By Gregory H. Hale, MD
Back pain is one of the most common orthopedic issues affecting children and adolescents. It is estimated that more than 50% of children have back pain by 15 years of age. In adolescents, there is usually no obvious cause of back pain and it can be attributed to muscular pain. Back pain in toddlers and younger children is less commonly muscular, and the primary cause needs to be determined.
Evaluation of back pain
If a child with back pain wishes to be evaluated, an appointment with his/her pediatrician or pediatric orthopedist should be made to determine the cause of the pain.
In the evaluation of back pain in a child, details about the history of the pain can help to differentiate the cause. Whether or not the pain was associated with an injury, the character of the pain, and location of the pain are all important. It is necessary to take note of activities that exacerbate the pain and those measures that improve the symptoms. Pain that radiates into the arms or legs, pain that is associated with bowel or bladder dysfunction, is worsened by back extension activities, wakes children from sleep at night, or affects routine daily activities is less likely muscular and needs to be worked up further.
A complete physical exam is necessary in the evaluation of back pain. Observation of gait, posture, and the assessment of pain with certain movements are all key components. A detailed neurologic exam including assessing strength and reflexes can differentiate causes of back pain as well.
Often times an x-ray of the back is needed to rule out specific conditions. Rarely an MRI, CT scan, or bone scan is ordered as well. In young children, and some older children with concerning findings on history and physical exam, lab work is also required.
Fortunately, the most common type of back pain is muscular. This responds well to physical therapy with a focus on stretching, core strengthening, and local modalities a vast majority of the time. If the pain does not respond to this treatment, further imaging with MRI is often considered.
In rare instances, back pain is due to another cause and may require more advanced treatment. A stress fracture in the back (spondylolysis) is treated with bracing. An injection is sometimes used to treat a disc herniation if more conservative measures fail. Antibiotics are used to treat the rare diagnosis of infection. The above conditions and other rarer diagnoses will occasionally require surgery.