Low Back Pain

Is it worrisome if your child experiences low back pain?  In short, yes.  Unlike adults, back pain is not common in children and should raise concern.  However, as children transition to adolescence, back pain becomes more common and similar to mechanical back pain that adults often experience.

Young children experiencing back pain should always be seen by their pediatrician for a more thorough evaluation.  It is important to determine the cause of the pain with further tests (such as x-ray or MRI) because it is rare for young kids to have back pain purely from muscles (but it can happen), and and assessment for a tumor or other lesion must be performed.

As children reach middle school and beyond, back pain becomes more common and is usually attributed to mechanical back pain (mechanical means that the source of pain may be in the spinal joints, discs, vertebrae, or soft tissues and muscle).  However, like young kids, it is still important to get tests to evaluate the spine (x-ray, etc).  Adolescents can experience herniated discs, but that generally does not occur until adulthood, and more often the mechanical back pain is because of a muscle strain or tight lower extremity muscles.  Physical therapy is very effective in treating mechanical back pain. Core strengthening and flexibility is the focus of physical therapy and should become part of an adolescent's daily routine (like brushing your teeth) if he or she is diagnosed with mechanical back pain.  For a fantastic list of core strengthening and flexibility exercises click here.

A source of low back pain in the young athlete can also be a stress fracture in the bones of the low back (also known as spondylolysis).  This occurs in active children or teens, especially in sports such as swimming, gymnastics, football, tennis, volleyball - all which include repeated extension of the low back.  Stress fractures of the low back are treated with rest, physical therapy, and sometimes bracing.

Scoliosis (curvature in the spine) can be a cause low back pain, but it is often painless. Some states require children to be screened for scoliosis just prior to middle school (around 5th grade).  This is an important time to be screened because scoliosis can dramatically worsen during the years of rapid growth and puberty.  Your pediatrician should also screen your child by doing a simple exam at his or her annual physical. Scoliosis rarely requires surgery - if discovered early and the curve is big enough, it can be treated with bracing.  Bracing only prevents the curve from getting worse - it does not actually fix the curve.

Bottom line - don't ignore your child if he or she complains of back pain!

Rachel Brewer, MD