Back & Neck Pain

While back pain will likely afflict all of us at some time during our lives, it is not as universal in the younger population. Fortunately, most low back and neck pain that kids complain about is muscular and likely to resolve in one to two weeks. For ANY back or neck pain that persists for greater than two weeks, a trip to the pediatrician is warranted. Muscular back pain is usually local and occurs in the mid to low back region. It is NOT associated with pain radiating into the legs, weakness, evening pain, or constitutional symptoms such as fever, chills or a rash. It is best treated via warm or cold packs applied directly to the region. The packs should not be placed directly onto the skin, rather onto a towel overlying the skin. Application of warm packs or ice for five minutes on and five minutes may be beneficial. A total of 30-45 minutes for either is adequate. In addition, if approved by the pediatrician, an anti-inflammatory medication taken for a few days may help. If symptoms last for more than 2-3 weeks, a visit to the pediatrician, orthopaedist, or physiatrist is recommended. If the child complains of back pain that does radiate into the legs or arms, is accompanied by weakness or is exacerbated by certain postures, such as sitting, this may represent a disc ailment (bulge, herniation). If these symptoms occur, a visit to the pediatrician, orthopaedist or physiatrist is recommended. Fortunately, greater than 80% of back pain will resolve in time with conservative measures such as physical therapy and medications. For disc pain, a course of physical therapy will likely be suggested and imaging (X-ray and/or MRI) may be recommended. 

For some, back pain that is associated with radiating pain, but mainly produced with certain postures such as leaning backward, may signify one or two specific entities. They are commonly seen in thin people who participate in a sport such as gymnastics. These conditions are spodylolysis and spondylolisthesis. The mechanism of these injuries is usually related to excessive extension maneuvers (leaning backward at the waist) that stress the bones (vertebrae) that support our stature. The underlying pathology is a fracture (spondylolysis), but one that is usually relatively stable. If this results in excessive motion between the bones of the spine, the condition is called spondylolisthesis. These individuals may complain of pain that is initially located directly over the spine which then manifests as electricity-like sensations that travel down the legs (when the individual leans backward). Evaluation by an orthopaedist or physiatrist should be done if suspicion arises for spodylolysis or spondylolisthesis. Treatment paradigms vary but usually involve rigid bracing of the spine to protect it. Bracing can last up to six months. Physical therapy may be recommended during this time to maintain general fitness and flexibility.