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It used to be that children who were sick or injured were treated like miniature adults. Doctors felt that if a treatment worked on adults, it only needed to be reduced in dose or number and it would work on children as well. There was also a school of thought that children just didn’t suffer from many problems, such as headaches or back pain.

Thankfully, we’ve come a long way from both those ideas. Doctors now understand that children are not miniature adults and they need care specially designed for their age and size. They also now know that yes, children do suffer from adult-like problems, such as back pain. In fact, although it used to be thought that back pain in children was rare and when it did occur, it had to be the result of something quite serious, doctors have learned that back pain is not uncommon at all. It’s estimated that about one-fifth of adolescents (teens) have some type of recurring and severe lower back pain.

Add to this, the findings that many adults who have chronic back pain began experiencing this type of pain during their teen years. Knowing this, it’s important for doctors and researchers to understand why teens develop back pain in order to reduce the number of adults living with chronic lower back pain.

According to an article that appeared in Orthopedics Today in October, 2008, back pain in children differs from adult back pain because of its quality. While adults may experienced generalizes and arthritic back pain, children and teens’ back pain is more specific.

Children with certain disabilities have a higher risk of sustaining a neck injury than those who don’t have the disabilities. These include children who have Down’s syndrome (a disability resulting from having an extra chromosome); Ehler-Danlos syndrome (a disability that affects the connective tissue in the body); Klippel Feil syndrome (a condition where children have two or more bones in the back that are abnormally fused together), as well as skeletal dysplasias (dwarfism), and odontoid anomalies (abnormalities involving the small, toothlike, upward protrusion from the second vertebra of the neck).

What has been studied?

Over the years, many studies have been done on adults to see what has caused their back pain, how they recuperate, and any obstacles to recovery, such as social problems or maladaptive behaviors in response to the back pain. Unfortunately, not as much work has been put into understanding childhood back pain and its accompanying issues.

Researchers do know that various studies that identify risk factors, such as certain types of sports, can result in changes in equipment, routines, or rules, in order to minimize these risks. Behaviors that may contribute to back pain may be addressed to also lessen the risk.

How do children hurt their back?

Often, childhood back injuries are caused by sports, either organized or recreational. It’s estimated that between 1 percent and 30 percent of athletes, overall, develop lower back pain and up to 50 percent of teen athletes do.

Sprains and strains are the most common back injuries among teen athletes, but these can happen in any teen who is participating in a physical activity, from a pickup game in a local park to the occasional skier. Some teens have part-time or summer jobs that require lifting or moving awkward equipment, or standing for long periods of time. These can all contribute to lower back pain.

For teens who are more serious about their sports, one who is in intense training for gymnastic competition, for example, puts tremendous strain on his or her developing back. The stretching of the back in backward bends, as in tumbling, goes against a humans natural ability and flexibility. The gymnastic exercises and positions the body is constantly being forced to perform can end up resulting in a condition called spondylolisthesis. Spondylolisthesis begins as a stress fracture (bone injury due to overuse) in one of the vertebrae (a bone in the spine). This usually occurs in the lower back, but can happen anywhere along the spine. If the stress fracture isn’t allowed to heal, it can weaken the vertebrae to the point that it can’t stay where it should. The vertebrae then begins to collapse or move and can press on the nerves in the spine.

Overall, it’s estimated that about three-quarters of elite gymnasts, those who are competing at a very high level, have some sort of spinal degeneration that can be seen on magnetic resonance imaging (MRI). This means that even if the gymnasts don’t yet feel the pain, the damage has begun.

Other teen athletes who are prone to developing spondylolisthesis are football linemen, ice skaters, and ballet dancers. In what part of the back the injuries occur also depends on the sport involved. Weight lifters put a tremendous amount of stress on their upper part of their lumbar spine, the area in the so-called small of the back. Players of sports that require twisting of the body, such as golfers or soccer players, usually have pain in the lower part of the lumbar spine.

Teens who participate in sports like skateboarding or mountain biking can develop back pain caused by a less obvious way. The force of landing on their feet while skateboarding and on their seats in biking, can cause significant damage to the spine. The force of the landing is transmitted up to the spine, which then absorbs it.

Children and teens can also have cervical (neck, pain). According to a report from October 2008, approximately 13 percent of children under 16 years old have cervical spinal injuries and about 25 percent of the injuries are causes by sports. Most injuries are in children over eight years old. Certain sports have higher rates of cervical injuries. These include football, gymnastics, horseback riding, and wrestling.

Another cause of back injuries, one that has been getting a lot of news over the past few years, is the carrying of heavy backpacks. Gone are the days of school bags that are carried back and forth with some papers and a few books. Now, children and teens are carrying backpacks that can weigh quite a bit – too much sometimes – causing injury to their back.

How common is back pain in children overall?

A study done in the early 1990s looked at how common lower back pain was in teens. Todd L. Olsen and colleagues looked at 1,242 teens aged from 11 to 17 years. The teens completed a questionnaire to determine if there was any lower back pain, how severe it was, how old they were when it started, how often it came back, if it limited their activity, and any medical treatment that they may have had for the back pain.

The researchers were surprised at the high number of teens who said they had lower back pain (30.4 percent), with 22 percent who said they had lower back pain within the previous year. Seven percent said that they had to see a doctor at least once because of the pain, with girls seeking medical help more than boys (8 percent compared with 6.7 percent). Almost 9 percent of the teens said that the lower back pain was bad enough for them to miss school or to miss playing in their favorite sports or activities.

