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October 2017

Paediatric Lower Back Pain

By Body Balance Quarterly

The Body Balance Quarterly

A newsletter designed for the patients of Body Balance Health & Physiotherapy Inc. that addresses current rehabilitative methods and addresses the current questions people may have regarding Physiotherapy related “HOT TOPICS”.


Paediatric Lower Back Pain

It’s that time of year! The kids are back in school and the scheduling of homework, sports and other activities are in full mode. Lower back pain is one of the most common ailments/disabilities that people suffer from and its not just an injury faced by adults. The incidence of lower back pain in the paediatric population and the effects of lower back issues early in life can have resounding impacts later in life.

In this issue of the BBQ we will look at some recent studies to investigate the incidence, causes and recommendations to help parents deal with lower back pain in children and adolescents.

 Potential Risk Factors

Currently, one of the most common talked about risk factors for Paediatric lower back pain is a sedentary lifestyle. Part of the reason for this trend may be due to the increasingly sedentary lifestyle choices young people make. Below are four explanations of how your children’s decisions can contribute to their lower back pain.

  1. Weaker Supporting Muscles

A general lack of regular exercise gradually weakens muscles that support the spine, including the abdominal and iliopsoas muscles and the obliques, or side muscles. Weaker supporting muscles can place added strain on the joints and bones of the spine and affect posture.

  1. Increased Susceptibility to Injury

Children are more likely to sustain an injury when muscles aren’t conditioned to absorb the impact. A study of more than 300 children with lower back pain found those who had some type of physical therapy reported a greater reduction in pain than those who did not receive therapy.

  1. Excess Weight

A sedentary lifestyle often means an increase in weight beyond what’s ideal for a child’s height. Excess weight also means added pressure on the spine, which can throw off posture and affect bone growth. As a result, some children may develop hyper-lordosis, a condition where a slight spinal arch forms.

  1. Unhealthy Eating Habits

Being consistently inactive tends to translate into making unhealthy eating choices. Children need to maintain an optimal balance of essential nutrients to promote muscle strength and spine health.

Most instances of back-related aches in younger patients are related to muscle strain. However, it is always important to seek the advice of a Medical practioner when concerns arise regarding pain in the lower back. Knowing what to do and how to exercise is very important for children as preventative measures can be as simple as encouraging kids to participate in some type of physical activity for at least an hour a day.


Those Heavy Backpacks!!

“Students carrying heavier backpacks relative to their body weight were more likely to report back pain,” write the researchers in the March/April 2004 issue of the Journal of Pediatric Orthopedics.

How much is too much? Pain was associated with wearing a backpack weighing more than 20% of the student’s body weight, write the researchers.

How Kids’ Backs Respond to Backpacks

A backpack is a great way for children to carry schoolbooks and other items in a practical way by distributing the heavy load across the strong back and shoulder muscles. However, when the back pack is overloaded the risk is injury to the neck, shoulders and lower back.

By overloading a backpack, the following compensations in the back can occur:

  • Distort the natural curves in the middle and lower back, causing muscle strain and irritation to the spine joints and the rib cage
  • Lead to rounding of the shoulders
  • Cause a person to lean forward, reducing balance and making it easier to fall
  • Habitually carrying backpacks over one shoulder will make muscles strain to compensate for the uneven weight distribution. The spine leans to the opposite side, stressing the middle back, ribs, and lower back more on one side than the other. This type of muscle imbalance can cause muscle strain, muscle spasm, and back pain in the short term and speed the development of back problems later in life if not corrected.
  • A heavy backpack can pull on the neck muscles, contributing to headache, shoulder pain, lower back pain and/or neck and arm pain.

“Although there are very few studies and the medical literature does not agree on specific guidelines for backpack safety to avoid back pain, parents can use common sense to reduce the chance that their child or teen will suffer back pain due to carrying a backpack.”

The following back pack features may help in the prevention of back stress and strain.

