Definition

• Pain or discomfort in the upper, mid or lower back
• Includes minor muscle strain from back overuse

Health Information

Causes

• 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 the muscle mass.
• Sciatica is pain caused by a pinched nerve in the lower back. Sciatica gives a burning pain in the buttock without back pain. The pain shoots into the back of the leg. The most intense pain can be in the lower leg and foot. Leg weakness, numbness or tingling can also occur. Sciatica is rare in children but common in adults.
• Hard coughing can cause pain in the upper back

Symptoms of Strained Back Muscles

• 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)

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 back pain is 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.
   • Both of these cause strained back muscles (also called muscle overuse).
   • Pain is not the only symptom. Walking a little bent over or stiff may occur for a few days.
   • 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 (45 kg) should not carry more than 15 pounds (7 kg).
   • 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:
   • New back pain without a reason most often goes away in a few days.
   • 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 starts to shoot into the leg
• Fever occurs
• Pain lasts more than 2 weeks
• You think your child needs to be seen
• Pain gets worse

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

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