Low Back Pain Common in Children and Adolescents

Once children reach school-age, the prevalence of low back pain increases, according to a review of literature published inJAMA Pediatrics.

Although a majority of low back pain is benign, it can have a significant impact on daily and athletic activities. Furthermore, low back pain in adolescents puts individuals at an increased risk of low back pain as an adult.

Despite prior beliefs, there is no single risk factor forlower back pain. The results of the review found that most cases are due to the overuse of the musculoskeletal system or trauma.

The prevalence of low back pain increases once children reach school age: 1% at age 7 years, 6% at age 10 years, and 18% aged 14 to 16 years.

There are several possibilities for the prevalence in adolescents, including participating in athletic activities, rapid growth, adverse psychosocial factors, aging, previous back injury, and a family history of low back pain, according to the authors.

“Historically, pediatric training has emphasized that a specific factor or factors cause low back pain in children and adolescents, but recent studies have informed us that is not necessarily the case,” said lead author James P. MacDonald, MD, MPH. “It is important for physicians to have a firm understanding of the relevant spinal anatomy and the etiological factors of low back pain in children and adolescents.

“While some lower back pain needs to be treated by a specialist, most pediatricians who have a good understanding of the principles outlined in our article can help children and adolescents prevent and manage lower back pain. Most pain with non-specific cause responds to rest, rehabilitation, and identification of predisposing risk factors.”

Primary care physicians who perform a thorough evaluation on school-aged children with lower back pain can help rule out more serious conditions, even though most causes are often benign.

According to the authors, evaluation questions should include obtaining a full clinical history, asking questions associated with lower back pain caused by inflammation, examining the back for signs for deformities, neurologic workups, and potentially ordering imaging tests if necessary.

Because the musculoskeletal systems of children and adolescents are still developing, they have an increased risk of explosive muscle contractions and trauma, particularly during periods of rapid growth. The study findings suggests the importance of pre-season sports conditioning programs and neuromuscular training. Rest should also be incorporated into training regimens, the authors advised.