I see from the news that there’s concern about young students carrying heavy backpacks. I went to school 30 years ago and we never used backpacks or even a book bag. What do they carry in them that’s so heavy?

Books, calculators, cell phones and other electronic devices, sports equipment, water bottles, and other personal items. That’s probably just a partial list of what most students haul around with them everyday.

Time is limited between classes so to avoid going back to the locker on the other side of the building, students just carry all their books with them for the morning. At lunch, they trade for the afternoon books. With homework in every subject, they may end up taking all their books home on any given night.

The amount of information available today is definitely on the rise. Textbooks reflect the information glut by being much thicker and heavier. Sometimes more than one book is
required for a course. All of this adds up to a pretty hefty weight even for some young students.

I don’t want my child exposed to any more X-rays than absolutely necessary. The doctor wants to do X-rays to look for curvature of the spine in my 13-year old daughter. Isn’t there some other way around this?

It depends. If the doctor has already taken measurements and found a scoliosis (curvature of the spine), then an X-ray is the next step before deciding treatment.

There are some ways to assess and measure normal curves in the spine. These methods can be used to measure abnormal curves as well. The first is a device called a scoliometer. Another is a kyphometer. Both of these are placed on the spine
and give a reading or measure of the different spinal curves.

The measures taken with these tools can be converted by using a math formula to equal what an X-ray would find. The results aren’t as accurate as an X-ray. The X-ray gives the shape and exact location of any increased spinal curve.

Check with your doctor about using the nonradiographic means of measuring scoliosis before pursuing X-rays. However, be aware that X-rays may be needed to guide the doctor
and to see if your child’s scoliosis is getting better or worse.

My 14-year-old daughter competes in gymnastics on the balance beam. After injuring her ankle, she’s gone back to practice. Now it seems like she can’t keep her balance and her hip on the same side is starting to bother her. What’s the connection?

Keeping balance is a complex task. It relies on a system called the postural control system. This involves the inner ear, the eyes, the muscles, and the brain. If the
ankle is injured it can lose its ability to sense the joint’s position in space. A delayed response to a shift off-balance can result in a loss of balance.

If the ankle can’t adjust to maintain balance then the knee and hip get in the act. Too much shear force through the hip can lead to hip problems. Walking on a balance beam, with only partial support for the foot can also shift forces through the hip.

You may need to contact a physical therapist to help your daughter retune the ankle, the postural control system, and the hip. Often a simple set of exercises (and a little time)is all that’s needed.

I’m planning on homeschooling my three children starting with the oldest this fall. Over the summer, I’m going to check garage sales for school desks. How can I tell if the desk fits each child?

Good question! Sitting for long periods in an ill-fitting seat has already been linked with back pain in young children. Take your child with you when shopping. Have him or her sit in the desk.

When the child sits as far back as possible, is the thigh in contact with the seat of the chair? Does the seat press into the back of his or her knees (if yes, it may be too big).
Is at least half (or more) of the thigh supported? If no, it may be too small.

Can the child sit with both feet flat on the floor? If the legs are dangling, the seat is too high. Can it be adjusted? This would be an important feature. Having a seat or desk that can “grow” with the child is very helpful and saves money over time.

To check for desk height: while the child is sitting as far back as possible, can he or she place both forearms on the desk? Can she or he do this without raising the shoulders
or bending over the desk?

A desk with a slight slant and a ledge at the bottom to keep papers from sliding off is a good feature. Placing the desk at a 30-degree angle (or less) puts the shoulders and upper body in the best possible position for upper body stability. This helps with writing skills.

Some people also want a desk that has some storage space for books, papers, and school supplies. This is just a matter of personal preference and doesn’t usually affect the student.

My two boys ages 10 and 12 are in elementary and middle school. The 10-year-old is much smaller than his older brother, yet they both use desks that are exactly the same size. Is there any danger in using a desk that is too big or too small for the student?

A recent study says, “Yes.” There is an increased risk of low back pain with prolonged sitting in desks. This is especially true for desks that don’t match the height and weight of students.

