Case 10: A 17-year-old overweight male presents with 6 months of intermittent low back pain. Most of his pain occurs with prolonged sitting or standing. He does not remember an injury but has pain when he does his homework on his bed. He has hyperlordosis along with tenderness to palpation of his lower lumbar paraspinal muscles. He has a normal neurologic exam but does go into a valgus maneuver with single leg squats.
Muscular low back pain during adolescence may be acute secondary to a muscle pull or more chronic due to rapid growth, poor posture, and core body weakness. Muscular pain usually occurs with prolonged sitting or standing especially in those with poor posture. Pain may also be elicited during or after sports activity or with overuse. Adolescents with hyperlor-dosis may experience pain as they grow secondary to pulling along the apophyses of the lumbar spine. Pain occurs along the low back paraspinal muscles or spinous processes and is usually bilateral. There is no radiation of pain, neurologic symptoms, night pain, or bowel/bladder dysfunction.
On examination adolescents may have hyperlordosis or hyperprona-tin. They have full range of motion of the back but may have difficulty with full forward flexion secondary to tight hamstrings. They may have discomfort with extremes of motion, side bending or twisting. They have a normal neurologic exam. Many have poor core body strength and go into a valgus maneuver with a single leg squat.
Treatment consists of daily physical therapy focusing on core body strengthening and hamstring flexibility. Weight control measures are important to discuss with overweight adolescents. Heating before activity may help to increase stretch of muscles. Pilates and yoga are excellent activities for this group. Pain medications may be used but are not particularly helpful for relieving discomfort. Proper posture, workspace/computer ergonomics, use of a lumbar support pillow for sitting and shoewear with good arch supports during prolonged walking may benefit adolescents with muscular low back pain.
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