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Back Pain May Start in Childhood

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Degenerative disc disease - an illness commonly seen in adults and often leading to low back pain - may start as early as childhood, new research shows.

The study examined 154 children in Scotland who had no symptoms of back pain. Each of the 11-year-olds underwent spinal MRIs and 14 were found to have an abnormal disc in the lower back. The discs either showed signs of disc breakdown or bulging.

The affected children denied any back pain. Only three had previously experienced a brief episode of back pain related to a fall, but this had been short-lived.

Experts say the unexpected finding means children should protect their backs and engage in early preventive measures. For adults, back pain is the second most common cause of lost work in the United States, according to the American Academy of Physical Medicine.

But others questioned the testing of patients who do not have symptoms, since degenerative changes on an MRI do not always predict whether someone will develop low back pain later.

"Most people with disc herniation on a scan don't necessarily have any symptoms, said Dr. Scott Boden, director of the Emory Spine Center and professor of orthopaedic surgery at Emory University School of Medicine in Atlanta. "It's important to remember that you need to treat symptoms. ... We should treat patients, not X-rays."

Is MRI a Guide for Back Care?

Still, results of the research are surprising, and even the study's authors were puzzled about the cause of the spine abnormalities.

"Perhaps something happened so early in life for which we can find no predisposing factors," said Dr. Francis W. Smith, the study's lead author and a radiologist and sports medicine physician at the Woodend Hospital in Aberdeen, Scotland. "We usually blame smoking, but clearly these kids have not smoked at all or long enough. Sedentary factors such as playing video games for too long or maybe heavy backpacks are to blame. There is quite possible a hereditary factor."

Smith, who is presented his research at the annual meeting of the Radiologic Society of North America on Dec. 1, believes the study may give physicians guidance in taking care of their pediatric patients.

"This study gives practicing physicians a stronger argument to encourage kids to look after their backs, become more active and participate in sports, don't participate in playing video games while sitting bent over for a long time," Said Smith, adding that physicians should "reinforce that backpacks should not weigh more than 10 percent of a child's body weight or [children should] stop wearing them all together and get one of those backpacks with wheels that they can pull around."

Strive for Good Back Health

While the implications of the study for treating back pain may be arguable, the results point to the overwhelming benefit of good preventive maintenance.

"We should pay more attention to what we expect of our children in terms of both the potential significance of complaints of back pain and of the back strain demands that the schools expect through the use of heavy books that are brought back and forth to schools each day in heavy backpacks," argued Dr. Lonnie Zeltzer, director of the Pediatric Pain Program at the University of California at Los Angeles.

She added: "Also, we need to understand the potential impact of elimination of physical education and exercise in general from the schools' curricula on the health of our children."

Dr. Michael J. Bolesta, associate professor of orthopaedic surgery at The University of Texas Southwestern Medical Center at Dallas notes the study provides an opportunity to promote good back and overall health. "It is a good time to learn and practice what will hopefully become lifelong habits: healthy eating in moderation, avoiding obesity, regular aerobic exercise, shunning all tobacco use. This will not reverse disk degeneration, but is associated with less back pain in adult life."

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