Back pain and backpacks in school children

Association of postural education and postural hygiene with low back pain in schoolchildren: Cross-sectional results from the PEPE study

Background

Low back pain (LBP) is the leading cause of disability in the world that affects the population of all ages globally. The main aim of the present study was to analyze the cross-sectional association of postural education and postural hygiene habits with LBP, differentiating between frequency and intensity of pain.

Methods

This cross-sectional study assessed 849 students aged 10-12 years from primary schools. The study was based on four different structured and self-administered questionnaires: back pain questionnaire, Back Pain and Body Posture Evaluation Instrument (BackPEI), Frequency of Commuting to and from School Questionnaire, and the Hebacaknow questionnaire. In addition, height and weight were included to determine the body mass index (BMI).

Results

Participants with prevalence of LBP were significantly older (P=0.038), girls (P<0.001), taller (P=0.018), and practice active travelled back from school (P=0.016). Otherwise, participants with no prevalence of LBP sat correctly at the desk (P<0.001). Higher knowledge of postural education was associated with lower intensity of LBP (β=-0.07, CI=-0.12 - -0.02, P=0.004).

Conclusion

The knowledge related to postural education it is associated with less LBP. School interventions improving knowledge about postural education, ergonomics and postural hygiene are needed to address this important matter.

The Effect of comprehensive rehabilitation on Lithuanian adolescent's nonspecific low back pain, depending on the duration: Nonrandomized single-arm trial

OBJECTIVE

To determine pain and functional changes during comprehensive rehabilitation (CR) in adolescents with nonspecific low back pain (NLBP), and to determine the optimal CR duration.

METHODS

The study included 106 adolescents (39 boys [36.8%], 67 girls [63.2%]), 14 to17 years old, with the following inclusion criteria: duration of NLBP for at least 12 weeks; conservative NLBP treatment was effectless; pain intensity using the visual analogue pain scale (VAS) ≤ 7 points; disrupted daily activities; ability to understand and answer the questions; written consent to participate voluntarily in the study. The pain was assessed using the VAS scale, functional changes were assessed using the Oswestry Disability Index (ODI), 12-Item Short Form Survey, Hospital Anxiety and Depression Scale (HAD), and physical functional capacity and proprioception (Proprio) were assessed using an isokinetic dynamometer. The participants performed a comprehensive pain rehabilitation program consisting of physiotherapy, TENS, magnetotherapy, lumbar massage, and relaxing vibroacoustic therapy. The active CR cycle lasted for 22 sessions (with intermediate measurements after 5 and 16 sessions), after which we performed passive observation for another half a year. Five measurements were performed.

RESULTS

Pain, functional assessment, and physical capacity were improved with CR. Statistically significant improvement became apparent after 5 CR sessions, but statistical and clinical significance became apparent after 16 CR sessions. In the distant period, after the completion of CR, neither statistical nor clinical changes occurred.

CONCLUSIONS

CR is effective in reducing pain, and improving functional state and physical capacity quickly and reliably in 16 CR sessions, which is sufficient to obtain clinically satisfactory CR results. Good results were achieved during CR and neither improved nor deteriorated spontaneously in the distant period. This study shows a possible mismatch between NLBP intensity and impaired functional state in adolescents.

Tools for Assessing Knowledge of Back Health in Adolescents: A Systematic Review Protocol

Back pain is common in adolescents as a result of their typical daily activities. There is a critical need for developing instruments that can assess the adolescents' knowledge of proper posture, because adequate postural habits are essential for preventing back pain and facilitating physical well-being. Unfortunately, there is insufficient understanding about appropriate back health in the general public, even though this knowledge is decisive in the development of physical skills and attainment of health literacy. Furthermore, relevant substantive literature is scarce. Therefore, the proposed systematic review aims to identify instruments that are used for assessing knowledge of back health in adolescents. Relevant search terms and descriptors will be combined, and searches will be carried out in a uniform sequence within the PubMed, Embase, CINAHL, and Cochrane Library databases. Eligible articles must present data on the assessment of the adolescents' knowledge of back health and describe the applied instrumentation. Articles will be selected by two reviewers independently; all disagreements will be resolved by a third reviewer. Mendeley and the Rayyan software will be used for the systematic review, and the checklist proposed by Brink and Louw will be used to verify the methodological quality of the included studies. Our findings may confirm the relevance of constructing and validating back health instruments for use in Brazil and other countries.

Pain medication use for musculoskeletal pain among children and adolescents: a systematic review

OBJECTIVES

Musculoskeletal pain is common among children and adolescents. Despite the lack of evidence regarding harms and benefits, musculoskeletal pain is often managed with pain medication. The aim of this systematic review is to assess the prevalence of pain medication use for musculoskeletal pain among children and adolescents and the factors and side effects associated with use.

CONTENT

Three databases (EMBASE, CINAHL and PsychINFO) were systematically searched to identify studies designed to examine the prevalence, frequency or factors associated with the use of pain medication for musculoskeletal pain in children and adolescents (aged 6-19 years). The included studies were assessed for study quality and data were extracted.

SUMMARY

The search initially provided 20,135 studies. After screening titles, abstracts and full-texts, 20 studies were included. In school settings, 8-42% of children used pain medication for musculoskeletal pain, and 67-75% of children in sports clubs and from pain clinics used pain medication. The most consistent factors associated with the use of pain medications were pain characteristics and psychological factors (e.g. being bullied, low-self-esteem), while mixed evidence was found for increasing age and female gender. Only two studies reported on the duration of use and only one study on adverse effects related to the use of pain medication.

OUTLOOK

We found that 8-42% of adolescents from school-based samples use pain medication for MSK pain, while the prevalence among adolescents from sports clubs and pain clinics is higher (67-75%). Pain characteristics (pain duration, severity, intensity, disability levels and the presence of ≥2 pain conditions or multisite pain) and psychological factors were associated with a higher use of pain medication, while for higher age and female gender the evidence of association was mixed. Future studies should systematically collect information on the type, duration of use of pain medication and side effects to confirm the findings of this review.

Prevalence and factors associated with low back pain in schoolchildren in Cameroon, sub-Saharan Africa

BACKGROUND

Data on the prevalence and factors associated with low back pain (LBP) in schoolchildren are scarce in Africa, particularly in sub-Saharan Africa.

OBJECTIVES

To assess the prevalence and factors associated with LBP in schoolchildren in Cameroon.

PATIENTS AND METHODS

We performed a cross-sectional study in 10 randomly selected schools (public and private) in Douala, Cameroon. Using a self-administrated questionnaire, sociodemographic, usual physical activity, and clinical data were collected and all the schoolbags were weighted. Informed consent was obtained from the parents. Statistical significance was established at P < .05. Logistic regression was performed to identify factors associated with LBP.

RESULTS

We included 1075 schoolchildren (543 boys, 50.5%). The prevalence of LBP was 12.3% (132 children: 81 girls and 51 boys). The mean age was 11 ± 1 years (range, 8-14 years). Body mass index was normal in 110 schoolchildren (83.4%). Sixteen schoolchildren had already met a physician for LBP. Among the factors evaluated, those associated with LBP were female gender, doing competitive sport, sitting position, and LBP in at least 1 parent. The mean weight of the schoolbags was 4.9 ± 1.9 kg. We had 99 children with LBP and a schoolbag weight ≥10% of their body weight. No association was found between the weight of schoolbag and LBP.

CONCLUSION

LBP is common in Cameroonian schoolchildren, where 12.3% suffer from it. The weight of schoolbags was not associated with LBP. However, female gender, competitive sport, sitting position, and parental history of LBP were significantly associated with its occurrence.

Effectiveness of a Back School and Postural Education Program on the improvement of literacy about postures and low back pain in adolescents: A 1-year follow-up study

BACKGROUND

Some health problems can be associated with the school environment and lifestyles, so it is necessary to carry out intervention actions that promote health and problem prevention. This study evaluates the effects of a Back School and Postural Education on improving short-term and long-term ergonomic knowledge of postures adopted at school and home, as well as reducing low back pain (LBP) in adolescents.

