BACK PAIN IN CHILDREN AND ADOLESCENTS

DR PREM PILLAY, PEDIATRIC SPINE+NERVE+PAIN SPECIALIST AND CHILDRENS BACK PAIN EXPERT

Back pain in children and adolescents is a relatively common condition, with prevalence rates ranging from 28% to 48% in school-aged children, showing increased incidence in older adolescents, The reasons for increasing back pain in children and teenagers include poor posture, overuse of mobile phones and computers for both studies and social media, prolonged sitting in school and at home for homework and gaming/social media, and the carrying of heavy school bags explains Dr Prem Pillay a Spine Specialist and expert for back pain and neck pain in children and teenagers.

While most cases are benign some are serious.Proper evaluation and management by a Spine Specialist are crucial for optimal outcomes as some causes of back pain are serious and disabling if not found and treated early.

Common Causes

Primary Categories of Back Pain:

  • Muscular pain
  • Bone-related pain
  • Discogenic pain
  • Spine Nerve pain

Risk Factors:

  • Sports participation : either too little or sports related injuries
  • Obesity
  • Sedentary lifestyle including poor posture and overuse of computer devices
  • Family history
  • Psychological stress
  • Smoking and Vaping

Specific Conditions:

  • Muscle strain or spasm
  • Scoliosis
  • Scheuermann’s disease (juvenile kyphosis)
  • Spondylolysis
  • Spinal tumors
  • Spine Infections of the bone or disc or both
  • Spine Disc Injury

Diagnosis

Clinical Evaluation:

  • Detailed medical history
  • Physical examination including:
  1. Posture assessment
  2. Spinal symmetry evaluation
  3. Range of motion testing
  4. Gait assessment
  5. Leg length measurement

Special Tests:

  • One-legged hyperextension test
  • Straight leg raise (SLR) test
  • FABER test

Imaging Studies:

  • Spine X-rays for initial evaluation
  • Digital Test using AI and Machine vision of the range of Spine Movement
  • MRI Spine for detailed assessment
  • CT Spine scans only for specific conditions

Laboratory Tests:

  • Complete blood count
  • Erythrocyte sedimentation rate
  • C-reactive protein (when infection or inflammation suspected)

Treatment Approaches

Conservative Management:

  • Physical therapy with emphasis on:
  1. Active exercises
  2. Home exercise programs
  3. Regular monitoring and adjustment
  4. Ergonomics including study chairs and desks witrh reducing mobile and computer use

Psychological Support:

  • Cognitive behavioral therapy (CBT)
  • Particularly effective for chronic pain management

Physical Interventions:

  • Stretching and strengthening exercises
  • Core muscle conditioning
  • Postural education
  • Activity modification

Medication Guidelines:

Oral Muscle Relaxers when indicated.

Recent Advances

Multimodal Pain Management:

  • Combination of different treatment approaches
  • Focus on non-opioid alternatives
  • Integration of physical and psychological therapies

Rapid Recovery Protocols:

  • Structured rehabilitation programs
  • Early mobilization
  • Multimodal pain management
  • Reduced hospital stays

Special Considerations

Red Flags Requiring Urgent Evaluation:

  • Back pain in children under 10 years
  • Persistent or severe pain
  • Neurological symptoms including numbness, weakness
  • Fever or weight loss
  • Changes in bladder or bowel function

Prevention Strategies:

  • Maintaining proper posture
  • Regular physical activity
  • Appropriate backpack weight (10-20% of body weight)
  • Ergonomic school furniture

Long-term Outlook:

  • Most cases resolve with the correct diagnosis and conservative treatment
  • Early diagnosis of Spine Tumors, Infection and Spine Instability or severe scoliosis with less invasive surgery including microsurgery gives the best chance of a good outcome
  • 10-15% may develop chronic low back pain in adulthood
  • Early intervention and proper management are crucial for preventing chronicity and long term disability

Back pain in children and adolescents requires a structured, age-appropriate approach to diagnosis and treatment. While most cases respond well to conservative management, proper evaluation is essential to identify serious underlying conditions states Dr Prem Pillay a Pediatric Spine Specialist. Recent advances in multimodal pain management and rapid recovery protocols have improved outcomes, particularly in surgical cases. The focus remains on non-pharmacological interventions and prevention strategies to minimize the risk of chronic pain development