In recent years there have been growing concerns over the prevalence of lower back pain (LBP) in children. Of particular concern to parents, teachers and medical professionals are the overloaded backpacks and excessive screen time habits that may play a role in the development of childhood and adolescent LBP. LBP is typically considered a disease pertaining to adult and elderly populations, however 40% of children and adolescents will experience LBP before turning eighteen (1). In addition to the range of serious lifestyle complications that childhood and adolescent LBP can lead to, the condition has an annual cost of $19.6 billion in the US (1). Girls past the onset of puberty are among the adolescents most likely to report experiencing LBP, however the condition appears to develop in a wide variety of children and adolescents (2). While the risk factors for LBP in children and adolescents are not completely clear, researchers have found that early education and intervention programs are useful in preventing and managing childhood and adolescent LBP.

Parents and teachers around the world have repeatedly raised concerns about children carrying an exorbitant amount of weight in their backpacks and whether that leads to the development of chronic back pain (3). While there is no universally accepted guideline for backpack weight, most medical professionals recommend that a child’s backpack not exceed 10% of their body weight (3). Seventy percent of orthopaedic surgeons in the American Academy of Orthopaedic Surgeons believe that children’s backpacks are currently too heavy and likely contribute to the development of childhood and adolescent back pain (4). A study found that when a child’s backpack exceeds 15% of their body weight, they exhibit increased breathing frequency, shortened stride and increased stride frequency (4). Additionally, postural changes are likely to occur with an overly heavy backpack, including leaning forward while walking or misalignment of the spine when carrying the backpack asymmetrically (4, 5). In contrast to these findings, is the fact that periodic loading of children’s spines contributes to proper locomotive system development (4). Furthermore, while children’s backpacks may anecdotally lead to back pain, there is no explicit evidence linking overweight backpacks to either childhood or adult chronic LBP (4, 3). These studies together suggest that parents and teachers should minimize backpack weight to below 10% of body weight when possible, without worrying excessively that heavy childhood backpacks are permanently damaging children’s backs.

Another commonly cited contributor to LBP in children and adolescents is the damage inflicted when children spend excessive hours in front of electronic screens. The increasingly concerning trend for children to spend their days predominantly in front of electronic screens is highlighted by the fact that the most recent version of the Diagnostic and Statistical Manual of Mental Disorders now includes screen addiction-related disorders that are primarily observed in children (6). Good body posture necessitates maintaining body symmetry, a requirement that few children meet when spending hours in front of electronic screens (7). Studies have found that when viewing screens, children often sit in static postures that may lead to postural changes in the spine (7). Studies in young adults have found a link between sustained, slouched sitting posture and chronic back pain (8), lending support to the theory that excessive time spent on electronic devices may be damaging to the back health of children and adolescents. Given that the COVID-19 pandemic has left many students receiving their education via electronic devices as opposed to in classrooms, finding ways to manage childhood and adolescent LBP that results from poor posture is increasingly pressing.

Instead of waiting for childhood and adolescent LBP to manifest, some researchers have found success with preventative back health education programs early in childhood. Beyond preventing immediate back injury, these programs may have positive long-term effects that can prevent LBP in adolescence and even into adulthood. After completing a postural hygiene program as 3rd and 4th graders, four years later these children were less likely to require medical treatment for LBP (9). These results suggest that a key strategy to preventing childhood and adolescent LBP may be to implement early education programs that prevent LBP from developing in the first place.

Individuals who experience LBP in childhood or adolescence are more likely to suffer from LBP as an adult, highlighting the importance of treating and managing the symptoms of childhood and adolescent LBP (2). Physical therapy (PT) treatment for childhood and adolescent LBP is highly effective for reducing pain intensity (10). Specifically the combination of physical therapy conditioning and manual therapy has been found via meta-analysis to be the most effective PT regimen for treating LBP in children (10). Young people undergoing PT are particularly inspired by their ability to assume greater responsibility for their treatment and bring about positive change in their bodies (2). The process of PT helps young people feel more engaged in the process of managing their pain, a particularly important attitude for individuals to have if they are going to be managing chronic LBP throughout childhood/adolescence and into adulthood (2). Esurgi has developed the Biostabilizer, a pressure biofeedback unit (PBU) that increases patients’ ability to feel engaged with a customized PT process. PBUs have demonstrated previous success in both treating the adolescent population and correcting postural issues (11, 12). These previous successes indicate that using a PBU to treat posture-related LBP in children and adolescents would likely be a helpful addition to the PT regimen. Would you find the Biostabilizer a helpful tool to use with young people suffering from LBP?

