Definition

• Back muscle pain from carrying or lifting heavy things

Health Information

Symptoms

• The pain is in the middle or lower back
• The pain is made worse by bending
• The muscles near the spine are tender to the touch
• The muscles may be tight (in spasm)
• Walking a little bent over or stiff also may occur

Causes

• Some of the muscle fibers in the back have been stretched and injured. This is called a muscle strain or muscle overuse.
• Strained back muscles cause most lower back pain.
• New backaches in teens are mostly from strained back muscles (muscle overuse). There are 200 muscles in the back that allow us to stand upright.
• Triggers are carrying something too heavy or lifting from an awkward position. Bending too far backward or sideways can cause back pain. Digging in the garden for too long causes overuse of back muscles.
• In school age children, heavy backpacks have become a common cause. They also can cause shoulder and neck pains. Children who have not gone into puberty are at greater risk. Reason: They lack muscle mass.

Pain Scale

• Mild: Your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.
• Moderate: The pain keeps your child from doing some normal activities. It may wake him or her up from sleep.
• Severe: The pain is very bad. It keeps your child from doing all normal activities.

Care Advice

1. Overview:
   • Most strained back muscles are caused by carrying heavy objects. The main trigger in school age children is heavy backpacks.
   • Lifting a heavy object while the back is twisted is also a common cause.
   • Muscle strains gradually get better with home treatment.
   • Here is some care advice that should help.
2. Pain Medicine:
   • To help with the pain, give acetaminophen (such as Tylenol) or ibuprofen. Use as needed.
   • Reason: Helps back pain and muscle spasms.
3. Cold Pack:
   • For pain or swelling, use a cold pack. You can also use ice wrapped in a wet cloth.
   • Put it on the sore muscles for 20 minutes.
   • Repeat 4 times on the first day, then as needed.
   • Reason: Helps with the pain and muscle spasms.
   • Caution: Avoid frostbite.
4. Heat Pack:
   • If pain lasts over 2 days, put heat on the sore muscle.
   • Use a heat pack, heating pad or warm wet washcloth.
   • Do this for 10 minutes, then as needed.
   • Caution: Avoid burns.
5. Sleep:
   • Sleep on the side with a pillow between the knees.
   • If your child only sleeps on the back, put a pillow under the knees.
   • Avoid sleeping on the stomach.
   • The mattress should be firm. Do not sleep on a waterbed.
6. Activity:
   • Avoid any sports or work that increase the pain.
   • Avoid lifting or jumping until well.
   • After 48 hours, start gentle back stretching exercises.
   • Complete bed rest is not needed.
7. Prevention of Backpack Pain:
   • Limit the weight of what is carried. It needs to less than 15% of body weight. That means a 100 pound child should not carry more than 15 pounds.
   • A sign of carrying too much weight is having to lean forward when walking.
   • Buy a well-made backpack with wide, padded shoulder straps.
   • Never carry the pack on just one shoulder. Reason: causes shoulder and neck pain.
8. What to Expect:
   • Back pain from muscle overuse (strained back muscles) goes away in 1 to 2 weeks.

Call Your Doctor If

• Back pain becomes severe
• Walks different than normal for more than 3 days
• Pain lasts more than 2 weeks
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC