Backpack Misuse and the Pain it Inflicts on our Children
Backpacks are a common site in today’s schools. Almost every child seems to carry one in some form or another. And there is ample evidence to link backpack misuse or overloading to the back pain more and more children are reporting.
Recent studies have reported that up to 64% of children suffer from back pain (Negrini, 1999). That number may be alarming, but it does not really matter. What matters is if your child is one of them.
1. Studies from John Hopkins Children Center and many other places have shown that backpacks cause back and shoulder pain and poor posture in children. Here are the numbers:
2. The average student has a visual analog pain scale ( refer Fig.1 ) level of 4.3 with some reaching an 8-9, as reported by Northeastern University in June of 2001.
3. From a survey by the American Academy of Orthopedics: 71% of doctors feel backpacks are a clinical problem, 58% see patients with pain related to backpacks, and 52% think that this is a serious problem.
4. 55% of students carry an overloaded backpack, as reported by Simmons College in February of 2001.
5. 3,300 children aged 5-14 were treated in emergency rooms in 1997 for backpack related injuries according to the Consumer Product Safety Commission.
6. An Auburn University study showed that 67% of children suffered muscle soreness, 51% back pain, 24% numbness and 15% shoulder pain.
7. 65% of adolescents’ doctor visits are due to backpack injuries as reported by National Public Radio in October of 1998.
Get a Visual Pain Scale
Backpacks are a common site in today’s schools. Almost every child seems to carry one in some form or another. And there is ample evidence to link backpack misuse or overloading to the back pain more and more children are reporting.
Recent studies have reported that up to 64% of children suffer from back pain (Negrini, 1999). That number may be alarming, but it does not really matter. What matters is if your child is one of them.
1. Studies from John Hopkins Children Center and many other places have shown that backpacks cause back and shoulder pain and poor posture in children. Here are the numbers:
2. The average student has a visual analog pain scale ( refer Fig.1 ) level of 4.3 with some reaching an 8-9, as reported by Northeastern University in June of 2001.
3. From a survey by the American Academy of Orthopedics: 71% of doctors feel backpacks are a clinical problem, 58% see patients with pain related to backpacks, and 52% think that this is a serious problem.
4. 55% of students carry an overloaded backpack, as reported by Simmons College in February of 2001.
5. 3,300 children aged 5-14 were treated in emergency rooms in 1997 for backpack related injuries according to the Consumer Product Safety Commission.
6. An Auburn University study showed that 67% of children suffered muscle soreness, 51% back pain, 24% numbness and 15% shoulder pain.
7. 65% of adolescents’ doctor visits are due to backpack injuries as reported by National Public Radio in October of 1998.
Get a Visual Pain Scale
Fig. 1:1 Visual Pain ( Chris Adams )
Tracking your pain is a helpful diagnostic tool when dealing with repetitive stress injuries. A visual analog pain scale like this lets you bypass the cognitive level of your brain and give a truer representation of your pain. Print out a number of copies and start a file to track your pain level over time.
Track Your Problem Tasks
Fig. 1:2 Visual Pain Note 1 ( Chris Adams )
Keep a file on your pain near the work site for every problem task you have identified as a potential cause for your injury. Pull it out and record your pain every time you perform that task no matter how long it is for.
Date & Time Stamp
Fig. 1:3 Visual Pain Scale Note 2 ( Chris Adams )
Note the date and the start time of your task.
Mark Your Setting Pain
Fig. 1:4 Visual Pain Scale Note 2 ( Chris Adams )
Indicate your pain level on the colored bar of the chart. Go with your instinct. Just point and mark. The color bar helps bypass your higher brain functions and lets you respond with a truer understanding of your pain. Use an “S” or some other symbol to denote the starting pain level.
Mark Your Ending Pain
Fig. 1:5 Visual Pain Scale Note 2 ( Chris Adams )
Indicate your pain at the end of the task. Use an "E" or some other symbol to denote it. Mark the time you stopped your task.
What to do Now?
You now have all the information you need to track your pain over time and duration, as well as the tools needed to determine which tasks are the real culprits.
If you break up your day into discrete tasks, that is tasks that have a definitive start and finish, and track your pain over those tasks you will be able to identify which ones help, hurt, or do nothing. If your pain decreases over the task it is probably helping your injuries. Do it more often.
