Category: Back, Body & Joint Pain

If you’ve ever been involved in a motor vehicle collision, you’re probably familiar with the term “replacement parts” or “crash parts”. Your auto insurance company will usually offer to repair your car using after-market bumpers, door panels, wheel assemblies, and other parts. Or, you may prefer to have the repair done with parts from the original manufacturer. Regardless of the source of the parts, your car will not be the same as it was in its original condition. It’s important to bear the auto analogy in mind if a surgeon has recommended a hip, knee, or shoulder replacement as a solution to a problem of chronic pain.

The frequency of joint replacement procedures of all types is dramatically on the rise within the last 20 years.¹ For example, in the United States there has been a 58% increase in total knee replacements from 2000 to 2006. There has been a 50% increase in total hip replacements from 1990 to 2002. Unfortunately, the revision rate (repeat procedures) for total knee replacement more than doubled and revision total hip replacements increased by 60% within the respective, above-noted intervals.

The simple fact is that although your body may appear to be a machine, it is rather an exceedingly complex entity whose whole is much greater than the sum of its parts. Thinking of your body as a machine may be a useful metaphor, one that may aid considerably in medical practice. But the metaphor is not the reality, and forgetting this crucial distinction may lead to substantial and possibly irremediable problems for a patient. Manufactured joints are never as good as your actual physiological structures, no matter the quality of the replacement components.

Of course, there are many circumstances in which joint replacement is indicated and provides great benefit for a patient. However, such procedures should probably be a last resort and never considered standard of care. A best practice would be to reserve joint replacement for situations in which pain is unrelenting and the person has failed several forms of conservative care.

Optimally, in most cases measures are available to avoid such radical outcomes. The best steps for each of us to take is to begin ongoing programs of regular vigorous exercise and healthy nutrition.^2,3 Regular exercise, a healthy diet, and sufficient rest will assist all our physiologic systems to achieve peak levels of performance. By making such beneficial lifestyle choices, we help diminish the likelihood of chronic, debilitating pain and loss of function. As a result, we help ourselves avoid the need for replacement parts.

¹Singh, JA: Epidemiology of Knee and Hip Arthroplasty: A Systematic Review. The Open Orthopaedics Journal 5:80-85, 2011
²Marley J, et al: A systematic review of interventions aimed at increasing physical activity in adults with chronic musculoskeletal pain–protocol. Syst Rev 2014 Sep 19;3(1):106. [Epub ahead of print]
³Tanaka R, et al: Effect of the Frequency and Duration of Land-based Therapeutic Exercise on Pain Relief for People with Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Phys Ther Sci 2014 Jul;26(7):969-75. doi: 10.1589/jpts.26.969. Epub 2014 Jul 30

Do you suffer from neck pain? If you do, you’re not alone. Nearly 75 percent of American adults will suffer from neck pain at some point in their lives. And, looking at our anatomy, it’s no wonder so many of us do. Though having your head perched on top of your spine gives you a great view of your environment, the set-up is rather like propping a bowling ball atop a tower of blocks. The price? Our necks are prone to injury of the muscles, ligaments, tendons, and joints. But by paying attention to our posture, doing regular stretching and strengthening exercises, and visiting our chiropractors, we can help keep our necks pain-free.

Causes of Neck Pain

Neck pain ranges from mild (annoying and distracting) to severe (incapacitating). Poor posture during normal, everyday activities such as watching TV, using a computer, reading a book, or talking on the phone can easily trigger minor neck pain. TV watching can be particularly bad for the neck if you’re lying on a couch, with your head propped at an awkward angle for a prolonged period of time. Holding the phone between the jaw and shoulder (rather than in your hand), reading at a desk or table with your head hung over a book, or working with a computer monitor below eye level can also be particularly stressful for the neck. By resting and making efforts not to repeat the offending stresses on the neck, minor neck pain usually disappears on its own within a day or so.

