Q&A on Low Back Pain in Adolescent: Causes, Treatment, Symptoms,Tests
Is Low Back Pain Common Among Adolescent?
Yes, low back pain is the most common symptoms among young adults and adolescents. Low back pain is localized over lower back or lower 1/3rd of spine. Back pain in adolescents is often triggered by either sports injury or carrying heavy objects on the back. Study suggests carrying heavy bags every day to school, loaded with books and computer can trigger back pain in 26% of children of age 13 to 14 years.1 Fifteen to twenty percent adolescent participate in school sports every year. The study of 278 adolescents participating in sport activities (158 males and 113 females) indicated that at the end of one year 57% of the adolescent were suffering with low back pain.2
Should I Be Worried About My 14-Year-Old Adolescent Son Complaining About Low Back Pain?
Your son should be seen by a physician as soon as possible to evaluate cause of backache. Prevention of such injury is essential since lifetime prevalence of back pain in individual participating in sports related activities is 66%.2
The common cause of back pain in adolescent boys is sports injury and carrying heavy bags to school and other outdoor activities. Recent MRI study of fifteen children suggests carrying heavy object causes mechanical low back pain. MRI study was performed carrying zero, 4 kgm and 8-kgm weight. Study suggests the heavier objects were compressing the L5/S1 disc only.3 Though some other study also suggests computer use, physical activity, or heavy backpacks do not cause any mechanical low back pain.4 Sports injury and carrying heavy object often causes "Undiagnosed mechanical low back pain (Spondylolysis)"5, 6 or Stress Fracture of Disc or Facet Joint.
What is Spondylolysis?
Spondylolysis is also known as vertebral arch stress fracture.7 This condition is also known as undiagnosed mechanical low back pain in young and adolescent patients.
What Is The Cause Of Vertebral Arch Stress Fracture Of Lower Back?
Vertebral arch stress fracture is a fracture of pars interarticularis of the vertebral arch. Vertebral arch stress fracture causes mechanical low back pain and if not treated promptly results in long term disease known as Spondylolysis.
What Other Causes Can Result In Low Back Pain In Adolescent?
Causes of Low Back Pain in Adolescent Are As Follows-
Most Frequent Causes Of Low Back Pain In Adolescents Are-
- Undiagnosed Mechanical Low Back Pain or Spondylolysis.
- Muscle Strain
- Ligament Sprain
- Stress Fracture of Disc
- Discogenic Pain
- Facet Joint Pain
Less Common Causes Of Low Back Pain In Adolescents Are-
- Disc bulge
- Disc herniation
- Inflammatory joint disease- Juvenile arthritis, psoriatic arthritis, juvenile rheumatoid arthritis or ankylosing spondylitis.
What Should I Do If My 14-Year-Old Adolescent Son Has The Above Listed Low Back Pain Symptoms?
Your son should be seen by an orthopedic or neuro surgeon to evaluate cause of pain and initiate treatment if necessary as soon as possible.
Which Tests Would Be Necessary For Diagnosis Of Low Back Pain In Adolescent?
Test recommended for diagnosis of low back pain is Radiological Study8 such as X-ray, CAT scan and MRI of lower back. The other lab tests recommended are Ultrasound Study, bone scan and Blood Examination.
Are These Tests Harmful?
Frequent CAT scan study exposes individual to multiple X-rays. CAT scan study involves series of X-ray pictures. Frequent exposure to multiple X-Ray can be harmful.
Is There An Alternative To CAT Scan?
MRI study is an alternative study to CAT scan. MRI does not expose patient to X-ray radiation.
Why Is Ultrasound Study Necessary To Evaluate Low Back Pain In Adolescent?
Ultrasound study is useful to diagnose epidural abscess, dislocation and hematoma (blood clots).
Is Blood Test Important For Diagnosing Low Back Pain In Adolescent?
Blood test is recommended for inflammatory back diseases, epidural abscess, osteomyelitis (infection of bone) and discitis.
Which Blood Tests Are Significant?
