Monday, April 9, 2012

There was a time when back pain was so unusual in children that it was felt that there was always some underlying disease.  Mechanical back pain is for adults, we learned, so look for the fracture or the infection or some other rare cause in those infrequent cases that come into the clinic.
In reality, I think back pain was always there but we were not listening.  Thinking that something is rare gives one license to make it invisible – you can’t be in pain, because kids simply don’t have pain like that.  It’s growing pains or a pulled muscle.
Back pain certainly exists now.  In my pediatric back clinics a full third or more of my patients present complaining of daily pain that interferes with their regular activities.  Many of these patients have not had injuries.  Most of them do not show signs of the typical causes of back pain that we are taught – infection, bony growths or stress fractures.   All of a sudden, kids are catching up to adults in back related problems.
Why are we seeing this rise in back pain in the younger population?  I think there are four major reasons why more children are having adult type pain:
1)      Childhood obesity – The American Academy of Pediatrics has tracked rising BMI in kids over the last decade and there are a concerning number who are morbidly obese.  As in adults, increased weight leads to increase stress on the back and more pain
2)      Strenuous athletic programs – Especially in the Raleigh area where I live, but all over America, kids are playing organized sports to the extreme.  Even when not training and practicing for specific sports, many children are involved in strenuous weight and conditioning programs, like P90X or similar, which may not be appropriate for their age and muscular development.  Also the use of weight and diet supplements has been shown to cause muscle symptoms as well.
3)      Backpacks – The weight that we are requiring children to carry on a daily basis is absurd.  It’s been recommended that a child should carry no more than 10% of body weight at any time.  I have had 70 pound girls in my clinic carrying 40 pound backpacks!  The packs themselves may be a problem as well.  The typical rucksack type may not distribute the weight properly and may lead to increased back stress.  Other types of pack may be better for the child, but are not judge “cool” or are forbidden by the schools for various reasons.
4)      Psychological stress – The level of pressure and number of stressors on children today are at an all-time high.  Kids today not only have to deal with the typical internal stresses of adolescence, but external stresses like the economy, war, the general state of the Earth that may be adding higher amounts of pressure leading to psychomotor strain.
I think the most important thing we can do for children now is recognize that back pain and these factors all exist.  If we can communicate with the kids to understand how they are feeling about life and the world around, teach them coping skills, review their sports and conditioning programs and take steps to reduce the book loads that they must carry on a given day, we should be able to give children and parents the tools to manage the back pain and keep it from becoming a chronic adult-type problem.
The most radical point is taking the time to communicate and understand the problems and challenges facing a young person today.  We should let them know that we respect their back complaints and that their problem is not invisible to us.

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