The problem is a rapid growth spurt during the preteen years. It makes seating children and teens difficult, since there’s no way to predict when this will happen or who will be affected. With limited school funds, the schools often adopt a “one size fits all” approach. Unfortunately, this can become a problem of “one size fits none.”

I am an elementary school nurse. It’s come to my attention that our students aren’t getting enough physical activity during recess. Are there any programs to help us with this?

Two programs come to mind right away. The first is the Playground Enhancement Project called PEP by everyone who uses it. PEP is run by parents, school staff, and other volunteers. The idea is to teach and model getting along while playing games. A second
goal is to teach game-playing skills.

You can find out more about this program by going to http://www.jrpc.org/Issues/pep/

The second program is called the Peaceful Playgrounds Program, which also happens to be known as PEP. This program has a kit with activity guides, rule books, program
video, and game and activity designs painted on blacktop. There’s also an equipment package you can use to start the program.

This PEP has grants available each year to help schools improve their playgrounds. Check them out at http://www.peacefulplaygrounds.com

My 13-year-old son was just diagnosed with spondylolisthesis. The doctor warned us that damage to the disc is also possible with this condition. Is there any way to know for sure if this is happening?

Spondylolisthesisis a condition of the spine with slippage of one vertebra forward over the one below it. The most common site for this problem is in the lower lumbar spine, often the last lumbar vertebra.

Until recently we haven’t known if disc damage occurs allowing this slippage or not. A study from Japan using rat models suggests the slippage may occur as a result of damage to the growth plate, not the discs.

The growth plate is made up of cartilage at the end of a growing bone. The separation between the bone and cartilage closes up and the bone solidifies when the child reaches full maturity. It’s possible that the stress of the bone slipping forward separates the cartilage from the bone at the growth plate. An MRI can show this, but it can be present
and not appear on the MRI.

Have you ever heard of a growth plate coming apart? My 12-year old daughter had an MRI for a back injury. The results showed separation of the growth plate where she hurt herself. What could be causing this?

The growth plate is made up of growing bone and a cap of cartilage at the end. When the bone stops growing, the cartilage ossifies or becomes the end of the bone. At maturity when the bones stop growing, the growth plate disappears.

Growth plate separation can occur with traumatic injury or from a condition called spondylolisthesis. This term describes when one vertebra slips forward on the one below it. This usually occurs when there is a crack or tiny fracture in the supporting
structure of the vertebra on top.

Research shows that extraordinary stress can break a weak growth plate. The cartilage separates from the bone allowing the bone to slip forward. It’s possible the damage occurred during the injury.

I notice my 9-year old son’s shoulder blades stick out. No one else in our family has this problem. Should we do anything about it?

If he isn’t complaining of shoulder pain, it’s probably nothing to worry about. Children, especially boys before puberty, often have this. It’s most likely caused by an under developed muscle called the serratus anterior (SA). The SA is attached to the scapula (shoulder blade) and comes around the ribcage under the armpit. It attaches to the sides of the first eight or nine ribs.

If you think there’s something more serious going on, have your doctor check the child. Once the child enters adolescence, the influence of hormones on the muscles will likely strengthen the SA, and the problem will go away. Some people do have a tendency toward
scapular winging into adulthood.

What causes Little Leaguer’s Shoulder?

Injury to the end of the upper arm bone (the humerus) in young pitchers is called Little Leaguer’s shoulder. It occurs most often in the athlete who is still growing. Overuse from repeated throwing causes a fracture in the growth plate.

This injury is related to the frequency and intensity of pitching. Rapid growth of the shoulder growth plate from age 13 to 16 creates a weak area. This puts the young pitcher at risk for injury. Throwing curve balls, a high number of pitches per game and per
season are other risk factors.

What is “Little Leaguer’s shoulder?”

Injury to the growth plate in the shoulder from repetitive throwing is called Little Leaguer’s shoulder. It occurs in young athletes who haven’t finished growing yet.

Most often the growth plate gets a small fracture called a stress fracture. The growth plate is a separate piece of fibrous cartilage at the end of the bone. It stays
“soft” until the bone has grown as much as it’s going to. Then the growth or end plate hardens and connects with the rest of the bone and can no longer be seen on an X-ray.

