A groundbreaking study on children of both sexes in selected schools in Colombo conducted by a team from the Faculty of Medicine, University of Colombo recently reportedly demonstrated the bio mechanical effect of carrying heavy school bags, which showed that the thick stack of books that children have to carry daily to school, exceeding their weight, has an adverse impact on their developing spine, causing stress and leading to musculoskeletal complications and breathing difficulties that could affect them for life. According to the report, around 64% of the students allegedly carried bags weighing between 10-20% of their body weight, while 20.6% had a bag weight more than 20% of their body weight. Only 15% had a bag weight within the recommended range of below 10% of body weight.
The good news is that most physical complications including curvature of the spine etc can often be corrected when detected and treated early without surgery by some simple exercises, says a physiotherapist in a leading hospital who tells anxious parents how to prevent and reduce common complications in growing children, caused by carrying heavy bags on their backs.
Excerpts from Physiotherapist Shashika Karunathilake’s interview with the Sunday Observer…
Q. Back problems caused by injuries have increased among schoolchildren in recent years. What are the most common of these injuries?
A. Muscle strains and Ligament sprains are the most common injuries that cause back pain in schoolchildren. Also back problems can arise from slipped discs, joint malalignment, etc. They can be caused by athletic overuse, improper body mechanics and technique, lack of proper conditioning, insufficient stretching, as well as trauma.
Q. What kind of sports cause these injuries and back pain?
A. When engaged in active sport, the spine undergoes a lot of stress, absorption of pressure, twisting, turning, and even body impact. These strenuous activities put a strain on the back that can cause injury to even the finest and most fit sportsmen. So any strenuous or impact sport can cause back problems. But some studies suggest that the football causes more injuries in childhood than other sports.
Q. How can they be minimized?
A. Develop a fitness plan that includes cardiovascular exercise, strength training, and flexibility; alternate exercising different muscle groups; follow proper warm up, cool down, stretching protocols. Take a well-balanced diet, stay hydrated and get rest; use right equipment. And, following medical advice get the help of a qualified physiotherapist.
Q.How can physiotherapy help?
A. Early detection is the key to prevent any injury. Physiotherapists can detect the muscle imbalances, weakened or tightened muscles, joint malalignment, and improper body mechanics during the assessment. Suitable interventions should be implemented for those identified problems to prevent future injuries.
Q. Some coaches push injured players to go back to the field to ensure the school wins the game. What harm can be done when a child with a sprain or suspected fracture is forced to go back to the field?
A. An injured player shouldn’t participate for practices or matches without medical advice.
It could harm the injury more and affect his/her future sports career or could be the end of it. Continuing to play with an injury could make it worse.
A small stress fracture that might have healed quickly can grow into a serious, more painful fracture that would take longer to heal. Returning to play too soon after a concussion increases the risk of serious brain injury. Also playing when you’re already injured means you can get injured somewhere else.
Q. Can exercise reduce injury during sports? How important is exercising before a match or competitive game with respect to avoiding injury?
A. Yes. With the exercises, flexibility, muscle strength, agility can be improved. Proper warm-up and stretching routine is more important before any sport activity to avoid injuries.
Q. The adverse impacts of heavy backpacks on growing children have recently been highlighted by health experts and confirmed by studies here and abroad. Share with us the problems likely to impact on the developmental health of a child carrying such heavy loads on his/her back daily, from your own studies and research.
A. According to research carried out in other countries, heavy backpacks with a large amount of book loads puts pressure on the lower back, upper back, shoulders and neck. Backpacks for teens are often larger, which encourages heavier weight loads that contribute to back/spine problems.
Also it increases the risk of chronic back pain in adulthood. However, it also depends on the gender, age, strength of the muscles, poor lifestyle habits, poor posture, etc.
Q. Why?
A. When you carry a heavy bag you tend to bend your back and neck forward. If you keep doing that for a long period it leads to a bad posture. It also increases energy consumption and you can develop a structural bad posture. This could result in decreased pulmonary volume and increase cardio respiratory parameters. However, the common problem is the lower back pain. In addition, you can get neck, shoulder and upper back pain, breathing difficulties and postural deformities.
Q.How heavy is too heavy for a backpack?
A. According to experts, the total weight of the schoolbag should not exceed 10% of body weight.
Q. Some simple rules to ensure a backpack will not hurt your back?
A. Always wear both shoulder straps. Adjust the shoulder straps so the backpack is high on your back (don’t wear it too low) and the shoulder straps are comfortable on your shoulders. Backpack should not sway from side to side as you walk. If the backpack has a waist strap, use it. That helps to distribute the weight more evenly across the body.
Q. Which is better - a backpack or a shoulder/side bag?
A. A backpack is way better than using a shoulder bag. Shoulder bag loads only one side of your body and it tends to develop muscle imbalances in your shoulders, upper and lower back. This can also lead to scoliosis which is a common condition among teenage girls.
Q. How does Physiotherapy treatment help children suffering from back pain due to heavy backpacks? What is the procedure?
A. When a child comes with a back pain initially, the physiotherapist will thoroughly assess the child and then start the treatment. Treatments include pain relief, correction of muscle imbalances through specific strengthening and stretching exercises, correction of altered spine curvatures by specific exercises and manual techniques, releasing of trigger points by specific muscle energy techniques, etc.
Q. Age of students most at risk of injuries on playgrounds in school?
A. Any child can be injured while playing if proper techniques on reducing such risks are not adhered to.
Q. Signs to look for if a child has an injury during sports?
A. You can detect it by altered body mechanics, facial expressions, behaviour, etc.
Q. Obese children- does the excessive weight they are carrying on their bodies make them more vulnerable?
A. Research studies suggest obesity increases risk of injury. However if the muscular and bone strength is higher, that reduces the risk of injuries.
Q. Can healthy diets minimize injury risk on playgrounds? How?
A. Adequate Protein intake helps repair muscle tissue, reduces muscle breakdown after exercise, and supports immune function. Carbohydrates replenish glycogen stores, stabilize blood sugar, provides immediate energy, and aids with the protein synthesis recovery process. So eating a well-balanced diet and staying hydrated should be your first line of defence against sports injuries.
Q. There is a move to make sports part of the school curriculum and ensure that every child begins the day with exercise and also engage in outdoor sports for at least one period. Is this a good thing?
A. Yes, that’s a great thing for the young generation because nowadays they’re confined to indoors with modern technology such as mobile phones and computers.
Q. Since schoolchildren today are open to all sorts of injuries while at play what is your message to parents, school coaches and children on how they could reduce these risks?
A. My advice is: Stop loading heavy bags on the kids. Make sure to give them a well-balanced diet. Keep them hydrated and rested. If an injury is suspected send the child for medical examination, if recommended follow proper physiotherapy treatments, with emphasis on correct exercises to strengthen the muscles and improve flexibility.