BACK to School: Spine Health and Kids

Sep. 26, 2018

Little boy walking away with a backpack on.

It’s the end of summer and students are back in school. This is a great time to think about the spine: Kids will be loading up their backpacks and sitting (slouching?) at their desks, while gym classes and sports teams raise special concerns for kids with spine conditions like scoliosis or Chiari.

For tips on making every student’s back-to-school season as back-friendly as possible, read on.

First, consider the backpack. Put a student’s loaded pack on a scale and get ready for a little real-world math lesson: According to the American Occupational Therapy Association, for ideal back health, an able-bodied student’s backpack should not weigh more than about 10 percent of the student’s body weight. For a 75-pound kid, that’s a 7.5-pound backpack.

Those pounds can add up quickly in a pack. Save weight by leaving whatever possible at school, packing empty (not filled) water bottles and hand-carrying especially heavy textbooks, lunchboxes or other items. For back-friendly packing, put the heaviest items closest to the wearer’s back, with lighter items farther out.

In the market for a new backpack? The ideal option will have wide, well-padded shoulder straps; be no larger than the wearer’s torso (from shoulder blades down to the curve of the lower back); and have waist and/or chest straps to help distribute the weight. And remember, no matter the backpack, two straps are better than one—wearing both provides a much healthier weight distribution than just slinging the bag over one shoulder.

Next, consider posture. For a lot of students, the beginning of the school year means the beginning of a lot more desk time. In general, kids’ positioning at a desk should follow the same 90-90-90 rule as for adults: feet flat on the floor at a 90-degree angle to the legs, a 90-degree bend in the knees and a 90-degree bend at the hips. For more tips on healthy positioning at a desk or computer workstation, see information from our physical therapists here.

For ideal posture, the spine should be in what’s known as a neutral position. For tips from our PTs on achieving a neutral spine position, read here, or watch a video about finding neutral spine here.

Once neutral spine has been achieved, difficulty keeping that healthy posture can often be traced to poor core strength. In other words, poor strength in the belly and the mid- and lower back. For help with core strength, check out these helpful exercises from our PTs.

Then there are questions about school-year spine health for kids with specific spine conditions, like scoliosis or Chiari. Now, those two conditions are very different: Scoliosis is a side-to-side curvature of the spine, and Chiari is a condition in which part of the base of the brain presses down into the spinal canal. One thing the two conditions have in common, however, is that parents often wonder how safe it is for a kid with one of these conditions to participate in physical activity—gym class, say, or sports.

When it comes to scoliosis, pediatric neurosurgeon Dr. Richard Anderson says first and foremost, check with your child’s doctor. Scoliosis can have a variety of causes and severities. Even in its most common form, adolescent idiopathic scoliosis, every child’s case is different. But in the majority of cases, kids can play sports.

This is especially true for sideways curves of up to 50 degrees, which are considered mild to moderate. Physical therapist Dr. Rami Said, D.P.T., with the Spine Hospital at the Neurological Institute of New York, says that for kids with mild or moderate curvature who want to play sports, “We [physical therapists] get them ready by teaching them how to strengthen and stretch their core. In fact, learning how to manage asymmetries in their bodies caused by scoliosis really prepares them for the rigors of most sports. In most cases, the benefits of sports far outweigh any potential risks.” More evidence that scoliosis doesn’t need to hold a kid back? There is even a world-class sprinter with scoliosis.

In severe cases, scoliosis may be treated with surgery to straighten and stabilize the spine. The child’s surgeon will advise what level of activity will be appropriate after a full recovery. Some activities might be off-limits, but doctors are likely to rule in as much activity as possible—the benefits of physical activity over the course of a lifetime are well known, and childhood is a perfect time to develop the exercise habit.

For Chiari, the situation is more nuanced. Dr. Neil Feldstein, Director of the Adult and Pediatric Chiari Malformation Center at Columbia Neurosurgery, says that many neurosurgeons base their recommendations on whether the Chiari is causing symptoms. If a child has no symptoms, many—even most—neurosurgeons recommend no activity restrictions whatsoever. Even with mild symptoms, the surgery may be elective, as it was for Dr. Feldstein’s patient Carly. She had surgery once her symptoms became problematic, and she was back to running at the gym in no time. “The research [into increased risk of sports injury with Chiari] is sporadic and often based on anecdotal reports,” says Dr. Anderson. “It is difficult to deny a child the opportunity to play sports their entire life by arguing an increased risk when little to no data exists.”

But if the Chiari is causing symptoms? That’s different. This was the case for Dr. Anderson’s Patient, young Jack Cacase, whose Chiari began causing symptoms when he was 12. He had surgery to treat the condition, and during his recovery he sat out part of the ice hockey season. But he was soon back on the ice, playing full games with no restrictions. Read Jack’s story here.

Best wishes from everyone at the Spine Hospital for a back-friendly back-to-school season!

Learn more about Dr. Richard Anderson on his bio page here.

Learn more about Dr. Neil Feldstein on his bio page here.

Learn more about Dr. Rami Said on his bio page here.

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