White Blood Cells count and Erythrocyte Sedimentation Rate (ESR) is elevated in infection like discitis, osteomyelitis and epidural abscess. Erythrocyte sedimentation rate is also increased in inflammatory back diseases. Rheumatoid factors are increased in-patient suffering with back pain caused by rheumatoid disease.
What Is Bone Scan And Which Diseases Are Diagnosed With Bone Scan?
Bone scan is performed in special lab or hospital radiology department. Patient receives an intravenous dye. Dye spread in bones of lower back is examined by special camera known as bone scan. Dye is retained by hyperactive tissue secondary to inflammation, infection, tumor and fractured bone.
Which Other Symptoms I Should Be Looking For With Chronic Low Back Pain In Adolescent?
Fever is often present with pain if cause of pain is discitis or inflammatory back disease like rheumatoid arthritis, juvenile arthritis or epidural abscess.
How Soon Should The Treatment For Low Back Pain In Adolescent Be Initiated?
Low back pain in adolescent if ignored can cause serious problems in later stage of life. Low back pain when followed by minor trauma or domestic fall should be investigated for "Undiagnosed mechanical low back pain (Spondylolysis)"5, 6 or stress fracture of disc or facet joint. Such injury or any other cause of lower back pain should be treated as soon as possible.
What is The Treatment For Low Back Pain in Adolescent?
Treatment For Low Back Pain in Adolescent Includes Following Choices-
- Anti-inflammatory medications.
- Restriction movements of lower back, which may provoke further injuries.
- Physical therapy to strengthen lower back muscles.
- Rehab to prevent similar injury.
- Rarely epidural steroid injection.
1. No kidding: low back pain and type of container influence adolescents' perception of load heaviness.
Nicolet T, Mannion AF, Heini` P, Cedraschi C, Balagué F.
Eur Spine J. 2014 Feb 7.
2. Prevalence of Low Back Pain in Adolescent Athletes - an Epidemiological Investigation.
Schmidt CP1, Zwingenberger S2, Walther A2, Reuter U2, Kasten P2, Seifert J2, Günther KP2, Stiehler M2.
Int J Sports Med. 2014 Jan 14.
Spine (Phila Pa 1976). 2014 Feb 1;39(3):243-8. doi: 10.1097/BRS.0000000000000114.
3. Altered disc compression in children with idiopathic low back pain: an upright magnetic resonance imaging backpack study.
Shymon SJ, Yaszay B, Dwek JR, Proudfoot JA, Donohue M, Hargens AR.
4. Neck/shoulder, low back, and arm pain in relation to computer use, physical activity, stress, and depression among Dutch adolescents. Diepenmaat AC, van der Wal MF, de Vet HC, Hirasing RA. Pediatrics. 2006;117:412–6.
5. Imaging modalities for low back pain in children: a review of spondyloysis and undiagnosed mechanical back pain.
Miller R, Beck NA, Sampson NR, Zhu X, Flynn JM, Drummond D.
J Pediatr Orthop. 2013 Apr-May;33(3):282-8. doi: 10.1097/BPO.0b013e318287fffb.
6. Evaluation of Back Pain in Children and Adolescents
ROBERT M. BERNSTEIN, MD, Cedars-Sinai Medical Center, Los Angeles, California
HAROLD COZEN, MD, Palos Verdes Estates, California
Am Fam Physician. 2007 Dec 1;76(11):1669-1676.
7. The structure of the pars interarticularis of the lower lumbar vertebrae and its relation to the etiology of spondylolysis, with a report of a healing fracture in the neural arch of a fourth lumbar vertebra.
Krenz J, Troup JD.
J Bone Joint Surg Br. 1973 Nov;55(4):735-41.
8. Imaging modalities for low back pain in children: a review of spondyloysis and undiagnosed mechanical back pain.
Miller R, Beck NA, Sampson NR, Zhu X, Flynn JM, Drummond D.
J Pediatr Orthop. 2013 Apr-May;33(3):282-8.