Schools are back in session. Students are groaning and parents are rejoicing as schools reopen for another year of helpful instruction. Education is the single most important thing a young person must accomplish, for the lack of it leads to economic slavery.
Aspects of my practice are seasonal and predictable. One of the things I look for at this time of year is for a young person to be brought to the clinic with thoracic spine and shoulder pain within the first two months of classes. These are not athletes as a rule, and we did not see these injuries in such numbers until the last few years. What's happening?
Some schools have removed lockers. In fact, my wife and I found a school locker in an antique store this past weekend. Perhaps there is a concern in current sociocultural environment that students will conceal illicit substances or weapons on campus. There is certainly precedent for that concern. Whatever the reason, the absence of lockers means that students have to carry their books from class to class and back and forth from school to home (assuming, of course, that they are studying!). Many students will be carrying their books on their backs in backpacks.
Dr. Scott Bautch, a colleague of mine from the American Chiropractic Association, recently quoted a study that was done in Italy on this topic. The authors of this study found that the average student is carrying the equivalent of a 39 pound weight for the average adult man, or a 29 pound weight for the average adult woman. This changes the curves in the spine, resulting in back pain complaints for 60% of the children in this study. A French study done as a follow-up notes that the longer the children carry these backpacks, the longer it takes for the natural spinal curves to recover.
In my practice, I find that complaints among children are red flags and should be investigated. Sometimes it is related to the weight they are carrying in school. Other times I find that there are congenital issues in the spine or scoliosis. I do not x-ray children or teenagers unless the risk:benefit ratio favors it, but when I see evidence of scoliosis or signs of a congenital defect in the skeleton, I will do so in consultation with the parents. With a thorough history and physical exam, and imaging when it is necessary, we can typically find the reason for back pain in children and teenagers.
Meanwhile, what can we do when the schools have removed lockers, forcing the children to carry their books? Here are some tips that might help to cope with the problem.
First, the backpack should not weigh more than 10% of the body weight of the carrier. Ladies, this applies as well! A backpack that is heavier will change the curve of the thoracic spine unfavorably and cause muscle strain. See how much your child weighs and do the math.
A backpack should not hang more than 4 inches below the waist. If it hangs lower than that, there is a natural tendency to lean forward while walking, adding additional strain to the back. You can think of this adaptation as just the opposite of what happens with pregnancy, in which the weight is in front of the body and the woman leans backward accommodate it.
Look for a backpack that has individual compartments so that sharp, pointy objects can be located away from your child's back. Heavy books should also be placed so that they do not rub on the child back as he or she walks. Bigger is not better in this case, as a larger backpack invites more cargo.
Take a look at how your child wears the backpack. Urge them to use both shoulder straps because an asymmetric load will be harmful to the back and shoulders. Shoulder straps should be padded for comfort. Look also at the width of the straps. Wider straps distribute the weight of the backpack over a larger area, making it easier to carry. I experienced this as I play some of my electric guitars that can get heavy after a few hours of playing, and a wide guitar strap makes a big difference.
If your child must carry significant amounts of weight, a rolling pack is ideal. This offloads the spine as the weight is carried on wheels like the carry-on bag I take on the airplane when I travel. Unfortunately, many schools disallow these rolling bags because some administrators feel that these bags clog the traffic in the hallways. If you have an 80 pound child who is carrying 30 pounds of books, however, you should have a strong case for appeal of this policy.
If your child is having back pain, it is a red flag and should be checked out. I am here to help you if you need it.
Robert Hayden, DC, PhD, FICC