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. 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. 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. Nonsurgical measures are usually the first line of treatment for this type of pain (such as physical therapy, medications, osteopathic or chiropractic adjustment). 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 back pain treatment for 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 back pain 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.
See Backpacks and Back Pain in Children for more information
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 back 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.
Read more about the causes of Back Pain in Children
