Editor's note: This is the first column in a two-part series. Check next week's Tuesday health section to read the second column.
Children generally do not complain of back pain. When this complaint is heard, the initial impulse is to have the child "run it off." Many times, lower back pain in an adolescent may generate from overuse syndrome or a strain/sprain. Overuse is the temporary internal disruption of the contracting proteins (actin and myosin) in the muscle that creates the "soreness" we all know from performing an activity that we have not participated in for a while. A strain is a small tear of a muscle or tendon and a sprain is a small tear of a ligament. (A ligament is a tough fibrous structure that connects bone to bone like an ACL- anterior cruciate ligament - in the knee).
All these conditions are generally benign and symptoms will disappear with time and rest (two to four days for overuse, three to four weeks for a strain and six to eight weeks for a sprain). There are, however, complaints of pain that do not disappear or only recede if the sporting activity is halted. The return to sports recreates the pain. In addition, if the child is not questioned regarding the presence of pain, some individuals will not report pain for fear of being removed from competition.
There are three conditions that need to be diagnosed if lower back pain is present for some time or the child demonstrates "favoring behavior" (antalgia) while competing. These are Scheuermann's disorder, isthmic spondylolysis, and degenerative disc disease with or without herniation.
We must first describe the anatomy of the lower back to understand of these disorders. The lumbar vertebra is shaped with a large body in the front to carry the loads of the chest and head and transfer the load to the disc. The disc is sandwiched in between the two vertebrae and is the shock absorber of the spine. The projections out of the back of the vertebra (the pedicles and lamina) contain the facets, the "doorstops" that hook one vertebra onto its neighbors above and below. These facets act like train tracks to guide the motion of the vertebrae. See. Figure 1.
In children and adolescents, there are open growth plates on the top and bottom of the body of the vertebra. These growth plates (there are two) are like the tops and bottoms of an Oreo cookie, with the main body of the vertebra sandwiched in between these growth plates like the creme filling. The growth plates are attached to the bone of the body of the vertebra by cartilage, which is not as strong as bone. See Figure 2.
In the next article, we will discuss the various conditions that require the attention of a physician.
If you would like more specific information about these disorders, look for information at NeckandBack.com or the book "Everything You Wanted to Know About the Back."
Dr. Donald Corenman is a spine surgeon with The Steadman Clinic in Vail. Email comments about this column to cschnell@vaildaily.com.
