Anatomy
The back is made up of box-shaped vertebrae that are held in place partly by the shape of the bones, partly by ligaments and partly by the large and small back and abdominal muscles.
The back from the side:
A. Vertebra prominens
B. Vertebra coccygea I
C. Promontorium
D. L I
E. Th I
F. Axis
Cause
Low back pain is relatively common in children and adolescents and increases in frequency with age. In adolescents, approximately 80% do not have a specific diagnosis (non-specific back pain) (Potaczek T, Jasiewicz B. 2023), while in children under 10 years of age, a specific diagnosis is much more frequently obtained.
Back pain is particularly common in girls and in cases of excessive screen time, depression, psychosocial problems and known family history of back pain. Overuse-related back pain due to excessive sports activity is relatively rare, but can of course occur.
Symptoms
Pain and tenderness in the back, lower back and possibly radiating to the buttocks.
Examination
Mild back pain usually resolves spontaneously and has a good prognosis. Children under the age of 10 with low back pain should be examined by a doctor. Persistent (> 2-3 weeks), night pain, morning stiffness, fever, weight loss, radiating below knee level or severe back pain should also be examined by a doctor, partly to make a possible specific diagnosis (e.g. archolysis, scoliosis, Mb Scheuermann) and partly to rule out serious diagnoses such as arthritis of the back (inflammatory conditions), infections and neoplasms.
The examination should include pain provocation, examination of nerve outcomes including reflexes, sensory disturbances, mobility and nerve root irritation (stretched leg lift test). There is often asymmetric and altered mobility in the back and localised pressure soreness in the back muscles or on the vertebrae.
It may be necessary to supplement X-ray examination with other imaging (e.g. MRI scan) and blood tests depending on the diagnostic suspicion (León-Domínguez A, et al. 2023). If a specific diagnosis is found, referral to a specialist in rheumatology or orthopaedic surgery is often indicated.
Treatment
Treatment is dependent on the severity and diagnosis. Most people with a non-specific diagnosis will be able to play sports with non-monotonic back loading within the pain threshold. Strength training and stretching of the abdominal and back muscles is recommended (Frosch M, et al. 2022).
Complications
If the pain does not subside after relief and treatment, you should be (re)examined by a doctor.
In particular, the following should be considered:
- Slipped disc
- Secondary muscle infiltrations
- Scheumanns desease
- Fracture of the vertebral arch (arkolyse)
- Skoliose
However, there are many other causes of lower back pain (arthritis, infections, metabolic disorders, nerve disorders, tumours), some of which will require further specialist investigation.