Neck pain that won’t go away or keeps coming back can signal a more serious underlying problem. Subluxations or joint restrictions; injuries such as whiplash; diseases like osteoarthritis, meningitis and tumors; congenital malformation; and degeneration (such as that in arthritis) require more than rest. A trained healthcare professional such as a doctor of chiropractic (DC) can help. He or she can determine whether the cause of your neck pain is minor and easily treatable or more serious and requiring more intensive, extended treatment. Then he or she may recommend chiropractic adjustment, massage, natural anti-inflammatory supplements, and/or strengthening and stretching exercises. In some cases, the DC will refer you to a specialist.

Prevention is Key

How can you avoid the need for treatment in the first place? The first step is to take note of your everyday posture. If your job requires a lot of phone use, consider wearing a headset. Do you slouch when you watch TV? Lie on the couch? Choose to sit upright, in a posture-supporting chair. When studying or reading, avoid putting the book or magazine on a flat surface. Instead, consider using a book prop. And, if you notice your computer monitor is below eye level, elevate it by placing it on top of a shelf or tower.

If you experience neck pain that doesn’t abate within 24 hours, seek the advice of a trained healthcare specialist for the appropriate diagnosis and treatment. And remember, because chiropractors specialize in the neuromusculoskeletal system, they are some of the most well-trained healthcare professionals to consult about neck pain

Trigger points are painful nodules in muscular tissue, commonly found in the upper back, low back, and gluteal muscles. Trigger points are frequently chronic, persisting from day to day without much relief. When someone says, “My muscles are all in knots”, those knots are most likely trigger points.

The formal definition of a trigger point describes a localized region of tenderness, located in a tight band of muscle, which is associated with a palpable twitch in response to deep pressure over the tight band.¹ Such deep pressure usually results in pain radiating from the trigger point to the surrounding soft tissues. Formally, if the twitch response is not present, the localized muscle tightness cannot accurately be termed a trigger point. It may also be argued that characterizing a local muscle “knot” as a trigger point requires the presence of the above mentioned radiating pain. These definitions are of importance when making decisions about appropriate care for painful muscle knots.

As with any care management decision-making process, some procedures make sense and others do not. Many so-called pain management physicians will recommend injecting painful trigger points with an anesthetic or even botulinum toxin.^2,3 Such an invasive procedure is rarely required. Pain management practitioners and even specialists in internal medicine will recommend muscle relaxers such as Robaxin, Flexeril, or even Soma in attempts to diminish muscular pain in the shoulders or low back that may or may not be associated with the presence of trigger points. The problem with such medications is they do not address the underlying cause of the painful muscle knots. Further, their efficacy with respect to muscular pain is questionable.

The mistake, as is frequently the case, is in thinking of trigger points as a real entity. But trigger points do not exist in a vacuum. These painful muscle knots arise as a consequence of mechanical disturbances and stress in the rest of the body. Attempting to treat the trigger points themselves with injections or medications misses the real problem. Trigger points have arisen in a person’s shoulders or low back owing to chronic issues elsewhere, typically involving the spinal column itself and the small muscles that enable those vertebras to move in three-dimensional space.

Trigger points are best managed by directing care to the underlying issues, primarily involving loss of full mobility of spinal vertebras and resultant inflammation in spinal muscles. As with many other biomechanical problems, chiropractic care is often the best solution. By utilizing a specific, highly targeted, noninvasive approach, chiropractic care helps alleviate the factors that have led to the painful muscle spasms known as trigger points. As the underlying biomechanics improve, the trigger points themselves begin to resolve, all without the need for injections or medications.

¹Fernández-de-las-Peñas C, Dommerholt J: Myofascial trigger points: peripheral or central phenomenon? Curr Rheumatol Rep 16(1):395, 2014
²Kim SA, et al: Ischemic compression after trigger point injection affect the treatment of myofascial trigger points. Ann Rehabil Med 37(4):541-546, 2013
³Zhou JY, Wang D: An update on botulinum toxin a injections of trigger points for myofascial pain. Curr Pain Headache Rep 18(1):386, 2014

Many people experience radiating pain as a component of neck pain or low back pain. A person with neck pain might have pain that radiates down her arm, possibly into the hand.¹ A person with low back pain might have accompanying leg pain, possibly traveling into the foot. Such arm/hand pain or leg/foot pain can represent a serious underlying health problem. However, not all types of radiating pain are of equal importance. The key is to be able to identify which patterns require prompt attention and which merely appear to be significant but are not.

