Most people think of lower back pain as an “older person’s” diagnosis, but it has become prevalent in children and adolescents. There are many causes ranging from joint inflammation as a part of disease, to injury due to participation in sports.
Often, the patient can pinpoint a moment when he lifted an object or moved a certain way, and had sudden onset of pain. Other times, the patient details a more gradual onset of pain during specific activities, such as bending, lifting, running, or walking. The pain can progress to the point that the patient is uncomfortable even at rest.
The common theme in both of these instances is that patients can attribute the onset of pain to movement. The typical response is to avoid that movement, thus preventing further discomfort. This is completely expected and there are times when this is an appropriate response, but in the case of low back pain, research shows just the opposite to be true.
Each vertebra of the lumbar spine has five different joints which have to move correctly for normal spinal motion to occur. When one of these joints becomes dysfunctional due to an abnormal pull or inadequate stabilization, it creates an atypical movement pattern, which is perceived as pain. By avoiding this movement, relief is gained.
Because avoiding the movement affords relief, this becomes a habit, further altering the biomechanics of the spine and trunk muscles. Here is where the problem worsens; atypical movement patterns are reinforced, creating further weakness and inflexibility, creating a vicious cycle. The brain is re-trained to associate movement with pain, and non-movement with relief. So, how does one avoid falling into this pattern?
The best way is to get up and move.
This may seem counter-intuitive, but one of the most effective ways to combat low back pain is to begin a walking and strengthening program. The walking program should begin and be progressed according to tolerance.
For example, a patient notes he is able to walk for 5 minutes, then has onset of back pain. If after another minute of walking, the pain continues to increase, this patient’s starting point is 5 minutes of walking. He should continue to walk 2-3 times per day, 5 minutes at a time, for a week. The next week, he should attempt to increase the time to 8-10 minutes, and so on.
The strengthening program should be targeted at correcting the coordination between the muscles of the abdomen, lower back, and hips in order to provide appropriate spinal stabilization and to correct the movement patterns that have lead to the onset of pain. The strengthening program is progressed according to tolerance and mastery.
Once the correct motor patterns are learned for appropriate spinal motion, relief is often gained. Patients are then able to monitor their symptoms appropriately, understanding which type of pain is dangerous, and which type is safe to work through.
Working through pain helps lessen the association between pain and movement. For more information on low back pain in children and adolescents, listen to our PediaCast, here. If you have questions regarding treatment for low back pain, please contact Nationwide Children’s Hospital Sports and Physical Therapy at 614-355-1381.
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