Low-back pain in adolescents with an osteopathic component

Abstract

Low-back pain (LBP) is a common symptom presenting in adolescents. Most back pain in adolescents is benign and musculoskeletal in nature, due to trauma or congenital anomalies. Other less common causes include infection, inflammatory conditions or neoplasm. A comprehensive history and physical focusing on posture, muscle tenderness, range of motion, muscle strength and neurological function is essential in understanding the cause of low-back pain. Identification of risk factors for low-back pain will help the clinician in managing their patient. Treatment includes rest, avoiding activities that cause pain, physical therapy, osteopathic manipulative treatment, limited use of non-steroidal anti-inflammatory drugs and family and patient education. Assessing for warning signs or red flags of serious causes of LBP is a fundamental part of the clinical assessment. Pain that awakens from sleep, pain lasting longer than 4 weeks, sudden onset pain, systemic findings such as fever or weight loss and abnormal neurological findings should warrant immediate evaluation as these may suggest serious infectious conditions, malignancy or fracture. This article presents a comprehensive review of the epidemiology, relevant anatomy, biomechanics, causes and major risk factors for adolescent low-back pain. A diagnostic algorithm utilizing a step-by-step approach is also introduced to aid the clinician in management of the patient. Finally, the article presents guidelines for management of the adolescent with low-back pain including conservative, pharmacologic, as well as the osteopathic approach to treatment. Evidence-based recommendations on osteopathic approach to treatment has been reviewed from meta-analysis data and randomized controlled trials.

Non-steroidal Anti-inflammatory Drugs and Osteopathic Manipulative Treatment for Pain Management in Patients With Osteoarthritis: A Literature Review

“…In the past, pharmacotherapy of OA has been supplemented with a multitude of non-pharmacological treatment modalities, including patient education, PT, OMT, and weight loss [9]. Combinations of nonpharmacologic management, such as spinal manipulation, OMT, and PT, have been shown to decrease pain and improve function in patients suffering from chronic knee pain [3,8].…”

“…Active and passive treatments refer to the patient assisting in the treatment or relaxing while the provider moves their body, respectively [10]. OMT techniques that have been used for AO of the knee include muscle energy technique (MET), counterstrain (CS), facilitated positional release (FPR), high-velocity low amplitude (HVLA) techniques, and myofascial release (MFR) [3].…”

“…MET can be used for a wide variety of dysfunctions caused by OA, as seen in the OMT management of post-knee replacement surgery [11]. MET can be used in nearly any joint affected by OA, especially dysfunctions of the tibiofemoral joint, knee extension, knee flexion, and internal or external rotation [3].…”

“…These changes often lead to inflammation, chronic pain, and impaired function in daily life [2]. The chronic pain seen in OA can originate from several different locations, including, but not limited to, periarticular muscles and ligaments, synovial membranes, joint capsules, periosteum, and subchondral bone [3]. Nerve endings in the joint capsule and adjacent tissues play a major role in the pain mechanisms of OA [4].…”

“…), targeting fascia, musculature, joints, nerves, and surrounding tissue that can ultimately provide pain relief and improved functionality [5]. A complete osteopathic structural exam should be performed and may include monitoring the patient's gait, assessing bony and muscular landmarks, and assessing for tissue texture changes [3]. The physical manipulation used in OMT allows physicians to address anatomical and physiological pathology.…”