» Non-Specific Low Back Pain in Children Needs More Research
Non-Specific Low Back Pain in Children Needs More Research

Physical Therapy in Grapevine for Pediatric

There are many conditions that can cause back pain in children and the authors of this review article focused on the causes and risk factors for children developing back pain, as well as diagnosis and treatment options.

While there has been a good bit of research on children and back pain over the past 30 years or so, there hasn't been any consistency or standardization of data or even the definitions of back pain. The researchers found a recent review article that discovered that although much research had been done in the area of back pain prevention and education, there haven't been any substantial studies that looked at the effectiveness of back pain prevention in children and adolescents.

Although there have been many studies that have looked at the risk factors of back pain, there hasn't been much in the way of putting them all together. Interestingly, some of the studies have contradicting findings. Several studies came to the conclusion that girls had more back pain than boys. Other studies found no difference between boys and girls with back pain. Yet, a study by Burton and colleagues found that boys, because of increased sports activities, had a higher risk of back pain. Family history, often an issue in medical problems, has been found to be a factor in some studies, but not in others. Environmental issues could also play a role, as shown in a study of twins, by El-Metwally and colleagues.

Other issues that could play a role in low back pain in children include physical activities. Even the legs have been implicated in lower back pain. One study found that tight quadraceps (upper leg muscles) and hamstrings could cause lower back pain. Lack of exercise can cause lower back pain as well. A few studies have looked at the amount of time children spend playing video games. One found that those who played two hours per day had more back pain than children who just watched television for two hours. Their posture while game playing is one aspect that the researchers felt could contribute to back pain.

Obesity is another issue that not only contributes to lower back pain, but other health issues as well. Finally, a problem that has been identified over the past decade or so, is the increased weight of the backpacks many children use to bring school work and books between school and home. Children are not only carrying very heavy weights on their back, many children are not using/wearing their backpacks correctly, increasing their risk of developing back pain.

The researchers write that we can't forget psychosocial issues as well. Children who are happier and appear to be well adjusted tended to have fewer incidences of lower back pain, compared with children who weren't doing so well. A study by Diepenmaat and colleagues found that children who showed signs of depression also reported more back pain than children who weren't depressed.

Diagnosing lower back pain in children should begin with a full physical exam and a complete medical history. This information can rule out some issues and point the doctors in the direction of others. If no definite diagnosis can be made, a diagnosis of non-specific lower back pain, NSLBP, can be made. However, before this diagnosis is made, it's essential that testing be done.

The generally accepted procedure for investigation begins with the physical exam and history, which then could lead towards having x-rays taken of the lower back. If the x-rays show something, a diagnosis could likely be made. If the x-rays don't show anything, and the child is complaining of only occasional pain, it's likely non-specific pain and it can be treated as that. However, if the pain is constant, at night, radiating (down to the legs), or the child is having neurological (nerve) problems as well, than a magnetic resonance imaging test should be done. This test allows for a more detailed view of the spine. Again, if this is negative, then it's likely non-specific pain. If it's positive, a diagnosis may be made.

Treating lower back pain can be as complicated as diagnosing it. Non-specific lower back pain has no specific cause that can be treated, therefore, the symptoms have to be treated. This could include education on preventing back pain, Physical Therapy, and exercise programs, although some studies say that Physical Therapy and exercise does not have the same positive effects on children as they do in adults.

The authors of the article point out that treatment may not even be necessary. Lower back pain isn't always reported to doctors and is often dealt with at home, if at all.

In conclusion, the researchers found that although there is a better understanding that children do experience lower back pain and it's not always caused by something serious, not much is known about the non-specific lower back pain. More research needs to be done in order to help prevent, diagnose and treat it.

Reference: Ryan Cieply and Todd Milbrandt. Back pain in children and adolescents. In Current Orthopaedic Practice. Nov./Dec. 2009. Vol. 20. No. 6. Pp. 627 to 633.