Authentic radiating pain is most often caused by pressure and/or irritation of a spinal nerve root.² The spinal nerve becomes inflamed and sends pain signals to the brain that are interpreted as pain in the region of the body supplied by that nerve. Inflammation of a certain spinal nerve in the neck region will result in the experience of pain down the outside of the arm and forearm and into the thumb and possibly index finger. Inflammation of a certain spinal nerve in the low back causes the person to feel pain traveling along the back of the thigh and calf and into the fifth toe.

Specific patterns of radiating pain are associated with inflammation of specific spinal nerves. Such inflammation may be typically caused by pressure from a herniated intervertebral disc. Other disorders which may create local space-occupying pressure need to be considered as well. A thorough history and physical examination will help to identify the cause of the problem. X-ray studies may be needed, as well as an MRI scan. The underlying problem, including the pattern of pain radiation, may be termed a radiculopathy or radiculitis.

But most cases of what appears to be radiating pain are not, in fact, related to pressure on a spinal nerve. Most patterns of radiating pain are not associated with a radiculopathy or radiculitis. Rather, the large majority of pain patterns involving the arm/hand or leg/foot are caused by normal, everyday aches and pains. Our run-of-the-mill physical problems involve relatively large muscles such as the trapezius (overlying the upper back, shoulder, and mid back) and relatively small muscles such as those that overlay the spinal bones themselves and help move the spinal column. Ligaments that hold bones together and tendons that attach muscles to bones may also be involved in these everyday ailments.

Irritation and inflammation of muscles, ligaments, and tendons may cause more difficulty than mere soreness and tightness. Such inflammation may also cause radiating pain, but in broader, more diffuse patterns than those caused by inflammation of a nerve root. A person might experience neck pain with arm and hand pain, or back pain with leg and foot pain, but in a broad pattern not associated with a spinal nerve. This is actually good news for the patient, as such forms of radiating pain (known as scleratogenous patterns), are usually more easily treated than those associated with a radiculopathy or radiculitis.

The bottom line is that your chiropractor is experienced in the diagnosis and care of such problems. Your chiropractor will be able to determine if your radiating pain is associated with muscles, ligaments, and tendons or if it is related to pressure on a spinal nerve.³ Your chiropractor will make specific recommendations for care of your specific health problem and help guide you in the process of returning to good health.

¹Caridi JM, et al: Cervical radiculopathy: a review. HSS J 7(3):265-272, 2011
²Magrinelli F, et al: Neuropathic pain: diagnosis and treatment. Pract Neurol 2013 Apr 16 [Epub ahead of print]
³Mena J, Sherman AL: Imaging in radiculopathy. Phys Med Rehabil Clin North Am 22(1):42-57, 2011

No one really wants to be a worrier. We certainly don’t want to visit our chiropractor or family doctor for every ache and pain. But eventually we all experience physical problems and it may be difficult to know what to do about them. Some problems are immediate and serious. If you suddenly experience crushing chest pain and radiating pain down your left arm, possibly with nausea, profuse perspiration, and a feeling of impending doom, you know you have to call “911” immediately, if you can. If you awaken in the middle of the night with an intense, deep, sharp pain in your lower right abdomen, accompanied by vomiting and a fever, you know you need to go to the Emergency Room right away. In these exceptional cases, however, most people know which steps to take. What should you do when your pain is not clear-cut and dramatic, as it is in a heart attack or acute appendicitis? General guidelines are available which may be applicable in many situations.

Overall, pain is a warning signal. But many problems that cause pain take care of themselves. For example, you may twist an ankle on your daily walk. It may hurt to put weight on that ankle and there may even be a bit of swelling, but within two days your ankle is much better. There was initial pain owing to soft tissue injury, possibly involving muscles, tendons, and/or ligaments. However, the injury wasn’t so severe that your body’s ability to self-heal couldn’t manage the situation. In the case of a greater degree of initial pain and more swelling, or if improvement wasn’t being obtained within 48 hours, a visit to your chiropractor would be appropriate. In borderline situations involving musculoskeletal pain, whether you choose to seek professional advice depends on your intuition and level of pain tolerance. If you think something is “wrong”, regardless of the nature of the injury or the intensity of your pain, you should seek professional assistance.

