X+Y= 1/3 of America’s Youth with Back and Neck Pain….Now Let’s Solve For These Variables.
Hint: It mainly has to do with physics but you don’t have to be Einstein to implement.
As some of you may know, my focus is on preventing back and neck pain beginning with our Youth. Recently a paper was presented at The American Academy of Orthopaedic (old English for Orthopedic) Surgeons (AAOS) 2019 Annual Meeting. Their study was entitled, “The Epidemiology of Back Pain in Children and Adolescents: A Cross-Sectional Study of 3,669 American Youth”.
Staggering Take-Aways:
1/3 of the children studied reported back pain.
Back pain is common in children and adolescents and increases linearly with age
(For each increasing year of age, the percentage of children and adolescents who reported back pain in the previous year increased about 4%.)
Only 40% seek any kind of treatment.
The majority do not required injections or surgery: 44% utilized PT, 34.1%, chiropractic, & 33.9% massage.
Higher levels of back pain are reported in association with level of competition, with participants performing at the highest levels reporting the most back pain.
Children using backpacks with two straps were likely to suffer back pain at 30.6% and those who used rolling backpacks experienced pain at 54.5% - more about this below…
Prior studies reported by the researchers showed back pain was reported significantly more in girls than boys.
Lumbar Pain was the most common type reported (68.9%)
insurance access was a non factor in prevalence
Overall, it appears our youth are ill-equipped to manage their spines into adulthood. To paraphrase Matthew Schmitz, MD from the San Antonio Military Medical Center in his interview with Medscape, “at least a study like this establishes a baseline and the need to look further.”
Let’s do some of that:
This study highlights the need to address back pain early. According to the US Burden of Disease Collaborators, low back pain alone has consistently accounted for the largest number of years lived with disability in the US population in 1990 and 2010 (1). Based on this current study’s linear progression and what we learn from other such studies, chronic back pain in teens usually lends towards chronic back pain and disability in adults.
Questions arise here about high-level competition and back pain:
Is it that young underdeveloped core muscles are not able to handle the mechanical demands of certain sports done repetitively and at high levels of engagement as other studies have suggested?
Do more sports meets in general increase the opportunities of becoming injured.
Are there certain sports that are more likely than others to lend to back pain (and if so, by what mechanism(s)?
Are the increased levels of pain a manifestation of carrying heavy sports bags to more meets -some of which are a considerable distance from the parking lot. Should these bags have wheels like some golfers use?
Do the higher level athletes tend to over-train? Do we need to look at Training methods such as exercise timing along with technique?
Are there psychosocial pressures to outperform despite early signs of discomfort? (The Cobra Kai Creed)
A study out of South America suggested that other postural issues outside of sports were plaguing athletes only to be felt on the field of play when their predisposed frames were subject to challenge.
Backpacks: Wheeled vs. Two straps.
Pain reports of 30.6% for two strapped backpack users is an unsettling number. Even though it is desirable to use both straps when carrying a backpack, there can still be issues as to how the backpack is worn:
Straps need to be of equal length
The center of the load of the backpack is placed opposite the upper lumbar vertebra. (or as Anna Brzek, et. al term it: “place the middle of the bag at the middle of the back”
Ideally, the weighted load should not be greater than 10% of a child’s weight
Would the use of additional backpack waist straps help further as some studies suggest ?
The researchers astutely point out that some may choose to use wheeled backpacks because they already have back pain and that this may account for the higher percentage of back pain reported in the wheeled backpack users.
Other considerations regarding wheeled backpack use are that, by enlarge, the wheeled backpacks tend to be quite a bit heavier than the standard backpacks. This is in part because the wheel mechanism adds weight and not having to carry it over the shoulders lends to overlooking how much more stuff kids will place in these packs. The issues with the wheeled backpacks may further be:
It’s increased weight coupled with transitioning in and out of a car, over curbs and up and down stairs - especially at school (most schools don’t have or allow for elevator use -probably for good reasons).
Most of these backpacks have a handle at the top which, when upright, is pretty high-up relative to ideal carrying heights for most kids. A child then has to clear an elevation such as steps through skewed shoulder and spinal positioning. (side handles would likely be deemed appropriate under field-testing) . (See our Ergotracker section on our site)
Training on lifting and carrying mechanics would be welcomed in this effort as well and would be a useful life skill to learn in school.
General Ideas based on increasing rates of back pain:
Shouldn’t we be looking at the body mechanics in all facets of a child’s life? Sitting, reading, lifting, sleeping, and computer work mechanics, to name a few? Bookstands for reading and tilted platforms to write on for notebooks and devices would limit prolonged neck flexion, which could lead to the dreaded “Tech Neck”. In so far as sleep positioning, avoiding prone or “stomach” sleeping” as this position increases lower back pressure and strains the muscles and ligaments of the neck. Better lifting strategies for various lifts should be demonstrated, performed, and reinforced. Should there be more textbooks available digitally to lessen backpack weight? Could copying sections of books as PDFs or having hard copies for home and school be offered as solutions to limit the carrying loads? School policy could be brought up at school board meetings to discuss the allotment of locker time and location, so that between class drop off and book pick up can occur efficiently.
Insurance access was a non-factor in Prevalence according to the study:
Where is the Prevention? Would insurers be interested in educational programs to equip our youth with biomechanical know-how to prevent pain and injury? We are already paying into these plans, and would rather not burden taxpayers further. The children sitting in the classroom, in general, are covered by insurance. If you are an insurer, never mind which plan - as parent’s jobs and later so will their kid’s jobs vary and each insurance will inherit whatever is brought into their network - so just assume they are all of your covered lives. Better yet, the children of our nation are indeed our responsibility regardless of affiliations. Insurers contributing together towards preventative education would save both the insured and the insurance companies money in the short, intermediate, and long run. Isn’t this a good first line of defense, or rather an offense, in the war on opioid addiction? Or, would government health agencies be interested in these programs early on to protect little citizens and prevent a leading cause of disability from taking its monetary toll and limiting a population’s contribution to the creative aggregate of society?
Plugging these ideas back into our original equation, If you answered “Yes.” Or “Yes, let’s study that”, to any of these questions, you are correct.
- Dr. Goodbender
Medscape, “Back Pain Affects One-third of American Youth.” by Michael Vlessides March 14, 2019.
Murray CJL, Atkinson C, Birbeck G, Burstein R, Chou D, et. al. The state of US health, 1990-2-10: burden of diseases, injuries and risk factors. JAMA. 203;310:591-608.
Ana Brzek, Tarja Dworrak, Markus Strauss, Fabian Sanchis-Gomar, Ibtissam Sabah, Birgit Dworrak, Roman Leischik. The Weight of Pupils’ schoolbags in early school age and its influence on body posture. BMC Musculoskeletal Disord. 2017;18:117. PMID: 28320364.
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