While pediatric training often focuses on etiology, recent studies have found that most cases of lower back pain in school-aged children have no definitive diagnosis and are benign and self-limiting.
Primary care pediatricians are often taught that lower back pain in school-aged children has a definitive cause. As a recent review published in JAMA Pediatrics highlights, studies conducted over the last decade have challenged that idea.
A full evaluation of a patient with low back pain is still necessary to exclude serious pathologies, says James P. MacDonald, MD, MPH, a physician in the Sports Medicine Program at Nationwide Children’s and lead author of the publication. Once those pathologies are ruled out, though, the specific causes still may not be apparent.
For the majority of children presenting with low back pain, a primary care doctor can provide appropriate evaluation and management.
“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,” says Dr. MacDonald, who is also an associate professor of Pediatrics and Family Medicine at The Ohio State University College of Medicine.
“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 no specific cause responds to rest, rehabilitation and identification of predisposing risk factors.”
The publication includes a list of conditions and symptoms that can be used in the differential diagnosis. Generally, when an etiology can be identified, it is associated with an injury to the posterior spine, such as spondylolysis or spondylolisthesis. The review also includes an evaluation guide. In brief:
Because children and adolescent musculoskeletal systems are still developing, they are at an increased risk for trauma and explosive muscle contractions, especially during periods of rapid growth. Previous studies suggest the importance of pre-season sports conditioning programs and neuromuscular training that will allow the athlete to gradually increase his or her training intensity and help reduce injuries, according to Dr. MacDonald.
Additionally, rest should be incorporated into the training regimen, especially for athletes who perform repetitive motions, such as tumbling in gymnastics. Young athletes should not participate in more hours of sports in a week than their number of age in years.
MacDonald J, Stuart E, Rodenberg R. Musculoskeletal low back pain in school-aged children: A review. JAMA Pediatrics. 2017 Jan 30. [Epub ahead of print]
Photo credit: Nationwide Children’s