Your kid’s lower back hurts? Really?

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Backpack alert from a rheumatologist

by Marcin Gornsiewicz, M.D.


July2013-MarcinBack pain in adults has been extensively studied. Until recently, a complaint of back pain in a child or adolescent was rather uncommon, but that has changed. Aside from specific medical conditions, long hours spent on computers, tablets and smart phones, obesity, a sedentary lifestyle, heavy schoolbags, competitive sports all likely contribute to an increased number of kids with either acute or chronic back pain.

The vertebral column, commonly known as the backbone or spine, is made up of 26 bone discs called vertebrae. They protect the spinal cord and allow us to stand and bend. There are three general portions of the spine. The cervical portion (neck), the thoracic portion (mid-back), and the lumbar portion (lower back), which connects with the pelvis at the sacrum. The spine is not a straight line, and there are specific curves associated with each region. There are two inward curves called a lordosis and one outward curve called a kyphosis. These three curves maintain balance of the spine.

The majority of children with back pain have no definitive diagnosis, meaning the cause is unknown with normal physical exams and x-rays. This is especially true for children older then 10. The pain arises from within the muscles surrounding the spine rather then from the spine itself. This is often related to muscle sprain, strain and overuse, exacerbated by twisting and lifting. This type of pain usually responds to rest, anti-inflammatory medications, and an exercise program.

July2013-Marcin2There is also a growing concern of back pain caused by heavy backpacks. If the backpack is stuffed with books and any other possible “stuff” that kids carry these days and worn incorrectly, a child may lean forward to compensate or arch the back, which can cause the spine to compress unnaturally. The American Academy of Pediatrics recommends that a backpack weigh no more then 10 to 20 percent of the child’s body weight. For example, if your child weighs 80 lbs., the backpack should weigh no more than 16 lbs.


“The American Academy of Pediatrics recommends that a backpack weigh no more then 10 to 20 percent of the child’s body weight.”


Here are some suggestions for choosing the right backpack and wearing it the right way:

  • Buy a backpack with multiple compartments to more evenly distribute the weight, and try to place the heaviest items closest to the back.
  • Always use both shoulder straps, tighten them and use a waist strap if the bag has one. The backpack should never hang more then 4 inches below the waistline.
  • Canvas backpacks are usually lighter than leather and are generally less expensive.
  • The shoulder straps should be adjustable, wide and padded to prevent interference with circulation and nerves.
  • Urge your child not to wear a backpack in a “cool way” over just one shoulder.

In some cases, non-specific back pain may be related to psychological problems such as depression, anxiety and stress in school. In such instances, a consultation with another health specialist may be appropriate.

20 to 40 percent of children and teens with back pain will be diagnosed with a specific condition with findings on examination and changes in imaging studies (x-ray or MRI). Here are the most common conditions:

  1. A stress fracture in one of the vertebrae, which is called spondylolysis. This may occur during periods of rapid growth or with sports that repeatedly twist and hyper extend the spine, like gymnastics, weight lifting, diving, rowing, and football. It will usually heal with a change in activity and rest.
  2. Slipped vertebra called spondylolisthesis. This usually occurs at the base of the spine, when one vertebra shifts forward on the next vertebra directly below.
  3. Scheuermann’s disease. There is wedging of three or more vertebrae in the thoracic region, causing a rounded, or hunched back.
  4. Scoliosis, a lateral (toward the side) curvature of the spine. While the majority have no specific identifiable cause and only require watching for worsening, some may need bracing or surgery.
  5. Infection in a disc space (discitis), and rarely tumors.
  6. Inflammatory arthritis. A limited number of systemic inflammatory conditions that can affect the spine.

In summary, most episodes of back pain in children and adolescents are not serious and resolve without treatment; however, certain congenital and acquired conditions must first always be excluded.


MarcinDr. Marcin Gornisiewicz graduated with an MD degree from the Medical School of Warsaw in Warsaw, Poland. He completed residency training in internal medicine at Saint Barnabas Medical Center in Livingston, New Jersey. He completed fellowship training in rheumatology at the University of Alabama at Birmingham in Birmingham, Alabama. He joined Rheumatology Consultants, PLLC ( in 2002. He is board certified in Rheumatology.

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