Causes of Back Pain

Back pain in children is common and is frequently mechanical / non-specific with contributory factors such as poor posture, physical inactivity, obesity, psychological influences or abnormal loading (such as carrying heavy school bags on one shoulder).

Back pain in children is more likely to have pathology identified in comparison to adults where mechanical back pain is very common. It is important to consider and exclude red flag conditions which include infection (abscess) and malignancy. Prolapsed intervertebral disc in young people does occur but is more likely in adolescents.

Neck pain is also common and often due to mechanical causes (e.g., posture) but serious pathology does occur and must be suspected - further information about neck pain is available.

Certain sporting activities such as wrestling, cricket, bowling or gymnastics may pose increased risk of back pain, due to spondylolysis and spondylolisthesis which arise due to congenital abnormality of the vertebral arch (spondylolysis) and if bilateral, then instability results with forward slip of one vertebra over another (spondylolisthesis) causing potential root or cord compression. The clinical presentation can be acute, or acute on chronic pain, with pain on spine extension and also with localised tenderness.

Spondylolysis (is due to an abnormality in the neural arch) and if bilateral can result in forward slip of one vertebra over the other (spondylolisthesis).

Scheuermann’s 'disease' results from vertebral wedging due to an osteochondrosis of the thoracic spine and may or may not be symptomatic (i.e., may be an incidental finding on radiograph), although it can result in thoracic kyphosis, in which case warrants referral to orthopaedics.

Scoliosis can result from a variety of causes. However scoliosis - rarely causes back pain and if it does, then this is a 'red flag' and urgent referral (to orthopaedics) is warranted.

The radiograph below shows severe thoracolumbar scoliosis

Inflammatory back pain occurs in adolescents. It is unusual in isolation as a feature of Juvenile Idiopathic Arthritis (Enthesitis Related Arthritis or Psoriatic Arthritis) but can occur in association with inflammatory bowel disease. Symptoms are similar to adults with morning stiffness, tenderness over the sacroiliac joints and limited forward flexion.

Disciitis is a cause of back pain in young children and can be an indolent presentation.