Back Pain In Children And Teens. What Are The Causes?

Back pain is commonly known to affect adults, but children and teenagers may get this problem too. What are the most common causes of back pain at young ages? Let’s review them in this article. 

Heavy backpacks

According to health experts, the majority of American children carry backpacks that are up to 20% of their body weight, and roughly one in three children suffer from back pain related to school backpacks. Based on MRI studies, heavy backpacks cause compression of the discs and increase the curvature of the lower spine. While the studies assessed backpacks with straps over both shoulders, the spine injuries maybe even worse when the backpack is carried over one shoulder, as children do. 

Muscle strains

Muscle strains are a common cause of back pain in children and teenagers. The pain improves with rest, anti-inflammatory medication, and stretching exercises. Persistent pain seen in teenagers is often due to right hamstring muscles, poor posture, and weak abdominal muscles. Carrying a heavy backpack can further aggravate the pain, as it affects the intervertebral discs and spine curvature. Low back pain caused by muscle strains improve with special exercises targeting hamstring stretches, strengthening the abdomen, and correcting the posture. 

Stress fracture (Stress injury)

A stress fracture can affect children and teens involved in sports, particularly gymnastics, diving, football, and other activities that involve regular twisting and hyperextension of the back. Stress fractures may also develop during adolescent growth spurts. Although it feels more like a muscle sprain, the pain is caused by small cracks in the surface of the vertebrae. The back pain worsens when sitting or bending forward, may radiate to the buttocks and improves with  rest, anti-inflammatory medications like ibuprofen, and physiotherapy. The child may walk in an unusual way, with a stiff legged gait and take short steps. 

Slipped vertebrae 

Medically known as  spondylolisthesis, a slipped vertebrae  develops when the vertebra shifts forward on the next vertebra below.  Back pain is usually experienced when the slipped vertebra presses against a nerve or a disc. The pain increases during movement, especially when carrying heavy objects. Numbness in the legs suggests compression of a nerve root. This condition  may be caused by a stress fracture, sport injuries, misalignments during a child’s growth or can be hereditary. Mild cases are treated with conservative measures like rest and antiinflammatory drugs. Severe cases may require surgery. 

Spine curvature problems

In teenagers,Scheuermann’s kyphosis or round back of the spine is more likely to cause middle back pain than low back pain. The pain gets worse with activity. Abnormal curvature of the spine becomes obvious when the child bends forward. Another form of kyphosis called postural kyphosis tends to occur more in girls who tend to slouch and improve with proper posture.  

Mild cases of  Scheuermann’s kyphosis do not require treatment. Braces can be used occasionally when exercising or to improve posture. Severe cases may require surgery.  

A third form of kyphosis- congenital kyphosis is present at birth. In this case, the bones do not form properly and some vertebrae may be fused together. This condition tends to get worse over time and often requires surgery at a young age. 


Infections, tumors, other causes

While muscle, bones, discs, and ligaments are the most common causes of low back pain, infections of the discs (discitis) can develop in rare cases, especially in young children between ages 1 and 5. In addition to low back pain, a child may walk with a limp or refuse to walk, and squat rather than bend from the waist when picking up an object from the floor. 

Tumors of the spine are rare, and they typically affect the middle and lower back. The pain tends to be more severe, is not related to exercise, and gets worse over time. 

In some cases, back pain is caused by conditions unrelated to the spine such as kidney diseases. In this case, the pain in the lower back is associated with painful urination.

Treating the underlying cause (ie infection, removal of the tumors, kidney diseases) will improve the back pain. 

Red flag symptoms 

More serious causes of back pain require early diagnosis and treatment from the doctor. Warning signs that the back pain is due to a more serious underlying condition include back pain associated with fever, weight loss, weakness or numbness, difficulty walking, pain that goes down to the legs, and bowel or bladder symptoms. Pain that doesn’t go away becomes worse, or keeps the child awake at night is also concerning. 

There are a few simple things that can prevent back pain

Help your child or teenager to sit up straight and maintain proper posture.

The backpack should not be overloaded and carried on both shoulders.

If your child takes up a new sport, it is important to take lessons to learn the proper techniques, use the recommended equipment, and all the workouts should include a warm-up and cool down period. 

Seek medical advice If the back pain doesn’t go away, or becomes worse. In addition to physical examination, the doctor may order X-rays, bone scans, blood tests, and other investigations. 

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