METHODS

The sample comprises 98 students, aged 10-16 years (11.61 ± 1.28 years), with 63 (64.3%) girls. The measuring instruments included a theoretical and a practical test, a low back pain (LBP) questionnaire and a scale. The tests and the scale have been applied 1 week before the intervention, 1 week following the Back School and Postural Education Program, and a 1 year later. The questionnaire was applied 1 week before of intervention and after 1 year. The intervention included three sessions of a theoretical and practical nature, each lasting 45 min, with intervals of 1 week.

RESULTS

The values of the theoretical test before the intervention, 1 week, and 1 year after the intervention were, respectively, 8.67 ± 2.64, 11.37 ± 1.93, and 11.11 ± 1.92 (p ≤ 0.001), and the practical test were 6.42 ± 2.47, 12.48 ± 2.25, and 12.83 ± 1.78 (p ≤ 0.001). The presence of LBP fell by 42.9%-25.5% after the 1-year period.

CONCLUSIONS

Our data show an improvement of ergonomic knowledge of postures adopted at school and home as a result of the education program and a decrease of self-reported LBP.

School physiotherapy programme: Improving literacy regarding postures adopted at home and in school in adolescents living in the south of Portugal

BACKGROUND

Health literacy consists of an individual's ability to make informed decisions in various sectors, including school. Most of the health problems and risky behaviours associated with the environment and lifestyle can be minimised or even prevented by increasing health literacy.

OBJECTIVES

This study aimed to evaluate the effectiveness of a school physiotherapy programme in improving literacy regarding postures adopted at home and in school in adolescents living in the south of Portugal.

METHODS

The sample was comprised of 84 students in the 5th grade, 42 (50%) were boys, aged to 10 and 13 years old (10.35±0.61). The measurement instruments included a theoretical and practical test applied one week before and one week after the school physiotherapy programme.

RESULTS

The values obtained on the theoretical test before and after the intervention ranged from 1-13 (7.70±2.47) and 5-13 (10.83±2.27), respectively (p≤0.001) and, on the practical test, before and after ranged from 0-10 (4.14±2.21) and 6-15 (11.8±2.28), respectively (p≤0.001).

CONCLUSION

This study found significant improvements in both theoretical and practical knowledge acquisition after participants attended a school physiotherapy programme. Thus, a school physiotherapy programme could be a useful tool to prevent and/or minimise musculoskeletal disorders in adolescents.

Back School Postural Education Program: Comparison of Two Types of Interventions in Improving Ergonomic Knowledge about Postures and Reducing Low Back Pain in Adolescents

This study aimed to compare the impact of two Back School Postural Education Programs on improving ergonomic knowledge of postures adopted at school and home, as well as on reducing low back pain (LPB) in adolescents. The sample was constituted by 153 students, aged 10–16 years, with 96 (62.7%) girls, divided into 2 intervention groups (GA, GB). Two tests (theoretical and practical) and LBP questionnaire were applied 1 week before and 1 year after the end of the program. In GA, three sessions were performed for each class separately, on theoretical and practical issues, lasting 45 min and at intervals of 1 week, and in GB, only one theoretical session (90 min) was given to all students. Statistically differences on GA were obtained between the values 1 week before and after 1 year of evaluation in both theoretical and practical tests (p ≤ 0.001). In GB, only the values of the practical test present a statistical difference (p ≤ 0.001). GA obtained higher values on both tests after 1 year of follow-up compared with GB (p ≤ 0.001). The number of students with LBP decreased on GA (p ≤ 0.001). The program with longer duration, higher weekly frequency, and more practical and individualized character promotes better effects.

Ergonomic factors of school bags and their adaptation to the weight of students

BACKGROUND

Students use a school bag to carry their school supplies which may not have the required standards and ergonomic factors.

OBJECTIVE

This study was aimed to examine the ergonomic factors of schoolbags and their adaptation to the weight of elementary school students.

METHODS

This cross-sectional study was carried out on 721 primary schoolchildren. To collecting data a checklist, which its final version was approved by the experts, was designed by researchers. Data were analyzed by using SPSS ver. 22 and Chi-square test, One-Way ANOVA, and univariate and multivariate logistic regression models.

RESULTS

In this study, about 90.1% of students used a backpack to carry their items and most students carried backpacks with a weight up to 10% of their body weight. In 43.5% of the students, waist width was appropriate with backpack width at the bottom, and in 96.6% shoulder width was appropriate with backpack width at the top. Multivariate logistic regression showed that girls in compared to boys were more likely tolerated ratio of backpack weight to body weight, and also had more likely proportion of waist width and the backpack width at the bottom. The grades of the first, second, and fourth used more heavy backpacks. Students who their mothers were employee compared to housewives, carried heavier backpacks and had more likely proportion of waist width and the backpack width at the bottom. As the mother's age increased, the proportion of waist width and the backpack width at the bottom is diminished.

CONCLUSION

The schoolbags weight of many students was more than the standard weight, and their schoolbags did not have the required standards. Educational interventions can increase the knowledge of students and parents about the ideal weight of a schoolbag and the criteria for choosing a proper school bag.

Optimization of backpack loads using gait parameters in school boys

BACKGROUND

Backpacks are an efficient way of manual carriage used by people of all ages, and is commonly used by schoolchildren. Carrying heavy backpacks may result in cumulative trauma later in life due to biomechanical adaptations during gait. Gait parameters are known to be sensitive to force vectors, which can be altered by load carrying. This study attempts to find the most favorable backpack weight using gait changes as an indicator.

METHODS

This was an observational study conducted on twenty typically developing boys aged between 9 and 14 years. Gait analysis was done using standard recommendations, with increasing backpack loads with respect to their body weights. Gait cycles were captured using video cameras and analyzed using Kinovea0.8.25 motion analyzing software.

RESULTS

As the backpack load increased, significant kinematic changes were noted in the child's ankle, knee, and hip joints. These changes were evident when the backpack load increased beyond 15% of their body weight.

CONCLUSIONS

This study concludes that the optimum weight that can be carried without having an impact on dynamic posture will be less than 15% of the body weight.

Back Pain in Children and Adolescents

Back pain has long been considered an uncommon complaint in the pediatric population. When present, teaching had been that pediatric back pain almost always has a diagnosable cause, many of which are progressive and potentially debilitating. Recent evidence has suggested that pediatric back pain is not only more common than once thought but also, within certain populations, benign and idiopathic. This, in turn, places an increasing amount of pressure on pediatricians to accurately assess and manage their patients presenting with complaints of back pain. The aim of this article is to serve as a review of the current literature on pediatric back pain. The article reviews the epidemiology, basic anatomy, and important elements of a history and examination, which should be considered when a child presents complaining of back pain. Last, a common differential diagnosis with evaluation and management is also given to help guide pediatricians through their medical decision making.

Musculoskeletal spine pain in adolescents: Epidemiology of non-specific neck and low back pain and risk factors

BACKGROUND

Neck pain (NP) and low back pain (LBP) have become a growing public health problem in adolescents that involve multiple factors, including modifiable factors, such as behavioral factors that include sedentary activities and adoption of inadequate postures. This study aimed to determine the prevalence of NP and LBP in adolescents and to investigate its association with sedentary activities and postures.

METHODS

The sample was comprised of 304 students, being 144 (47.4%) boys, aged between 10 and 17 years old (13.68 ± 2.02). The measurement instruments included a questionnaire, postural evaluation of some task and the transportation and weighing of the backpack.

RESULTS

The prevalence of NP and LBP were, respectively: in the lifetime: 51% and 65.1%; at the moment: 5.9% and 8.6%; and in a 12-month period: 39.8% and 47%. The older students (15-17 years old) had 3.03 times higher probability of developing LBP (95% CI (1.82-5.03; p ≤ 0.001) than the younger one (10-14 years), adolescents who used a mobile phone more than 10 h per week had 2.48 times higher probability of developing NP (95% CI: 1.29-4.75; p = 0.006) than those who had used for a shorter period (until 10 h) and 2.39 more probability to developed the LBP (95% CI: 1.41-4.08; p = 0.001). The students who sit with a spine in a wrong position had 3.24 more chances to have LBP (95% CI: 1.33-7.89; p = 0.010).