Baseball pitchers around age 14 are affected the most. Pain with throwing is the main symptom. An X-ray shows an increase in the space between the bone and the growth plate at the end of the bone. Any damage to the growth plate can cause a delay in growing. Treatment is rest, physical therapy, and sometimes, surgery.

My 14-year-old son has Little Leaguer’s shoulder. Right now he’s being treated with rest. It’s been four weeks of rest without playing baseball and his symptoms are still the same. Will he have to have surgery?

Treatment with rest is usually needed for six to 12 weeks for Little Leaguer’s shoulder. The athlete can be active so long as there are no symptoms. In some cases physical therapy is needed to regain range of motion and strength to prevent reinjury.

Surgery may be needed if pain persists or the athlete can’t get back to his or her previous level of play. X-rays, MRIs, and CT scans are used to find fractures in anyone with continued pain. In such cases an operation may be needed.

Sometimes a fracture doesn’t heal or the fracture site fills in with fibrous tissue instead of bone. It may be necessary to surgically hold the bone together with a plate, pin, or screw.

My 14-year old son was in a BMX race and broke his leg. He’s in a cast, but is it safe to still run a few practice courses?

Bicycle Motocross (BMX) racing has become very popular since it got started in the early 1970s. Soft tissue injuries and bone fractures are not uncommon in either the freestyle or the racing competitions.

Studies show that even inside a cast there is some motion. A small amount of pressure, force, and movement is actually helpful to bone healing, but too much and there can be a delay in healing. Not only that, but the quality of the newly formed bone is less when
there’s too much load through the healing bone.

Most doctors advise patients to limit their activities during the first four to six weeks of healing. This helps prevent tissue damage from high stress and strain. How much your son can do is based on the type of fracture, his general health, and the kind of brace or cast he is in.

Be sure and talk to his doctor about your concerns. Get some guidelines directly from the doctor about BMX activities in particular.

My 13-year old daughter wants to ride horses. Her father is in a wheelchair from a spinal cord injury after a car accident. He’s afraid she’ll injure herself riding and is against the idea. What are the chances of this happening?

Different sources report varying rates of risk. A recent survey of the trauma unit at the Denver Medical Center reported a very low 0.02 percent rate of horseback riding accidents over a three-month period of time. This was less than car accidents, falls, or motorcycle accidents.

Other studies say that more injuries occur on horseback than on a motorcycle when riding time is compared hour for hour.

The main difference may be in the kind of injuries that occur. The most common horseback riding accidents are bruises, strains, and sprains. Many injuries occur in the stable while handling or feeding the horse and not when riding at all.

Spinal cord injury (SCIs) can occur from a fall. SCIs and deaths from horseback riding injuries are not very common. Wearing a proper helmet can prevent many injuries. Keeping the foot in the stirrup correctly is also important. A well-trained horse and rider are also keys to safety. Riders must never goof off around horses or try daredevil stunts.

With proper instruction and training most anyone can enjoy horseback riding safely and accident-free.

My 15-year-old son has come up with one problem after another. First it was low back pain and headaches. Now it’s asthma. Are these common problems during the teen years?

When medical problems occur together they are called comorbidities. It’s well known that adults have comorbidities with low back pain. They report rheumatoid arthritis, dermatitis, diabetes, headaches, and others along with low back pain (LBP).

A recent study from the Back Research Center in Denmark looked at teens and young adults ages 12 to 22. They found a positive link between LBP, headaches, and asthma in this age group. They suspect some children are just frailer than others. This puts them at increased risk for problems.

The specific risk factors for back pain aren’t known yet. More research is ongoing to find ways to prevent LBP in all ages.

Our eight-year old son shows a natural ability for wrestling. Is this too young to start? What about injuries at this age?

Injuries can occur in any sport at any age. Research is showing injuries never seen before in children are starting to show up. This reflects the young age of many athletes and the competitiveness of sports today.

The most serious injury in wrestling is damage to the spinal cord. This injury usually occurs when the wrestler is thrown and lands on his head. In other wrestling moves, the head can be forcibly flexed to one side. The nerves in the neck going down the arm may be stretched. This injury can cause nerve damage with pain, tingling, and numbness to the arm, wrist, and hand.

