# data[].attributes.body
- Sedentary individual
- Had pain for 6 months, thought if it was a tumor it would have progressed more pain over the 6mos.
- Overweight with a poor diet, but average considering most kids his age.
- Pain could be caused by
- Parents both have diabetes; could potentially have diabetic neuropathy therefore causing low back pain could present numbness and tingling (which was not discussed)
- Would want to rule out pancreatic
- Pediatric diabetes is usually type 1, whereas parents have type 2
- Postural creep - a lot of sitting most likely with a poor posture.
- Not very active, therefore poor muscle tone contributing to his back pain.

Recommendations:
- increase movement, activity to improve proprioception of lower back
- biomechanically disadvantaged position, mechanical/postural pain
- limit screen time, opportunity to get him more active, root cause effect kind of approach, would need to replace it with something to see improvements
- Give suggestions for postural improvement
- Suggest involvement in sports/team activities, something that is enjoyable for him
- Suggest a stand up desk for use with screen time
- Get an adjustment, help improve mobilization (would need to have a more detailed diagnosis prior, thorough examination)
- Exercises such as core work
- Simple ROM exercises
- Stretching
- Suggestions for improving diet

# data[].attributes.body
What is the cause of pain?
What recommendations do you have to improve wellness?
Joseph 16yo
Sedentary outside PE and eats junk food
Family history of type 2 diabetes and hypertension
-father previous heart attack
localized low back L3-L4 (4/10 pain scale)

Possible causes:
Posture, leg length inequality, hypo mobility, pars fracture, obesity

Possible pain causes Chiro can address:
Musculoskeletal injury (related to: posture?)
-erector spinae (tight/tender muscles/tissues)
->reciprocally inhibiting core stability

Why worse over past week?
Disc herniation (spinal nerves being impinged)
-would also present with loss of sensation/motor abilities; muscle atrophy
Seated position keeps hips flexed, so if more activity in PE class occurred, could result in worse pain

Was the 4/10 current? What was it before?

Chief Complaint - want to know:
Location
Onset
Chronology (timing)
Quality (what does it feel like - achy, sharp, burny)
Severity
Modifying factors (has anything helped/worsen the pain)
Activities of daily living (how is the pain impacting daily life)
Treatment (has patient sought out treatment before)
*has anything like this happened before

Suggestions:
If there were tight muscles - muscle work
Hips probably tight from being in a sitting position - suggest muscle work, activities to help improve blood flow
Suggest sitting with proper posture while playing video games; sit/stand desk
-sit on an unstable surface (yoga ball)
Suggests different stretches to help loosen muscles
Suggest exercises that focus on core/glute

# data[].attributes.body
Although the below factors are likely factors, it might be beneficial to treat the patient as an acute case and not jump to nutritional issues immediately to avoid alienation in compliance.

Mechanical LBP - stemming from low physical activity and carrying excess weight
Congenital Effects - Poor health of parents with type 2 and father with a heart attack

Postural Relief: 1 time every 30 minutes hold a postural awareness for 30 seconds-1 minute.
Stabilization Tracks - side bridge, plank, etc.

Nutrient Deficiency - stemming from poor diet

# data[].attributes.body
1) Possibly tight hip flexors due to long periods of sitting and lack of movement. When he stands they remain tight causing his lumbar spine to overextend.

2) congenital illnesses such as tumors,

3) changes in his life when he started to notice low back pain. (changing his chair, level of activity, etc)

4) Ask the child about what type of pain it is. and if it radiates anywhere (goes into his lower extremities or upper)

5) Spinal compression due to extended periods of sitting

6) Look into the type of shoes he is wearing and leg length. Look at how he stands

Recommendations
1) Proper nutrition for the whole family, avoid processed food, take-in more whole foods. More veggies. Dont go cold turkey but substitute things out such as the fries for veggies fries.

2) Reduce caffeinated drinks = effect bone mineral density. lack of dairy products. Can alter sleep, especially if its right before bed.

3) Increase water intake

# data[].attributes.body
Potential Causes of pain:
-lack of exercise
-diet
-more weight on his anterior side of his body
-posture from sitting on the couch & not having proper support
-increase in obesity & screen time

How would the patient respond to advice:
-most likely poorly since he will have to engage in large lifestyle changes
-will be difficult for him since his parents are most likely uneducated about proper nutrition & healthy daily habits (history of diabetes)

Advice:
-educating his parents on easily healthy swaps that they can incorporate in a simple way
-mental health counseling--potential behavior concerns (increased time on social media/technology)
-developing a friend connection with the patient

Important details:
-severity & intensity of pain
-parent communication (more stern with parents) but more positive with the teenager
-life style choices
-guiding the parents towards the right resources (within their budget & capabilities)

# data[].attributes.body
1. Please select one person in your mentoring group to document your ideas. You may screen share if you'd like.
2. Please title your post by your Mentor's last name.
3. Document your group discussion about the cause of lower back pain in a teenager.
4. Document your group discussion about recommendations you can make to improve wellness in a teenager.

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