Children and Back Pain — When to Seek Help

Many parents are surprised to learn that back pain in children and adolescents is relatively common. A 2011 systematic review (Jeffries et al., BMC Musculoskelet Disord) found that the prevalence of back pain in children increases with age, with rates in adolescents approaching those seen in adults.

If your child has mentioned back pain, neck discomfort, or musculoskeletal aches, it is worth taking seriously — not because it is necessarily a sign of something serious, but because early assessment can help identify what is going on and whether anything needs to be done about it.

Common musculoskeletal complaints in children

The most frequent reasons parents bring children in for a musculoskeletal assessment include:

• Back pain from school bags and prolonged sitting — heavier school bags and more time sitting (at desks and on devices) can contribute to musculoskeletal discomfort, particularly in the thoracic and lumbar spine
• Sports-related injuries — growing bodies respond to impacts differently. Joint sprains, muscle strains, and overuse injuries from sport are common in active children
• Postural concerns — parents sometimes notice changes in how their child carries themselves, particularly during adolescent growth spurts
• Growing-related aches — while "growing pains" is a commonly used term, persistent or recurrent musculoskeletal discomfort in children is worth assessing rather than assuming it will resolve on its own
• Scoliosis screening — some families seek assessment where there is a family history or a school screening has raised a question

What the evidence says about musculoskeletal care for children

The research on manual therapy for paediatric musculoskeletal conditions is more limited than for adults. The studies that do exist are generally smaller, and more high-quality research is needed. That said:

• A 2019 systematic review (Parnell Prevost et al., BMJ Open) examined manual therapy for musculoskeletal conditions in children and found that adverse events were rare and typically mild (temporary soreness), though the authors emphasised the need for better-designed studies.
• Exercise, movement, and ergonomic advice are consistently supported as part of managing musculoskeletal pain in adolescents (Aartun et al., BMC Musculoskelet Disord, 2014).

The honest position is this: there is some evidence supporting musculoskeletal assessment and low-force manual therapy for children with relevant complaints, but the evidence base is still developing. What is well-supported is the combination of assessment, age-appropriate exercise, and practical advice.

What a paediatric assessment looks like

A musculoskeletal assessment for a child or adolescent is adapted to their age, size, and comfort level. At Evolve Chiropractic:

• A parent or carer is present throughout the entire visit
• The assessment begins with a conversation about what prompted the visit and the child's health history
• The physical assessment is scaled to the child — techniques are substantially lower-force than those used for adults
• Nothing happens without the child's assent and the parent's informed consent
• If the assessment reveals anything outside the scope of chiropractic care, a referral to the child's GP or another appropriate provider is made

For older children and adolescents, care is typically combined with exercise advice, movement strategies, and practical guidance — such as tips for school bag weight, desk setup, and device use.

Important: what chiropractic care for children is about

This article is specifically about musculoskeletal complaints in children — back pain, neck discomfort, sports injuries, and related conditions. Chiropractic assessment and care for children is directed at these musculoskeletal concerns.

Chiropractic care is not a treatment for non-musculoskeletal childhood conditions. If your child has a health concern that is not musculoskeletal in nature, their GP or paediatrician is the appropriate first point of contact.

When to see your GP first

While most musculoskeletal pain in children is not serious, there are situations where your GP should be involved first:

• Pain that wakes the child from sleep consistently
• Pain accompanied by fever, weight loss, or general unwellness
• Pain following a significant injury or fall
• Neurological symptoms such as numbness, tingling, or weakness in the limbs
• Pain that is worsening despite rest and normal activity modification

These situations may warrant further investigation — such as blood tests or imaging — before any manual therapy is considered.

Practical tips for parents

Regardless of whether you seek professional care, there are some practical things that may help:

• School bag weight — aim for no more than 10–15% of the child's body weight, worn on both shoulders
• Screen breaks — encourage regular breaks from devices and desk work, ideally every 30 minutes
• Regular movement — any form of physical activity the child enjoys is beneficial. It does not need to be structured sport
• Sleep — adequate sleep supports musculoskeletal recovery, particularly during growth phases