Back pain in children and adolescents
Tension in the neck and shoulders, a feeling of stiffness at chest level or a dull ache at the base of the lumbar spine: back pain has long since made a name for itself as the number one common ailment. What is less well known is that more and more children and adolescents are complaining of such symptoms.
«There are no evidence-based figures for Switzerland,» says Sylvia Willi, «but I also have the impression that this is increasing.» The orthopaedic surgeon with her own practice in Zurich deals with young patients with low back pain practically every day.
Experts' estimates of how many children and young people are affected vary greatly, with the average figure being around one third. This is one of the findings of Europe's largest study on the health of children and adolescents, KiGGS, conducted by the German Robert Koch Institute. «We often see six and seven-year-olds suffering from back pain, and the number increases as they get older,» says Sylvia Willi. Girls are affected more often than boys.
Mental strain and stress
But why are young people's backs so plagued by pain? Doctors have targeted several suspects. Even if some orthopaedists still hold this opinion today, the school desk has been largely exonerated as a suspect. A number of other factors are still under critical observation: mental strain or stress, for example, and - particularly obvious - a lack of exercise. A number of studies have now shown that there is a link between sitting for long periods and back pain.
«The fact is that children today certainly have very different everyday movements than children twenty or thirty years ago,» says Sylvia Willi. «On the one hand, of course, this is due to increasing digitalisation and the availability of electronics for everyone, but on the other hand it is also due to the good expansion of local public transport.»
Children sit too much
Walking half an hour to school or cycling five kilometres to football training or piano lessons in the afternoon used to be a matter of course and neither parents nor doctors classified this as physical activity.
Today, even shorter distances fall into the «sport» category. In addition to sitting at school, many children and young people spend two to three hours a day playing computer games and watching TV - time that they don't have for exercise. It doesn't necessarily have to be «real» sport, says Willi. It is enough to do intensive exercise outside of school several times a week - with variety and fun taking centre stage.
Football and hockey are not back-friendly
Children who want to take part in sport are best advised to choose a sport that requires their arms: Dancing, climbing, volleyball, handball or a martial art, for example. «You have more body tension and body awareness,» says Willi, «and the back is also moved well. Sports such as football or hockey are not so back-friendly, as the players are often in a crouched position. But they are better than no movement. "My general advice is to work with the children to find a sport that they enjoy, because that's the only way they'll really stick with it,» says Willi.
Regardless of the sport, stretching is particularly important in childhood and adolescence, as the muscles are still growing. If the muscles shorten during this phase because they are loaded too one-sidedly, this also leads to pain.
The pain and poor posture are usually temporary, they come and go.
Sylvia Willi, Orthopaedist
It is helpful to do sport in clubs. Going jogging with mum, says Willi, is a well-intentioned approach, but doesn't usually work in the long term. In groups and with people of the same age, the dynamic is higher and the motivation to keep going is correspondingly stronger.
Just as too little exercise can have an impact on back health, the well-being of our spine and back muscles is jeopardised when children go to the other extreme and demand too much of their bodies, for example in competitive sport.
The pain is usually temporary
The concern of many parents that their offspring's back problems are the basis for corresponding complaints in adulthood is unfounded, as there is no scientific evidence to date. «The pain and poor posture are usually temporary, they come and go,» reassures Sylvia Willi. However, those who do little exercise as children rarely turn into sports fans as adults. So it's possible that new back problems will appear as you get older.
Back pain in children and adolescents is sometimes caused by growth. As the child grows taller, the proportions of the body change and the body awareness can get a little lost. «When I say to a child like this: «Stand up straight», the result is a completely unnatural posture,» explains Sylvia Willi.
In such cases, a few sessions with a physiotherapist can help a lot. It is important to see a therapist who is familiar with the particularities of the growing body.
It is far more difficult to treat back pain that has developed due to emotional stress. Worries or fears in children and adolescents are quickly transferred to the physical level. Arguments with or between parents, problems at school or even emotional neglect by carers can manifest themselves as pain in the head, stomach or back. This is where the doctor's careful anamnesis is required.
