Pediatric Back Pain | Treatment and Prevention

Back pain in children, though often overlooked, is relatively common and can greatly impact their quality of life. Nearly 34% of children report experiencing back pain, with 9% describing their pain as severe. Identifying the optimal treatments is key to restoring health and wellness.

Causes and Symptoms

Back pain has many potential causes including muscular strains, overuse injuries, and spinal conditions.

Common Causes

Muscular strains account for most cases of back pain in children. Everyday activities like bending, lifting, or even just poor posture can overwork the muscles, tendons, and ligaments along the spine. As children grow, it’s not uncommon for them to experience muscle stiffness that leads to discomfort.

Overuse injuries are another culprit, especially for young athletes. Sports that involve repetitive motions like gymnastics, dance, and football can place too much strain on the back and lead to pain. Stress fractures along the spine may also occur.

Spinal conditions like scoliosis, spondylolysis, spondylolisthesis, and Scheuermann’s kyphosis involve abnormalities in the vertebrae. These can alter proper movement and functioning of the spine, resulting in pain over time.

Symptoms

• Pain that worsens with movements like bending
• Discomfort after long periods of sitting or standing
• Loss of ability to participate in regular activities

If the pain lasts several weeks, severely disrupts sleep, or is accompanied by concerning symptoms like numbness/tingling, bowel/bladder issues, or fever, be sure to see a doctor.

Diagnosis

To determine the cause of back pain, the doctor first takes a medical history and performs a physical exam. They may check range of motion or look for signs of scoliosis. If the source remains unclear, they can utilize:

• Imaging tests like X-rays, CT scans, or MRIs to visualize the spine
• A psychology evaluation to assess contributing behavioral health factors

Treatment Options

Depending on the severity, various lifestyle changes, medications, therapies, interventions, and sometimes surgery may help relieve children’s back pain.

Lifestyle Changes

• Rest & activity modification: Getting adequate rest by avoiding strenuous activities that worsen pain can help injuries heal. Taking breaks from sports, dance, gymnastics, or other repetitive activities reduces strain on the back. Gentle walks or light stationary cycling are better initial options. Slowly easing back into fuller activity under a doctor’s guidance can help prevent reinjury.
• Heat/ice: Applying heat packs or taking warm baths can relax muscles, boost blood flow, and temporarily reduce feelings of pain and stiffness. Cold packs can decrease inflammation and swelling. Use for 10-15 minutes at a time. Alternate or choose based on what feels most soothing.
• Exercises & stretches: Building core and back muscle strength supports the spine and prevents future injuries. Specific exercises will depend on areas of weakness but often include bridges, bird dogs, planks, and more done at an easy pace. Gentle yoga or swimming keeps muscles flexible without taxing joints. Stretches while sitting can counter tightness from long study sessions.
• Proper posture: Slouching strains the back but positioning shoulders over hips with a gentle arch in the lower spine while sitting and standing reduces tension. Use pillows, lumbar rolls, or monitors positioned at eye-level as needed. Remind children to stand up straight.
• Weight management: Excess weight puts more stress on the back. Develop healthy eating strategies to fuel growing bodies without overeating. Get the whole family moving to support activity goals and maintain ideal weights. Consult doctors on specifics.

Medications

There are various medicine options to help ease back pain in children, including:

• Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) or naproxen (Aleve) to reduce inflammation
• Muscle relaxants such as cyclobenzaprine (Flexeril) or baclofen to relieve muscle spasms
• Anti-seizure medications like gabapentin (Neurontin) or pregabalin (Lyrica) that also calm nerve pain
• Certain anti-depressants such as duloxetine (Cymbalta) or milnacipran (Savella) that modify pain signaling

In addition, targeted injections can deliver steroid medication directly to painful sites along the spine to reduce swelling.

These medications can temporarily help relieve discomfort and allow the back to heal. Doctors will determine appropriate types and dosages based on the child’s age, symptoms, and health history. Close monitoring helps ensure optimal pain relief and prevent side effects. Discuss all medication questions or concerns with the prescribing provider.

Physical Therapy

Seeing a physical therapist can be very helpful for treating back pain in children. Physical therapists create customized exercise programs to meet each child’s needs.

Gentle stretching exercises that target tight muscles can improve flexibility and mobility. Strengthening exercises for core and back muscles help support the spine and prevent future injuries. Sports-related rehab focuses on safely rebuilding activity tolerance and technique after an injury.

Physical therapists also teach proper posture and movement patterns to use during daily activities. This helps retrain the body to use the back muscles correctly. Making sure to stand up straight and lift objects with bent knees reduces strain.

As children learn and advance through their specialized exercise programs, they begin to function better and experience less discomfort.

Alternative Therapies

Other non-medication options that may help ease back pain include:

• Massage therapy uses hands-on pressure to increase blood circulation, relax muscles, and reduce stiffness
• Acupuncture applies tiny needles to specific body points thought to influence energy flow and provide pain relief
• Spinal adjustments from chiropractors aim to improve spinal alignment and nerve functioning
• Heat/ice therapy and electrical nerve stimulation devices offer additional relief

These therapies encourage healing while lowering tension, anxiety, and inflammation levels. They can be used alone or combined with other treatments.

Interventions

If back pain persists despite initial treatment attempts, more advanced options may be considered, like:

• Braces: Custom fitted rigid braces or flexible orthotics can be worn to stabilize and support the spine, preventing unwanted movement that causes pain. These work by limiting mobility of irritated areas while healing occurs. Proper brace use also promotes better posture and movement mechanics.

• Injections: Delivering anti-inflammatory corticosteroid medication directly into painful sites along the spine serves to reduce localized swelling and irritation of joints, discs or nerves. These shots may provide temporary relief when other measures fall short.

• Surgery: If conservative therapy fails to adequately treat an underlying spinal condition contributing to prolonged severe pain, surgery may be necessary. Examples include rod implants to correct scoliosis curvatures or repairing slippages between vertebrae that impinge nerves. Recovering full function after spinal surgery takes extensive commitment to physical therapy. Surgery is generally the last resort for stubborn cases with clear anatomical abnormalities.

Cognitive Behavioral Therapy

Since mental health affects surgical outcomes, pain levels, and more, cognitive behavioral therapy can equip children with tools to manage psychological stressors and promote overall wellness.

Long-Term Outlook

With proper treatment, most children find relief from back pain within a few weeks and can resume normal activity. Lifestyle changes may prevent the return of symptoms. If pain persists or worsens, further evaluation is warranted.

While mild back pain often resolves fairly quickly, severe or lasting pain deserves medical attention. A customized, multidisciplinary approach addressing both physical and mental health provides children the best chance at recovering function and comfort. Identifying and treating pain early is crucial for quality of life. Assessing concerning or persistent pain is key, as is preventing reinjury through proper strengthening, posture and activity pacing. A collaborative effort optimizes health outcomes.