Back Problems Are Not Uncommon in Children, Adolescents

A CT scan of C1-C2 with the head turned to the right and left makes the diagnosis in most cases. If detected within 1 week, treatment involves placement of a soft cervical collar. If detected within 1 month, treatment involves traction for reduction followed by placement of a cervical collar. Detection after 1 month of onset usually requires surgical fusion.

Kids don't keep up physical therapy. 'It's better to get them involved with something like yoga and Pilates.' DR. SKAGGS

The 60-Second Exam for Back Pain

Here are tips to quickly assess children for back pain:

▸ Have the child jump up and down on one foot, then jump up and down on the other.

▸ Have the child walk on his or her heels with the toes pointed upward. That covers L4 for ankle dorsiflexion. With these first two tests, almost all of the strength and balance of the lower extremities have been covered.

▸ Test the reflexes, including the umbilicus. If you lightly stroke the umbilicus on either side, the belly button should move to one side or the other. If it doesn't move, that's normal. “But if it's asymmetrical, there's a great chance there's syrinx.”

▸ Test for ankle clonus. Push up on the ball of the foot and forcibly dorsiflex the ankle. “If it beats once or twice that's normal,” he said. “Three or four beats of clonus and I'd consider a neurological work-up and/or an MRI.”

▸ Assess hamstring tightness. A popliteal angle up to 30–40 degrees is normal.

▸ Check the feet. “If you have claw toes or a cavus foot, that's a sign that something neurological is going on in the spine,” he said.