With some categories of physical problems, making the time to visit your chiropractor is the best course of action.^1,2 A single occurrence of low back pain or neck pain could be ignored, especially if the problem goes away in a few days. But repetitive episodes of spinal pain should always be evaluated by your chiropractor. A severe headache should probably lead to a chiropractic examination, especially if you’ve never before had the type of pain and the intensity of pain that you’re currently experiencing. Persistent radiating pain into an arm or leg, accompanied by numbness and tingling, should be evaluated by your chiropractor. Again, if discomfort persists and you can’t clearly explain to yourself why you’re having the pain that you’re having, the best thing to do is to make an appointment to see your doctor, that is, your chiropractor or your family physician. You want to obtain expert information and advice, and you want to receive treatment if needed and instructions on how to care for yourself in the days, weeks, and months ahead.³

Comfort level is a valuable criterion with respect to your overall health and well-being. After considering the general guidelines, people should take the appropriate action that they believe will best serve their welfare.

¹Smart KM: Mechanisms-based classifications of musculoskeletal pain. Part 1. Symptoms and signs of central sensitisation in patients with low back (plus/minus leg) pain. Man Ther 17(4):336-344, 2012

²Thornton GM, Hart DA: The interface of mechanical loading and biological variables as they pertain to the development of tendinosis. J Musculoskelet Neuronal Interact 11(2):94-105, 2011

³McCarberg BH, et al: Diagnosis and treatment of low-back pain because of paraspinous muscle spasm: a physician roundtable. Pain Med 12(Suppl 4):S119-S127, 2011

Herniated discs in the lumbar spine are fairly common and having one doesn’t sentence you to a lifetime of back problems. In fact, at least one-third of people over age 30 are found to have one or more herniated discs in the lower back when a magnetic resonance imaging study (MRI) is done for reasons other than back pain. What this means is that lumbar disc herniations represent routine wear-and-tear on the body. Lumbar disc herniations are not a problem in and of themselves.¹

Problems of interpretation arise when a person with back pain is found to have a lumbar herniated disc on MRI. The main questions are whether the herniated disc is causing the back pain, whether it’s related to the back pain, or whether it’s an incidental finding (something discovered on examination but which has nothing to do with the present problem).

Your chiropractor is aware that these possibilities exist and will not jump to the conclusion that the disc herniation is the source of the pain. The majority of cases of lower back pain are not clearcut, but one set of circumstances is fairly straightforward. If a patient experiences sudden, severe lower back pain and also has leg pain and/or numbness and tingling that radiates down one leg to below the knee, then a lumbar disc herniation pressing on a spinal nerve is a very likely scenario. In such a case, if an MRI confirms that a lumbar disc has herniated and is actually pressing on a spinal nerve, then your chiropractor will probably reasonably conclude that the disc injury is the cause of both the back pain and leg pain.

But this is an uncommon scenario. Most people with lower back pain do not also have such radiating symptoms. If a person’s back pain is not getting better within a reasonable period of time, then an MRI might be done. If lumbar disc herniations are found, it is very difficult to determine conclusively whether they are related to the back pain. Lower back pain can result from numerous causes, including injuries to the muscles that bend, rotate, and flex and extend the spine. Injuries to tendons that connect these muscles to the bones of the lower back are possible. And injuries to ligaments that hold the lumbar vertebras together can be very painful. Thus, a herniated disc may or may not be contributing to the overall pattern of compromised muscles, tendons, and ligaments.

The bottom line in the majority of cases is being able to treat the person effectively with conservative care. Chiropractic care, combined with appropriate rest and followed, when the time is right, with rehabilitative exercise, is usually all that is required for even acutely severe back pain.^2,3 Each aspect of such conservative care – chiropractic care, rest, and rehabilitative exercise – is key to the person’s recovery. A small proportion of cases, in which a herniated disc is actually pressing on a spinal nerve and causing back pain and radiating pain below the knee, may require more than conservative care. Regardless, chiropractic care is the right way to begin care for almost all cases of lower back pain.

