Back Pain



Any condition causing pain of the thoracic, lumbar, or sacral spine


  • 12-month period prevalence: 10–20% of children
  • Lifetime prevalence: 12–50%


  • 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 as with juvenile idiopathic arthritis (JIA) or juvenile ankylosing spondylitis


  • Unidentified in 50% of cases
  • 30% of chronic cases (back pain >3 years) without clear etiology despite workup

Risk Factors

  • Poor conditioning or high athletic performance
  • Joint hypermobility
  • Role of backpack weight and style of wear undetermined
  • Role of overweight or obesity yet to be determined

General Prevention

  • Back muscle strengthening and hamstring stretching exercises may be helpful.
  • Maximum backpack load: 10–15% body weight
  • Weight loss and increased physical activity in overweight or obese children
  • 3 months off from sport per year, 1 day off from scheduled activity per week

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