enthusiasm for these programmes ahead of the evidence? Pooling twenty controlled trials in children and adolescents up to 18 years old, mostly delivering exercise, postural hygiene, and physical activity interventions, the meta-analysis found favourable effect sizes across behaviour, knowledge, trunk flexion and extension endurance, posture, and hamstring flexibility, with some benefits for behaviour and knowledge persisting at follow-up of one to twelve months. The effect sizes were generally moderate to large, though confidence intervals for trunk flexion endurance crossed zero and the follow-up knowledge estimate had a very wide interval, signalling inconsistency in that outcome. Using GRADE, the authors rated the overall body of evidence as very low to moderate quality, which limits how confidently these pooled estimates can be generalised. For practice, this tells us that exercise, postural hygiene, and physical activity components are the interventions most consistently studied and associated with measurable change in these proxy outcomes, but the review does not establish that these programmes reduce the incidence of non-specific low back pain itself, since the outcomes measured are knowledge, behaviour, and physical performance rather than pain occurrence.