Back pain is a well-known source of discomfort in adults, but it is being more frequently diagnosed in children and teenagers. Most parents don’t expect otherwise healthy children to complain about back pain, which is a problem usually associated with middle age. However, back pain can also occur in children and teenagers.
Some reasons that back pain might be more common in children include higher average body weights, higher rates of obesity, higher intensity, and year-round sports, and the increasing weight of backpacks that students wear at school.
Some of the worries around back pain include knowing when the problem might be more serious than a strain and when specialized tests might be needed. There are warning signs to look for to help you tell when back pain might be more serious in a child or teenager.
WARNING SIGNS TO KNOW
Every parent who has a child with back pain worries that there might be a more serious problem that might be occurring. There are serious cases of back pain in your people, but the vast majority of kids with back pain have symptoms that are caused by muscle or ligament injury, with no structural abnormality to worry about.
Some of the warning signs of a more serious problem that you should look out for include:
- Night pain, especially pain that wakes your child up
- Constant symptoms of pain
- Symptoms of illness, such as fever, chills, malaise, or weight loss
- Symptoms in very young children
- Leg pain, numbness, or weakness
These warning signs don’t always mean that there is a more serious problem, but they are a good screening test to determine if more evaluation should be carried out. For example, muscular back pain can persist for months, but if the symptoms have been going on for a few weeks, it’s a good idea to make sure the diagnosis is clear.
MUSCULAR BACK PAIN
Muscular back pain is the most common cause of back pain in children and teenagers. In juries include muscle strains, ligament strains, overuse injuries, posture problems, and poor conditioning of the muscles in the back.
In most cases, imaging, like x-rays and MRIs, aren’t helpful at making this diagnosis, and tests like this are not usually needed unless there are other warning signs.
As with any test, there are downsides to excessive testing, such as exposure to radiation or tests that lead to more unnecessary testing or procedures, so discuss with your doctor what the value of obtaining any specific imaging study would be.
In most cases, muscular back pain will respond to rest and modifications in daily activity. Many treatments will give transient relief, but the long-term effects of treatments are debatable, although generally safe. These treatments include physical therapy, chiropractic treatment, stretching programs, yoga, or massage treatment.
STRESS FRACTURES
Stress fractures can occur in the spine. In most cases, these stress fractures occur in adolescents, and these teenagers might never know an injury has even happened. Over time, signs of the stress fracture might show up.
The most common kind of spinal stress fracture is called a spondylolysis, which is an injury to the bone in the back of the spinal column. This injury is most common in teenagers who do sports that involve repetitive bending backward (hyperextension) of the spine, like gymnasts and divers.
If the stress fracture happens on both sides of the spinal column, this can make the spinal column unstable, which is called spondylolisthesis. This is sometimes called a spinal slip and can lead to the vertebral column alignment to shift.
Stress fractures can make children and parents nervous because these injuries don’t heal. They can cause symptoms into adolescence and young adulthood. However, most children and teenagers that are diagnoses with spondylolysis are treated without surgery and do better with less-invasive treatments.
Surgery is usually reserved for those who have persistent pain even after months of nonsurgical treatment or for patients with severe slips leading to loss of spinal alignment.
Long-term studies show that the chance of having back pain in adulthood is unchanged by the presence of a stress fracture in childhood. This can be a source of problems, but the chance of developing back pain in adulthood is not changed by spondylolysis as a child.
ALIGNMENT ABNORMALITIES
Problems with the alignment of the spine can cause a noticeable deformity and might be associated with the occurrence of back pain. It should be understood, however, that more subtle deformities, that while noticeable, usually don’t cause issues with pain.
The most common spinal deformities in children are scoliosis and Scheuermann’s kyphosis. Scoliosis is a deformity that causes the spine into an S-shaped curve, which can be seen from the back. You can learn about it from the Southwest Scoliosis Institute. Scheuerman’s kyphosis causes a sharp bend in the spine when seen from the side.
These two conditions are very different, but the treatments are similar. With less severe deformities, observation is the most appropriate treatment. Once the deformity has progressed to a more significant level, which is determined by measurement of angles seen on X-ray images, a brace might be needed.
Surgery is only considered as a treatment of these conditions for the most severe deformities. Even when surgery is considered, a deformity of the spine might persist, as the full correction of the deformity might cause more problems than just a partial correction.
Back pain in children and teens is not unusual and becoming more common. This is partly due to changes in children’s activities, and partly due to changes in the conditioning of children.
If your child has back pain, especially if it comes with any other warning signs, it’s worth having them seen by your doctor.
Getting the proper treatment and making sure symptoms are improving can help to ensure that the problem doesn’t stick around. If the symptoms are unusual or worrying you, further tests might be needed to check a more unusual cause is not the culprit.
The good news is, the majority of children with back pain find lasting relief. Back pain can interfere with sports and other activities, but with proper treatment, children almost always return to full health with no ongoing discomfort.
