Low back pain in youth: Recognizing red flags

Abstract

Low back pain in youth: Recognizing red flags Although low back pain in children and teens is usually benign, recognizing red flags that indicate the need for imaging, referral, bracing, or surgery is critical. L ow back pain in not uncommon in children and adolescents. 1-3 Although the prevalence of low back pain in children < 7 years is low, it increases with age, with studies reporting lifetime prevalence at age 12 years between 16% and 18% and rates as high as 66% by 16 years of age. 4,5 Although children and adolescents usually have pain that is transient and benign without a defined cause, structural causes of low back pain should be considered in school-aged children with pain that persists for > 3 to 6 weeks. 4 The most common structural causes of adolescent low back pain are reviewed here. Etiology: A mixed bag Back pain in school-aged children is most commonly due to muscular strain, overuse, or poor posture. The pain is often transient in nature and responds to rest and postural education. 4,6 A herniated disc is an uncommon finding in younger school-aged children, but incidence increases slightly among older adolescents, particularly those who are active in collision sports and/or weight-lifting. 7,8 Pain caused by a herniated disc often radiates along the distribution of the sciatic nerve and worsens during lumbar flexion. ❚ Spondylolysis and spondylolisthesis are important causes of back pain in children. Spondylolysis is defined as a defect or abnormality of the pars interarticularis and surrounding lamina and pedicle. Spondylolisthesis, which is less common, is defined as the translation or "slippage" of one vertebral segment in relation to the next caudal segment. These conditions commonly occur as a result of repetitive stress. In a prospective study of adolescents < 19 years with low back pain for > 2 weeks, the prevalence of spondylolysis was 39.7%. 9 Adolescent athletes with symptomatic low back pain are more likely to have spondylolysis than nonathletes (32% vs 2%, respectively). 2,10 Pain is often made worse by extension of the spine. Spondylolysis and spondylolisthesis can be congenital or acquired, and both can be asymptomatic. Children

Relation between Physical Fitness Components and the Occurrence and Subjective Intensity of Back Pain in Secondary School Adolescents

“…Despite this and the simultaneous extremely low rate of cases of severe back pain, more than one-third of the adolescents involved in this research pointed out having suffered from mild- to-moderate back pain episodes (37.5%). Such results are in line with those from similar research: according to Phillips et al [ 6 ], frequency of back pain in adolescents ranges from around 20% in youth aged 11–13 years, to up to 60% at the age of 16 years. Matching these data, Kedra et al [ 7 ] found out that back pain occurred in approximately 40% of a population of over 10,000 Polish adolescents aged 11 to 19 years old.…”

“…In line with these authors, a recent study revealed that in 2017 back pain accounted for a total of 64.9 million YLDs globally, which constitutes an increase of about 20 million YLDs compared to reports for the year 1990 [ 5 ]. The prevalence of back pain is high also in youth, and, while not common in kids aged 7 years or less, it increases with age: in early adolescence (11–13 years old) it can affect up to 18% of the population, whereas this percentage rises to over 60% already at the age of 16 [ 6 ]. A study of over 10,000 Polish youth aged 10 to 19 years old confirms that the average prevalence of back pain is about 41.5% for the entire sample, with increased chances of suffering from it at later ages [ 7 ] and peaks of up to 90% in some cohorts of adolescents [ 8 ].…”