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Phone 59 77 04 66 | FAX 59 75 6752.  938 Nepean Hwy, Mornington
M 8am-6:30pm | T 9am-7pm | W 9am-8pm | T 9am-6pm | F 8am-6.30pm

Paediatric back pain

Causes of back pain in children:

Did you know that the most common cause of persistent back pain in children and adolescence is due to lumbar bone stress injuries? While children may experience back pain due to poor posture at school or while studying, back pain in children due to sport is not something that should be occurring.

What are bone stress injuries?

Bone stress injuries is the term used to describe a reaction in the bone that may lead to a fracture. Not all bone stress injuries are fractures, and are graded according to how progressed they are, which include:

  • 0: no abnormality
  • I: changes to the bone, but it is still intact. Some marrow oedema (fluid buildup in the bone marrow)
  • II: bone marrow oedema, fragmentation or irregularity of the bone (no fracture yet)
  • III: bone marrow oedema and either a one sided or two-sided fracture
  • IV: complete fracture on both sides with slipping of the vertebral body on the bone below it. No bone marrow oedema is present anymore.

How do they occur?

Bone stress injuries occur when we exceed the capacity of the body, and the bone can’t cope with this. This can occur when we are putting too much load on the bone, such as when we are over training, or if there is decreased capacity of the bone- such as inadequate condition or other underlying conditions.

 What are the risk factors and what should I look out for?

One of the largest risk factors for bone stress injuries is participation in extension-based sports. This means any sport where there are repetitive movements involving leaning backwards. Examples include gymnastics, tennis, swimming, cricket, rowing.

Another large risk factor is a sudden increase in training load, which is particularly common during the cross-over of sporting seasons (such as when cricket is finishing up and footy training has started). This increased load on the body can leave the bone more susceptible to stress injuries, so it is particularly important to keep an eye on young athletes around this time and in the weeks following.

The most common way that lumbar bone stress injuries can manifest is as one-sided low back pain, that gets flared up by playing sports.

What does management include?

In clinic we will take a thorough history to understand the level of activity of your child, how long their pain has been occurring for, what is making it worse, where it is located, and how it feels. From here we will perform a hands-on assessment and may refer for imaging to ensure that we have the correct diagnosis and can commence management as appropriate.

If a lumbar bone stress injury is present, management will involve a period of rest from physical activity to ensure there isn’t further progression. In some severe cases referral to an orthopaedic specialist for advice on bracing may be indicated. We may also refer you to a dietitian who can assist in ensuring that your nutritional needs are met, as low energy intake can lead to relative energy deficiency which decreases the body’s capacity to function as it should and heal.

While returning to sport may take several months, rehabilitation can start with gentle exercises to build up supporting musculature, and hands on treatment to address muscular compensation that may have occurred due to the injury. Your osteopath will assess how you are moving and guide you through structured exercises in a graduated program until you are ready to return to sport.