¹Maus T: Imaging the back pain patient. Phys Med Rehabil Clin North Am 21(4):725-766, 2010

²van Middelkoop M, et al: Exercise therapy for chronic nonspecific low-back pain. Best Pract Res Clin Rheumatol 24(2):193-204, 2010

³Standaert CJ, et al: Comparative effectiveness of exercise, acupuncture, and spinal manipulation for low back pain. Spine 36(21 Suppl):S120-S130, 2011

Not all back problems are created equal. One person may have been working on a home improvement project and injured her back while simultaneously bending and twisting. Another person may have developed back pain as a result of a vehicular collision. Another person may be experiencing back pain as a result of osteoporosis. Yet another person may have a serious illness which causes back pain as a related problem.

Back pain is a problem common to many types of injuries and illnesses. How can you tell the difference – in other words, how can you tell when back pain requires you to take action, such as seeing your chiropractor? A reasonable approach is to use a 48-hour guideline. Your body usually has a powerful ability to heal itself. If your back pain hasn’t gone away on its own within 48 hours, then seeking professional assistance is a very good plan.

However, some situations require immediate attention. For example, if you’ve had an accident, seeing your chiropractor right away is probably the right thing to do. In another scenario, if you begin to experience severe pain without an obvious cause, then seeing your chiropractor right away makes a great deal of sense. Like many things in life, having physical pain requires us to use good judgment. The 48-hour rule-of-thumb applies to most situations, but if you’ve had an accident or are having an unusual problem, see your chiropractor as soon as possible, today if necessary.

When a person has back pain, it’s very important to make sure there are no related problems. Most of the time there aren’t, but no one wants to be the exception and it’s always better to be safe than sorry. Making your own diagnosis is never a good idea. “Oh, that’s been bothering me for months,” some people will say. “It’s just back pain.” Of course, such an approach to one’s health violates the 48-hour rule. If the problem really wasn’t anything much, it would have gone away within a few days. Something else is going on, and usually the longer a physical problem is left untreated the more difficult it is to deal with. The old expression, “an ounce of prevention is worth a pound of cure” is as true today as it was 100 years ago.

Your chiropractor is an expert in back pain. They know that physical pain happens for a reason.^1,2 Their job is to discover that reason, using the tools of history taking, physical examination, biomechanical analysis, and special tests, if necessary, such as x-rays and other imaging methods. Most of the time, the underlying problem is mechanical in nature, involving the spinal joints and associated soft tissues, including the ligaments, muscles, and tendons. Such mechanical problems cause the vast majority of cases of back pain, and are directly addressed by chiropractic care.³ In unusual circumstances, your chiropractor will refer you to another specialist. The important approach in all situations is to seek appropriate care. Your chiropractor’s office is the right place to start.

¹Bakker EW, et al: Spinal mechanical load as a risk factor for low back pain: a systematic review of prospective cohort studies. Spine 34(8):E281-E293, 2009

²Shambrook J, et al: Clinical presentation of low back pain and association with risk factors according to findings on magnetic resonance imaging. Pain 157(7):1659-1665, 2011

³Wilder DG, et al: Effect of spinal manipulation on sensorimotor functions in back pain patients: study protocol for a randomised controlled trial. Trials 12:161, 2011

Out of the blue, your back starts to hurt. At first, it’s just an annoyance. You can live with it. You’ve had lower back pain before and it went away on its own.

Now it’s a few weeks later. You’ve got a low-grade pain that’s not getting any better. You’re actually worse, in fact, because your back hurts most of the time.

What to do?

You don’t want to run to a doctor. After all, it’s just back pain. Everybody has back pain. So you begin to solicit advice from your friends. And, of course, your friends have plenty of advice. “Do these exercises my doctor gave me.” “Do these stretches – they worked for me.” “Go to yoga class.” “I know a great Pilates instructor. She’ll get you in shape and your back will stop hurting.” “Take vitamins and drink more water.” “Meditate.”

