Potential causes of back pain in children and teens
While adults can have vertebral disc injuries involving
rupture, protrusion or slipping, and compression, these
problems are uncommon in children. However, as kids
age and their bodies mature, it becomes more likely
that an injury to the spinal discs may occur and cause
back pain.
Causes of back pain that tend to occur among older
children:
- Spondylolysis. As kids’ sporting events
become more competitive and the activities more specialized,
certain types of injuries causing back pain tend
to arise. Spondylosis, a defect of the joint between
vertebral bones, is commonly found in those who tend
to hyperextend their backs (bend backwards), such
as gymnasts. This injury may actually represent a
stress fracture and the period of rest and recuperation
may be extensive – up to 4 to 6 weeks.
- Spondylolisthesis. Occasionally, further
injury can be found as spondylolisthesis, a “slipping” of
one vertebra upon another. This condition can progress
through adolescence, and if it results in instability
and back pain it may require spinal fusion surgery
at a later point.
- Disc Injuries and vertebral fractures. Teens
who tend to punish their spines through gymnastics
or extreme sports (such as skateboarding, in-line
skating, and vert biking) will frequently land very
hard on their feet or buttocks. Either way, the force
is transmitted to their vertebrae, which can result
in a vertebral fracture and/or damage to the intervertebral
discs.
If the disc material is extruded out or herniated, the spinal cord nerve
roots leaving the cord can be compressed. This causes the sensation of pain
along the path of that nerve. A well-known version of this is sciatica, which
presents as buttock pain radiating down the back of a leg. Conservative measures
are usually the first line of treatment for this type of pain (such as physical
therapy, medications, osteopathic or chiropractic manipulation). If these
treatments do not provide sufficient pain relief, patients may require surgery
(e.g. a microdiscectomy or discectomy) to relieve pressure on the nerve.
Causes of back pain that may occur in younger or
older children:
- Infection. Of constant concern to physicians
is the diagnosis of infection of the spine (discitis)
in children. An infection of the spine is of great
consequence and requires prompt diagnosis. Diagnosis
of an infection is usually made with the assistance
of a good physical exam and laboratory data. Signs
of inflammation may be present (e.g. redness, swelling)
even to the level of the skin. Radiographic studies
are frequently normal. Treatment may consist of antibiotics
if bacteria are found to be the cause of the infection.
Again, prolonged rest is the primary treatment for
the back pain resulting from the infection.
- Tumor. Another major concern for pediatricians
treating a child’s back pain is potential for
a tumor in the spine. Luckily, back pain caused by
a spinal tumor is a very rare occurrence. As with
infection of the spine, the diagnosis hinges on obtaining
a good medical history, physical exam, and the suspicious
nature of physicians when they cannot get an otherwise
satisfactory diagnosis to explain the child’s
back pain or other symptoms. Treatment once again
depends upon the final diagnosis and the skills of
several subspecialties.
Backpacks and back pain among kids and teens
Importantly, pediatricians are starting to see a new form of injury in school-age
children and teens become more common: overuse injuries and back strain caused
by carrying back packs that are too heavy.
Often, backpacks may equal 20% to 40% of the child’s
own body weight (equivalent to a 150-pound adult carrying
a 30 to 60-pound back pack around 5 days a week). This
amount of weight understandably creates a great deal
of strain on the child’s spine. Additional strain
that may cause back pain comes from children and teens
carrying their backpacks over one shoulder, causing an
uneven load on the spine.
Careful process of diagnosing back pain in kids
and teens
As you may have noted, rest and careful monitoring of symptoms seems to be the
answer for most diagnoses. This is because the vast majority of back pain problems
in children are related to soft tissue damage (such as muscles, ligaments and
tendons), which is often caused by overuse or strain.
Surgery for back pain in children is very rare, and
is usually only considered for the more severe cases.
If the child’s pain is severe, and he or she
is having difficulty functioning, then surgery may
be considered.
Most importantly, a careful process of elimination
of medically more significant causes of back pain (such
as tumor, infection, fracture) should always precede
any therapeutic plan for treating back pain in kids
and teens.
By: Julian
Huang, MD
July 10, 2002
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