Lancaster Physician Summer 2017 - 13

SUMMER 2017

Children's Back Health

lthough often thought of as a problem
in adults, back pain and related issues
are more commonly being recognized
among children. By age 10, up to 6
percent of children will experience back pain.
The percentage jumps up to 18 percent for
children 16 years of age and older. Risk factors
for back pain in children include physical
inactivity, over-activity in highly competitive
sports, being female, recent growth spurts, and/
or previous episodes of back pain in the child
or in the family. Children that experience back
pain tend to have repeated episodes as adults.
Although back pain is a very common complaint, most episodes in children are benign
and self-limited. However, evaluation and care
should be sought more expeditiously when pain
occurs with any associated symptoms (such as
fever or neurologic issues) or when sudden severe
pain wakes a child from sleep. A physician should
also evaluate back pain that gets progressively
worse or that lasts for more than a few days to
weeks. The evaluation would include a medical
history, physical examination, imaging studies,
and possibly laboratory tests.
Up to 80 percent of cases of lower back pain
in children have no specific identifiable causes.
Instead, most episodes are thought to be musculoskeletal, due to normal use of the muscles,
ligaments, tendons, and bones in the spine.
Because of this, most treatment has the simple
purpose of helping alleviate the symptoms. This
includes taking a break from strenuous activity
that can worsen the discomfort, applying heat,
and using over-the-counter anti-inflammatories.
For prolonged cases of benign lower back pain,
physical therapy and avoidance of repetitive
motions may be useful, as well.
Focusing on prevention of these back issues is
also becoming more important. Proper stretching, training, and strengthening before any
high-intensity athletic activity is recommended.
Encouraging and teaching proper technique in
sports-related activities could also help prevent
injury. Steering clear of prolonged repetitive
activities that load the spine may help, as well;
this might include avoiding improper use of
backpacks and loading them with too much
weight. Additionally, attention to good posture
may be an important component long-term.

Up to 80 percent
of cases of lower back pain
in children have no specific
identifiable causes.
There are a couple of common specific causes
of back pain in children and adolescents. One
is spondylolysis, a stress fracture in the spine. A
related second condition is spondylolisthesis, in
which one vertebra in the spine slips forward on
a second vertebra. Certain sports or activities,
including football and gymnastics, put children
at higher risk of spondylolysis and spondylolisthesis, but any activity that involves repetitive
hyperextension or rotation of the spine can lead
to these injuries. The first line of treatment for
these diagnoses is usually conservative, including
a period of rest and possibly a back brace. If the
back pain resolves after rest and treatment with
the brace, most patients benefit from physical
therapy and can resume normal activities.
Another condition that can cause back pain
in children is scoliosis, a curvature of the spine.
Treatment of scoliosis depends on multiple
factors, including age and severity of the curve.

LANCASTER

PHYSICIAN

Depending on how severe the curve, options
include observation, bracing, or surgery. Thankfully, other more serious causes of back pain are
relatively rare in children.
While back pain is common among adults, it
is important that parents and children become
aware of its frequency in children, especially
athletes. Parents and youth should know the
simple preventive actions mentioned above to
help prevent injury. Also, it is important that
children tell their parents or coaches about any
back pain immediately to help prevent further
injury. Reduction of the risk of injury as well
as giving injuries prompt attention are vital to
minimizing long-term effects and symptoms.
When in doubt, please consult with your
pediatrician or other health care provider for
evaluation and guidance.

Table of Contents for the Digital Edition of Lancaster Physician Summer 2017