Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

The Back Pain of Back to School

The child abuse of a locker-less school system.

You must remember those days: The walls outside the classroom lined with lockers, the built-in combination lock a little off-center on the locker door, the brand name “Master” prominently displayed, an imprimatur of the inviolability of all the secrets within.

The school locker was an island of self-expression amidst the conformity of pep rallies and society’s expectations of new adolescence. It might be wall-papered with troubling photos of Iggy Pop, or the latest work of Flavia. The school locker was the student, no matter how the student appeared to the school.

But something happened. Schools and parents began wondering what really was behind that glorified locked shoebox: A weapon to take down an airplane? Or a magazine encouraging the student to take down his or her pants?

Suddenly one autumn, the school locker was abolished. The pornography was now lodged between chapters on the isosceles triangle and the Pythagorean theorem, the gun precariously tucked in that pair of sagging slacks. That bastion of immorality, the school locker, had been conquered!

However, research has shown an increase in the incidence of back injuries in some students, which has been directly attributed to the lack of lockers for the storing of those large text books, thus forcing students to spend more time carrying heavy loads of books (and, I suppose, contraband) in backpacks. According to the Consumer Product Safety Commission, thousands of children, ages ranging from 5 to 18 years, are treated yearly in hospitals and physician offices for injuries related to backpacks.

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So, parents, do not wait for the complaints of back pain; you created this mess, the least you can do is anticipate the aftermath of a locker-less childhood. Pay attention to your child’s posture, and monitor all that is being loaded into that backpack. The American Academy of Orthopedic Surgeons offers the following suggestions:

• Always use both shoulder straps to keep the weight of the backpack ideally distributed.

• Tighten the straps and use the waist strap—if the bag has one.

• Remove or organize items if too heavy, placing the largest items closest to the back.

• Teach your child proper lifting technique, bending at the knees to pick up a backpack.

• Assure that your child carry only those items that are required for the day.

• Encourage your child to tell you about the pain or discomfort that may be caused by a heavy backpack, including numbness or tingling in the extremities.

• Observe how your child puts on or takes off the backpack; see if it is a struggle. Look for red marks on the shoulders.

• If necessary, create a dialogue with the school about the degree of the load, which should be kept under 10 to 15 percent of bodyweight.

Chronic pain is a threat to school performance, negatively impacting a child’s sense of self worth. In a study published this past March in the “Archives of Disease in Childhood,” researchers in Spain assessed the backpacks and back health of over 1,400 children aged 12 to 17. More than 60 percent were carrying packs weighing more than 10 percent of their body weight, and nearly one in five had schoolbags that weighed more than 15 percent of their own weight.

Not surprisingly, one in four students said they had suffered back pain for more than 15 days during the previous year; scoliosis — curvature of the spine — accounted for 70 percent of those with pain. The remaining 30 percent had either isolated low back pain or contractures — continuous, involuntary muscle contractions. Girls faced a greater risk of back pain than boys, and their risk increased with age (and, presumably, years of lugging around their heavy packs).

Working together, schools, parents and physicians can cooperate to lessen the burden—and pain—of Back to School.

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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