Topic 08
Special populations
For growing children, older adults, and pregnant women, the same pain comes with different risks to check and different methods that can be used. This page outlines, as general information, the signs to look for first and the positions and techniques to avoid for each group; confirm an accurate assessment and care plan with a qualified healthcare professional and the relevant specialist.
Do you have these symptoms?
- Growing children: uneven shoulder or hip height, or an asymmetric back when bending forward
- Growing children: a rounded upper back that does not straighten when lifting the chest while lying face down
- Older adults: after a cough or sneeze, or stepping down from a stair or threshold, the back suddenly rounds and keeps hurting
- Older adults: the legs hurt and feel weak when walking, and get better with rest
- Pregnant women: numbness runs from the buttock down the leg
- Pregnant women: fingers feel numb and swollen
Causes and understanding
- Growing children — scoliosis
- Infantile scoliosis usually resolves on its own, but juvenile scoliosis often progresses and needs regular checks. Adolescent scoliosis is the most common, and ages 12–16 carry the highest risk of progression.
- Growing children — rounded back
- It may not be a posture problem but structural kyphosis (Scheuermann's disease), in which the vertebrae become wedge-shaped.
- Older adults — compression fracture
- With osteoporosis, even a minor impact can cause a vertebra to collapse. Many are found without symptoms. Risk factors include being a postmenopausal woman, smoking and drinking, long-term steroid use, and physical inactivity.
- Older adults — spinal stenosis
- Typically the legs hurt when walking and improve with rest. Leaning back makes it worse and bending forward eases it.
- Pregnant women
- Pregnancy is a risk factor for sciatica, and swelling can cause carpal tunnel syndrome. Lying flat on the back requires caution because of pressure on blood vessels.
Assessment from a chiropractic perspective
- Growing childrenAssessment typically looks at shoulder and hip height, the forward bend test, a scoliometer, and lifting the chest while lying face down (flexibility of a rounded back).
- Older adultsRisk factors for compression fracture are usually checked first, along with nerve status before and after walking. Imaging and bone density tests are ordered and interpreted by a physician.
How it's managed
Growing childrenChest and hamstring stretches, strengthening of the muscles between the shoulder blades, and spinal extension exercises are commonly used, and regular posture checks are recommended.
Older adultsAdjusting technique and force to bone density and using low-force instruments is typical. Manual and adjustment techniques are performed by professionals qualified in the relevant country, and whether they are appropriate is decided after assessment. With a compression fracture, it is advisable to avoid heavy lifting and bending exercises for a period of time, and exercise and nutrition are known to be important.
Exercise within a pain-free range, and stop if pain starts.
When to see a doctor first
- Growing children: scoliosis progressing quickly at ages 12–16 → orthopedic (spine) specialist
- Growing children: low back pain in an active child, suspected spinal stress fracture → orthopedic specialist
- Older adults: a suddenly rounded back with ongoing pain after a minor impact → imaging and bone density test
- Older adults: nerve problems after walking, bladder or bowel problems → specialist; in an emergency, go to the emergency room immediately
- Pregnant women: obstetric symptoms such as bleeding, abdominal pain, or contractions → obstetrician-gynecologist
Related columns
Your child's spine: 3 things to check at homeA Parent's Suddenly Rounded Back May Signal a Compression Fracture
Herniated disc vs. spinal stenosis: the symptoms differ when you walkThis article is for general health information. Everyone's condition is different, so an accurate assessment requires consulting a professional.