Lower back pain in children and teenagers is not a recognized symptom of normal physical growth. The condition people call “growing pains” typically shows up as aching in the legs, not the back, and its peak incidence does not even line up with periods of rapid growth. That said, growing taller does put changing mechanical demands on the spine, and research shows that taller adolescents are more likely to report spinal pain than their shorter peers. So the relationship between growing and back pain is real but more complicated than the folk explanation suggests.
What Growing Pains Actually Are
The term “growing pains” has been in use since the 1800s, but it is something of a misnomer. The condition involves recurrent, aching pain in both legs, usually in the thighs, calves, or behind the knees. It tends to strike in the evening or at night and resolves by morning. It does not cause limping, and it is not triggered by physical activity. The children who get it are typically between three and twelve years old.
The back is not part of the clinical picture. When clinicians evaluate a child for growing pains, the expected finding is bilateral lower-extremity pain with no swelling, no focal tenderness, and no joint abnormalities. If the pain is in the spine, or if it is one-sided, persistent during the day, or accompanied by other symptoms, a different explanation should be considered.1PubMed Central. Growing Pains
Perhaps the most telling detail is timing. If growing pains were truly caused by the skeleton elongating, you would expect them to peak during the fastest growth spurts, around infancy and again during puberty. Instead, they are most common in children well before puberty, during a period when growth velocity is relatively slow. The cause remains unclear, but the evidence does not support the idea that the pain comes from bones getting longer.
Being Tall Does Seem to Matter for Spinal Pain
Even though “growing” itself is not the culprit, the body changes that come with getting taller do appear to influence back pain risk. A large cohort study using data from the Danish National Birth Cohort tracked children’s height at ages seven, eleven, and eighteen and compared it to their reports of spinal pain. Among girls, being in the tallest group at age eleven was associated with roughly a 26% higher likelihood of severe spinal pain in pre-adolescence compared to girls of normal height. The same pattern held for spinal pain in late adolescence. Among boys, the association was weaker in pre-adolescence but emerged clearly by late adolescence, with tall boys at age eighteen showing about a 24% higher likelihood of spinal pain.2PubMed Central. Body height and spinal pain in adolescence: a cohort study from the Danish National Birth Cohort
The researchers also found hints of a dose-response pattern for boys: the taller the adolescent, the greater the risk. This fits with what you would expect from basic biomechanics. A longer spine means longer lever arms, more compressive load on the lower vertebrae, and more surface area exposed to mechanical stress during activities like sitting, bending, and carrying loads. None of that is “growing pains” in the traditional sense, but it does mean that the process of becoming taller can set the stage for back discomfort.
Why the Adolescent Spine Is Vulnerable
The teenage years are an unusual period for the spine. Vertebrae are still ossifying, growth plates at the top and bottom of each vertebral body are actively producing new bone, and the surrounding muscles and ligaments are trying to keep pace with skeletal changes that can be surprisingly fast. This creates a window of vulnerability that adults do not face.
Humans are also the only species that walks fully upright, and that upright posture concentrates shear forces on the lower lumbar vertebrae. During the adolescent growth spurt, these forces intensify because the spine is lengthening while the stabilizing structures are still maturing. The result is a high incidence of stress-related problems in the posterior elements of the lumbar spine, particularly the pars interarticularis, the thin bridge of bone that connects the facet joints.3PubMed Central. Lower back pain
This vulnerability does not mean every teenager with back pain has a structural problem. But it does mean that back pain during the growth years should not be dismissed as just “growing.” The spine is going through a genuinely stressful phase, and several specific conditions can develop during this window.
Structural Spine Conditions That Show Up During Growth
A handful of conditions are closely linked to spinal growth and can present as lower back pain in young people. They are worth knowing about, because the symptoms can be subtle and the window for effective treatment is often during adolescence itself.
- Spondylolysis: A stress fracture of the pars interarticularis, most common in adolescent athletes who do repetitive extension and rotation, like gymnasts, dancers, and football players. It can progress from a stress reaction to a full fracture and, in some cases, to spondylolisthesis, where one vertebra slips forward on the one below it. Females appear to be at particular risk.4PubMed Central. The pars interarticularis stress reaction, spondylolysis, and spondylolisthesis progression
- Scheuermann’s disease: A rigid, progressive rounding of the upper or mid-back that develops during late childhood or adolescence. It affects up to 8% of adolescents and is considered the most common cause of excessive forward curvature of the spine in that age group. The underlying problem is defective growth of the vertebral end plates, possibly from excessive mechanical stress on weakened bone during the growth spurt. Back pain is a common accompanying symptom.5PubMed. Scheuermann’s Disease 6PubMed Central. The Natural History of Scheuermann’s Kyphosis
- Adolescent disc herniation: Rare compared to adults, but it does happen. Risk factors include genetics, trauma, congenital spine abnormalities, and repetitive sports loading. A distinguishing feature in teens is that nearly 90% will have a positive straight-leg-raising test, and imaging often reveals a fracture of the posterior apophyseal ring, which is a growth-plate related finding specific to young spines.7PubMed Central. Adolescent lumbar disc herniation: etiology, diagnosis, and treatment options
All three of these conditions are directly tied to the growing skeleton. But they are not “growing pains.” They are distinct clinical diagnoses with specific management approaches. The common thread is that the growth process creates a biomechanical context where these problems can develop, especially under repeated physical stress.