CONCLUSIONS

Data of this study showed a higher prevalence of NP and LBP in this sample and revealed that adolescents who used a mobile phone more than 10 h per week had more probability to develop both NP and LBP and older students and who sit with a spine in a wrong position had more chances to have LBP.

Postural habits in adolescents: the influence of a school physiotherapy program on improving the knowledge of postures

Background School physiotherapy programs can promote an increase in health literacy promoting healthier postural habits. This study aimed to verify the effectiveness of this program in improving the theoretical-practical ergonomic knowledge about postures in adolescents and to verify the postural habits adopted. Methods The sample comprised 206 students, 109 (52.9%) being boys, aged 12-19 years old. The measurement instruments included a theoretical-practical test and a scale. The intervention program included one session lasting 90 min, using both theoretical and practical approaches. Results The mean values obtained on the theoretical-practical test before and after the 1-month period were 9.14 ± 2.51 and 13.05 ± 1.41, respectively (p ≤ 0.001). One hundred and ninety-nine (96.6%) students sat with the spine wrongly positioned, 197 (95.6%) students used mobile phones with a cervical flexion, and 165 (80.1%) lifted a heavy object from the floor incorrectly. Conclusions This data revealed that a school physiotherapy program improves ergonomic knowledge in adolescents.

The relationship between neck angles and ground reaction forces in schoolchildren during backpack carriage

Study aim: This study aimed to examine the effect of carrying backpacks on neck posture and ground reaction forces (GRFs) and to investigate the relationship between neck angles and GRFs during backpack carriage in schoolchildren.

Material and methods: The craniohorizontal angle (CHA), craniovertebral angle (CVA), sagittal shoulder posture (SSP) and GRFs were measured in right-handed schoolchildren (14 male and 12 female) with mean age 10.17 ± 1.15 years during loaded and unloading conditions. The Qualisys motion analysis system with a force plate was used to assess the neck angles and GRFs.

Results: During backpack carriage there was a significant increase in the CHA (p = 0.001), significant decrease in the CVA and SSP (p = 0.001, 0.016 respectively), no significant difference in the normalized (scaled to body weight) vertical GRFs (p > 0.05), and a significant increase in the anterior braking and posterior propulsive GRFs (p = 0.035, 0.002 respectively) compared to the unloading condition. While carrying a backpack there was a moderate negative correlation between the SSP and first vertical GRF (r = –0.464) and a strong negative correlation with the second vertical GRF (r = –0.571) and the posterior propulsive GRF (r = –0.587).

Conclusion: Carrying a backpack weighing 15% of the child’s body weight changes the head posture and increases the normalized value of the anterior-posterior shear force. During backpack carriage, decreasing the SSP is associated with increasing the load acceptance, thrusting and posterior propulsive forces. Increasing the shearing force may lead to development of postural abnormities. Consequently, the ideal backpack weight should be considered by parents and teachers.

Potential risk factors and triggers for back pain in children and young adults. A scoping review, part II: unclear or mixed types of back pain

Background

Back pain is a global problem in terms of disability and financially, with a large burden both to the individual and to society. Back pain was previously believed to be uncommon in children. However, there is a growing body of evidence that this is not the case.

Objective

Part I of this scoping review studied risk factors of incident and episodic back pain. In this part II we aimed to identify all risk factors and triggers with unclear or mixed type back pain in young people and to identify any gaps in the literature.

Methods

A scoping review design was selected to summarise the evidence, as there are many studies on "risk factors" for back pain. The scoping review followed the PRISMSA-ScR guidelines. We considered all studies that tested potential risk factors and triggers for thoracic and/or lumbar spine pain, in children, adolescents, and young adults (≤ 24 years). PubMed and Cochrane databases were searched from inception to September 2018, to identify relevant English language articles. The results regarding potential risk factors were separated into temporal precursors and bidirectional risk factors and the studies were classified by study design.

Results

Our comprehensive search strategy identified 7356 articles, of which 83 articles were considered eligible for this review (part II). There were 53 cross-sectional studies and 30 cohort studies. Potential risk factors for back pain were: female sex, older age, later pubertal status, positive family history of back pain, increased growth, and a history of back pain, most of which are temporal precursor variables. There was limited research for the illness factors, spinal posture, and muscle endurance in the development of back pain.

Conclusion

Many of the included studies approached risk factors in similar ways and found factors that were associated with back pain but were not obvious risk factors as causality was uncertain. Future research should be more rigorous and innovative in the way that risk factors are considered. This could be through statistical approaches including cumulative exposures, or longitudinal approaches including multi-trajectory methods. Additionally, data on proposed risk factors should be collected before the onset of back pain.

Back pain and school bag weight - a study on Indian children and review of literature

Back pain in children is a complex phenomenon, which has been shown to be associated with physical and psychosocial factors. None of the studies on Indian children have investigated the possible association between back pain and psychosocial factors. We decided to determine the prevalence of back pain in students and association with both physical and psychosocial factors. A cross-sectional study was conducted on 163 students from two city schools. Physical factors were evaluated using a structured questionnaire. Strengths and difficulties questionnaire was used to assess psychosocial factors. The studied sample consisted of 49.7% boys and 50.3% girls. Mean school bag weight was 6.1±2.4 kg (range: 2.2-15.6 kg). Mean weight of school bag as a percentage of body weight was 13.5±6.2%. Approximately 76% students carried more than 10% of their body weight. The prevalence of back pain (over last 1 month) was 53.9%. No associations were found between back pain and weight of school bag, weight of school bag as a percentage of body weight and physical activities. Significant associations were found between back pain and number of hours spent watching television [odds ratio (OR): 3.3, 95% confidence interval (CI): 1.5-7.5; P=0.003], history of injury to the back (OR: 4.8, 95% CI: 1.47-15.8, P=0.003), presence of a family member complaining of back pain (OR: 1.98, 95% CI: 1.25-3.14, P=0.002), conduct (P=0.042) and hyperactivity problems (P=0.045). Thus, there appears a need to consider psychosocial factors along with physical factors when evaluating a young student with back pain.

Assessment of perceptions, knowledge, and attitudes of parents regarding children's schoolbags and related musculoskeletal health

Background

Heavy schoolbags and their adverse musculoskeletal effects are a cause of great concern. Parents’ awareness and knowledge about this are crucial to prevent such health problems. Thus, this study aimed to assess parents’ perceptions, knowledge, and attitudes regarding children’s schoolbags and related musculoskeletal health.

Methods

A cross-sectional study was conducted targeting parents with children of school age. In January 2015, a self-administered, validated questionnaire was distributed to all participants, consisting of questions about their awareness, knowledge, and attitude regarding the negative effects of carrying inappropriate schoolbags on children’s musculoskeletal health.

Result

A total of 616 parents (284 fathers and 332 mothers) completed the questionnaire (response rate of 100%). A total of 247 (87.3%) fathers and 301 (90.9%) mothers knew that carrying heavy schoolbags produces back problems. However, only 105 (36.9%) fathers and 107 (37.6%) mothers knew that incorrect schoolbag weight and inadequate way to carry it may impede the normal alignment and growth of the spine. Only 107 (37.6%) fathers and 96 (28.9%) mothers knew the ideal weight of the schoolbag, while 49.6% of fathers and 42.8% of mothers did not check their children’s schoolbags for unnecessary contents.

Conclusion

Awareness of parents about the consequences of heavy schoolbags and correct use is still limited and suboptimal. Educational sessions for parents and awareness campaigns may help to reduce the prevalence of musculoskeletal health problems among children.

Electronic supplementary material

The online version of this article (10.1186/s13018-019-1142-9) contains supplementary material, which is available to authorized users.