Your friends mean well and it’s all very good advice. But none of it seems to work. Another month goes by and now the pain is increasing. It’s even affecting your sleep.

It’s time to see a doctor. But which one? For the most part, medical physicians are not experts on back pain. Typical recommendations include rest, moist heat, and anti-inflammatory medication.^1,2 But, really, you’ve done all that. You need more specific advice.

Choices might include doctors of chiropractic, orthopedic surgeons, and physical therapists.

Many orthopedic surgeons are spinal specialists, but what they do is surgery. This would be a last resort, typically, after other treatment options have failed.

Physical therapists are highly skilled practitioners who focus on exercise, rehabilitation, and re-training. They are not primary care providers, and typically patients are referred to physical therapists by family physicians, chiropractors, and orthopedic surgeons.

Doctors of chiropractic are spinal specialists, too, and what chiropractors have to offer is expert conservative therapy.³ Chiropractors treat back-related problems all day, every day, and are the right doctor to see first.

As spinal specialists, chiropractors receive extensive training in evaluating patients with back pain. Chiropractors consider all aspects of the problem, and develop sound treatment plans based on the facts. If a person does not respond as anticipated, their chiropractor has a “Plan B” in place for further evaluation and possible referral.

When choosing a doctor, you’re allowed to ask questions and participate in the process. The strategy for follow-up is critically important.

First, if you’re improving and doing well, how will can you help keep the problem from recurring? Will your chiropractor prescribe stretches, exercises, and other self-care action steps to help you keep yourself well?

And, what steps will be taken if your problem and pain are not improving? Where might you be referred for further tests and evaluation? Chiropractic treatment is a powerful tool in most cases of back pain. Symptoms should begin to improve quickly. Have your chiropractor outline the “Plan B” if you are, in fact, not getting better.

Your doctor of chiropractic will be able to answer these questions.

¹Zuhosky JP, et al: Industrial medicine and acute musculoskeletal rehabilitation. Arch Phys Med Rehabil 88(3 Suppl 1):S34-39, 2007.
²Cayea D, et al: Chronic low back pain in older adults. What physicians know, what they think they know, and what they should be taught. J Am Geriatr Soc 54(11):1772-1777, 2006.
³DeVocht JW: History and overview of theories and methods of chiropractic. Clin Orthop Relat Res 444:243-249, 2006

It seems that as they get older, many people expect their knees to give out. Osteoarthritis of the knee is, in fact, common in those over age 50 and knee arthroscopy is one of the most frequently done orthopedic surgeries.¹ Also, increasing numbers of people are undergoing total knee replacements. The rate has been recently described as “soaring”.²

What’s going on? Is this mechanical failure people seem to be experiencing in their joints a new phenomenon? Or are more diagnoses being made now owing to the ready availability of CAT scans and MRI units? Are more surgeries being done owing to the abundance (at least in urban areas) of surgeons wanting to perform these procedures?

Regardless, deeper questions point to lifestyle patterns that may predispose a person to developing knee osteoarthritis. A comparison with earlier times may be useful in this context. For example, it’s not well-known that people in the Middle Ages – the 11th and 12th centuries – lived into their 80s. They managed to get along without ibuprofen, without arthroscopy, and without major surgical procedures. But we live in the 21st century. What is our problem?

The major difference between the average person living 900 years ago (or even 100 years ago) and us is that most of those people did a variety of physical activities all day long. People plowed fields and chopped down trees. They built fences and did housework. They walked to the market and carried their purchases back home. They were active, frequently intensely active throughout the day, often working 6 days a week. We’re just as active and work just as hard. But most of our work and activities involve a seated position. In contrast to our forebears, we sit all day. Compounding the problem, more than 2/3 of adults (in the United States, at least) do no regular exercise.

The result is that joints which were designed to perform heavy physical work are now effectively doing none. Our hips, knee, and ankles were built to support a labor-intensive lifestyle which initially involved hunting and gathering and then (for the majority of Homo sapiens) focused on agriculture. Now these large joints are inactive for most of the day. Everyone knows that a machine left untended will begin to malfunction. Dust and rust accumulate and the machine will break down, usually sooner than later. Our bodies are no different.

