Concerned parents are all too familiar with the sight of their children slouching off to school under the burden of an overweight school bag. Dr Frances le Roux offers advice on how to avoid resulting long-term posture problems.
The musculoskeletal system of the human body is a very finely tuned piece of mechanical engineering. Every structure has its set place and function and for normal movement all of these structures have to work perfectly together. The skeleton grows continually from birth to 18 years. This means the spinal ligaments and muscles are not fully developed in schoolchildren and overloading of the spine can result in poor posture. This subsequently will lead to wrong curvature of the spine. Specially musculoskeletal problems associated with backpack use have become an increasing concern for not only carrying heavy loads, but also how the bag is loaded, the size, shape and distribution of the load and time spent carrying.There are also growing concerns about the potential side effects of children slumped over computers for prolonged periods of time. Not only will children suffer from poor posture but also from overuse-type injuries at their wrists, shoulders, neck and hands.
SUMMARY OF STUDY REVIEWS
There is growing evidence that back pain at a young age has a predictive value on lower back pain as an adult. An Australian study found that heavily loaded backpacks were responsible for posture problems that may cause neck and back pain and could lead to permanent spinal damage in later life.3 A Finnish study found lower back pain to be a common complaint among children to the point of disrupting their school work and leisure activities.4 A Norwegian study explored the hypothesis that greater computer use during weekends is associated with lower bone density. The data was obtained from 463 girls and 484 boys aged 15 to 18 years in the Tromso region of Norway.
CHOOSING AND USING A SCHOOL BAG
The following guidelines might help to prevent neck, shoulder and back pain from a schoolbag:
- Choose a backpack with padded and adjustable shoulder, waist and chest straps.
- Distribute weight evenly across both shoulders rather than putting strain on one shoulder.
- Place heavy objects as close to the body as possible to avoid ‘bag sag’.
- Minimise the weight of the bag by only carrying that day’s work.
- Have a backpack with multiple compartments. This distributes the weight more evenly.
The weight of the backpack has an effect on changes in the neck and shoulder posture. It is recommended to carry a backpack that is less than 10% of the body’s weight, especially for school children aged 13 to 17 years. This will help to maintain a better postural alignment. The top of the backpack should not be any more than 3cm high from the shoulders so that the child can look up at the ceiling without hitting it. The bottom of the bag should be slightly lower than the iliac crest (that bony part of your waist you can put your hands on). If the child’s bag has a waist strap, it should wrap around the body just below the chest. This allows some of the bag’s weight to be taken by the hips, and lightens the load on the back and shoulders, holding the bag against the torso. The backpack shouldn’t be leaning away, leaving a gap between the back of the shoulders and bag. This means it will have no room to swing around.
The following signs will indicate that the back- pack is too heavy:
- red marks on shoulders, chest or back
- tingling or numbness in arms or hands
- pain when wearing the backpack
- struggling when putting the backpack on or taking it off
- changes in posture: either bending for- ward or sideways when wearing the back- pack.
HOW TO MAINTAIN A GOOD POSTURE
Posture is the ability of the body to control its position in space against the forces of the external world. Poor posture can result in stress on the spine at certain levels. This means when you slouch, you put unnecessary loading on the middle spine, while the head will be moved forward. This posture can lead to headaches and backache.
Natural remedies for maintaining good posture consist of not sitting for a long period. It is important to take walking breaks often. It is better to walk to school than drive. Encourage your child to take regular breaks every hour and stretch or walk around.
Physical activity is particularly important when your child is studying for major exams and spending long periods of time sitting and reading. Cleaning the house or helping in the garden is also a healthy activity. Allow at least 30 to 60 minutes of sport or leisure activities per day. Regular exercise not only improves joint flexibility and pumps blood to the muscles, bringing oxygen and nutrients to these areas, but it also improves nerve function to the brain, helping with concentration and mental performances. Be a positive role model for your child. If you carry loads on a family outing, ensure you carry the right load and that you choose a backpack according to the recommendation in this article.
POSTURE AT THE COMPUTER
- The computer screen should be directly in front of the child, slightly below eye level.
- Have an appropriate chair with a backrest support that conforms to the curves of the back.
- Sit up as straight as possible in the chair.
- When first sitting down, push the bottom as far back in the chair as possible. This will help to keep the back straight.
- Take short breaks every hour.
- Look away from the computer screen every 20 minutes and fix the eyes on something far away from the screen.
- The feet must be flat on the floor and hips, knees and el- bows at comfortable angles (around 90 degrees).
- Always put the laptop on a laptop stand on the desk or table directly in front of the body which must not be twisted, crooked, arched, or zigzagged.
- Avoid sitting curled up on the floor or on your bed, when using the laptop.
- Laptops were designed to be portable; they shouldn’t be used for long periods.
Teaching the habits of good posture early in a child’s life can save her or him from later discomfort and pain. Poor posture develops from a heavy school bag or unhealthy sitting habits such as sitting with a laptop on the upper legs or slouching in a chair. It is important to buy the correct backpack, and to fit it correctly. Follow a good postural hygiene programme with regular exercises. A physiotherapist can do a musculoskeletal evaluation and provide your child with an exercise programme for better functional status.
- Knapik J., Harman E., et al. 1996 Load carriage using packs. A review of physiological, biomedical and medical aspects. Applied Ergonomics. 1996; (27):207-16.
- Adams M.A., Mannion A.F. et al. Personal risk factors for first-time low back pain. Spine. 1999; (24):2497-2505.
- Grimmer K., Dansie B., et al. Adolescent standing postural response to backpack loads: a randomised controlled experimental study. BMC Musculoskeletal Disorders. 2002; (3):10.
- Taimela S., Kujala U.M., et al. The prevalence of low back pain among children and adolescents. A nationwide, cohort-based questionnaire survey in Finland. Spine. 1997; 15:22(10):1132-6.
- Winther A., Dennison E., et al. 2014 Leisure time computer use and adolescent bone health: findings from the Tromsø study–Fit Futures. Osteoporos Int. 2014; (25), Suppl. 2.