Managing low back pain in active adolescents

Adolescent low back pain has received limited research attention despite its potentially considerable impact on quality of life. The role of diagnostic triage to identify serious or specific pathology and/or order relevant investigations is considered. An overview of contemporary pain mechanisms is provided, with specific reference to the wide range of risk factors for persistent low back pain. Education and exercise framed within a biopsychosocial framework are the cornerstones of treatment. There is a lack of data on more comprehensive personalized treatment approaches among adolescents. One such approach - Cognitive Functional Therapy - which has shown promise in adults and active adolescents with low back pain, is described and illustrated using a case study. The most promising avenues, in practice and research, may be those that view adolescent low back pain as less of a local structural spinal issue and more of an indication of the general health of the adolescent.

Adolescent idiopathic scoliosis for the primary care physician: frequently asked questions

PURPOSE OF REVIEW

Provide primary care physicians with the best available evidence to support answers to frequently asked questions by caregivers of patients with adolescent idiopathic scoliosis (AIS).

RECENT FINDINGS

A review of best available evidence shows that schoolbag design and weight are not associated with higher odds of developing AIS. However, patients with AIS are more prone to balance problems with asymmetric backpack carrying and with rising weights. In patients with AIS, the backpack should be worn in a symmetric way and should never exceed 10% of the child's body weight. Although no relationship was found between systematic exercising in general and development of AIS, classical ballet and professional swimming in skeletally immature adolescents were associated to higher odds of having AIS. Since AIS affects adolescent girls mainly, women health issues are of paramount importance in this disease. Except for limited sexual activity and higher need for infertility treatment, patients with AIS perform similar to controls in marriage rates, age at first pregnancy, gestational age, offspring, labor and delivery. Best available evidence shows that adults with AIS diagnosed during adolescence have similar physical activity level compared with controls. In patients with AIS, adults with surgically treated idiopathic scoliosis have slightly lower physical activity level than previously braced and untreated patients.

SUMMARY

Although schoolbag weight isn't associated with higher odds of developing AIS, classical ballet and professional swimming in adolescents are. Except for limited sexual activity, patients with AIS perform similar to controls in remaining women health issues. Adults with AIS diagnosed during adolescence have similar physical activity level compared with controls.

A prospective 1-year study on load reduction of school backpacks shows reversible changes of body posture in schoolchildren

BACKGROUND

The impact of backpack carrying on body postural changes in schoolchildren has been discussed intensively. However, findings are inconsistent mainly due to the lack of long-term results.

OBJECTIVE

The purpose of this investigation was to study the influence of backpack weight on body posture and prevalence of back pain.

METHODS

In our prospective, comparative study, we investigated the influence of backpack weight on 77 schoolchildren (average age 10.8 ± 0.7 years) over a 1-year period. Participants were evaluated at the beginning of the study by clinical examination and formal static posture analysis. Forty-nine students comprised the control group while 28 students in the intervention cohort had the weight of their backpacks reduced by 2 kg. All students were reevaluated after 6 and 12 months by formal postural examination.

RESULTS

Children with reduced backpack weights had a significantly improved bending posture when wearing their backpacks when compared to the participants of the control group, whereas the analysis of the children while they did not wear their backpacks revealed no difference between the groups. Within the follow-up period all postural changes were reversible once the backpack weight was removed.

CONCLUSIONS

Schoolchildren with heavy backpack loads show postural changes while carrying their backpack but this impact was reversible when backpacks were removed. Continuous reduction of backpack loads minimizes prevalence of back pain.

Understanding child and parent perceptions of barriers influencing children's active school travel

BACKGROUND

Physical activity plays a fundamental role in the health and well-being of children. Walking is the most common form of physical activity and the journey to and from school provides an opportunity for children to be active every day. This study examines how child and parent perceptions of barriers to active school travel influences children's behaviour.

METHODS

Participants were recruited from 48 elementary schools in Southwestern Ontario, Canada. The study sample includes 1296 children (ages 9-14 years) who live within walking distance of their school, defined as 1.6 km network distance. Chi-square analysis examined differences between child and parent perceptions of barriers to active school travel. Logistic regression models examined how parent and child perceptions of barriers influence active school travel behaviour, while controlling for key intrapersonal, interpersonal, and physical environment factors.

RESULTS

The results indicate that there are significant differences in how parents and children perceive barriers to active school travel. Model results find older children, children without siblings, households with no vehicles, and children who live closer to school are most likely to use active school travel. Parent perceptions of barriers are found to have a greater influence on children's active school travel behaviour than children's perceptions. Different perceptions of barriers influence active school travel to school compared to returning home from school.

CONCLUSIONS

Child and parent perceptions of barriers to active school travel differ and have different impacts on children's travel behaviour. Understanding how child and parent perceptions of barriers differ can help policymakers and practitioners develop specialized interventions aimed at increasing children's use of active school travel and children's overall physical activity. Interventions used to promote active school travel should focus on safety, as well as perceptions of distance to break parental habits of routinely driving their children to school. Overall, this study highlights the importance of considering both child and parent perceptions to create a safe and accessible environment to allow for an increase in active school travel behaviour among elementary school children who live within walking distance of their school.

The Influence of Backpack Weight and Hip Belt Tension on Movement and Loading in the Pelvis and Lower Limbs during Walking

The introduction of hip belts to backpacks has caused a shift of loading from the spine to the hips with reported improvements in musculoskeletal comfort. Yet the effects of different hip belt tensions on gait biomechanics remain largely unknown. The goal of this study was to assess the influence of backpack weight and hip belt tension on gait biomechanics. Data from optical motion capture and ground reaction forces (GRF) during walking were acquired in nine healthy male subjects (age 28.0 ± 3.9 years). Six configurations of a commercial backpack were analyzed, that is, 15 kg, 20 kg, and 25 kg loading with 30 N and 120 N hip belt tension. Joint ranges of motion (ROM), peak GRF, and joint moments during gait were analyzed for significant differences by repeated measures of ANOVA with Bonferroni post hoc comparison. Increased loading led to a significant reduction of knee flexion-extension ROM as well as pelvis rotational ROM. No statistically significant effect of hip belt tension magnitudes on gait dynamics was found at any backpack weight, yet there was a trend of increased pelvis ROM in the transverse plane with higher hip belt tension at 25 kg loading. Further research is needed to elucidate the optimum hip belt tension magnitudes for different loading weights to reduce the risks of injury especially with higher loading.

Low Back Pain in Adolescents: A 1-Year Analysis of Eventual Diagnoses

BACKGROUND

Back pain in adolescents is very common and often seen in the office for evaluation of potential spinal pathology. Pediatric back pain has often thought to be from serious identifiable causes such as spondylolysis, spondylolisthesis, tumor, or infection. A follow-up analysis of adolescents initially presenting with back pain to their eventual subsequent diagnosis within 1 year has not been reported on a large scale with a national sample.

METHODS

A national insurance database (PearlDiver Patient Records Database) was queried for ICD-9 codes to identify patients aged 10 to 19 years with back pain from 2007 to 2010. These patients were tracked for imaging obtained, and eventual development of subsequent associated spinal pathology diagnoses using CPT and ICD-9 codes for up to 1 year after initial presentation.

RESULTS

A total of 215,592 adolescents were identified presenting with low back pain (LBP) from 2007 to 2010. Over 80% of adolescents with LBP had no identifiable diagnosis within 1 year. The most common associated subsequent diagnoses were lumbar strain/spasm (8.9%), followed by scoliosis (4.7%), lumbar degenerative disk disease (1.7%), and lumbar disk herniation (1.3%). The rates of all other diagnoses including spondylolysis, spondylolisthesis, infection, tumor, and fracture had <1% association with LBP.

CONCLUSIONS

In conclusion, adolescent LBP is a common diagnosis for which underlying serious pathology is rare. The most common diagnosis aside from strain or muscle spasm associated with LBP are scoliosis and degenerative disk disease. Pediatric orthopaedists often are consulted on patients with LBP and should always have high suspicion for potential serious spinal pathology, but should recognize the most common etiologies of back pain in adolescence.

