Each year, approximately $200 billion is estimated to be spent on managing back pain, and it's not just middle-aged or elderly adults experiencing the aches and strains. Even children and adolescents are affected, with a monthly prevalence of about 20%, and it only increases with age up to 18 years. By the time they reach adulthood, nearly 40% will have experienced this potentially debilitating condition, and between 10% to 15% of children with back pain will develop chronic low back pain later in life. With children spending a substantial portion of their days at school, school nurses play a pivotal role in addressing this surprisingly common student health issue. 

Etiologies

While it is estimated that nearly 80% of cases of low back pain have no specific cause, discomfort and stiffness in the back are most often associated with strained ligaments, pulled muscles, or bruising. Back pain in children and adolescents is frequently the result of injuries sustained during athletics or play, falls, or undue stress on the back, as in the case of carrying a backpack that is too heavy. Physical activity - both too much and too little - can commonly cause back pain in the student population. Intense training can lead to overuse injuries, and an overly sedentary lifestyle can result in back pain due to weak core muscles, poor posture, or obesity.

Underlying pathophysiologies, including spondylosis (stress fracture), Scheuermann's disease (round back), a herniated disc, and scoliosis, although less common than musculoskeletal strains, can also be the source of back pain in kids. Additionally, evidence has also indicated an association between low back pain in adolescents and various psychosocial factors, including depressive symptoms, perceived stress, negative well-being, and other emotional problems.

Considerations

Most health office visits regarding back pain are not serious. Still, even minor or persistent complaints, signs, or symptoms require careful diligence in assessment and thorough communication with parents or guardians. Severe pain, inability to walk, numbness or tingling in the legs or feet, fever, and reported changes with urination require more urgent evaluation and treatment. Likewise, if students' pain lasts longer than two weeks, worsens over time, or appears to be a chronic problem, a primary care referral is appropriate.  

Interventions

According to the AAP, "Symptoms of back pain usually disappear within a week without special treatment." However, even mild to moderate back pain can significantly interfere with students' academic performance, prevent them from participating in extracurricular activities, and negatively impact their emotional health.

• Pain Medication - If ordered and permitted by policy and consent, OTC analgesics can help alleviate discomfort and spasms.

• Cold Therapy - Applying ice for 20 minutes, up to four times daily, can ease pain and decrease swelling.

• Heat Therapy - For back pain lasting more than two days, applying a heat pack for 10 minutes, as needed, can relax muscles, increase blood flow, and promote healing.

• Education & Awareness - Conveying information to students, parents, and teachers about maintaining good posture, correct backpack usage, and the importance of regular physical activity can help prevent many common back problems.

Given that a substantial proportion of students experiencing back pain are at risk for future spinal issues in adulthood, it's essential to address complaints of back pain seriously, integrating back care within school health services. In partnership with healthcare providers and parents, school nurses can contribute to a more comprehensive approach, incorporating healthy habits into students' lives that will aid in minimizing the prevalence of back pain and foster academic growth without physical discomfort as a setback.