Back Pain

Descriptive text is not available for this imageBASICS

DESCRIPTION

  • Perception of thoracic, lumbar, or sacral spine pain
  • Specific back pain: due to underlying disease
  • Nonspecific back pain: without evident cause for pain

EPIDEMIOLOGY

  • Monthly prevalence: 20% of children, increasing into adolescence
  • 12–20% of those affected will seek care.
  • Lifetime prevalence: approximately 40%

ETIOLOGY

  • Largest cause in adolescence is nonspecific.
  • Unidentified in 50% of cases
  • 30% of chronic cases (back pain >3 years) without clear etiology despite workup

RISK FACTORS

  • Female gender
  • Poor conditioning or high athletic performance
  • Physical inactivity and sedentary behavior
  • Psychosocial distress (e.g., depression, anxiety, stress)
  • Family history of back pain
  • Regular smoking
  • Joint hypermobility
  • Overweight and obesity for low back pain
  • Vitamin D deficiency association is controversial.

GENERAL PREVENTION

  • Weight loss and increased physical activity in children living with overweight or obesity
  • Moderate physical activity/endurance sports can provide protection against nonspecific back pain.
  • Back muscle strengthening and hamstring stretching exercises may be helpful.
  • Maximum backpack load: 10–15% body weight
  • 3 months off from sport per year, one day off from scheduled activity per week

PATHOPHYSIOLOGY

  • Dependent on underlying cause
  • Until skeletal maturity, partially ossified posterior column and vertebral body are weak points.
  • Hyperextension with rotational spinal loading in the case of pars defects (e.g., spondylolysis or spondylolisthesis).
  • Autoimmune or autoinflammatory processes—for example, juvenile idiopathic arthritis (JIA) or juvenile ankylosing spondylitis
  • Repetitive movements may cause microtrauma.

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