A high percentage of back pain in children has no organic cause, says Kerstin Kuminack, head of the paediatric orthopaedics section at the Department of Orthopaedics and Trauma Surgery at the University Medical Centre Freiburg in Germany. This means that changes in the skeleton or body can be ruled out as the cause of the pain. «However, evidence has been found that back pain and stress can be linked,» says Kuminack.
When should the doctor be consulted?
If a child or adolescent complains of back pain, it should definitely be checked out medically. Because even if it is a functional and muscular problem, there may be serious medical conditions behind the complaints. A pronounced scoliosis, for example, a congenital spondylolisthesis, tumours or a so-called flat back. Poor posture that is not painful is also a common reason for a visit to the clinic, says Kuminack.
It is important for parents to know that they should consult a doctor, especially if the pain occurs suddenly and can be localised very precisely. «Medical advice should also be sought if there are accompanying symptoms such as fever or joint pain or other abnormal changes in the body,» says Kuminack.
If children and adolescents suffer from chronic, often not precisely localisable back pain and an organic cause can be ruled out, the family and school situation as well as the lifestyle - keyword exercise and healthy diet - should be critically examined.
Theoretically, affected children and adolescents can receive pain therapy. In practice, however, parents should never give out painkillers on their own, but should consult a paediatrician in detail. «They will know which medication is suitable for the specific case and whether a change in behaviour may also be necessary. This could be more exercise or a reduction in sport, for example,» explains Kuminack.
For a long time, experts recommended this: The weight of a school desk should not exceed ten per cent of the child's body weight. This has now been abandoned, as it has not been shown that heavier schoolbags are harmful to the back. How heavy a school bag can be depends on various factors.
Parents should be guided by their child's muscle strength and the length of the journey to school and, above all, walk the route together with a fully packed backpack. While one child will be panting after two-thirds of the way with a backpack that weighs ten per cent of their body weight, another may be able to manage fifteen per cent of their body weight without any problems. It is not advisable to use generalised figures as a guide.
However, the following applies to all children: the back part of the rucksack should be padded and adapt well to the shape of the body. Wide shoulder straps make carrying easier as they distribute the weight of the satchel better. They should be taut so that the back rests against the shoulder blades and the top edge is flush with the shoulders.
If they are set too long, the child will bend into a hollow back with the corresponding weight. This puts more strain on muscles and joints. Younger children should not wear rucksacks as they offer less stability and cannot fit snugly around the back.
The smartphone neck
Leaning forward when looking at your mobile phone can lead to severe discomfort in the long term. How to prevent this. The smartphone generation is often described as constantly looking down at the display. Doctors call this flexion posture: the head bent far forwards, as if the owner wants to let it sink to their chest.
Normally, we balance our head, which weighs around 5 to 7 kilograms - in children and adolescents it may not weigh much less, depending on their age - above the centre of our body. This keeps us upright and balanced. US scientists have found in a study that the weight that the neck has to carry increases to 13 kilograms when the head is tilted at an angle of 15 degrees.
We get the bill in old age
If we tilt our head by 45 degrees - typical for mobile phone users - this load increases to more than 20 kilograms. The problem is that this is not a short-term high load, but that this bending posture is permanent. Bending the head forwards leads to stress in the neck and generally on the back of the body. The muscles shorten and are harder to stretch, making it increasingly difficult to straighten up.
The posture ensures that the shoulder heads move further forwards, the humerus is no longer positioned correctly in the shoulder. This puts more strain on the joint capsule and tendon structures. In the long term, this leads to pain and limited mobility. A young body can still cope with a lot in this respect, but as we get older we get the bill for our incorrect posture.
Voice rather than text messages
If the head is bent forwards, it must be held. This is also done by the muscle responsible for lifting the shoulder. If it becomes tense due to constant strain, this can lead to neck pain and headaches. The intervertebral discs in the cervical spine are less strong than those in the lumbar spine and react to the strain with bone deposits on the edges. These can sometimes become very sharp, which can easily lead to serious injury to the cervical spine in the event of an accident or fall. Young athletes such as snowboarders and mountain bikers in particular are known to have suffered such injuries.
So-called paraesthesias, i.e. tingling and numbness in the arms and hands, are also the result of overloaded intervertebral discs. What can help? It's better to dictate voice messages instead of typing and - even if it looks silly - hold your mobile phone at eye level instead of lowering your head.