The Everyday Causes Parents Overlook
Most adolescent back pain is not caused by a structural condition. It falls into the category of “non-specific” low back pain, meaning there is no fracture, herniation, or deformity driving it. The causes are often surprisingly mundane, and several of them are modifiable.
Heavy backpacks are a well-documented contributor. In a national study of children aged eight to thirteen, more than 70% carried schoolbags that exceeded the recommended limit of 10% of body weight. About a third of the children reported back pain, and after adjusting for other factors, the weight of the bag relative to the child was independently linked to that pain.8PubMed Central. Schoolbags and back pain in children between 8 and 13 years: a national study A separate systematic review confirmed a positive relationship between backpack use and musculoskeletal pain in adolescents, with girls reporting higher rates of pain and injury than boys.9PubMed Central. Backpack improper use causes musculoskeletal injuries in adolescents: a systematic review
Screen time is another increasingly relevant factor. A meta-analysis covering nearly 58,000 children and adolescents found that daily computer use, mobile phone use, and television watching were each independently associated with a higher risk of low back pain. The relationship with computer use was linear: each additional hour of daily use raised the risk by about 8%.10PubMed Central. Dose-response relationship between daily screen time and the risk of low back pain among children and adolescents: a meta-analysis of 57831 participants A separate review of Brazilian studies found the clearest risk associations in adolescents spending three or more hours per day on screens.11PubMed Central. Screen time and low back pain in children and adolescents: a systematic review of Brazilian studies
School furniture also deserves mention. A study of adolescents in Saudi Arabia found that between 75% and 94% of students were sitting at desks and chairs that did not match their body dimensions. About 11% reported back pain specifically related to prolonged sitting at school, and a mismatch between seat depth and the student’s leg length was a significant risk factor.12PubMed Central. Classroom Furniture Mismatch and Back Pain Among Adolescent School-Children in Abha City, Southwestern Saudi Arabia This makes intuitive sense: a teenager going through a growth spurt may suddenly be too tall for furniture that fit them six months earlier.
Sleep, Stress, and the Psychological Connection
Back pain in teenagers is not purely a mechanical story. Psychological and social factors play a role that is easy to underestimate. A study of adolescents found that the frequency of psychological and social difficulties was significantly higher among those reporting spinal pain, and that as the burden of those difficulties increased, the odds of both occasional and substantial spinal pain went up.13PubMed. The association between psychological and social factors and spinal pain in adolescents
Sleep quality appears to be an important mediating factor. A large international study using data from 2002 to 2018 found that the prevalence of chronic back pain in adolescents increased over that period, and that the rise was significantly linked to increasing sleep difficulties and psychological symptoms. The pathway worked like a chain: poor sleep predicted more psychological distress, which in turn predicted more chronic back pain. This pattern held across both boys and girls at ages thirteen and fifteen.14The Journal of Pain. Increases in Sleep Difficulties and Psychological Symptoms are Associated With the Increase of Chronic Back Pain in Adolescents: The HBSC Study 2002 to 2018
For parents, this is worth considering. A teenager who is sleeping poorly, feeling stressed or anxious, and spending hours hunched over a phone is hitting several back-pain risk factors simultaneously. The pain is real, not imagined, but the contributors may be lifestyle-related rather than structural.
Vitamin D and Bone Health
Vitamin D levels have attracted research attention in the context of pediatric back pain. A cross-sectional study of schoolchildren found that those with more severe low back pain had lower levels of vitamin D and calcium compared to pain-free children.15PubMed Central. Mechanical factors and vitamin D deficiency in schoolchildren with low back pain: biochemical and cross-sectional survey analysis That is an intriguing finding, because vitamin D is essential for bone mineralization, and a growing spine needs adequate bone density to handle the loads placed on it.
