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ASK DR. SPINE: Causes of back pain in the young adult

ASK DR. SPINE: Causes of back pain in the young adult

Although back pain in young adults and teenagers is less common than back pain in adults, it can be equally bothersome to both the patients and their parents. The main cause of back pain in the grown adult, arthritis, is not common in the young adult, except for very rare instances. Most young adults’ back pain is from activity such as sports or perhaps an injury.

The following are some of the main causes of back pain in the young adult:

1. Activity related: Since young adults tend to be very active in sports, muscle overuse and fatigue is a main cause of back pain. Muscle overuse is common in young athletes at the start of a season, as athletes quickly ramp up their activities, often without proper pre-conditioning such as stretching and gradual weight training.

The solution for this type of back pain is often a decrease in the level of activity, rest, back muscle conditioning and medications if needed. If these interventions do not resolve the patient’s back pain, further evaluation with X-rays and possibly an MRI might be needed to make sure that there isn’t another cause of back pain, such as a pars defect.

Once the athlete’s back pain is resolved then he or she can resume sporting activities.

2. Pars defect: This is a developmental defect or an acute fracture in a part of the vertebral body that can lead to back pain. The pars intra-articularis, or pars for short, is a part of the posterior portion of the vertebral body which serves as a connection between the top and bottom part of the vertebral joints.

The pars can be injured from excessive back bending and extension, leading to a fracture and back pain. This is often seen in young athletes such as divers, football linemen and gymnasts. Other times, a par defect is a result of that part of the vertebral body just not developing properly.

Back pain from this condition is located in the lower back near the pelvis and can be accompanied by leg pain. Evaluation of this condition includes an MRI scan, plain radiographs and a CT scan.

If these studies show that the pars defect is old, then symptomatic treatment with rest, medications, bracing and therapy is all that is needed to relieve the symptoms. If the pars defect is new or recent then a surgical repair is recommended.

3. Tumors: Osteod osteoma is very rare benign tumors of the spine and classically will cause night pain that is relieved by NSAIDS. The diagnosis is often confirmed with a CT scan which will show a characteristic lesion.

The treatment for these lesions is often surgery to remove them if the pain is not controlled by medications. The back pain usually resolves once the lesions are removed. Malignant tumors of the spine in young adults are very rare.

4. Scheuermann’s kyphosis: This condition is seen in the thoracic spine and is the result of the vertebral bodies not forming properly during growth. As a result, the vertebral bodies in the thoracic spine become wedge-shaped rather than the normal square shape.

This wedging leads to increased forward posture, or what is called increased kyphosis or round shoulder. Pain can be seen in Sheuermann’s kyphosis, but is treated non-surgically with medications, therapy and occasionally a brace.

In conclusion, back pain in the young adult is mainly activity-related and usually responds to rest, medications and activity modifications. Rarely is surgery necessary to treat back pain in young adults.

Dr. Dwight S. Tyndall, FAAOS, is a minimally invasive spine surgeon practicing in the Region at His column, which appears every other week, covers a wide range of health and medical issues.


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