Back Pain Increasingly Common in Adolescents

Pediatricians from Alfred I. duPont Hospital, writing in the January issue of the Journal of the American Academy of Orthopaedic Surgeons, indicated that children and adolescents appear to be increasingly seeking medical care for nonorganic back pain. However, according to the new literature review, physicians are often unable to determine the exact cause for such pain, even with expensive, advanced testing that includes MRIs.

“If your history, physical exam or simple tests reveal a diagnosis or problem, this can be treated early and you will probably be able to return to your activities or sport,” said lead study author Suken A. Shah, MD, Division Chief of the Nemours Spine and Scoliosis Center at Alfred I. duPont Hospital for Children in Wilmington, DE.

According to Shah and Jeremy Saller, MD, an Orthopedic Surgeon at Children’s Hospital of the King’s Daughters in Norfolk, VA, and a former fellow at Alfred I. duPont Hospital for Children, clinical physical examination and imaging may not produce a clear cause for nearly two-thirds of adolescent patients with back pain. “It could be from a muscle strain, poor posture, too much training in a single sport or multiple sports in the same season, or the opposite—too little activity and not enough exercise,” said Shah.

Dull, achy low back pain not resulting for a specific injury usually subsides with rest and anti-inflammatory medication, such as ibuprofen, wrote Shah and Saller. They add that these instances of pain may be less likely to recur among those who participate in physical therapy and strengthening of core muscles near the abdomen, low back, and hips. However, Shah said, “it is very important to know that if you are experiencing any weakness, numbness or pain that extends down your leg, pain that wakes you up from sleep, or pain that is getting worse over days, you need to seek medical attention quickly.”

The authors discussed the importance being knowledgeable in the most common diagnoses associated with back pain:

• Spondylolysis
• Spondylolisthesis
• Scheuermann kyphosis
• Overuse syndromes
• Disk herniation
• Apophyseal ring fracture
• Spondylodiscitis
• Vertebral osteomyelitis
• Neoplasm

They also discussed how appropriate clinical workup leads to earlier diagnosis and management of back pain and helps avoid unnecessary cost. They wrote that the “use of a systematic method to select appropriate diagnostic tests can help clinicians minimize costs and maximize the likelihood of making the correct diagnosis and providing appropriate treatment.”

To help prevent or minimize back pain, physicians should encourage patients to:

• Maintain proper posture
• Maintain good core muscle strength, flexibility, and aerobic conditioning
• Exercise regularly to avoid a sedentary lifestyle
• Avoid frequent use of heavy backpacks, and always wear both backpack straps to better distribute the weight of the load evenly