However, the evidence for vitamin D as an independent risk factor for back pain is mixed. A pediatric bone health review noted that while low vitamin D levels have been found in children with non-specific low back pain, multiple studies have produced conflicting results on whether deficiency actually causes the pain or just happens to coexist with it. There is also no strong evidence that supplementation alone resolves back pain. That said, correcting a deficiency in a child who already has back pain is low-risk and could provide a benefit, so many clinicians consider it reasonable.16Journal of the Pediatric Orthopaedic Society of North America. Pediatric Bone Health Update Spine health: Back pain and deformity progression
When to Take a Child’s Back Pain Seriously
One of the trickiest aspects of adolescent back pain is knowing when to worry. Most cases are non-specific and resolve on their own or with simple changes. But pediatric back pain can sometimes signal conditions that need medical attention, and younger children warrant a lower threshold for investigation. In children under three, low back pain is considered an alarming sign that should prompt evaluation for more serious underlying problems.17PubMed Central. Low back pain in children and adolescents: an algorithmic clinical approach
For older children and teenagers, features that should prompt a visit to the doctor include pain that wakes the child at night, pain that lasts more than a few weeks, pain that radiates into the legs, pain accompanied by fever or weight loss, and any weakness or numbness. A limp or a noticeable change in posture also warrants evaluation.
Imaging is sometimes needed, but guidelines emphasize using it judiciously. An expert panel review noted that excessive use of advanced imaging like MRI and CT in children can lead to unnecessary costs and additional patient risk without improving outcomes.18PubMed. Imaging in Pediatric Low Back Pain: AJR Expert Panel Narrative Review Plain X-rays are often the appropriate first step when imaging is indicated, with MRI reserved for cases where the clinical picture suggests something more complex. Newer techniques like zero-echo-time bone MRI are being explored as a way to detect stress fractures without radiation, though they are still considered a supplement rather than a replacement for CT in that role.19PubMed. Pars defect detection with 3 T GE ZeroTE bone MRI in children, adolescents and young adults with low back pain: a pilot study of inter-rater reproducibility and CT-linked feasibility
What Helps When a Teenager Has Back Pain
For the majority of adolescent back pain that falls into the non-specific category, physical activity and exercise are the most consistently supported interventions. A systematic review and meta-analysis of twenty studies found that physiotherapy approaches including exercise, postural education, and general physical activity produced meaningful improvements in trunk endurance, posture, flexibility, and pain-related behaviors in children and adolescents. The average age in the studies was about twelve.20PubMed Central. Effectiveness of physiotherapy interventions for back care and the prevention of non-specific low back pain in children and adolescents: a systematic review and meta-analysis
Core stability exercises appear to be especially effective. A study comparing children and adolescents who performed core exercises to a control group found significant reductions in pain intensity and significant increases in trunk muscle endurance in the exercise group.21Studies in Sport Medicine. The Effectiveness of Core Stability Exercises on Reducing Pain and Increasing Trunk Muscle Endurance in Children and Adolescents with Non-Specific Low Back Pain This makes sense in context: if the adolescent spine is vulnerable because supporting muscles have not kept pace with skeletal growth, strengthening those muscles directly addresses the mismatch.
Beyond targeted exercise, practical changes matter. Reducing backpack weight to under 10% of body weight, limiting prolonged sitting, taking breaks from screens, ensuring adequate sleep, and checking that desks and chairs roughly fit the child’s current proportions are all reasonable steps. None of them are dramatic, but the research suggests that back pain in this age group is often driven by an accumulation of small stresses rather than a single dramatic cause.
Adolescent Back Pain and the Risk of Adult Back Pain
One reason not to brush off a teenager’s back pain as “just growing” is the evidence linking adolescent symptoms to adult outcomes. A prospective study tracking young people from ages twelve to twenty-two found that those with persistent low back pain during the previous year had about 3.5 times the odds of still having persistent low back pain eight years later.22PubMed Central. Is comorbidity in adolescence a predictor for adult low back pain? A prospective study of a young population Another study demonstrated a dose-response relationship: the more days a teenager had low back pain during the baseline year, the higher their risk of future pain. Among those who reported more than 30 days of low back pain in the study year, about a quarter also reported more than 30 days of pain in the follow-up year, compared to only 9% of the rest of the sample.23Spine. The Course of Low Back Pain From Adolescence to Adulthood
This does not mean every teenager with an achy back is destined for chronic pain as an adult. Most adolescent back pain is intermittent and resolves. But it does suggest that frequent or persistent pain in the teenage years is a meaningful signal, not a phase to be waited out. Early attention to modifiable risk factors like activity levels, sleep quality, and ergonomic habits could interrupt the pathway before it becomes a longer-term pattern.