Pain Worsens With Spinal Movement
Flexion of the spine increases the strain on the anterior elements of the spine, particularly the vertebral bodies and disk spaces. Thus, pain related to a herniated disk is usually worse with forward flexion. Other causes of pain with forward flexion include slipped apophysis and vertebral lesions .
Extension of the spine increases the strain on the posterior elements of the spine, including the facet joints, pars interarticularis, and pedicles. If an injury or lesion is present in this area, the patient will be reluctant to hyperextend the back. Spondylolysis occurs in approximately 4 percent of children younger than six years and in approximately 6 percent of adults.32 The condition is commonly associated with repetitive hyperextension such as with gymnastics and swimming.33,34
How Is Back Pain In Children Treated
Fortunately, it is very uncommon for a child to need surgery for back pain.
Research and experience show that a daily exercise program can greatly reduce your child’s back pain. Our team connects you with the best provider to manage your childs pain and arrange more tests, if needed.
If your childs back pain doesnt improve, your doctor may refer you to the Pain Clinic at Children’s Colorado where pain specialists will work together to help your child.
History Taking And Physical Examination
Similar to approach to other medical complaints, a complete and accurate history and physical examination play important role in proper diagnosis and well management of LBP in children. The physician should ask the patients regarding the onset of symptoms, description of the pain characteristics including location, duration, presence or lack of radiation and also exacerbating and alleviating factors. To differentiate between mechanical and inflammatory types of pain, the physician should ask the patients whether they have morning stiffness or reduction of pain after activity. Inflammatory type of pain normally increases after prolonged rest and reduces by physical activity. Therefore, increase of pain intensity after walking for a long period of time more implies on mechanical pain. In the history taking the physicians should also think on some familial conditions and ask for family history of neurological and rheumatologic diseases as well as congenital abnormalities.
FACES Pain Rating Scale which works on base of the facial expressions and has been quantified in recent studies can also be used by the pediatricians to measure the intensity of the pain in children.
FLACC is another pain scale which should be filled out by the nurses according to behaviors of the children. The scale has been validated for children under 7 years and older than 2 months . The level of functional disability of the children should also be recorded by the physicians.
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Diagnostic Tools And Assessment
Past studies have suggested that children with low back pain likely suffer from serious spinal pathologies, such as infections and tumors. These studies provided the evidence for the extensive diagnostic workup of pediatric low back pain practiced today.
However, recent epidemiological evidence has indicated pediatric low back pain may be much more prevalent than previously perceived and often mechanical in nature. As a result a far greater emphasis is being placed on conducting a thorough subjective history and physical examination, before performing costly and often inconclusive diagnostic tests.
The subjective history should include:
- Posture, pelvis heights, lower limb alignment, foot arches, skin markings are observed with the patient standing
- Lower limb lengths and alignment can be assessed in supine or sitting position
Range of Movement
Reproduction of symptoms, quality of movement and resistance should be observed.
- Active movements of the spine should be tested in a standing position with the pelvis/iliac crest stabilized
- Passive physiological intervertebral movements of the spine can be performed in side lying/ supine/ sitting to assess the range of movement at each segment of the spine
- Passive accessory intervertebral movements can be performed in supine/ prone as required
Resisted Isometric Movements
The following resisted movements should be performed with the spine in a neutral position
Provided neutral testing is normal further testing can be performed:
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 childs own body weight . This amount of weight understandably creates a great deal of strain on the childs 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
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Home Remedies For Back Pain In Teenagers
If your teenager has acute back pain without any additional symptoms, then some of these home remedies might help provide relief.
- According to a Cochrane review, superficial hot and cold compress might provide short-term relief from lower back pain .
- Menthol, which is the active ingredient in several topical pain-relieving creams, might help mask the pain for a short period by creating a cooling sensation. However, this does not treat the underlying cause .
- Topical pain relievers that contain methyl salicylate are said to provide relief, but there is no research to prove their effectiveness. You may try this if your child does not have aspirin allergy and is older that 12 years . Salicylates should not be used in younger kids.
- Topical non-steroidal anti-inflammatories, such as diclofenac, can be used for pain relief.
- Check your teens posture and correct it by showing them how to have a good posture.
- Use chairs that can offer better back support.
- Do not encourage your teen to spend hours playing video games and watching television ask them to take a break and stretch after every hour.
- If your teen exercises, then make sure they do it the right way.
