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Lower back pain
How do you approach a child or young adult with lower back pain (LBP)? Lucina has always found this a challenge with the desire to reduce unnecessary imaging and investigations but the worry about missing serious pathology. The causes of back pain in children are different compared with adults. Pate JW et al (J Paediatr and Child Health 2022; 58:566–71. doi:10.1111/jpc.15933) have presented a really useful approach to the assessment of LBP and it is well worth a visit. They highlight unique pathologies that only occur in this age group: (i) serious pathologies include infection, fracture, child abuse and malignancy; (ii) growth-related pathologies include scoliosis, Scheuermann’s dis- ease, pars fracture and spondylolysis; and (iii) rheumatological conditions include juvenile idiopathic arthritis and ankylosing spondylitis. They present a systematic and practical approach, emphasising a child and adolescent perspective. Lucina particularly liked their advice regarding the structure to physical examination: (i) observation (static and dynamic); (ii) active range of motion; (iii) passive range of motion; (iv) isometric muscle testing; (v) manual muscle testing; (vi) passive accessory movement testing also called ‘Joint Play’; (vii) neurological screening; (viii) special tests; (ix) functional tests; and (x) palpation. It’s a great review.
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Footnotes
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Provenance and peer review Commissioned; internally peer reviewed.