Question of the Week

September 3, 2007


As homework piles up -- and backpacks get heavier -- many students accept back pain as a part of the back-to-school routine. Since there can be so many causes of back pain, it is important that children and teens don't just assume that they know the cause and ignore the pain.

"Causes of back pain, besides the spine and muscles of the back, may be related to one of several organ systems including the heart, lung, kidneys, gastrointestinal tract or the central nervous system. Signs and symptoms in children that may suggest an underlying problem and the need for further diagnostic testing to rule out a significant disease process include:

  • no possibility of trauma or overuse;
  • arthritis and joint pain;
  • change in activity level or the child tires easily;
  • pain that awakens the child from sleep;
  • no improvement with simple analgesics (e.g., acetaminophen [Tylenol], ibuprofen [Advil]);
  • pain changes (i.e., gets better or worse) with changes in the child's position; fever;
  • appetite changes;
  • loss of bowel or bladder control;
  • gait problems; or
  • motor weakness.
"While many of these signs and symptoms may occur with simple musculoskeletal strain resulting in back pain, their presence also may suggest an underlying problem or disease and the need for further tests."
National Pain Foundation

It is important to check with a doctor to determine the cause of the pain and, with that information, figure out what course of action needs to be taken.

"Causes of back pain that may occur in younger or older children:

  • Infection. Of constant concern to physicians is the diagnosis of infection of the spine (discitis) in children. An infection of the spine is of great consequence and requires prompt diagnosis. ...
  • Tumor. Another major concern for pediatricians > treating a child's back pain is potential for a tumor in the spine. Luckily, back pain caused by a spinal tumor is a very rare occurrence."

Sometimes, the pain may not be caused by a disease, nor is it caused by carrying too many books.

While it is important for children and teens to be active and find activities that they enjoy, it is also important that they don't push so hard that they damage their developing bodies.

"Causes of back pain that tend to occur among older children:

  • Spondylolysis. As kids' sporting events become more competitive and the activities more specialized, certain types of injuries causing back pain tend to arise. Spondylosis, a defect of the joint between vertebral bones, is commonly found in those who tend to hyperextend their backs (bend backwards), such as gymnasts. ...
  • Spondylolisthesis. Occasionally, further injury can be found as spondylolisthesis, a 'slipping' of one vertebra upon another. ...
  • Disc Injuries and vertebral fractures. Teens who tend to punish their spines through gymnastics or extreme sports (such as skateboarding, in-line skating, and vert > biking) will frequently land very hard on their feet or buttocks. Either way, the force is transmitted to their vertebrae, which can result in a vertebral fracture and/or damage to the intervertebral discs. ... If the disc material is extruded out or herniated, the spinal cord nerve roots leaving the cord can be compressed. This causes the sensation of pain along the path of that nerve. A well-known version of this is sciatica, which presents as buttock pain radiating down the back of a leg. ..."

So what if the cause is, simply, carrying a backpack (or other school bag) that is too heavy?

"Teens who carry heavy backpacks sometimes also compensate for the extra weight by leaning forward; over time this can cause the shoulders to become rounded and the upper back to become curved. Because of the heavy weight, there's a chance you may develop shoulder, neck, and back pain. If you wear your backpack over just one shoulder, you may end up leaning to one side to offset the extra weight. You might develop lower and upper back pain and strain your shoulders and neck. Improper backpack use can lead to poor posture. Is your backpack getting on your nerves? It might be. Tight, narrow straps that dig into your shoulders can interfere with circulation and the nervous system, and you might develop tingling, numbness, and weakness in your arms and hands...."

Back pain indicates that there is some sort of problem that needs to be addressed. Sometimes students will accept the pain, assume it is caused by carrying too many books, and then ignore (or not notice) when the back pain is signaling something even more serious.

So, as the homework piles up, it is important for students to be sure that they are carrying their bags properly. This will not only reduce the risk of damaging the back with too much weight, it will also lower the chances of having pain become such a normal occurrence that it is ignored -- even when it is signaling something that requires more urgent medical attention.

To prevent injury when using a backpack, do the following:

  • "Always use both shoulder straps. Slinging a backpack over one shoulder can strain muscles.
  • Tighten the straps so that the pack is close to the body. The straps should hold the pack two inches above the > waist.
  • Pack light. The backpack should never weigh more than 20 percent of the student's total body weight.
  • Organize the backpack to use all of its compartments. Pack heavier items closest to the center of the back.
  • Stop often at school lockers and remove items you don't need, if possible. Do not carry all of the books needed for the day.
  • Bend using both knees, when you bend down. Do not bend over at the waist when wearing or lifting a heavy backpack.
  • Learn back-strengthening exercises to build up the muscles used to carry a backpack."
Questions of the Week:
What should you and your peers know about back pain? What can you do to reduce your risk of developing back pain? What should you do if you start to have back pain? When should back pain be checked by a medical professional?

Please email me with any ideas or suggestions.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.

I look forward to reading what you have to say.

Health Community Coordinator
Access Excellence @ the National Health Museum

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