Sadly, the number of children with back pain is increasing. In recent years, growing interest has spurred studies that support this worrying trend. Tessa Hicks explains how teachers can help protect their pupils from unnecessary pain.

A Scandinavian study in 1994 (Trousler) identified a cumulative prevalence of back pain in a group of nearly 1200 school children of 51 percent, with 73 percent having experienced back pain at least once. A British researcher (Buckle) more recently studied 2000 students, ages 11 to 14 year old, and found that 36 percent suffered serious ongoing back pain.

So why is this? As human anatomy and physiology has not changed in the last few decades, researchers have been looking for other causative factors.

Reduced exercise: exercise is fundamental to the human body. In a child (and adults!), the tensions and forces exerted through the body through normal exercise are potent factors in the develop-met of bone density and shape, as well as muscle strength and flexibility. Without this, children’s skeletons may not develop normally, weak muscles (especially abdominals) fail to support the spine effectively and overly tight muscles exert undue stresses on the spine.

In addition, exercise squeezes and stretches the intervertebral discs, which helps pump nutrition to them and hence keeps them healthier. Children are less active at home than they used to be, but also this is often the case at school where diminishing hours are spent on PE as a result of all the other competing National Curriculum pressures. Fear of injuries and potential litigation has even forced some schools to limit running around activities in the playground at break times.

Recommended physical activity for children is a minimum of an hour per day.

TV, computers, and games consoles: this leads to too much sitting – whether at school or at home. Obviously, time spent doing this (especially at home) also limits time spent on healthy exercise through active play. Sitting, even with correct posture, places increased stress on the spine and the intervertebral discs. Compounding the situation is the fact that most children sitting in front of screens are doing so with particularly poor posture, often tightly gripping a joystick or mouse, which creates additional tension up into the shoulder and neck. Hours spent in such round-ed back and shoulder positions can cause RSI (repetitive strain injuries) and can actually dam-age the shape of the vertebrae that make up the spinal column, especially in children in whom the spine is still developing.

Poor seated posture: as discussed, this is particularly prevalent in the use of computers, including those at school. Strict health and safety regulations aim to protect adults working with computers in the workplace – no such protection is offered to children. They should be using appropriately designed and sized chairs and tables, wrist sup-ports etc. in correct lighting conditions. This is usually not the case – instead they are awkwardly positioned, often without foot support, in adult sized furniture. Most adults would not dream of letting a child use an adult sized bicycle, so why an adult-sized computer station?

Obesity: it is well known that there is an obesity epidemic in many parts of the world, including the UK where a frightening number of children are now overweight or obese. One in ten children are already clinically obese by the age of 6, and this trend is set to increase – again, largely linked to decreasing physical activity, although modern dietary trends also contribute to this. The spine is integral to posture and movement and becomes increasingly stressed by having to bear the excess weight accumulating in the body.

Schoolbags: many researchers have argued that the increasing trend in back pain in children is due to the heavy loads they carry in their school bags. Again, adults are protected by manual handling regulations, children are not. Back in 1996, the Austrian Ministry for Education declared that schoolbags should weigh no more than 10% of a child’s body weight, yet research has shown that children can carry up to 17% or more. The safest way to carry schoolbags is using an ergonomically designed backpack, worn properly adjusted and over both shoulders. Although many children now use backpacks, they often wear them in a ‘cool’ manner – strung over one shoulder, or hanging way down their backs. Many school facilities and budgets no longer allow each child to have a lock-er at school, which would reduce the amount of carrying needed.

School Furniture: BackCare points out that a survey in UK schools in 1995 reported that 86% of school furniture in some schools was considered unfit for use, deemed inappropriate, ancient and in disrepair. In times gone by, children sat at the ergonomically preferable solid upright chairs at sloping desks but the cheaper moulded plastic chairs and flat tables have largely replaced these. Of course, it is also the ‘one size fits all’ approach, which is hardly appropriate to the variety of needs amongst children. Ergonomically, fully adjustable school furniture is available, but not at prices that most schools can afford. One orthopaedic surgeon even suggests that fidgeting and inattention at school may partly be caused by trying to find a comfortable posture.

