6 Causes of Back Pain in Children and When You Should Be Worried

Muscular Back Pain

Muscular back pain is by far the most common reason for back pain in children and adolescents. Injuries include muscle strains and ligament strains, overuse injuries, and problems with posture.

Most often, X-rays, magnetic resonance imaging (MRI), and other imaging tests are not helpful for diagnosing muscular back pain. These tests may not be needed unless the child has other concerning symptoms.

There are downsides to excessive testing, including exposing a child to too radiation. Don't hesitate to ask your child's doctor about the value of any tests they order.

Muscular back pain will usually respond to rest.

Many treatments may provide short-term relief too, such as physical therapy, chiropractic treatment, stretching programs, yoga, or massage treatment.

That said, it's unclear if these treatments can relieve back pain long-term.

Stress Fractures

Stress fractures can occur in the spine. Most often these stress fractures occur in adolescents. They may not even realize they are injured, as obvious symptoms can sometimes take time to show up.

The most common type of spinal stress fracture is called a spondylolysis—a bone injury that occurs in the back of the spinal column. This injury commonly affects adolescents who do sports involving repeated hyperextension (bending backward), such as gymnasts and diving.

If the stress fracture occurs on both sides of the spinal column, the spinal column can become unstable. Known as spondylolisthesis or a "spinal slip," this condition can cause alignment problems within the vertebrae (back bones).

Stress fractures often make kids and parents nervous, because these injuries typically don't heal. They can cause symptoms into adolescence and young adulthood.

However, most children and adolescents diagnosed with spondylolysis do not need surgery and actually do better with nonsurgical treatments like physical therapy, chiropractic care, and wearing a brace.

Surgery is typically reserved for those who have pain that doesn't go away, even after many months of trying other options. Children who have severe slips that lead to loss of spinal alignment may need surgery as well.

Disc Problems

A disc herniation of the spine means that the soft cushion between two vertebrae is ruptured. This disc material is forced out of its normal space and can push against the nerves and spinal cord.

Disc herniations are much less common in children than adults, but they can occur and cause serious symptoms.

Symptoms of a disc herniation can include:

• Leg pain
• Numbness and tingling in the legs
• Weakness of the lower extremities
• Difficulty bending or straightening the spine

MRI tests can be helpful to diagnose a disc herniation, as X-rays will typically be normal.

In children, disc material is normally pliable and elastic, meaning it has a great ability to handle unusual forces on the spine. With age, the disc loses its elasticity and pliability and can become prone to rupture.

In children, discs can still rupture due to excessive forces (traumatic injuries) or abnormal disc structure, leading to symptoms of a herniation.

Disc herniations can usually be managed without surgery, but children and adolescents with severe pain or signs of significant nerve injury may benefit from surgery to relieve pressure on the nerve.

Infection

Often occurring in young toddlers or in adolescents, spinal infections may cause vague symptoms of malaise (general feeling of not being well), low-grade fevers, and back pain.

Infections of the spinal bone or discs can be challenging diagnoses to make.

This diagnosis is often made because of abnormal laboratory studies showing signs of infection (elevated white blood cell count) or inflammation (elevated ESR or CRP). When suspected, imaging tests are usually done to confirm the location of the infection.

Treatment can usually be accomplished with antibiotics, most often given intravenously (with an IV), at least until the infection has started to improve.

Surgery is generally only considered if the infection has damaged the spinal structure or if the infection cannot be controlled with antibiotics.

Alignment Abnormalities

Problems with spinal alignment can cause a noticeable deformity along with back pain. It should be noted, however, that while more subtle deformities may be noticeable, they seldom cause pain.

The two most common spinal deformities in children are:

• Scoliosis, a deformity that causes an S-shaped curve to the spine that can be viewed from the back
• Scheuermann's kyphosis, a condition that causes a sharp bend in the spine that can be seen from the side

These two conditions are very different, but the treatments are similar. If the deformity becomes severe, the child may need to wear a brace.

To determine how severe it is, a doctor will measure the spine's curve using X-ray or MRI images.

Surgery is only considered for the most severe deformities. Still, deformity of the spine may persist even after surgery is done, as a full spinal correction may cause more problems than just a partial one.

Tumor

Several different benign (noncancerous) and malignant (cancerous) bone tumors can occur in the spinal column. Sometimes these cause significant pain, other times they can be found without causing symptoms.

While spinal tumors are a highly uncommon cause of back pain in children and adolescents, they should be considered as an unusual but possible diagnosis.

Some of the warning signs listed above can be associated with tumors, specifically pain at night, generalized illness, or weight loss. Back pain that happens with these symptoms may raise concern for possible tumors, and imaging tests can help determine if that is the case.

Treatment for spinal tumors depends on the type of tumor. Even benign tumors may require surgery as untreated tumors can lead to spine deformities.

Cancerous tumors in the spine often require a combination of treatments, including medications, radiation, and surgery.