Thus for many of us, the short answer is that our knees hurt because we don’t use them properly. Of course, some persons have medical conditions such as rheumatoid arthritis that often involve chronic knee pain. But the vast majority of knee problems are due to lack of use. What there is to do is to get active. The good news is that restoring regular vigorous exercise is easy. Walking at a modest pace for thirty minutes, five times a week, is all that it takes. You can do more, but that’s a personal choice. Exercise is not a magic solution, but restoring needed activity levels is an important part of the solution to chronic knee pain.³

¹Potts A, et al: Practice patterns for arthroscopy of osteoarthritis of the knee in the United States. Am J Sports Med 40(6):1247-1251, 2012

²Leskinen J, et al: The incidence of knee arthroplasty for primary osteoarthritis grows rapidly among baby boomers: A population-based study in Finland. Arthritis Rheum 64(2): 423-428, 2012

³Smith TO, et al: The effectiveness of proprioceptive-based exercise for osteoarthritis of the knee: a systematic review and meta-analysis. Rheumatol Int 2012 Jul 22 [Epub ahead of print]

Back pain is pervasive among American adults, but a new and disturbing trend is emerging. Young children are suffering from back pain much earlier than previous generations, and the use of overweight backpacks is a contributing factor, according to the American Chiropractic Association (ACA). In fact, according to the U.S. Consumer Product Safety Commission, the use of book bags or back carriers resulted in over 6,500 injuries in 2000 alone.

Over the past 10 years, the chiropractic profession is noticing a marked increase in the number of young children who are complaining about back, neck and shoulder pain. This new back pain trend among youngsters isn’t surprising when you consider the disproportionate amounts of weight they carry in their backpacks— often slung over just one shoulder. A 2002 study conducted in Italy found that the average child carries a backpack that would be the equivalent of a 39-pound burden for a 176-pound man, or a 29-pound load for a 132-pound woman. Of those children carrying heavy backpacks to school, 60 percent had experienced back pain as a result.

Other studies have shown that slinging a backpack over one shoulder could exacerbate the curvature of the spine in scoliosis patients.

According to the ACA, preliminary results of studies being conducted show that the longer a child wears a backpack, the longer it takes for a curvature or deformity of the spine to correct itself. The question that needs to be addressed next is, Does it ever return to normal?

The results of these types of studies are especially important as more and more school districts— many of them in urban areas— remove lockers from the premises, forcing students to carry their books with them all day long.

What Can You Do?

• Make sure your child’s backpack weighs no more than 5 to 10 percent of his or her body weight. A heavier backpack will cause your child to bend forward in an attempt to support the weight on his or her back, rather than on the shoulders, by the straps.
• The backpack should never hang more than four inches below the waistline. A backpack that hangs too low increases the weight on the shoulders, causing your child to lean forward when walking.
• A backpack with individualized compartments helps in positioning the contents most effectively. Make sure that pointy or bulky objects are packed away from the area that will rest on your child’s back.
• Bigger is not necessarily better. The more room there is in a backpack, the more your child will carry— and the heavier the backpack will be.
• Urge your child to wear both shoulder straps. Lugging the backpack around by one strap can cause the disproportionate shift of weight to one side, leading to neck and muscle spasms, as well as low-back pain.
• Wide, padded straps are very important. Non-padded straps are uncomfortable, and can dig into your child’s shoulders.
• The shoulder straps should be adjustable so the backpack can be fitted to your child’s body. Straps that are too loose can cause the backpack to dangle uncomfortably and cause spinal misalignment and pain.
• If the backpack is still too heavy, talk to your child’s teacher. Ask if your child could leave the heaviest books at school, and bring home only lighter hand-out materials or workbooks.

What We Can Do for You…

If you or your child experiences any pain or discomfort resulting from backpack use, call your doctor of chiropractic. Doctors of chiropractic are licensed and trained to diagnose and treat patients of all ages and will use a gentler type of treatment for children. In addition, doctors of chiropractic can also prescribe exercises designed to help children develop strong muscles, along with instruction in good nutrition, posture and sleeping habits.