  • Lightweight material (canvas as opposed to leather)
  • Two padded, wide (2-inches), adjustable shoulder straps on the backpack
  • Padded back
  • Individualized compartments
  • Hip strap, waist belt, or frame to redistribute the weight of the backpack from the shoulders and back to the pelvis
  • Wheels so that the backpack can be pulled rather than carried
  • Consider using a separate bag for the child’s laptop or other heavier electronic items

Habits are important as well so it becomes just as important to teach your child how to properly load and wear the backpack to avoid back pain:

  • Always use both shoulder straps and wear the backpack on the back rather than over one shoulder
  • Pack heaviest objects into the backpack first so they are carried lower and closest to the body
  • Fill compartments so that the load is evenly distributed throughout the backpack and items do not shift during movement
  • Pack sharp or bulky objects in the backpack so they do not contact the back
  • Adjust the straps to fit the backpack snugly to the child’s body, holding the bottom of the backpack 2 inches above the waist and keeping the top just below the base of the skull; do not carry the backpack low near the buttocks
  • Lift the backpack by using the leg muscles and keeping it close to the body, not by bending over with arms extended and arching through the back.
  • Do not lean forward when walking; if this is necessary, there is too much weight in the backpack


Less Common Causes of Back Pain in Children

Recent reviews of common causes of lower back pain in children found that the common causes of pain most often included postural related muscle strain and acute occurrences of sport/activity related muscle strain and less commonly included mechanical pain from pre-existing conditions. However, pre-existing conditions may not be as common but they typically involve more specific care and follow-up. One condition that we would like to review in this edition of the BBQ is Idiopathic Scoliosis in children and adolescents. The following information was obtained from an article that was an overview of articles from the Pediatric Orthopaedic Association of North America and the Scoliosis Research Society.

What is Scoliosis

Scoliosis is a condition that causes the spine to curve sideways. There are several different types of scoliosis that affect children and adolescents. By far, the most common type is “idiopathic,” which means the exact cause is not known.

Most cases of idiopathic scoliosis occur between age 10 and the time a child is fully grown. Scoliosis is rarely painful—small curves often go unnoticed by children and their parents, and are first detected during a school screening or at a regular check-up with the pediatrician.

In many cases, scoliosis curves are small and do not require treatment. Children with larger curves may need to wear a brace or have surgery to restore normal posture.


Scoliosis causes the bones of the spine to twist or rotate so that instead of a straight line down the middle of the back, the spine looks more like the letter “C” or “S.” Scoliosis curves most commonly occur in the upper and middle back (thoracic spine). They can also develop in the lower back, and occasionally, will occur in both the upper and lower parts of the spine.

Idiopathic scoliosis curves vary in size, and mild curves are more common than larger curves. If a child is still growing, a scoliosis curve can worsen rapidly during a growth spurt. Although it can develop in toddlers and young children, idiopathic scoliosis most often begins during puberty. Both boys and girls can be affected, however, girls are more likely to develop larger curves that require medical care.

Other less common types of scoliosis include:

  • Congenital scoliosis. Problems in the spine sometimes develop before a baby is born. Babies with congenital scoliosis may have spinal bones that are not fully formed or are fused together.
  • Neuromuscular scoliosis. Medical conditions that affect the nerves and muscles, such as muscular dystrophy or cerebral palsy, can lead to scoliosis. These types of neuromuscular conditions can cause imbalance and weakness in the muscles that support the spine.


Although doctors do not know the exact cause of idiopathic scoliosis, they do know that it is not related to specific behaviors or activities — like carrying a heavy backpack or having poor posture. Research shows that in some cases genetics plays a role in the development of scoliosis. Approximately 30% of patients with adolescent idiopathic scoliosis have a family history of the condition.


Small curves often go unnoticed until a child hits a growth spurt during puberty and there are more obvious signs, such as:

  • Tilted, uneven shoulders, with one shoulder blade protruding more than the other
  • Prominence of the ribs on one side
  • Uneven waistline
  • One hip higher than the other

If your Health Care Provider suspects scoliosis, he or she may refer you to a pediatric orthopaedic surgeon for a full evaluation and treatment plan.