Back pain occurs in about a third of patients at some point in their adolescence and is fairly common in children over the age of 10. Very rarely, however, is it the result of a structural issue such as a disc condition or nerve irritation, according to Joshua W. Meier, M.D, pediatric orthopedic surgeon with Norton Children’s Orthopedics of Louisville, affiliated with the UofL School of Medicine.

Common causes of pediatric back pain include acute injury experienced while playing a contact sport, but often the source is muscular pain of an uncertain etiology. Back pain in younger children warrants evaluation for a possible structural issue.

“A lot of times adolescents will have a number of months of some mild to moderate pain and, like many teenagers, they are not very forthcoming,” Dr. Meier said. “They might not mention it for a while until it gets to a point that it’s bad enough that they’ll speak up.”

If X-rays are normal and an exam doesn’t reveal any structural issues or weakness, at-home treatments such as ice, heat, massage, yoga and sports creams will bring relief. If they’ve already tried these remedies on their own, physical therapy may be the next step.

Some of the more common nonmuscular causes of pediatric back pain include tethered spinal cord and spondylolisthesis, Dr. Meier said in a recent continuing medical education opportunity, “Common Back, Hip and Foot Issues.”

A child with lower back pain, toe-walking and constipation will point us in the direction of tethered cord. Generalized leg pain,  weakness or tightness, and urinary control difficulties also can suggest tethered cord.

Kids who have the symptoms or abnormal reflexes in an exam would warrant a magnetic resonance imaging (MRI) scan of their lumbar spine. If tethered cord is the diagnosis, a neurosurgeon can release it, according to Dr. Meier.

Spondylolisthesis — basically a stress fracture in the pars interarticularis — can be congenital or trauma-induced, often a result of hyperextension in kids who do a lot of back-bending while participating in football, gymnastics, diving, dancing and similar activities.

X-rays don’t always reveal spondylolisthesis. MRI or computed tomography (CT) scans are more likely to reveal the condition.

Limiting hyperextending activity, physical therapy and perhaps bracing are strategies that very often can relieve spondylolisthesis symptoms. The condition almost never requires surgery in kids.

Full resolution of spondylolisthesis symptoms can take six to 12 months, according to Dr. Meier.

Perhaps surprisingly, scoliosis typically doesn’t present with back pain. Even kids with a large curve typically don’t have pain.

“Studies suggest about a third of patients with scoliosis will have some type of back pain. At the same time, about a third of teenagers in general have back pain. So, essentially, those of us in our field tend to think of scoliosis as not necessarily a pain-generating” issue, Dr. Meier said.