LEVEL OF EVIDENCE

Level IV-case series.

Understanding Adolescent Low Back Pain From a Multidimensional Perspective: Implications for Management

Synopsis Low back pain (LBP) is the leading cause of disability worldwide. It often begins in adolescence, setting a course for later in life. We have tracked the course of LBP in the Raine Study cohort from the age of 14 years into early adulthood. Our work has found that LBP is already prevalent in individuals at 14 years of age and increases throughout adolescence and into early adulthood. It is often comorbid with other musculoskeletal pain. For some adolescents, LBP has little impact; for others, its impact includes care seeking, taking medication, taking time off from school and work, as well as modifying physical and functional activity. Of concern is the increasing prevalence of LBP with impact across adolescence, reaching adult rates by 22 years of age. The predictors of disabling LBP in adolescence are multidimensional. They include female sex, negative back pain beliefs, poor mental health status, somatic complaints, involvement in sports, and altered stress responses. Genetics also plays a role. Ironically, the factors that we have historically thought to be important predictors of LBP, such as "poor" spinal posture, scoliosis, carrying school bags, joint hypermobility, and poor back muscle endurance, are not strong predictors. This challenges our clinical beliefs and highlights that adolescent LBP needs a flexible and targeted multidimensional approach to assessment and management. In most cases, we recommend a cognitive functional approach that challenges negative LBP beliefs, educates adolescents regarding factors associated with their LBP, restores functional capacity where it is impaired, and encourages healthy lifestyle habits. J Orthop Sports Phys Ther 2017;47(10):741-751. Epub 12 Sep 2017. doi:10.2519/jospt.2017.7376.

Parental awareness of schoolbag carriage: A comparative study of Irish and United States parents

BACKGROUND

Given the global nature of schoolbag carriage, there has been extensive research on schoolbag weight and use with resultant guidance on many aspects of carrying a schoolbag. However, there is limited evidence of knowledge translation or parents' awareness of schoolbag carriage.

OBJECTIVE

This study investigated parental awareness of factors related to schoolbag carriage.

METHOD

A cross-sectional survey using an anonymous 30-item questionnaire and purposive sampling was used. Questionnaires were distributed to parents of primary school children through the schools. Descriptive statistics of frequencies and percentages were used and associations were tested using Chi-square analysis in SPSS v23.

RESULTS

A total of 700 parents in Ireland (Ire) and the United States (US) participated in the study (n = 444 [Ire] and n = 256 [US]). Generally, parents had satisfactory awareness of appropriate schoolbag type and carriage. The majority of children owned a backpack (89.9% [Ire] vs. 93.7% [US]), although fewer parents considered this to be the most suitable bag for their child (69.6% [Ire] vs. 88.2% [US]). More Irish parents (29.2%) favoured a wheeled schoolbag compared to US parents (6.2%) (p < 0.001). The majority (70.8% [Ire] vs. 55.7% [US]) wanted more information. The preferred platforms for receiving information were a handout (78.1% [Ire] vs. 71.6% [US]) and on-line (44.6% [Ire] vs. 53.9% [US]).

CONCLUSIONS

Despite gaps identified, parents had good awareness of factors relating to schoolbag carriage, but this study shows that they would like more information. The preferred platform for knowledge translation was a handout. Parents are the best advocates for safety promotion and represent the group most likely to improve schoolbag carriage among children.

Postural habits and weight of backpacks of Portuguese adolescents: Are they associated with scoliosis and low back pain?

BACKGROUND

The adoption of incorrect postures or carrying overweight backpacks may contribute to the development of musculoskeletal disorders in school children.

OBJECTIVE

This study evaluated the weight of backpacks and the postural habits adopted in schools by Portuguese adolescents, and their association with scoliosis and low back pain (LBP).

METHOD

The sample comprised 966 Portuguese students, aged between 10 and 16 years. The instruments included a questionnaire to characterize the presence of LBP and the postural habits adopted by students, the weighing of backpacks and a scoliometer to evaluate scoliosis.

RESULTS

No association was observed between assuming incorrect postures and carrying overweight backpacks, in students with scoliosis. Students who adopted incorrect sitting postures had 1.77 times the risk (95% CI: 1.32-2.36; p < 0.001) of developing LBP; those positioned incorrectly whilst watching TV and playing games had 1.44 times the risk (95% CI: 1.08-1.90; p = 0.012) of developing LBP; and those standing incorrectly had 2.39 the risk (95% CI: 1.52-3.78; p < 0.001) of developing LBP.

CONCLUSIONS

The results revealed that students who sat with the spine positioned wrongly, as well as those who were standing incorrectly, were more likely to present with LBP.

Guidelines for schoolbag carriage: An appraisal of safe load limits for schoolbag weight and duration of carriage

BACKGROUND

There is no global agreement on a schoolbag weight limit and little assessment of its utility. The duration of carriage is another factor yet there is no previous systematic assessment of the utility of cut-off values for it in identifying schoolbag-related discomfort.

OBJECTIVES

The objectives were to establish if there was a threshold for musculoskeletal discomfort based on (i) percentage bodyweight (% BW) of the schoolbag; (ii) duration of carriage; or (iii) combined % BW and duration.

METHODS

Using data from 462 primary school children, a novel experimental approach was used to explore the utility of conventional schoolbag weight limit guidelines and duration of carriage. A receiver operating characteristic (ROC) curve was constructed to examine the predictive performance of schoolbag weight and duration of carriage.

RESULTS

The mean schoolbag weight (4.8±1.43  kg) represented a mean 12.4±4.18% BW. Only 30.7% of the sample carried schoolbags that were ≤10% BW. The majority (76%) carried schoolbags to school for ≤10 minutes. No % BW, duration of carriage or mechanical burden criterion provided a threshold cut-off point for accurately predicting schoolbag-related discomfort.

CONCLUSIONS

Guidelines for safe schoolbag carriage that are based on mechanical factors alone could not be upheld. The association between duration of carriage and back discomfort warrants further investigation.

The relationship between back pain and schoolbag use: a cross-sectional study of 5,318 Italian students

BACKGROUND CONTEXT

Back pain at a young age is considered to be predictive of chronicity. Several studies have investigated the relationship between the use of a schoolbag and back pain, although some aspects are still unclear.

PURPOSE

The aim of this study was to evaluate back pain due to schoolbag use in terms of (1) prevalence and intensity, (2) differences between male and female pupils, and (3) predisposing factors.

STUDY DESIGN

This is a cross-sectional study.

PATIENT SAMPLE

The sample was composed of 5,318 healthy pupils aged 6 to 19 years (classified according to three age groups: children, younger adolescents, and older adolescents).

OUTCOME MEASURES

Schoolbag-related pain was assessed by means of an ad hoc questionnaire. The intensity of pain was assessed using the Wong scale.

METHODS

Subjects underwent a face-to-face interview using an ad hoc questionnaire. The intensity of pain was assessed using the Wong scale. On the basis of the prevalence and intensity of back pain, we divided our population into two groups: (1) no or mild pain group and (2) moderate or severe pain group. The "schoolbag load" (ratio between schoolbag and pupil weight multiplied by 100) was calculated for each subject.

RESULTS

More than 60% of the subjects reported pain. Although the schoolbag load decreased from children to young and older adolescents, schoolbag-related pain significantly increased (p<.001). Girls reported significantly more frequent and more severe pain than boys. The logistic model confirmed that adolescent girls are the group at greatest risk of suffering from intense pain. The schoolbag load had a weak impact on back pain, whereas the schoolbag carrying time was a strong predictor.

CONCLUSIONS

Adolescent girls have the highest risk of experiencing severe back pain, regardless of schoolbag load. This suggests that other factors (anatomical, physiological, or environmental) might play an important role in pain perception. These aspects should be investigated to plan appropriate preventive and rehabilitative strategies.

