Newcastle Chiropractic

Adolescents

Hormones, puberty, attitudes, wet dreams, menarche. Back pain is not a word normally associated with this stage of life. Unfortunately there are plenty of children aged 12-18 that suffer from back pain. As the body rapidly grows, extra stresses and strains are placed on the spinal column. Peer pressure and self-consciousness can dramatically alter previously confident postures. Hormones can make a teenager boisterous or overconfident whereas others are shy and introverted. A teenage boy for example who is rapidly growing tall may feel out of place thereby slouching and subconsciously altering their posture to ‘fit in’. Teenage girls may be self-conscious about their newfound breast size and consequently roll the shoulders forward to hide their chest. This places added postural strain on the spine.

2 spinal conditions commonly found in adolescents and causing back pain are scoliosis and Scheuermann’s disease.

Scheuermann’s Disease

A common cause of back pain in adolescents is Scheuermann’s disease. Scheuermann’s has a slight male predominance and occurs in approximately 8% of the population. Scheuermann’s disease usually affects the mid to lower thoracic spine, in particular the cartilaginous endplates that lie between the vertebrae and discs. The endplates crack or fracture and this allows discal material to enter the adjacent bone. These indentations are known as Schmorl’s nodes. X-rays of the spine will usually confirm the diagnosis of Scheuermann’s with the appearance of Schmorl’s nodes on at least consecutive vertebrae.

The cause is not fully understood yet, however Scheuermann’s distinctly occurs during the adolescent period and is thought to be a result of trauma to the growth plates (where bone is formed from cartilage) in the spine during this period.

The symptomatic patient complains of pain and fatigue in the mid-thoracic area which varies in intensity. The patient usually has a long thoracic curve (hyperkyphosis), poor sitting posture and pain centred at the apex of the curve.

The condition is self-limiting and treatment is aimed at improving the patient’s posture and preventing a progressive thoracic kyphosis. The most important period for treatment and awareness is during the growth spurt in males. Prescription of exercises, muscular release techniques and gentle spinal manipulation are effective in the treatment of Scheuermann’s. Patients then do not normally suffer any more problems following skeletal maturity (~18 years) unless an exaggerated postural deformity has developed.

Scoliosis

Scoliosis is a sideways bending or curvature of the spine. Scolioses can be structural or functional. Scolioses are usually picked up through a simple postural assessment and confirmed with an x-ray.

Functional scolioses occur as a result of posture, injury/muscle spasm or compensation for a leg length deficiency and are temporary or flexible curves. Structural scolioses are either idiopathic, congenital or due to certain conditions such as neurofibromatosis or poliomyelitis.

Structural scolioses are permanent, less flexible and can progress as a person ages. Only a small percentage of scolioses are congenital infantile meaning they occur from birth or within the 1st five years of life.

Most structural scolioses are idiopathic meaning there is no known significant cause and begin to occur in the adolescent ages (8-18).

Scolioses occur in equal distribution between boys and girls however there is a higher chance of a progressive scoliosis in females. A progressive idiopathic scoliosis is a scoliosis that actually curves more as the adolescent is going through the growth spurt. Most scolioses cease when the adolescent reaches skeletal maturity, which is usually between the ages of 18 and 21. Idiopathic curves that reach 40 degrees or greater may require surgery to prevent further progression.

Generally scolioses measured between 20 and 40 degrees may be treated chiropractically. Chiropractic treatment for scoliosis includes soft tissue techniques, manipulation, stretching exercises, heel lifts, orthotics or bracing is necessary.

It is important that scolioses are detected early. Severe scoliosis can actually affect lung and heart function. Surgical intervention in these cases, involves the placement of a titanium rod through the affected spinal segments, preventing all movement. Whilst potentially life-saving, this option is considered a last resort because of the risks associated with major surgery and the increased risk of arthritis as the body attempts to compensate for the loss of mobility.