Are we dooming our children to a lifetime of back pain?
Normally we associate an elderly person with a profile including rounded shoulders, a kyphotic (hunched) back and a forward jutting head shuffling in short strides as they walk, but these same body mechanics are seen in our children.
Poor postures during school hours, heavy backpacks, and sedentary lifestyles, including decreased play and physical education time and increased computer and gaming time, are encouraging poor posture and back pain that is usually associated with growing old.
The average child spends more than seven hours a day in school almost exclusively sitting.
Sitting in a seat that was designed more for its care than the care of its occupant.
According to physical therapist Marilyn Miller von Foerster (2002), sitting in bucket type seats requires the occupant to adopt a forward head, kyphotic posture with a posterior pelvic tilt that requires exaggeration when the child reads or writes.
She also adds that the hamstrings and hip flexors which are important to proper body alignment and mechanics are shortened while sitting in the seats.
Frequent stretching and movement should be encouraged to combat such a detrimental position, though individual class time is increasing and time between classes is minimal, allowing only enough time to sling on a heavy back pack and run to the next class.
Heavy backpacks also encourage poor posture, growth and development.
During middle school years, a time period when the spine is developing most rapidly, backpacks increase in weight.
Children fill their bags with not only textbooks, binders and folders, but also with their lunch, clothing, electronic devices, personal hygiene items, make up bags and small band instruments (Forjuoh, Little, Schuchmann & Lane, 2003).
While doctor’s offices and emergency rooms are frequented more than 10,000 times a year for backpack related injuries, 96% of parents admit to never checking their child’s backpack weight (Forjuoh, Little, Schuchmann & Lane, 2003). Although the American Chiropractic Association (ACA), American Physical Therapy Association, and the American Academy of Orthopedic Surgeons recommend a maximum backpack load of 10-15% of a child or adolescent’s body weight, it is believed that approximately 55% of students carry heavier loads (Moore, White & Moore, 2007).
While most chronic pain associated with backpack usage is located in the lumbar, or low back region, acute orthopedic injury due to chronic heavy loads is experienced more frequently in the upper back and shoulder area, an area built more slightly and not accustomed to the chronic heavy load that the pelvis is used to bearing.
In addition to the rounded shoulders and forward pitched head of a two strap back pack carrier, an over the shoulder one strap bag causes a compensatory curvature of the spine and shoulder elevation as well, which further damages posture, adding insult to injury.
Not only is the recommendation of a 10-15% body weight load considered the current standard, but other suggestions for backpack usage are as well.
Using a two strapped bag with padding on the straps and on the body facing side of the backpack are examples. Placing the items neatly with the heaviest on the bottom and having the backpack hang no more than two inches below the shoulder and four inches below the waist, are also helpful tips.
Chest and abdomen clips also help to distribute weight more evenly. With backpack donned children’s hands free, they often find it inconvenient to remove the bag and often carry it for longer periods of time than actually needed. Encourage removal of the bag when it is not necessary.
Emphasizing the importance of backpack’s effects on development, the ACA “passed a resolution urging schools across the country to put textbooks on CD-ROM- so children won’t need to lug heavy books in their backpacks” (“Watch Those Backpacks”, 2003, p.31).
Once the children finally reach home and dismount their heavy load, they often head to the couch to succumb to its shape while watching TV or playing a video game, rounding out the spine for most of the remainder of the day.
Extended walking or playing to appropriately move joints, decrease muscle strain and help to correct the day’s damage, never occurs. This daily abuse compounds, causing pain, and poor spine and posture development, leading to a lifetime of back pain.
Schools, responsible for the majority of our children’s waking hours, should take some responsibility for their contribution to the problem.
Not allowing backpacks in their first two classes, encouraging use of lockers with school and home versions of books, and allowing rolling backpacks have been suggested.
Enlisting “weigh-ins” in content appropriate classes (i.e. math class) and encouraging only school related contents in the bag, as these items often account for 10-30% of backpack weight, can also make a difference (Moore, White & Moore, 2007).
Spreading awareness throughout the year can start with National School Backpack Awareness Day, which occurs on the third Wednesday of September and encourages people of all ages to “Lighten up: pack it light, wear it right”.
Educating our children and their parents, drawing attention to these issues now, we may decrease disability, pain, and use of health care resources in the future.
Forjuoh, S.N., Little, D., Schuchmann, J.A. & Lane, B.L. (2003). Parental knowledge of school backpack weight and contents. Archives of Disease in Childhood, 88(1), 18-20.
Moore, M.J., White, G.L. & Moore, D.L. (2007). Association of relative backpack weight with reported pain, pain sites, medical utilization, and lost school time in children and adolescents. The Journal of School Health, (77) 5, 232-239.
Von Foerster, M. M. (2002). Our kids, backpacks, and the back epidemic. Orthopaedic Practice, (15) 3, 34-39.
Watch those backpacks. (2003). International School Health Network 37 (11), 31.