Double and triple lessons: it is well recognised that regular movement, for even a minute or two every 20 mins, is a significant factor in back health. Many children are expected to sit in inappropriate furniture for extended lessons at school.

Gender: back pain is more common in girls than boys. For example, a Finnish meta-analysis of research involving 12-18 year olds over a period of 16 years showed rates were nearly doubled in girls compared to boys.

Age: most research in this field seems to identify an increase in reported back problems in older children. For example, a study in the USA last year showed that 45% of older primary school children reported back pain compared to 15 percent of those in the youngest classes.The previously mentioned Finnish meta-analysis reported incidences in the younger girls of 25% rising to 40% in the 18 year olds, and equivalent figures for boys being 15% rising to 20%. It is suggested that this is largely due to an increasing accumulation of all the above factors, especially the inactivity, obesity and increasingly heavy schoolbags.

Other factors: include smoking (damages nutrient supply to the spinal structures), certain competitive sports (such as volleyball, basketball, golf), psychological and emotional issues.

How can the teacher help?

  1. Encourage children to sit (and stand) with correct neutral posture, and educate them about the importance of this.
  2. Encourage children to carry their school books and equipment in backpacks and to wear them correctly.
  3. Consider ‘first aid’ measures to help make furniture fit children e.g. blocks under dangling feet, rolled towels for lumbar support, cushions or wedges (commercially available) to encourage better posture, portable writing slopes to compensate for flat tables.
  4. Get ’em moving!! Allow children to get up to move and stretch every 20 minutes – this may seem disruptive but will probably be rewarded with reduced fidgeting and increased attention. Encourage children to be active at playtime. Try to ensure that the other demands of the National Curriculum do not swallow up PE.
  5. Computer use: children need to be properly seated in the same way as adults do – feet hip distance apart and under the knees, with feet flat on the floor/block. Body close to the desk, sitting square on, forearms (placed on the desk) are horizontal, and knees just slightly above hips.
  6. One researcher suggests schools should seek corporate sponsorship not only for computers for the school but for accompanying ergonomic furniture.
  7. Schools should try to provide lockers for all children, and should try to minimise the amount of heavy books etc that the children need to carry to and from home.

All this is vitally important. We already know (see issue 2 of TEX) that back pain in adults is a major health issue,or as the TUC describes it – a ‘workplace epidemic’. What will be the situation when the cur-rent generation of children, already experiencing unusually high levels of back pain,mature into working adults? In the words of the previously mentioned researcher, Buckle, ‘the workforce of tomorrow is already damaged before starting the rigours of an adult working life’. Powerful as they are, the economic arguments pale in comparison to the effect of chronic back pain on an individual’s quality of life. Surely, we all owe it to our children to take whatever positive steps we can to help with their back care and health both now and in the future?

The National Back Pain Association produces excellent leaflets on back care, and a book and activity pack, entitled Vertebral Reality, for teach-ers to use in schools. TEX


Resources and Further Reading

Back Care at the National Back Care Association – series of leaflets, Vertebral Reality book and teacher’s pack Tel: 020 8977 5474 Fax: 020 8943 5318

Body Action Campaign – visits schools, running workshops for children of all ages to help them look after their backs Tel: 020 8682 2154

RSI Association – for information, support and advice Tel: 0800 018 5012

Back Stability – Christopher Norris, published by Human Kinetics (ISBN: 0 7360 0081 X)

Tessa has a background in medical sciences and veterinary medicine, but since 1993 has been a self-employed fitness instructor and tutor. She is a qualified educator (PGCE) and delivers training in GP Referral to health professionals. She also has experience in designing and delivering customised training to the fitness and health sectors.