I opened my Twitter feed one morning last week to one of these sensationalist, scare mongering headlines; the type that health professionals trying to help people overcome pain absolutely loathe. It was an article warning of the long term dangers of school going children carrying heavy school bags and how 1/3 of parents thought their bags were too heavy. It is time people start realising the effect such articles have on people’s perception of pain. In fact the long term implications of being misinformed are likely doing much more lasting damage than the aforementioned heavy school bags themselves.
There are various studies that talk about the optimal weight of the schoolbags based on a percentage of the childs weight. The figures on this vary from 7% to 18%. But to throw those figures into disarray there is now more and more evidence mounting suggesting absolutely no link between school bag weight and back pain and certainly no risk of long term effects from carrying school bags. In fact it may even be the opposite. A study where after an adaptation period, those children carrying a bag a whopping 40% of their body weight actually had decreased risk of experiencing back pain than those carrying a bag less than 7%. Why might this be? Well if we think of anyone starting out an unfamiliar activity like the January joggers and gym goers: it is difficult to begin with but the body adapts and becomes more robust and used to the task. These children carrying the heavier bags were simply strengthening their backs.
Yet children are not exempt from back pain. But is it fair to point the finger at the school bag, which I do not doubt is heavy by the way. Could something else be triggering their problem? Is the child overweight or unfit? We know that children who spend more time playing video games and watching telly are 70% more likely to experience back pain. Also children undergoing growth spurts (>5cm over a 6 month period) are 3 times more likely to complain of back pain. Sleep too plays a big role. But another, and for me more frightening, statistic from last week was that ¼ of children are experiencing anxiety. Children? Anxiety? Yes, so it would appear our stressful lives are having an impact on our children and to bring this back to the topic at hand anxiety has been shown to be another risk factor for back pain in kids.
So what is the solution? Ipads are being trialed, with some practical success certainly but have they eradicated low back pain? Much like when the nursing profession introduced manual handling procedures and the use of hoists. Did the incidence of low back pain vanish? Not from what I see in practice. Because lifting is something we need to be able to do. Alienate yourself from it and you run the risk of hurting yourself more on that occasion you do need to lift. I once hurt myself putting on my socks. Another time sneezing. Should I stop doing these things? By not having children lift and carry school bags we are not doing them any favours. One of the biggest obstacles I see with patients in overcoming low back pain is fear; fear of the movement they perceive (and possibly did) caused their pain and the development of fear avoidance behaviour. And this fear can last long after the painful episode is over. Citing school bags as the cause of back pain is setting children up for a lifetime of avoiding lifting and bending. Children do not inherit back pain, much to many peoples surprise, but rightly or wrongly they do inherit our behaviours and beliefs.
I do not have an immediate solution to the bag problem. Firstly a multi-disciplinary approach between the parent, teacher and child needs to happen. Checking the child’s school bag for unnecessary items (like pottery and a collection of half empty water bottles – this really happens) might be a good place to start. I know from speaking with teachers that a lot of homework now consists of workbooks where they do not need to be hauling home all their books. If there is an option to lower the weight of the school bag then let’s do it! Certainly if it means the difference between a child walking to school or not then lets encourage that. But I would encourage parents to look at some additional factors that may be contributing to their childs’ back pain other than the school bag. We need more information about the reality of back pain. Dr. Mary O’Keefe is one who is passionate about this and is being seen more and more in mainstream media speaking about a lot of the myths surrounding the topic. My message is simple: Do not set our children up for a life time of avoiding activities that WE perceived would cause them pain.
For more information on any of the issues addressed throughout this article please contact Rob via email at firstname.lastname@example.org, Twitter @mccabephysio, Facebook at McCabe Physiotherapy or visit http://www.mccabephysiotherapy.com
Rob McCabe MISCP
MSc (pre reg) Physiotherapy, BSc Sport Science and Health, MSc Sports Physiotherapy, PG Dip Orthopaedic Medicine
Orchard House, Moorefield Rd, Newbridge, Co. Kildare