Peso e modo de transporte do material escolar no ensino fundamental I: efeito dos anos escolares e do sexo

RESUMO O peso do material escolar e o modo de transportá-lo podem contribuir para desvios posturais e dor nas costas. Por isso, o objetivo foi verificar e comparar, entre os anos escolares e os sexos, o peso do material escolar em relação ao peso corporal e o modo de transporte do material de alunos do Ensino Fundamental I, os quais deixam os seus livros em estantes na escola. Participaram 191 escolares. O peso do material escolar e o peso corporal dos alunos foram verificados com uma balança, e o modo de transporte do material foi avaliado por meio de fotos. Observou-se que 47,7% dos alunos transportavam um peso acima do limite estabelecido (10% do peso corporal do aluno), sendo que o 1º ano transportava um menor peso do que os 2º, 3º e 5º anos, mas não houve diferença entre os sexos. Foi encontrado predomínio do uso da mochila de duas alças. Contudo, apesar de a escola já ter uma estratégia para reduzir o peso do material, quase metade dos escolares transportava um peso superior a 10% do peso corporal. Logo, outras medidas para alertar os envolvidos são necessárias.

Evaluation and Diagnosis of Back Pain in Children and Adolescents

Although traditionally it has been accepted that back pain in young children and adolescents most often has an organic etiology, nonorganic back pain in this population is becoming more common. The most common identifiable clinical entities responsible for such pain are spondylolysis, spondylolisthesis, Scheuermann kyphosis, overuse syndromes, disk herniation, apophyseal ring fracture, spondylodiscitis, vertebral osteomyelitis, and neoplasm. Appropriate clinical workup leads to earlier diagnosis and management of back pain and avoids unnecessary cost. Knowledge of the most common diagnoses associated with back pain in children and adolescents and the use of a systematic method to select the appropriate diagnostic tests can help the clinician to minimize costs and maximize the likelihood of making the correct diagnosis and providing appropriate treatment.

Mechanical Predictors of Discomfort during Load Carriage

Discomfort during load carriage is a major issue for activities using backpacks (e.g. infantry maneuvers, children carrying school supplies, or outdoor sports). It is currently unclear which mechanical parameters are responsible for subjectively perceived discomfort. The aim of this study was to identify objectively measured mechanical predictors of discomfort during load carriage. We compared twelve different configurations of a typical load carriage system, a commercially available backpack with a hip belt. The pressure distribution under the hip belt and the shoulder strap, as well as the tensile force in the strap and the relative motion of the backpack were measured. Multiple linear regression analyses were conducted to investigate possible predictors of discomfort. The results demonstrate that static peak pressure, or alternatively, static strap force is a significant (p<0.001) predictor of discomfort during load carriage in the shoulder and hip region, accounting for 85% or more of the variation in discomfort. As an additional finding, we discovered that the regression coefficients of these predictors are significantly smaller for the hip than for the shoulder region. As static peak pressure is measured directly on the body, it is less dependent on the type of load carriage system than static strap force. Therefore, static peak pressure is well suited as a generally applicable, objective mechanical parameter for the optimization of load carriage system design. Alternatively, when limited to load carriage systems of the type backpack with hip belt, static strap force is the most valuable predictor of discomfort. The regionally differing regression coefficients of both predictors imply that the hip region is significantly more tolerant than the shoulder region. In order to minimize discomfort, users should be encouraged to shift load from the shoulders to the hip region wherever possible, at the same time likely decreasing the risk of low back pain or injury.

Schoolbag carriage and schoolbag-related musculoskeletal discomfort among primary school children

Schoolbag carriage is a common occurrence and has been associated with musculoskeletal discomfort in children. The current study investigated the relationship between schoolbag-related musculoskeletal discomfort and individual, physical and psychosocial risk factors in primary school children in Ireland. A cross-sectional survey and pretest-posttest quasi-experimental design was used. The site and intensity of musculoskeletal discomfort was assessed before and after schoolbag carriage to provide a dose-response assessment of schoolbag-related discomfort for the first time. Objective measurements of the children, schoolbags and other additional items were made, and a researcher assisted questionnaire was completed on arrival at school. A total of 529 children (male 55.8%: female 44.2%) with a mean age of 10.6 years ± 7.14 months were included. The majority had backpacks (93.8%) and 89.7% (n = 445) carried the backpack over 2 shoulders. The mean schoolbag weight (4.8 ± 1.47 kgs) represented a mean % body weight (%BW) of 12.6 ± 4.29%. Only 29.9% carried schoolbags that were ≤10%BW. A significantly greater proportion of normal weight children carried schoolbags that were >10%BW compared to overweight/obese children (p < 0.001). The mean %BW carried was 18.3 ± 5.03 for those who had an additional item. The majority (77.5%) carried schoolbags to school for ≤10 min. The prevalence of baseline musculoskeletal discomfort was high (63.4%). Schoolbag-related discomfort was reported more frequently in the shoulders (27.3%) than in the back (15%). The dose-response assessment indicated that both statistically and meaningfully significant increases in discomfort were observed following schoolbag carriage. Multiple logistic regression models indicated that psychosocial factors and a history of discomfort were predictors of schoolbag-related back discomfort, while gender (being female) and a history of discomfort were predictors of schoolbag-related shoulder discomfort. None of the physical factors (absolute/relative schoolbag weight, carrying an additional item, duration of carriage, method of travel to school) were associated with schoolbag-related discomfort. This study highlights the need to consider the multi-factorial nature of schoolbag-related discomfort in children, and also the need to identify background pain as its presence can inadvertently influence the reporting of 'schoolbag-related' discomfort if it is not accounted for.

Association of obesity with chronic disease and musculoskeletal factors

SummaryIntroduction:overweight and obesity in adolescents are major public health problems with particular interest, because of their potential association with risk factors for development of diseases. The study aimed to determine the prevalence of overweight and obesity in adolescents in southern Portugal and investigate the association with risk factors for development of cardiovascular, respiratory and musculoskeletal diseases.Methods:the sample consisted of 966 adolescents aged 10 to 16 years. The calculation of body mass index (BMI), evaluation of blood glucose, total cholesterol and triglycerides, blood pressure, spirometry and application of low back pain (LBP) questionnaire were performed.Results:178 (18.4%) adolescents were overweight and 52 (5.4%) obese. None of the variables revealed a statistically significant association with overweight and obesity. The presence of high blood pressure was observed in 200 (20.7%) individuals and hypertension in 158 (16.4%) adolescents. Overweight and obese adolescents are 2.3 times more likely to develop signs of pre-hypertension and hypertension. 559 (57.9%) students had restrictive respiratory disorders and 23 (2.4%) had obstructive disorders. Those who were overweight and obese had 0.64 probability of having restrictive respiratory disorders.Conclusion:there was a high prevalence of overweight and obesity in Portuguese adolescents and these showed a statistically significant relationship with the development of pre-hypertension and hypertension, and restrictive respiratory disorders.

Effect of backpack position on foot weight distribution of school-aged children

[Purpose] In the present study, we aimed to determine the effects of backpack position on foot weight distribution of standing school-aged children. [Subjects] Thirty school-aged children volunteered to participate in this study. [Methods] The subjects randomly performed four types of carrying a backpack: no backpack (condition-1), carrying a backpack at C7 (condition-2), carrying a backpack at 10 cm below C7 (condition-3), and carrying a backpack at 20 cm below C7 (condition-4). [Results] Statistically significant differences were noted in the anterior and posterior pressure values, and in the anterior-to-posterior ratio, among the four conditions (p < 0.05). Post-hoc analysis indicated that the pressure value of condition-4 was significantly lower in the anterior foot region and higher in the posterior foot region than in condition-2 and condition-3. In addition, the anterior-to-posterior ratio was lower in condition-4 than in condition-2 and condition-3. [Conclusion] These findings suggest that carrying a backpack in a higher position, with fastening of the shoulder strap, may be more favorable for normalizing the foot weight distribution.