Sources

1. Kamper, S. J., Yamato, T. P., & Williams, C. M. (2016). The prevalence, risk factors, prognosis and treatment for back pain in children and adolescents: An overview of systematic reviews. Best Practice & Research Clinical Rheumatology, 30(6), 1021-1036. doi:10.1016/j.berh.2017.04.003 

2. Ahlqwist, A., & Sällfors, C. (2012). Experiences of low back pain in adolescents in relation to physiotherapy intervention. International Journal of Qualitative Studies on Health and Well-being, 7(1), 15471. doi:10.3402/qhw.v7i0.15471

3. Lindstrom-Hazel, D. (2009). The backpack problem is evident but the solution is less obvious. Work, 32(3), 329-338. doi:10.3233/wor-2009-0831

4. Reneman, M. F., Poels, B. J., Geertzen, J. H., & Dijkstra, P. U. (2006). Back pain and backpacks in children: Biomedical or biopsychosocial model? Disability and Rehabilitation, 28(20), 1293-1297. doi:10.1080/09638280600554785 

5. Negrini, S., & Negrini, A. (2007). Postural effects of symmetrical and asymmetrical loads on the spines of schoolchildren. Scoliosis, 2(1). doi:10.1186/1748-7161-2-8

6. Domoff, S. E., Harrison, K., Gearhardt, A. N., Gentile, D. A., Lumeng, J. C., & Miller, A. L. (2019). Development and validation of the Problematic Media Use Measure: A parent report measure of screen media “addiction” in children. Psychology of Popular Media Culture, 8(1), 2-11. doi:10.1037/ppm0000163

7. França, E. F., Macedo, M. M., Francisco, F., Mafra, P., Miyake, G. M., da Silva, R. T., … & Junior, N. M. (2020). INFLUENCE OF EXCESSIVE SCREEN TIME ON PHYSICAL ACTIVITY LEVEL, EXCESS WEIGHT AND BACK PAIN IN CHILDHOOD: A LITERATURE REVIEW. doi:10.24327/IJRSR

8. Womersley, L., & May, S. (2006). Sitting Posture of Subjects With Postural Backache. Journal of Manipulative and Physiological Therapeutics, 29(3), 213-218. doi:10.1016/j.jmpt.2006.01.002

9. Méndez, F.J., & Gómez-Conesa, A. (2001). Postural hygiene program to prevent low back pain. Spine, 26(11), 1280-6. doi:10.1097/00007632-200106010-00022.

10. Calvo-Muñoz, I., Gómez-Conesa, A., & Sánchez-Meca, J. (2013). Physical therapy treatments for low back pain in children and adolescents: A meta-analysis. BMC Musculoskeletal Disorders, 14(1). doi:10.1186/1471-2474-14-55

11. Luo, H., Lin, S., Wu, S., Tsai, M., & Lee, S. (2017). Comparison of segmental spinal movement control in adolescents with and without idiopathic scoliosis using modified pressure biofeedback unit. Plos One, 12(7). doi:10.1371/journal.pone.018191512. Kang, D. Y. (2015). Deep cervical flexor training with a pressure biofeedback unit is an effective method for maintaining neck mobility and muscular endurance in college students with forward head posture. Journal of Physical Therapy Science,27(10), 3207-3210. doi:10.1589/jpts.27.3207

12. Kang, D. Y. (2015). Deep cervical flexor training with a pressure biofeedback unit is an effective method for maintaining neck mobility and muscular endurance in college students with forward head posture. Journal of Physical Therapy Science, 27(10), 3207-3210. doi:10.1589/jpts.27.3207

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