related talks: neck pain, low back pain, herniated disk, spondi, adolescent scoliosis
here are 5 facts about childhood and adolescent back pain
ONE: How common?
Childhood and adolescent back pain is not uncommon, in fact it probably occurs in 11 - 30% of children at some point during their development. So most cases are considered "organic" or "variants of normal", meaning that while its uncomfortable to the child, it is a part of the growing process and will resolve without medical intervention. Over 50% of kids that see a doctor will never be diagnosed with a true medical condition, and over 50% will not follow up with a doctor after 2 visits, presumably due to improvement in symptoms. However, that does not mean that all cases are "benign" (non-harmful), and some kids can develop back pain due to serious medical conditions: spondylolysis, spondylolisthesis, fracture, neoplasm, overuse syndrome, Scheurman's kyphosis, or osteomyelitis to name a few of the more common ones. Therefore, back pain, while common, should not be casually dismissed.
TWO: What causes it?
Over 50% of kids that see a doctor for back pain leave without a diagnosis. So what do doctors think about whats causing it? There are some theories, but there is not great scientific evidence to support them. One reason: Obesity. We have a lot of muscles in our back, and they are charged with holding our body upright. You can imagine that a big "beer belly" or generalized large overweight upper body, puts a lot of stress on your back muscles and may cause them to be overworked and tired. Another reason: deconditioning. "Kids these days". I know its a common saying, as old as our great great grandmothers. But there is some truth to studies that suggest kids spend more time on their butts...watching tv, playing video games, surfing the internet, and as a result, they become deconditioned, their muscles become weak and mushy. "Use it or lose it!" As a result, similar to the problem with obesity, our weak back muscles are over stressed by trying to hold the back upright. One study showed that kids with the best strength and endurance in using their back muscles had much lower risk for back pain. Now that we've looked at some theories behind the unknown cases of back pain, lets look at some of the medical diagnoses for back pain.
THREE: What are some medical causes of it?
Spondylolysis. This is a stress fracture in the pars of the spine. The pars are a part of each of our vertebrae (vertebrae are the bones within our spine, that are stacked on top of each other to form the spinal column). The pars connect the "anterior" and "posterior" column of our spine. Overuse in sports, commonly seen in offensive lineman playing football, or gymnastics, cause excessive stress to the pars, and the body cannot heal all of these tiny traumatic injuries, that build up over time to cause a fracture. The L5 vertebrae is most commonly affected. Treatment for a "Spondy" includes rest from sports, antiinflammatories, bracing and physical therapy. The good news is that while this condition is painful for children, it does not affect their long-term risk for back pain as adults many decades later.
FOUR: What are some "red flags" that suggest this is a more serious issue than muscle strain?
Radicular pain (pain that starts in the back, and radiates down the arms or legs). Pain with neurologic changes (such as numbness in the arms or legs...or weakness in the arms or legs). Clumsiness of the fingers. These together suggest that the spinal cord or spinal nerves are injured. Fevers are another red flag. Doctors are always concerned about infections developing within the vertebrae (called "osteomyelitis") or the vertebral disk (called "diskitis").
FIVE: What are some treatment options?
In cases of a specific diagnosis, the treatment really depends on the diagnosis. In cases of back pain without a diagnosis, or back pain associated with muscle strain or stress, Physical Therapy is an excellent start.
Sometimes, the best treatment is getting the advice of other medical doctors. Sometimes the pain is actually a child's way of expressing anxiety, depression, or problems with coping. In these cases where pain is associated with mental issues, the proper psychologist or therapist should be included in the child's care. Additionally, if types of inflammatory arthritis, such as Juvenile Rheumatoid Arthritis are suspected, then a pediatric rheumatologist should be involved.
References
1. Incidence of childhood back pain. see full article
2. Low return to doctors office, and low diagnosis rate. see full article.
3. Correlation between physical fitness and back pain. see full article.
4. Algorithmic approach to diagnosis of adolescent back pain. see full article.
5. Spondylolysis can be missed with MRI. see full article.
6. Spondylolysis does not affect long-term back pain. see full article.
7. Bracing has no major effect for spondylolysis. see full article.