A new nationwide Danish registry study involving nearly 50,000 children and adolescents shows that non-specific back diagnoses dominate in the hospital sector, particularly among school-aged children and adolescents.
The findings support a central role for primary care and may have implications for how chiropractors assess and manage back pain in children and young people.
The new study reinforces three important clinical messages:
- Most cases of back pain in children over the age of four are non-specific.
- Young children with back pain should be assessed with particular attention to specific pathology and red flags.
- Parental pain history and healthcare-seeking behaviour may be relevant factors in the overall assessment.
The study provides important evidence that non-specific back pain is the predominant issue among children and adolescents. At the same time, it supports the important role of chiropractors and other primary care practitioners in the assessment, guidance, and conservative management of this patient group.
63% Receive a Non-Specific Back Diagnosis
The researchers analysed all hospital-registered back diagnoses among Danish children and adolescents aged 0-17 years between 2007 and 2022. They found that 63% received a non-specific back diagnosis, while 37% received a specific diagnosis such as scoliosis, disc-related disorders, radiculopathy, or inflammatory conditions.
This finding confirms what many chiropractors observe in clinical practice: the vast majority of children and adolescents with back pain do not have an identifiable structural cause for their symptoms.
Age Is the Most Important Factor
The study shows that the likelihood of receiving a specific diagnosis is substantially higher among the youngest children (0-4 years). Beyond this age group, there is a clear shift towards non-specific diagnoses, which become predominant among both school-aged children and adolescents.
For chiropractors, the message is clear: back pain in very young children requires special attention to possible underlying pathology, whereas back pain in older children and adolescents should most often be understood and managed as a non-specific musculoskeletal condition.
There are certain diagnoses in children and adolescents that chiropractors should be particularly aware of, including conditions such as Scheuermann’s disease, spondylolysis, disc degeneration, and other pathologies that may occur in younger patients but are less common in adults. As a result, these conditions require a different level of attention and may carry different clinical implications than they do in adult populations. Therefore, triage should always be the chiropractor’s starting point, especially when assessing children and adolescents.
Family History Matters
Children whose parents had previously received a hospital-registered back diagnosis were more likely to receive a non-specific back diagnosis themselves. The researchers suggest that factors such as pain beliefs, healthcare-seeking behaviour, parental concerns, and possibly genetic influences may contribute to this pattern.
This finding highlights the importance of considering both the family perspective and the broader biopsychosocial context when assessing children with back pain.
Supports Management in Primary Care
The authors of the study note that the high proportion of non-specific diagnoses raises the question of whether many of these patients could be managed more appropriately in primary care rather than in hospital settings.
For chiropractors, this is an important perspective. Once serious pathology has been ruled out, the findings suggest that assessment, patient education, physical activity, exercise, and conservative treatment should remain key components in the management of children and adolescents with back pain.
Freja Gomez Overgaard, Casper Nim & Laura Montgomery. Specific versus non-specific hospital-based spine diagnoses in children and adolescents: a nationwide register-based cohort study. Chiropractic & Manual Therapies 2026.
Vil du vide mere?