For the most part, young wrestlers are supervised carefully. Coaches try to match opponents equally to prevent injury. At age eight your son will be learning some basic moves and many safety techniques. If you have further doubts, talk to the local wrestling coach about your concerns.

I noticed my 13-year-old daughter has a large swayback posture. Is she likely to have back problems when she’s older?

Swayback, also known as lumbar lordosis, is common in children and young teens. Some don’t develop the abdominal muscles fully to hold the spine in an upright position until much later. Even so, good posture can help reduce muscle fatigue and prevent injuries.

Research shows that women do have more lumbar curvature than men. Whether or not increased lordosis is linked with low back problems is unclear.

Physical therapists at the Washington University in St. Louis are studying the
relationship between lumbar curvature and low back pain. So far they report that people with back pain have about the same amount of curvature as people without back pain.

The difference occurs in certain types of low back pain. Women have larger lumbar curves. Women are more likely to have problems with rotation and extension when they have low back pain. Perhaps there is a link here but more study is needed to show what it is.

I’m 14 years old and have been playing the position of pitcher ever since I was 8. I notice that my pitching arm opens up much more than my nonpitching arm. I know it’s because I move my arm in that position so often. But what’s really happening inside the shoulder to do that?

It’s a good question and one for which we still don’t have an exact answer. We do know that as the shoulder cocks back for the pitch, the front structures of the shoulder are stretched over and over. This includes the capsule, a fibrous material that holds the joint together.

At the same time, the bone is actually changing as well. The angle of the upper arm bone (humerus) as it connects with the shoulder socket changes over time. This is called humeral retroversion. With increased laxity in the front and a change in the bone angle, the shoulder can turn or rotate outward farther than the other side (unless the pitcher uses both arms equally, which is unusual).

Both these changes can actually result in pinching of the soft tissue structures along the back (posterior) side of the shoulder. This is called posterior impingement syndrome.

My son has Legg-Perthes disease. His grandfather had this problem too. He ended up with hip joint replacements on both sides. Is that typical with this condition?

Legg-Calvé-Perthes disease (LPD) is a rare disease that most often affects boys between the ages of 2 and 12. Girls can have LPD. The hips are the main problem. Sometimes both hips are involved, but usually only one side is affected.

With LPD blood flow to the ball of the hip is stopped and bone death occurs. As bone death spreads, the ball develops a fracture of the supporting bone. This fracture signals the beginning of bone reabsorption by the body. As bone is slowly absorbed, the body tries to replace it with new tissue and bone.

Degenerative osteoarthritis can occur with age in adults with LPD. It seems to depend on two things. If the ball reshapes itself and fits into the socket, arthritis is usually
not a concern. If the ball does not reshape well, but the socket’s shape still conforms to the ball, mild arthritis occurs in later adulthood.

Degenerative arthritis occurs in patients whose femoral head does not shape well and does not fit well in the socket. These patients may need a joint replacement before the age of 50.

Today early treatment can help minimize the effects of LPD. The hope is for a brighter future for today’s children who have LPD as treatment continues to improve.

I notice my young children have large sway back posture and big bellies. Is this a sign of weak abdominal muscles? Should they be doing an exercise program for this?

You didn’t mention the ages of your children. A large abdomen in younger children is often due to the fact that the liver is a full adult-size but the belly is still child-sized. Their bodies will have to “grow up” around the liver.

Young children are also just beginning to develop enough muscle strength to support the body upright against gravity. Throwing the hips (and belly) forward is one way to stay upright until the muscles around the spine fully adapt to this position.

You’ll notice that by age nine or 10, most children have “outgrown” the postures you have pointed out. The best way to approach your concern is to encourage physical activity of all kinds. Try not to discourage what may seem like “dangerous” activities.

For example, climbing is a favorite activity of young children and for good reason. The movements required during climbing strengthen arms, legs, trunk, and abdomen. The trunk and abdominal muscles stabilize the spine. Find safe ways to foster all kinds of activities.