Paediatrics – Spine

Musculoskeletal (MSK) Therapy Services

Back pain has been reported to be as common in adolescents as it is in adults.

It is estimated that 30 to 70% of adolescents report episodes of back pain between the ages of 10 to 17 years. Most common causes of adolescent muscular back pain are thought to arise from the muscles either side of the mid and lower spine rather than the spine itself.

If you would like a more in depth understanding of the anatomy of the spine, check out – AnatomyZone – Your Guide to Human Anatomy and search ‘back’.

It is unusual to have back pain under the age of 10 and you should seek immediate medical advice regarding this from your GP.

Your GP, Advanced Practitioner or Physiotherapist might have given you a diagnosis already, and directed you here.

However, if you have any of the following problems that accompany your back or neck pain, you need to seek Emergency Care via 111 or the Emergency Department:

  • Difficulty passing or unable to pass urine
  • Loss of bowel control
  • Unstable when walking/feet do not go where you want them to
  • Numbness or tingling around your back passage or genitals
  • Decreased dexterity of hands e.g. buttoning shirts, writing
  • Numbness and/or weakness of both hands
  • Difficulty swallowing
  • Difficulty speaking
  • Fainting when looking up or to the side

Accordion

What is it?

This is the most common type of back pain in children and young adults and you can read more about it and some exercises that could help in the below leaflet.

Would an X-ray help?

Most back pains do not require any imagining to confirm diagnosis or to start treatment.

X-rays work by passing a low level radiation through the body to produce an image. Due to the radiation X-rays will only be used if there is no other way to accurately diagnose the problem or if there is a concern that there may be a more serious problem.

Radiologists (people who complete the X-rays) will only do one if they feel the referring clinician (such as a doctor, specialist physio or nurse practitioner) has given a valid reason for the risk of radiation. This means that you may have been referred for an X-ray but it has not been completed because the radiologists feel that other methods should be used to determine the problem first.

For more information about x-rays please see the NHS website below:

What are the pathways at East Sussex Healthcare Trust (ESHT)?

  1. Physiotherapy – If your back pain has not settled after 6 weeks, this is normally the first port of call. Options include advice, exercises, hands on therapy, acupuncture, hydrotherapy or gym-based rehabilitation.
  2. Advanced Practitioner – If your back pain has not improved with Physiotherapy, a referral to the AP may be your next option. Here you can discuss current management options, including the merits of medical imagining.
  3. Orthopaedics – If the AP is concerned or imagining is completed and shows something abnormal an appointment with an orthopaedic consultant maybe advised. Further management and treatments can be discussed here; including surgical intervention if indicated (although this is rare in children and would need to be completed at a specialised centre).
  4. Pain Management Programme – Although not provided by ESHT. A referral into the Evelina Hospital in London’s Pain management programme may help for pain that is not resolving or does not have a specific medical cause.

Additional info

What is it?

Scoliosis is a condition that can affect people of all ages; however, it is most commonly starts during adolescence between the ages of 10 and 15. It is a sideways curvature of the spine and the amount of curvature varies from person to person. There are no precursors to developing a scoliosis, although there is an increased risk of between 11 and 33 percent of developing one if a first degree relative has one.

Would an X-ray help?

In the case of a scoliosis an X-ray is required to determine the degree of curvature and this will allow for the medical team to determine the best course of treatment. There are clear International guidelines to advise on the most appropriate treatment for age and degree of curve. These will include; physiotherapy, monitoring, bracing or potentially surgery.

X-rays work by passing a low level radiation through the body to produce an image.

For more information about X-rays please see the NHS website below:

What are the pathways at East Sussex Healthcare Trust (ESHT)?

You will either see a specialist physiotherapist or advanced practice physiotherapist who will assess you and request an x-ray if there is a scoliosis. This can be easily determined by some simple physical tests. Based on the results of the x-ray you will either continue with physiotherapy, be referred to the Orthotics team for bracing or be referred to the Evelina Hospital in London for a surgical opinion.

Additional info

What is it?

Neck pain is commonly seen in older teenagers, but rarely in younger children unless there has been a specific trauma. Sprains and strains can occur as the result of poor posture, overuse, change in physical activity levels or as the result of a car accident (whiplash). The demands of modern life can often mean lots of prolonged positions – in cars, desks, on phones etc which can also lead to neck pain. Like lower back pain, most neck pain is mechanical – originating from the muscles, from the joints including ligaments and discs or from the nerves.

Will a scan help?

Most neck pains do not require any imagining to confirm diagnosis or to start treatment.

X-rays work by passing a low-level radiation through the body to produce an image. Due to the radiation X-rays will only be used if there is no other way to accurately diagnose the problem or if there is a concern that there may be a more serious problem. Radiologists (people who complete the X-rays) will only do one if they feel the referring clinician (such as a doctor, specialist physio or nurse practitioner) has given a valid reason for the risk of radiation. This means that you may have been referred for an X-ray but it has not been completed because the radiologists feel that other methods should be used to determine the problem first.

For more information about x-rays please see the NHS website below:

What are the pathways at East Sussex Healthcare Trust (ESHT)?

  1. Physiotherapy – If your neck pain has not settled after 6 weeks, this is normally the first port of call. Options include advice, exercises, and hands on therapy.
  2. Advanced Practitioner – If your neck pain has not improved with Physiotherapy, a referral to the AP may be your next option. Here you can discuss current management options, including the merits of medical imagining.
  3. Orthopaedics – If the AP is concerned or imagining is completed and shows something abnormal an appointment with an orthopaedic consultant maybe advised. Further management and treatments can be discussed here; including surgical intervention if indicated (although this is rare in children and would need to be completed at a specialised centre).
  4. Pain Management Programme – Although not provided by ESHT. A referral into the Evelina Hospital in London’s Pain management programme may help for pain that is not resolving or does not have a specific medical cause.