Back Pain in Kids and Teens
If you are a parent or have children in your care it is normal to be concerned with pain or other abnormal symptoms your child may report. Back and neck pain in Children is a lot less frequent than in adults. However, any episode of back or neck pain in children should be taken seriously. Although very rare, spinal infection or tumour are the most serious conditions that require early diagnosis and urgent medical attention. Chiropractors are fully trained and as registered health professionals legally expected to detect any indicators of serious pathology (also known as red flags) and then take appropriate action regarding medical attention. Fortunately, the most common causes of back pain in children can be safely treated and managed through Chiropractic Care.
Most back pain in children and teenagers tends to be somewhat age-dependent:
- Younger children normally do not put their spine under the same severe stresses as older children and adults. Thus, for the most part younger children do not have medically significant back pain and their discomfort tends to be short-lived. Also, younger children tend to stop an activity if it is causing pain, choosing not to repeat painful activities, which aids in their recovery if an episode of back pain does occur.
- Older children tend to be more aggressive in their activities and sports, thereby increasing the risk of injury to the bones, nerves and soft tissues in the spine. Teenagers are also more likely to test the limits of their bodies, often being exhorted by commercial advertising and/or peer pressure to push the envelope.
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. Spondylolysis, a defect of the joint between vertebral bones, is commonly found in those who tend to hyperextend their backs (bend backwards), such as gymnasts and fast bowlers in cricket. 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, contact sports, mountain biking, basketball) 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. 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.
New Spinal Conditions Among Kids and Teens
We are starting to see two new forms of injury in school-age children and teens become more common:
- Overuse injuries from IT devices like their mobile phone, Xbox, PS4, tablets or iPad. Common injuries include neck pain (Tech-neck), eye strain, sleeping disorders and upper limb muscle strains and tendoniitis.
- 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 70kg adult carrying a 12kg to 25kg 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.
As you may have noted, rest and careful monitoring of symptoms seems to be the answer for most back pain in children. 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. However, rest alone is not the solution and in fact can hinder full healing. Rest can result in deconditioning of the spinal muscles that are important in protecting the spine. As well, certain factors that may have contributed to the injury need to be addressed such as: poor posture, bad technique, over-training, poor equipment, poor core strength and stability.
Here at Spine Central our services include:
- A thorough history and examination to eliminate the likelyhood of any serious condition
- Determination of the true cause of the problem, ie a diagnosis
- The correct treatment including gentle manual therapies
- Assessment of spinal and limb movement, stability and strength levels and the prescription corrective exercises
- Posture correction and spinal education
1. Scoliosis among Kids and Teens
While scoliosis (curvature of the spine) is not an uncommon diagnosis among teenagers, it is very rare that adolescent scoliosis will cause back pain. However, there are many causes of scoliosis and any underlying serious cause should first be assessed. Fortunately the commonest form of scoliosis is what is termed idiopathic, meaning “of unknown origin or cause”. Teens with scoliosis may develop back pain, just as other teenagers, but it has not been found that people with adolescent idiopathic scoliosis are any more likely to develop back pain than the rest of the population.
2. Scheuermann’s Disease
Scheuermann’s Disease is a developmental disorder of the spine in which the normal roundback in the upper spine is increased and results in a hunchback appearance, . It is also known as Calvé disease and juvenile osteochondrosis of the spine. It is found mostly in teenagers and presents a significantly worse deformity than postural kyphosis. In postural kyphosis the hunched back appearance can be reversed simply by correcting the posture. Children suffering with Scheuermann’s kyphosis cannot consciously correct their posture. Although referred to as a disease it is a condition and rarely causes back pain.
Importantly, for parents concerned for the spinal health of their children the following are reasonable actions to take:
Have your child’s spine checked for any development of a scoliosis or other spinal deformity
If a scoliosis is developing assess whether idiopathic in nature or other possible cause
If scoliosis present it should be regularly assessed for progression
What is as equally important is to not label your child as having a scoliosis. The psychological effect if often greater than the physical effects, especially due to the body image and self-esteem.