Non-specific low back pain in adolescents from the south of Portugal: prevalence and associated factors

BACKGROUND

Low back pain (LBP) is a common condition in children and adolescents, and the prevalence has been increasing over the years. Most cases of LBP are due to non-specific causes; however, the role of these risk factors is still controversial. This study determined the prevalence of LBP in Portuguese adolescents and characterized the associated factors.

METHODS

The design of this study was observational, analytical and cross-sectional. The sample included 966 adolescents from southern Portugal, aged between 10 and 16 years. The assessments included a questionnaire to characterize the presence of LBP, postural habits, body mass index (BMI) and backpack weights and to use a scoliometer to evaluate the presence of scoliosis.

RESULTS

One hundred fifty-two (15.7 %) students had LPB at the present time, 456 (47.2 %) had experienced it in the last year, and 600 (62.1 %) had lifetime prevalence of LBP. Girls have 2.05 more probability of presenting LBP than boys (95 % CI 1.58-2.65; p < 0.001), and older students have a 1.54 greater probability (95 % CI 1.19-1.99; p = 0.001). Students who sit with the spine incorrectly positioned presented 2.49 greater probability of having LBP (95 % CI 1.91-3.2; p < 0.001), students using improper positions for watching TV or playing games have 2.01 greater probabilities (95 % CI 1.55-2.61; p < 0.001), and those who adopt an incorrect standing posture have a 3.39 greater chance of experiencing LBP (95 % CI 2.19-5.23; p < 0.001).

CONCLUSIONS

This study found a high prevalence of LBP in adolescents, with higher values in older students, female students and those who adopted incorrect positions when sitting or standing.

Alterations in the plantar pressure patterns of overweight and obese schoolchildren due to backpack carriage

BACKGROUND

Among other adverse consequences, childhood obesity is known to influence foot structure and functionality. Yet little information is available regarding how the physiologic foot-ground interaction is altered when a localized load is carried, as occurs in the case of schoolbags. We investigated plantar contact area and pressure modifications induced by backpack carriage under actual conditions. We hypothesized that a localized load acting on the body would further increase the already excessive plantar pressure that exists with overweight and obese status.

METHODS

Seventy overweight and obese schoolchildren aged 6 to 11 years underwent two 30-sec trials on a pressure platform during a regular school day, with and without a backpack. Total and subregion contact areas along with peak plantar pressures were obtained, and results were compared with those of an equal-numbered group of normal-weight schoolchildren.

RESULTS

Overweight and obese children generally had larger contact areas and higher peak plantar pressures compared with their normal-weight peers. In overweight and normal-weight participants, the backpack induced a similar generalized increase in contact area and pressures. However, the largest changes were observed in the forefoot, suggesting that load action tends to modify the physiologic pressure patterns.

CONCLUSIONS

Backpack carriage raises the already elevated peak plantar pressures in overweight children during upright stance and modifies the physiologic pressure patterns. Further investigations are needed to clarify the features of such phenomenon when dynamic activities are performed and to verify the existence of fatigue and overexertion on the foot as well as other possible negative long-term effects.

Altered disc compression in children with idiopathic low back pain: an upright magnetic resonance imaging backpack study

STUDY DESIGN

This study is a repeated measures design to measure the lumbar spine's response to common backpack loads in children with idiopathic low back pain (ILBP) using upright magnetic resonance imaging (MRI).

OBJECTIVE

The purpose of this study is to analyze the lumbar spine's response to backpack loads with upright MRI in children with ILBP to compare their results with previously published normal child data under the same conditions. We hypothesize that typical backpack loads will have a different effect on the lumbar spine of normal children and children with ILBP.

SUMMARY OF BACKGROUND DATA

Research in normal children shows that backpack loads compress the lumbar intervertebral discs (IVDs), increase lumbar coronal deformity, and increase pain.

METHODS

Fifteen pediatric and adolescent patients with ILBP were selected. Patients were excluded if a spinal deformity, an underlying pathology, or known injury was identified. A 0.6-T upright MRI scanner imaged the subjects while in supine and standing positions wearing 0-kg, 4-kg, and 8-kg backpacks. IVD height, lumbar lordosis, lumbar coronal deformity, and pain score were recorded after each condition and compared using analysis of variances. We compared the above-mentioned variables between ILBP and normal subjects using generalized least squares models.

RESULTS

The cohort's mean age was 13 ± 3 years. The 4-kg and 8-kg backpacks only compressed the L5-S1 IVD relative to upright with no load. Subjects experienced increasing pain with increasing load. Load had no effect on lumbar lordosis or lumbar coronal deformity. Compared with normal children, children with ILBP experience significantly less disc compression at T12-L1 to L4-L5, less lumbar lordosis, and more pain with increasing load.

CONCLUSION

In children with ILBP, increasing backpack load compresses only the L5-S1 IVD. Compared with normal children, children with ILBP experience less lumbar IVD compression, less lumbar lordosis, and more pain due to increasing load suggesting altered mechanisms for load tolerance in children with ILBP.

LEVEL OF EVIDENCE

3.

Relative weights of the backpacks of elementary-aged children

The purpose of the study was to describe the range of relative backpack weights of one group of elementary-aged children and the extent to which they exceeded recommended levels. A second purpose was to explore whether gender and age help predict the relative weight of children's backpacks. Ninety-five 8- to 12-year-old elementary school students (56% girls; 88% car or bus riders) participated. Their school backpacks were weighed, and their age, gender, and mode of transportation to school were recorded. Only 40% of the sample carried backpacks that were less than 10% of their body weights. Five percent of the students' backpacks exceeded 20% of their body weights. Neither age group nor gender significantly predicted relative backpack weight or relative weight levels. Recommendations are made for ways to reduce the weight these young children carry.

Schoolbag weight limit: can it be defined?

BACKGROUND

Carrying a schoolbag is a daily activity for most children and much research has been conducted in an effort to identify a safe load limit for children to carry in their schoolbags. Despite this, there is still no consensus about guideline weight and other factors associated with carrying a schoolbag. The objective of this article is to review the literature on schoolbags with particular emphasis on the load limit guidelines and schoolbag-related musculoskeletal pain, and to suggest directions for school health and future research.

METHODS

Science Direct, PubMed, AMED, CINAHL, OVID, EMBASE, and Scopus were searched for peer-reviewed articles using combinations of the following key words: schoolbag, backpack, rucksack, knapsack, satchel, book bag, book pack and included combinations of children, pain, gait, and posture. Article references were also checked for further citations. All are in English, with the exception of one which is in German but is widely cited.

RESULTS

There are conflicting findings in the literature. The recommended load limit for schoolchildren to carry varies from 5% to 20% of their body weight, and the evidence linking backpack weight and back pain is inconclusive.

CONCLUSIONS

The shortcomings in the current literature should be addressed so that evidence-based guidelines can be provided to schoolchildren, parents, and teachers. It is suggested that general guidance may be more appropriate than a single load limit guideline.

Effects of a postural education program on school backpack habits related to low back pain in children

PURPOSE

Population based studies have demonstrated that children and adolescents often complain of low back pain. A group-randomized controlled trial was carried out to investigate the effects of a postural education program on school backpack habits related to low back pain in children aged 10-12 year.

METHODS

The study sample included 137 children aged 10.7 years (SD = 0.672). Six classes from two primary schools were randomly allocated into experimental group (EG) (N = 63) or control group (CG) (N = 74). The EG received a postural education program over 6 weeks consisting of six sessions, while the CG followed the usual school curriculum. A questionnaire was fulfilled by the participants at pre-test, post-test, and 3 months after the intervention finished. The outcomes collected were: (1) try to load the minimum weight possible, (2) carry school backpack on two shoulders, (3) belief that school backpack weight does not affect to the back, and (4) the use of locker or something similar at school. A sum score was computed from the four items.

