Common Causes
Back pain in young people may arise from a range of structural and non-structural causes. The growing skeleton is subject to stresses that adults do not experience — including physeal (growth plate) injuries and apophyseal stress reactions that are unique to childhood and adolescence.
Spondylolysis
A stress fracture of the pars interarticularis, most common at L5. The most frequent identifiable cause of low back pain in young athletes, particularly gymnasts, fast bowlers, and rowers.
Scheuermann’s Disease
Abnormal ossification of the vertebral endplates causing a structural kyphosis (rounded back) in adolescents, often presenting with mid-back pain and postural changes.
Disc Pathology
Disc herniation and disc degeneration occur less commonly than in adults but should be considered in adolescents with leg symptoms (radiculopathy).
Other causes include idiopathic scoliosis (spinal curvature), sacroiliac joint dysfunction, muscle strain, and — importantly — serious pathology including spinal infection or tumour, which must always be considered and excluded.
Red Flags — When to Seek Urgent Review
Certain features of back pain in children warrant urgent medical assessment to exclude serious underlying pathology.
- Age under five years with back pain
- Night pain that wakes the child from sleep, or pain at rest
- Systemic features: unexplained fever, weight loss, malaise, or night sweats
- Neurological symptoms — leg weakness, sensory changes, or bladder and bowel dysfunction
- Pain that is constant, progressive, or not related to activity
- A history of malignancy or immunosuppression
Assessment & Treatment
Assessment begins with a detailed history and thorough physical examination, including neurological evaluation. Imaging typically commences with plain X-rays. SPECT-CT is the most sensitive investigation for spondylolysis. MRI provides detail on disc, neural, and soft tissue structures and is the investigation of choice when neurological symptoms are present or serious pathology is suspected.
The majority of paediatric back pain responds well to conservative management.
- Activity modification and rest — particularly for spondylolysis, where cessation of aggravating activities allows stress reaction healing
- Physiotherapy — core strengthening, postural correction, and sport-specific rehabilitation
- Bracing — a thoracolumbar orthosis is used in selected cases of spondylolysis and Scheuermann’s kyphosis to offload the affected segment and manage deformity progression
- Surgery — reserved for cases with neurological compromise, significant deformity, or failure of extended conservative management; surgical intervention for back pain alone in children is uncommon
Discuss Your Child’s Back Pain
For a personalised assessment and treatment plan, contact Dr. Pirpiris’s rooms at Cabrini Medical Centre, Malvern.
📞 Call 03 9508 9600