How well do teens recover from back pain?

Studies have shown that recovery from back pain among adults can be based on many outside factors, such as physical activity, smoking, and weight, for example. Even socioeconomic status can play a role on back pain recovery. What researchers don’t know is if these factors also influence recovery in teens. Many children experiment with different lifestyle choices during the teen years, including smoking, reducing their physical exercise, drinking alcohol, and so on. However, they don’t generally have the history of these behaviors over a period of years.

Other teens may be developing childhood or adolescent illnesses, such as asthma and allergies. An increasing number of teens are developing type 2 diabetes, as well. Many teens are also gaining more weight and choosing not to eat healthy diets. All these issues may play a role in their lack of activity and developing and recovering from back pain.

Another issue to consider is how compliant a child or teen may be with treatment for chronic back pain. While a parent may still have control over a younger teen, older teens are often more independent and are making their own lifestyle choices, some of which run counter to eliminating their back pain. Many teens may not be willing to put up with restrictions placed on them that would allow their back to heal. They may not take prescribed medications or they may mix medications with others or substances that may cause reactions. The teens may ignore advice to avoid certain activities or they may avoid attending appointments, like physical therapy, because they don’t see the importance. All these behaviors can strongly affect if back pain heals or if it comes back.

The other important issues that are predictors of poor health later in life and that have already been established include the socioeconomic status of the teen and school success. These predictors are used for many health issues, not just back pain.

A few studies have shown a fairly high rate of teens returning to their chosen sport or activity following a back injury. In one study by Daniel J. Sucato, MD, results showed that about 80 percent of teen athletes who had spondylolysis and who didn’t have surgery were able to return to their sport. However, if the teen participated in a high-risk sport, had a sudden onset of back pain, or also experienced hamstring (the large muscle located at the back of the thigh) tightening, their chances of returning to their sport were lower. Another study that followed two groups of athletes, one that had surgery and one that didn’t, found an equal return to activity rate.

Are the back injuries severe enough to require being in hospital?

Hospitalizing children for chronic lower back pain is not a common thing. According to the results of study by Ville M. Mattila and colleagues of over 72,378 teens between the ages of 14 and 18 years, only 810 teens (just slightly over 1 percent) were hospitalized for chronic lower back pain. Among this group of 810 teens, 643 were hospitalized just one time. More males than females were admitted to hospital (620 compared with 190) and the average stay for both males and females was about two days, but it ranged from one to 369 days.

The researchers found that almost half (49 percent) of hospital admissions were for injuries in the lumbar spine and problems such as radiculopathy (pain coming from the nerves) or problems with the vertebral discs. The remaining cases (51 percent) were of unknown cause, however.

In this particular study, the researchers were interested in seeing if there was a way to predict if a teen would need to be hospitalized or not because of the lower back pain. What they found was that teens who drank alcohol and had repeat incidents of getting drunk, those who did poorly in school, those with three or more health complaints during one week, and those who smoked, all had the strongest risk factors for being admitted to a hospital. There was also a higher risk if the teens lived in non-traditional families.

In terms of how the injuries may have occurred and the risk of being hospitalized, females who participated in organized sports two or three times per week had a higher risk of hospitalization from lower back pain. Males who experienced later puberty had a lower risk of having to be admitted to a hospital. Another interesting finding was that while physical activity in males didn’t increase the risk of hospitalization, it did for females.

There were some surprising findings, including the issue of later puberty in males. The researchers came up with some theories as to why this may be, such as late-maturing males had more slowly developing bones and muscle and, therefore, be less likely to take up extreme sports or participate in high-impact sports, such as football. The other surprise was the difference between males and females and their physical activity. The researchers suggested that females who were more physically active with high intensity work outs may be more affected because these work outs may result in muscle tightness and reduced flexibility in the spine.

When can teen athletes resume normal activity?

For many teens, their chosen sport is more than just an activity to keep busy, it’s a passion, which is why many do play while still injured. However, with back injuries, that can end up causing more harm. For these teens, telling them that they can’t return to their sport could be devastating and they may not listen and choose to continue anyway.

Whether to give the official go-ahead to participate in sports is controversial among doctors and other health care professionals. Some physicians, like Dr. Sucato, prefer that their patients wait 12 months before allowing them to go back to contact or collision sports. He also believes that if the injury was severe enough that was treated with surgery, the patient shouldn’t return to the sport at all.

Dr. Sucato isn’t alone. A survey was done of the members of the Scoliosis Research Society and nearly half of those who responded said that they wouldn’t allow patients who had had surgery for spondylolisthesis to return to a contact sport, however if they were treated without surgery, they would be allowed to participate in a non-contact sport.

So, what does this all mean?

We know that many of our behaviors and physical health as a teen affect us as we become adults. Therefore, if researchers can find ways to prevent or effectively treat health issues that may occur in our teen years, we may be headed for a healthier and pain-free adulthood.

The teens in Mattila’s study were followed for over 11 years and the researchers analyzed two time periods: zero to 11 years and over 11 years. What they found was that the increased risks for hospitalizations didn’t go away after a certain number of years and that the risks were carried over beyond the 11 years, as the teens became adults.