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Back pain and adolescents

 
I recently evaluated a 16-year-old with a five-week history of low back pain. This young man is the No. 1 tennis player at his high school and has not been able to play tennis since he woke up one morning with back pain. He has been to see his doctor and has received prescriptions for anti-inflammatories and pain medications. He had not had any imaging performed prior to his physical therapy evaluation in our office.Consistent and lasting back pain in children and adolescents is not common and compared to adults children rarely suffer from back pain like adults do. Therefore severe acute or chronic back pain in children should be taken seriously and consist of a detailed evaluation.



The most common causes of back pain in children and adolescents are typically age and activity dependent.
Young children do not put the same physical stresses on their spines as do adolescents and adults, and for the most part they do not have issues with medically significant back pain. Their symptoms are usually short lived and they tend to self-limit their activities as a result of the back pain. It is important not to ignore a child if they complain of back pain — try ice and rest. Monitor the child for basic symptoms like a fever. If they don’t improve within a few days seek the advice of your pediatrician or family physician. Don’t forget that heavy backpacks can contribute to stress and strain on the spine.
Adolescents and older teens tend to push the limits of activity and are more susceptible to injuries to the bones, nerves and soft tissue of the spine. Some teenagers may even push themselves beyond their limits due to peer pressure or commercial advertising. Common injuries seen in the athletic population of adolescents typically are fractures or painful joint stress injuries versus disc or nerve compression type of injuries. In these circumstances a basic spine X-ray is usually ordered to rule out fracture. If the pain persists a magnetic resonance imaging (MRI) may be warranted.
In the case of my young tennis player he presented with symptoms consistent of a stress fracture in his back that commonly occurs in adolescents who are involved with sports that require spinal extension (back bending) and rotation (twisting). We were able to reproduce his symptoms by having him move through specific ranges of spinal motion. His clinical evaluation supported recommendations to his physician for X-rays and possibly a MRI. Interestingly enough his X-rays were basically negative. A MRI was ordered and the findings were positive for early stress and internal bone swelling that if not treated could lead to fractures. Our tennis player will heal and be able to return to playing tennis in the next several months.
As in this example, children and adolescents with persistent back pain require our attention. If your child does not improve with rest, consider a physical therapy evaluation and assessment. Physical therapists are highly skilled at evaluating and assessing the spine and can assist with making recommendations for further follow-up or diagnostic testing.

 Source By: http://hanfordsentinel.com/features/back-pain-and-adolescents/article_a9405943-ffd8-5170-b138-5fb6812910d3.html

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