Kristian Larsen et al.
SPINE: December 2002, Volume 27. Number 24
This Study shows that it was possible to prevent low back problems and decrease the use of health care services during military service in a group of conscripts using an intervention of daily passive prone extensions of the back, motivated by an educational session.
Comments
These simple exercises are those described by Robin McKenzie. Results of this study are ground breaking as they in part justify the conceptual model postulated by McKenzie. They have been the basis of low back pain self management strategies world-wide as more physiotherapists (UK and USA) use the McKenzie system than any other. As well as theoretical support, these now have some evidence to support them.
The McKenzie system is uniquely embraced in Christchurch by PHYSIOSOUTH. It is the most researched spinal treatment offered in the Physiotherapy literature. The McKenzie Institute has 27 member countries and educates more physiotherapists post-graduate than any other organisation. Graeme Nuttridge is one of two certified lecturers of this system in New Zealand and all PHYSIOSOUTH staff are required to embrace this system. Cornerstones of the system are:
- Mechanical and symptom response
- Self management
- Education
The Association of Backpack Use and Back Pain
What advice should we give adolescents who carry heavy school bags? Two recent articles published in the Spine Journal have looked at the association of low back pain with the use of a large bag, and the weight of the bag, and also the occurrence of neck and back pain in young adolescents.
Shier-Niess et al in a cross-sectional study (part of a on-going program) expresses concern at the jump in back pain from pre-teen years (10%) to 50% in 15-16 year olds. They studied 1126 children via a questionnaire. Of the 1122 backpack users 74% were classified as having back pain. They concluded that backpack use was related to pain. Those with pain were also more likely to be female, report poorer general health and have a larger body mass index. They were also more likely to carry heavier packs than those who did not have low back pain. In a separate study from the Netherlands Van Gent et al looked at similar issues on 745 adolescents, reporting the incidence of back pain to be 43% (neck and shoulder) and 46% (back) and that the weight of the bag was not a factor but that psychosomatic factors showed the strongest association with these symptoms.
In a recent issue of the Backletter, New Zealand back expert Robin McKenzie has suggested children watch their posture when sitting, particularly after carrying heavy loads, in his experience this was a factor.
Backpacks are a factor in adolescent back pain. We should advise our clients to reduce the load. Most importantly we should take the issue of adolescent back pain seriously and consider appropriate counter measures. Perhaps if we could prevent the initial event, particularly at an early age, we could affect the long term history of this problem.
References
The Weight of Schoolbags and the Outcomes of Neck, Shoulder, and Back Pain in Young Adolescents. Van Gent et al. Spine 28;9:2003.
The Association of Backpackuse and Backpain in Adolescents. Sheir-Neiss et al. Spine 28:9:2003
Backletter – Backpage Vol 18:4:2003.
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