If it increases it is a candidate for a cause of your injury, especially if the pain increases dramatically. If it is only a slight increase it might just be the normal fatigue incurred as the day goes on. Try varying the time of day you perform this task to see if it really more pain.
Tracking the start and end time allows you to see what duration is causing harm. If you do the same task a number of times throughout the day, try varying the duration. You might be able to perform the task comfortably for 15 minutes, but a half hour might be overboard. Knowing this will help you plan your day to properly treat your injury.
If you are getting treatment from a health care professional show them your file. This will give them a more thorough history of your problem. Many doctors or chiropractors will actually use a visual analog pain scale during your office visit to get a better understanding of your current pain. If they don’t you can now educate them on its benefits!
Here are some ways to find an appropriate backpack and the right way to use it.
Features to look for :
Lightweight : we don’t want to carry any more weight than we have to.
Wide Padded Straps : they distribute the load over the shoulders and make things more comfortable.
Padded Back : this makes things more comfy as well. A lumbar support in the padding will also help prevent slouching.
Separate Compartments keeps things neat and organized and keeps the load where you placed it.
Waist Strap : it helps transfer the load to the hips. A strap between the two shoulder straps is a good feature as well as it helps prevent slouching.
Size : the pack should not be larger than the child’s back. Learn how to size the child's back for a backpack ( refer to Fig.2 ). Also consider that the more room in the pack the more stuff will fit in it. That’s a bad thing.
How to Measure a Child’s Back for Backpack
Fig.2:1- Fitting Guide for a Child’s Backpack
2006, Chris Adams, Licensed to About.com
A good ergonomic backpack should be no larger than the child's back. To simplify matters you can take two measurements off of a child's back and use those for the maximum height and width of the backpack.
Find the maximum height by measuring from the shoulder line to the waist line and add two inches. The shoulder line is where the backpack straps will actually rest on the body, about half way between the neck and shoulder joint. The waist line is at the belly button. The backpack should fit two inches below the shoulders and up to four inches below the waist so adding two inches to our measurement will give us that.
The width of the back can be measured at a number of locations. Each with different results. For a backpack we want the core and hip muscles to carry the weight so we want to keep it centered between the shoulder blades. Measure between the ridges of the shoulder blades. An extra inch or two here is acceptable.
Chart for Children’s Backpacks
Fig. 2:2 - A Chart of Average Sizes for Children’s Backpacks
2006, Chris Adams, Licensed to About.com
When you can not measure a child you have to guess. Here is a chart to help improve that guess. These are the maximum heights and widths for the average child of that age. Make adjustments as necessary.
Packing & Wearing
The acceptable load in a backpack is related to the child’s weight. Do not overload. Overloading is the chief culprit in backpack related injuries. The American Physical Therapy Association, American Academy of Orthopedic Surgeons, and the American Chiropractic Association recommend these weight limits:
· A 60 lbs. child can carry a maximum backpack weight of 5 lbs.
· 60-75 lbs. can carry 10 lbs.
· 100 lbs. can carry 15 lbs.
· 125 lbs. can carry 18 lbs.
· 150 lbs. can carry 20 lbs.
· 200 lbs. can carry 25 lbs.
· No one should carry more than 25 lbs. in a backpack.
· Pack only what you need.
· Pack heavier items at the bottom. The goal is to transfer the weight to the hips. A backpack with separate compartments helps keep the load where you place it.
· Pack flat items where they will rest on the back keeping bulky or pointy items away from the back.
· Use both shoulder straps. Always use both shoulder straps.
· Tighten the shoulder straps so that the backpack hangs slightly below the shoulders with no more that 4 inches hanging below the waist line. Note: the waist line is where the belly button is, not the hips.
· Use the waist and chest straps.
· Wear the pack only when necessary.
Other Options
· Keep a second set of heavy text books at home if possible. Or ask the teacher to use handouts instead of textbooks for homework.
· Use separate packs for separate activities. You don’t need to carry athletic or after school gear while in class.
· Try a different style of pack. A saddle bag design that goes over the head with a bag on both the front and back is a good option. Using a rolling back pack is good as well. Just ensure the handle on the roller bag is long enough so that your child does not need to stoop. Do NOT use a shoulder bag. It is all the weight with only half the support.
Reference : Negrini S, Carabalona R and Sibilla P (1999). Back pain as a daily load for school children. The Lancet 354: 1974.
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