Back pain is common in adults, but uncommon in kids.  Because children rarely suffer from back pain, any complaint by a child or teenager about acute or chronic back pain should be taken seriously by parents, especially if there was an injury preceding the pain. 

The most common causes of back pain in children are related to age and activity level.  Younger children are less likely to experience the same stress on the spine during activity as older children.  If a young child experiences back pain, there should be greater concern for the possibility of a serious condition, such as a spinal tumor, or infection of the spine.

Older children tend to be more aggressive in their activities and sports and therefore the risk of injury to bones, nerves, and soft tissues in the spine is more common. Tumors and infection of the spine may occur in teens, however, these are rare.  Back pain in teens is commonly caused by sports injuries or overuse syndromes.  Scoliosis, or curvature of the spine, is not uncommon among teenagers, but it rarely causes back pain. Teens with scoliosis may develop back pain, just as other teenagers, but are not more likely to develop back pain than other teenagers. 

Fractures are another common cause of low back pain in teens.  Fractures are often very painful, but rarely do the nerve roots become compromised.  However, as kids age and their bodies mature, it becomes more likely an injury to the spinal discs can occur and cause back pain.  

Common Causes of Back Pain

• Commonly referred to as a stress fracture, Spondylolysis is a defect of the joints between the bony scaffolding.  This type of injury occurs commonly in kids who tend to hyperextend their backs (bend backwards), such as gymnasts, or athletes who jump a lot, like triple-jumpers.  Non-steroidal anti-inflammatory meds (NSAIDS), bracing, and rest followed by physical therapy and core muscle strengthening are recommended treatments.  Surgery is very rarely performed.
• If instability develops at the site of the spondylolysis, a “slipping” occurs between one vertebra and another causing Spondylolisthesis.  Treatment is similar to treatment for spondylolysis, however, this condition can progress through adolescence.  If it results in instability and back pain it may require spinal fusion surgery.
• Disc Injuries and Vertebral Fractures, often caused from jumping and landing hard on the feet and/or buttock.  The force from impact is transmitted to the vertebrae, which may result in a vertebral fracture and/or damage to intervertebral discs. Occasionally the disc material may herniate and spinal cord nerve roots can become compressed. This causes pain along the path of the nerve root, commonly referred to as “sciatica”.  Nonsurgical measures such as physical therapy, medications, osteopathic or chiropractic adjustment, epidural steroid injections are usually the first line of treatment for this type of pain. If these treatments are not beneficial, surgery may be required to relieve pressure on the nerve.
• Infection: Of constant concern to physicians is infection of the spine (discitis). An infection of the spine has great consequence and requires prompt diagnosis, usually made by physical exam, blood tests, and imaging. Signs of inflammation also may be present, including redness, swelling, or fever. Treatment may consist of antibiotics if bacteria are found to be the cause, and prolonged rest will be prescribed for back pain.

Spinal tumors are another concern for physicians treating childhood back pain, however, the occurrence and likelihood  is very rare.

Could It Be the Back Pack?

Physicians are more commonly seeing a new form of injury in school-age children and teens which is overuse injuries and back strain caused by HEAVY back packs.  Overloaded back packs can 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 creates a great deal of strain on the child’s neck and spine, especially if they are carrying their back pack over one shoulder, creating an uneven load.  As a rule, kids should lighten the load and wear back packs evenly over both shoulders evenly.

Diagnosing Back Pain in Kids

Surgery for back pain in children is very rare, and usually only considered for more severe cases. If the child’s pain is severe, and he or she is having difficulty functioning, then back surgery may be considered.  Proper diagnosis depends on a good medical history, physical exams, radiologic studies, and lab tests.  The elimination of more significant causes of back pain (tumor, infection, fracture) should always precede any therapeutic plan for treating back pain in kids and teens.

For most injuries and episodes of back pain, treatment of choice is usually a short period of rest with a progression towards physical conditioning and core muscle strengthening.  The good news is, 90% of kids and teens with low back pain have resolution of their symptoms within a few weeks, as the vast majority of problems are related to soft tissue damage (muscles, ligaments and tendons). 

by Gregory Phillips, MD