What Treatment Options Are Available For A Child With Back Pain
In many children, back pain is short-lived and settles down without treatment. Studies have found that this happens in about half of all teenagers with back pain, and it’s usually due to over-enthusiastic sporting activities or the use of backpacks.
If the back pain is persistent it’s important to investigate the cause. Simple painkillers such as paracetamol or ibuprofen may help. Your child may be referred to a physiotherapist who will advise about any changes which can be made to your child’s lifestyle to relieve the pain and stop it from happening again. They may also provide various forms of physical treatment and advise a course of exercises that can be done at home,.
If your child’s pain lasts longer than 4-6 weeks, is getting worse, or is accompanied by unusual features such as a persistent high temperature or numbness, they may be referred to a specialist. If there is a serious cause, it is usually important to start treatment as soon as possible. The treatment advised by the specialist will depend on the cause.
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Can Exercise Improve Back Pain In Children
Committing to a home exercise program focusing on stretching and core muscle strengthening is important in treating your child’s back pain. Here are some home exercise tips:
- It typically takes 6 to 8 weeks of consistent exercise for pain to decrease.
- Activities such as Pilates, yoga, swimming, walking or bicycling are great ways for your child to strengthen their core muscles.
- You may consider adding alternative treatments such as chiropractic care, massage and acupuncture to support your child’s home exercise program.
Reasons You Should Take Your Childs Back Pain Seriously
Back pain is common in older adults, but it isnt normally thought of as a childhood ailment. When your child complains of back pain, it may leave you wondering if its a simply a normal ache or if its time to see a pediatric spine specialist.
Like any ache or pain, it isnt uncommon for children to develop back pain. Fortunately, it normally isnt a sign of a serious condition. However, it is important to know if your childs back pain warrants a trip to a pediatric spine specialist. Here are four reasons you may want to take your childs back pain seriously.
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Tips For Parents On Preventing Back Pain In Kids
Stop slouching! is more than just a parental nag its sound advice that can prevent back pain. Because children and adolescents’ musculoskeletal systems are still developing, its important to ensure they sit, stand and lift properly, and avoid activities that put repeated strain on the spine .
Here are some tips for keeping your kids back-pain free:
Ensure proper backpack wearing: carried on two shoulders instead of one
Avoid activities that cause repeated strain on the same muscles
Encourage stretch breaks when sitting for long periods of time
Limit sedentary activities
Teach them proper posture: no slouching, sitting up straight
Make your home a stress-free environment
Help them maintain a healthy weight and diet by providing balanced meals and snacks
Parents should also promote overall mental and physical health, says Dr. Chaudhary. Studies show that kids who are stressed or depressed have a higher incidence of more severe back pain. Encourage your kids to keep active on a regular basis, exercise, get proper sleep, recover, and rest.
If your child is experiencing back pain, take heart: with the right treatment program and lifestyle changes, your child will be on the path to being back-pain free and able to return to their favorite activities in time.
Diagnosis Of Back Pain In Teens
Diagnosis of teenage back pain is done by taking the medical history, physical examination of the back, imaging and laboratory tests.
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Georgia’s Only Nationally Ranked Orthopedic Program For Kids And Teens
We are among the best orthopedic programs in the nation for kids and teens based on factors like overall outcomes, number of patients treated, fewer complications, best practices and more.
Nicholas D. Fletcher, MD, is a Pediatric Orthopedic Surgeon and serves as Medical Director of Spine Quality and Outcomes at Childrens Healthcare of Atlanta. He is also an Associate Professor of orthopedic surgery at Emory University School of Medicine. Dr. Fletchers areas of clinical expertise include spine and hip conditions. For children with scoliosis, kyphosis and spondylolisthesis, he offers a range of nonsurgical and surgical options, including Mehta casting, bracing and posterior spinal fusion, as well as magnetic expandable growing rods and VEPTR.
This content is general information and is not specific medical advice. Always consult with a doctor or healthcare provider if you have any questions or concerns about the health of a child. In case of an urgent concern or emergency, call 911 or go to the nearest emergency department right away. Some physicians and affiliated healthcare professionals on the Childrens Healthcare of Atlanta team are independent providers and are not our employees.
What Are Your Options
If you try acetaminophen for a backache and it doesn’t work as well as you need it to, then stop taking it, says Dr. Katz. “Three to five days is all you need to find out if it will work.”
