Beyond heavy backpacks and computer overuse: Lower back pain in adolescents
Lower back pain has become a pressing issue not only for adults--for whom the annual cost in the United States alone is more than $90 billion--but for school-age children as well. Despite the popular notion that heavy backpacks and too much time in front of the computer are to blame, studies show the problem runs deeper, relating instead to children with psychological issues and conduct problems.
To get a gauge on just how prevalent back problems were amongst children and adolescents, a Belgian study was performed on children aged nine to 12. Of the group, 17.8% of the children who reported no back pain at baseline suffered from at least one incident in which significant back pain occurred by the end of a two-year trial. Flack has recently been given to heavy backpacks weighing down children's backs and consequential woes. In response to the attention, the American Academy of Pediatrics (AAP) recommended backpacks not exceed 10-20% of each child's body weight. The recommendation, however, was not evidence-based, as there is limited data on backpacks' relationship to back pain in adolescents.
When back pain cases are referred to a specialist, the most common diagnoses that have come to be known are muscle strain, herniated disk, spondylolysis and scoliosis. Tumor, infection and sickle cell crisis can also cause back pain but are far less frequent. In situations where back pain is accompanied by fever and other generalized symptoms, discitis (infection of the intervertebral disc space) is usually the diagnosis. Discitis can generally be cured with antibiotics and immobilization within three weeks or so. Acute back pain stems mainly from herniated disks, fractures and muscle strains. Specific symptoms of herniated disks include stiffness and pain radiating down the legs, while acute fractures also consist of radiant pain down the legs along with sharp pain in the lumbar spine (lowest part). Muscle strains are generally related to physical activity and aren't characterized by radiation of pain.
In cases of chronic pain, most issues are a result of developmental or psychological problems. Scheuemann's kyphosis affects vertebral growth plates and is identified by a gradual onset of pain that is at its worst at the end of the day. Inflammatory joint disorders such as juvenile rheumatoid arthritis and spondylitis include symptoms of morning stiffness and joint tenderness, but may be relieved with a hot bath or shower. Whenever psychological disorders appear to be linked to back disorders such as these, physicians recommend consulting a mental health professional. Rarely, back pain in adolescents can be consequential of a tumor or infection, including osteomyelitis, osteoid osteoma and discitis. These cases are limited to children with extreme nighttime pain strong enough to wake them from sleep, and require immediate medical attention.
When back pain is evident, physical examinations of adolescents should consist of a visual examination of the back and standing posture, notation of the presence of tenderness and the degree of pain during flexion and hyperextension. When these measures and a number of others are taken, physicians can determine the level of treatment necessary. For adolescents without significant physical findings, a short duration of pain and a history of minor injury, only conservative treatment is necessary. More serious cases should be followed up with plain radiography to the afflicted area. From there, MRIs, CT scans and bone scans may be used depending on the results, but the decision of which to use must be a careful one for physicians and the parents of patients, as each has pros and cons and specializes in specific disorders.
-As reported in the December '07 edition of American Family Physician
-By Greg Gargiulo