RESULTS

Single healthy items mostly improved after the intervention and remained improved after 3-month follow-up in EG, while no substantial changes were observed in the CG. Healthy backpack use habits score was significantly increased at post-test compared to baseline in the EG (P < 0.000), and remained significantly increased after 3-month, compared to baseline (P = 0.001). No significant changes were observed in the CG (P > 0.2).

CONCLUSIONS

The present study findings confirm that children are able to learn healthy backpack habits which might prevent future low back pain.

Biomechanical evaluation of different abduction splints for the treatment of congenital hip dysplasia

BACKGROUND

Abduction splints for the treatment of hip dysplasia normally operate on curbing the legs at the hip flexion and abduction. The forces are absorbed in different designs of shoulder straps and thus diverted to the shoulder and the spine. The present study is the first comparing these undesired forces of two spread orthoses and subsequently the transmitted forces to the infant's spine.

METHODS

Between March 2009 and October 2009 the hips of 290 infants were investigated by ultrasound within the first 3 days after birth. Thereof 20 infants with a hip dysplasia Graf type IIc, D or IIIa met our inclusion criteria and were investigated with a Tübinger and a Superior abduction splint. Biomechanical evaluation was performed by using a high-sensitive strain gauge sensor applied to the infant's orthoses between pelvic harness and shoulder straps.

FINDINGS

The transmitted forces to the infant's shoulders correlated significantly with their body mass (P<0.05). Maximal forces on the shoulder of the infants and subsequently transmitted forces on the spine were significantly higher (P<0.05) with the Tübinger splint (range 7.6N to 32.3N; arithmetic mean M: 13.7N) in comparison to the Superior orthosis (range 0.0N to 3.5N; M: 0.7N).

INTERPRETATION

The Superior orthosis works with primary load transmission to the pelvic bone. Using the Tübinger splint the shoulders of the newborn infants are loaded with a maximum of 93.9% of their body mass. This may influence the development of the growing infant's spine.

Spondylolysis is frequently missed by MRI in adolescents with back pain

PURPOSE

Magnetic resonance imaging (MRI) is often used in the evaluation of lower back pain in adolescents. The purpose of our study is to report on the frequency of MRI missing spondylolysis in adolescents with back pain in a pediatric orthopaedic practice.

METHODS

A retrospective review of all patients with a diagnosis of spondylolysis who presented from January 2000 to March 2010 was performed. All patients were evaluated at a single institution by the senior author. Inclusion criteria were patients with spondylolysis confirmed on computed tomography (CT) or plain film that also received an MRI.

RESULTS

Eleven patients with spondylolysis had an MRI performed. The mean age of the study patients was 14.2 years (range 10-17). The diagnosis of spondylolysis was missed in the MRI radiology reading in 7 out of 11 (64 %) studies.

CONCLUSIONS

MRI missed a spondylolysis in over half of the adolescents in this consecutive series. In patients with a history or physical findings suggestive of spondylolysis, such as localized pain of the lumbar spine with back extension, further radiographic evaluation should be considered, even if an MRI is negative.

LEVEL OF EVIDENCE

III, retrospective review.

Low back pain in 17 year olds has substantial impact and represents an important public health disorder: a cross-sectional study

Background

Prevalence of low back pain (LBP) rises rapidly during adolescence, reaching adult levels by the age of 18. It has been suggested that adolescent LBP is benign with minimal impact, despite limited evidence.

Methods

The aim of this study was to investigate the impact of LBP and the influence of chronicity, gender and presence of other spinal pain comorbidities at age 17. Subjects (n = 1283) were categorised according to experiencing current and chronic LBP, gender and presence of other areas of spinal pain. LBP impact was ascertained via questions regarding seeking professional assistance, using medication, missing school/work, limited normal or recreational physical activity and health related quality of life (HRQOL).

Results

12.3% of participants reported current but not chronic LBP, while 19.9% reported current chronic LBP. LBP was more commonly reported by females than males. Other spinal pain comorbidities were common in the LBP groups. Impact was greater in subjects with chronic LBP, in females and in those with other spinal pain comorbidities.

Conclusion

LBP, and particularly chronic LBP, has a significant negative impact at 17 years. It is commonly associated with care seeking, medication use, school absenteeism, and reduced HRQOL. These findings support that adolescent LBP is an important public health issue that requires attention.

[Prevalence of idiopathic scoliosis and associated variables in schoolchildren of elementary public schools in Cuiabá, state of Mato Grosso, 2002]

OBJECTIVE

To estimate the prevalence of idiopathic scoliosis and its associated factors in schoolchildren of elementary public schools.

METHODS

Cross sectional two-phase study, the first of which in classrooms. Those considered Adams positive were invited for the second phase, which consisted of an interview for associated factors and a scoliosis exam. Those with a confirmed test in the second phase were submitted to x-rays for scoliosis and other factors. To estimate the prevalence, curves with > 5 and > 10 Cobb degrees were used as cut off.

RESULTS

In the first phase, 382 students were counted as Adams positive; of these 210 came for the second phase, 142 of which with a confirmed test. Using a chi-square test to compare the variables age, sex and color of the lost group (n = 172) to the group that accepted the invitation (n = 210), no statistical significance was observed, allowing statistical inference for the sample studied (n = 3,105). The estimated prevalence of scoliosis in the sample studied was 5.3% for curves > 5 Cobb degrees and 2.2% for curves > 10 Cobb degrees. Thoracic curves were observed in 44.8%, Risser grade 1 in 97.4%, and vertebral rotation degree I in 3.2%. Statistical significance was observed (p < 0.05) for the association of scoliosis with: physical activity, hump, and flexibility of the spine to the right.

CONCLUSION

The estimated prevalence of scoliosis in our study is comparable to those from other studies. However, its diagnosis and follow-up are important to health promotion and to the prevention of more severe disorders.

Low back pain in adolescents: a comparison of clinical outcomes in sports participants and nonparticipants

CONTEXT

Back pain is common in adolescents. Participation in sports has been identified as a risk factor for the development of back pain in adolescents, but the influence of sports participation on treatment outcomes in adolescents has not been adequately examined.

OBJECTIVE

To examine the clinical outcomes of rehabilitation for adolescents with low back pain (LBP) and to evaluate the influence of sports participation on outcomes.

DESIGN

Observational study.

SETTING

Outpatient physical therapy clinics.

PATIENTS OR OTHER PARTICIPANTS

Fifty-eight adolescents (age = 15.40 +/- 1.44 years; 56.90% female) with LBP referred for treatment. Twenty-three patients (39.66%) had developed back pain from sports participation.

INTERVENTION(S)

Patients completed the Modified Oswestry Disability Questionnaire and numeric pain rating before and after treatment. Treatment duration and content were at the clinician's discretion. Adolescents were categorized as sports participants if the onset of back pain was linked to organized sports. Additional data collected included diagnostic imaging before referral, clinical characteristics, and medical diagnosis.

MAIN OUTCOME MEASURE(S)

Baseline characteristics were compared based on sports participation. The influence of sports participation on outcomes was examined using a repeated-measures analysis of covariance with the Oswestry and pain scores as dependent variables. The number of sessions and duration of care were compared using t tests.

RESULTS

Many adolescents with LBP receiving outpatient physical therapy treatment were involved in sports and cited sports participation as a causative factor for their LBP. Some differences in baseline characteristics and clinical treatment outcomes were noted between sports participants and nonparticipants. Sports participants were more likely to undergo magnetic resonance imaging before referral (P = .013), attended more sessions (mean difference = 1.40, 95% confidence interval [CI] = 0.21, 2.59, P = .022) over a longer duration (mean difference = 12.44 days, 95% CI = 1.28, 23.10, P = .024), and experienced less improvement in disability (mean Oswestry difference = 6.66, 95% CI = 0.53, 12.78, P = .048) than nonparticipants. Overall, the pattern of clinical outcomes in this sample of adolescents with LBP was similar to that of adults with LBP.

CONCLUSIONS

Adolescents with LBP due to sports participation received more treatment but experienced less improvement in disability than nonparticipants. This may indicate a worse prognosis for sports participants. Further research is required.