Related Topics
Kyphosis (http://orthoinfo.aaos.org/topic.cfm?topic=A00423)
Low Back Pain Exercise Guide (http://orthoinfo.aaos.org/topic.cfm?topic=A00302)
Spondylolysis and Spondylolisthesis (http://orthoinfo.aaos.org/topic.cfm?topic=A00053)
Sprains, Strains and Other Soft Tissue Injuries (http://orthoinfo.aaos.org/topic.cfm?topic=A00304)
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Copyright 2007 American Academy of Orthopaedic Surgeons
Back Pain in Children
Back pain in children is not like back pain in adults. Compared to an adult, a child with a backache is more likely to have a serious underlying disorder. This is especially true if the child is 4 years old or younger or if a child of any age has back pain accompanied by:
Muscle strain is the most common cause of back pain. It usually gets better on its own with rest. Many teenagers may have more persistent back pain. This is often related to tight hamstring muscles and weak abdominal muscles. These children seem to improve with a physical therapy program that stresses hamstring stretching and abdominal strengthening. More serious causes of back pain need early identification and treatment or they may become worse. Always see a doctor if your child's back pain lasts for more than several days or progressively worsens. The doctor will begin by learning about how the problem developed. Then, he or she will conduct a physical examination of your child. HistoryThe doctor will need to know everything about the child's health.
It is important to let the doctor know whether the child is involved in sports or other activities.
Physical ExaminationDuring the physical examination of the child, the doctor carefully examines the muscles, bones, and nerves. The doctor will be checking the following: The SpineThe doctor feels each vertebra and looks for deformities in the alignment and mobility of the spine. PostureThe doctor will check the posture for how the child walks (gait); whether he or she can bend over to touch the toes; and whether he or she can extend forward and bend to the right and left. Nerves in the BackWith the child lying face up, the doctor raises the legs (straight leg raising test). The doctor may also raise the legs with the child lying face down (reverse straight leg raising test). MusclesThe size and tightness of muscles in the back and legs are tested. (i.e., the hamstrings) Balance, flexibility, coordination, and muscle strengthMuscle spasm and areas of tendernessReflexes and reactions to pain and light touchImagingThe doctor may use one or several diagnostic imaging tools to see inside the body.
Laboratory TestsLaboratory tests may include checking white and red blood cells (complete blood-cell count) and looking for system-wide inflammation (measuring erythrocyte sedimentation rate). Musculoskeletal strain is most often responsible for back pain in children and adolescents. This type of pain frequently responds to rest, anti-inflammatory medications, and an exercise program. Other more serious diagnoses must always be given consideration. Rounded back, stress fracture of the spine, slipped vertebrae, infections, and tumors are among these. Rounded BackIn adolescents, rounded back, also called Scheuermann's kyphosis, is a common cause of pain in the middle of the back (the thoracic spine). Vertebrae become wedged, causing a rounded, or hunched, back. The curved part of the back may ache and pain may get worse with activity. Boys get Scheuermann's kyphosis more often than do girls. This usually occurs around 14 to 17 years of age.
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An adolescent male presents with excessive roundback localized to
the thoracic spine. The severe kyphosis is most obvious when he bends forward.
(Courtesy of Texas Scottish Rite Hospital for Children)
Stress Fracture of the SpineSpondylolysis, or stress fracture, may cause lower back pain in adolescents. Stress fractures may occur during adolescent growth spurts or in sports like gymnastics, diving, and football, that repeatedly twist and hyperextend the spine. Pain is usually mild and may radiate to the buttocks and legs. The pain feels worse with activity and better with rest. A child with spondylolysis may walk with a stiff legged gait and only be able to take short steps. Girls are more likely to get stress fractures. There are a range of treatment options.
In a few cases, spondylolysis may lead to slipped vertebrae (spondylolisthesis). Slipped Vertebra
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This lateral radiograph of the lumbrosacral spine demonstrates the
forward shift in the fifth lumbar vertebra on the sacrum (L5-S1 spondylolisthesis). (Courtesy of Texas Scottish Rite Hospital for Children)
Treatment may include:
InfectionIn young children, infection in a disk space (diskitis) can lead to back pain. Diskitis typically affects children between the ages of 1 and 5 years, although older children and teenagers can also be affected. A child with diskitis may have the following symptoms.
To treat diskitis, the child may need several days of bed rest and antibiotics taken through the blood stream (intravenous, or IV) or in tablets. In some cases, older children may need casting or bracing to immobilize the spine (for comfort) if infection narrows the disk space. Surgical drainage of the infection is rarely needed. TumorOn rare occasion, tumors can be responsible for back pain. When they occur, tumors of the spine are most often found in the middle or lower back. Pain is constant and usually becomes worse over time. This pain is progressive; it is unrelated to activity and/or happens at night. Other symptoms vary, and can include any of the following:
Last reviewed and updated: October 2007
AAOS does not review or endorse accuracy or effectiveness of materials, treatments or physicians.
Copyright 2007 American Academy of Orthopaedic Surgeons
Related Topics
Kyphosis (http://orthoinfo.aaos.org/topic.cfm?topic=A00423)
Low Back Pain Exercise Guide (http://orthoinfo.aaos.org/topic.cfm?topic=A00302)
Spondylolysis and Spondylolisthesis (http://orthoinfo.aaos.org/topic.cfm?topic=A00053)
Sprains, Strains and Other Soft Tissue Injuries (http://orthoinfo.aaos.org/topic.cfm?topic=A00304)
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