Also, you don’t necessarily have to choose between acetaminophen and NSAIDs you could try both at the same time. “They are often used in combination, because they don’t appear to have additive side effects, while many people find that they have additive benefits,” Dr. Katz says.
Finally, remember that pain relievers are just one tool available to men with back pain, whether occasional or chronic. Make sure to do all the other things mentioned above to recover from or prevent future flare-ups.
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What Are The Signs And Symptoms Of Back Pain In Children
Symptoms of back pain in kids can vary, with the most common being:
Increased pain with movement, such as bending
Increased pain after prolonged sitting or standing
Tender/sore muscles near the spine
Tight muscles or muscle spasms
Although most back pain in children is mild, there are some instances where your child will require medical attention. Your child should see a doctor if their back pain persists for more than two to three days, is accompanied by a fever, or theyre experiencing any numbness or weakness in their arms and legs, says Los Angeles-based neurosurgeon Khawar Siddique, MD.
When To Take Your Child To The Doctor
Take your child to a doctor if they complain of the below symptoms in addition to back pain.
- There is a pain in the legs associated with numbness and weakness.
- Persistent pain not relieved by rest.
- Intermitted back pain that persists for more than four weeks.
- They have other symptoms, such as fatigue and sleeplessness.
- The pain is severe and interferes with their activities and sleep.
- The back pain occurs at night, and your child wakes up in the middle of their sleep.
- Bowel or bladder problems .
- Pain associated with other symptoms such as weight loss, fever, night sweats.
If you notice any of the above symptoms, then back pain could be due to an underlying medical condition. Next, we list down a few possible medical conditions that might lead to back pain in teenagers.
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Medical Conditions That Can Cause Back Pain In Children
Always see your doctor for diagnosis if your child complains of ongoing back pain, particularly if it wakes them at night or is associated with long periods of stiffness in the morning. Soft tissue injuries are the most likely cause, but in some cases the pain is caused by medical conditions that require professional treatment. These can include:
- injuries to bones and joints such as compression fractures and disc injuries these are rare in children
- fibromyalgia although more common in adults, this chronic pain disorder does occur in adolescents, causing back and neck pain, with muscle spasm and fatigue
- sciatica pain radiating down the buttock and leg, caused by compression of the sciatic nerve this is rare in children
- Scheuermanns disease a growth disorder of the vertebrae in adolescents, which may produce a humpback curvature
- idiopathic scoliosis sideways curvature of the spine with an unknown cause. It is usually not painful. Any persistent pain associated with a fixed curvature must be carefully investigated
- spondylosis a congenital structural defect in the vertebrae. Certain activities may increase the potential for pain .
Will My Child Need Any Tests
Once the doctor has obtained information about your child’s symptoms and examined them, they will occasionally want to do some tests. In most cases this will be a blood test and an X-ray.
Occasionally your child will need more complicated tests, which will need to be requested by a specialist. This may include:
- A bone scan – this is a scan of the bones after a small amount of dye is injected into your child’s vein. The needle used is very small and doesn’t usually cause much, if any, discomfort.
- Other more complicated scans, such as a magnetic resonance imaging scan or a computerised tomography scan, are sometimes required.
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How To Relieve Back Pain
The following tips may help reduce your back pain and speed up your recovery:
- stay as active as possible and try to continue your daily activities this is 1 of the most important things you can do, as resting for long periods is likely to make the pain worse
- try exercises and stretches for back pain other activities such as walking, swimming, yoga and pilates may also be helpful
- take anti-inflammatory painkillers, such as ibuprofen remember to check the medicine is safe for you to take and ask a pharmacist if you’re not sure
- use hot or cold compression packs for short-term relief you can buy these from a pharmacy, or a hot water bottle or a bag of frozen vegetables wrapped in a cloth or towel will work just as well
Although it can be difficult, it helps if you stay optimistic and recognise that your pain should get better. People who manage to stay positive despite their pain tend to recover quicker.
Back pain usually gets better on its own within a few weeks or months and you may not need to see a doctor or other healthcare professional.
But it’s a good idea to get help if:
- the pain does not start to improve within a few weeks
- the pain stops you doing your day-to-day activities
- the pain is very severe or gets worse over time
- you’re worried about the pain or struggling to cope
If you see a GP they will ask about your symptoms, examine your back and discuss possible treatments.
They may refer you to a specialist doctor or a physiotherapist for further help.