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Small frame, big pain

Mehak Verma was in for a shock when Aabhas, her six-year-old son, returned from school with a nagging shoulder pain. It was only after relieving the child of his school bag and taking off his shirt that Verma realised what the child had been putting up with for the past few days. “He had developed blisters on his shoulders, and the pain refused to go,” says Verma, a resident of Delhi. “We are now thinking of consulting a physiotherapist, since I fear this might develop into back pain in future, if not cared for immediately,” she says.

In Calcutta, Avinash Sharma, the father of two school-going children, has similar apprehensions. “The stress is evident when my children trudge towards their school, burdened with their heavy school bags. Study pressure and working on computers only aggravates the problem,” says Sharma.

Recent incidents show that complications related to the backbone and back muscles in children are slowly on the rise in the country. Some years ago, doctors reported that people in their thirties had started suffering from aches and pains that were earlier seen in older men and women. Then, youngsters in their twenties, especially those working at business process outsourcing (BPO) companies, complained of backaches and related problems. School kids are now falling prey to back problems, thanks to their heavy bags, long hours at the computer and junk food.

Take 17-year-old Preeti (name changed), who suffered multiple fractures along her back and limbs, the result of her consuming nearly three litres of cola — known to be a calcium drainer — on a regular basis. Or take 15-year-old Nilesh (name changed), who recently reported to the doctor with spinal complications, caused by cycling six kilometres to school and back daily with his backpack.

In 2006, a study conducted by Apollo Hospitals among 1,134 schoolchildren between 10 and 15 years in Delhi showed that four out of five students carried school bags that exceeded prescribed weights. No surprise, then, that four out of 10 of them reported back pain, sometimes severe enough to keep them from attending school or playing games.

Doctors say the problem is on the rise and that the seeds of back-related problems are sown during early school years, only to reappear during high school and college. “Though there’s no study to support the observations, an estimate says that almost one in three students attending college in Delhi University suffers from lower back pain and other related problems,” says senior physiotherapist R.S.K. Nair, former physiotherapist with the Indian hockey team and now consultant physiotherapist at the university.

Calcutta-based orthopaedic surgeon Arindam Banerjee shares Nair’s views. “There is definitely a trend,” he says. “The number of children complaining of backaches has increased in the past few years. Earlier I used to have one or two such cases in a month, but now it’s escalated to about two cases a week,” he says.

V.A.S. Kumar, consultant orthopaedic surgeon at Max Hospitals, Delhi, has also spotted the rise in the incidence of back problems in youngsters. “These days, 40 out of 1,000 of my patients with back problems come from the below-18 age group,” says Kumar. “Five years ago such cases were very rare,” he says.

“Heavy school bags have done their damage. Our research shows that ideally a school-going child should not carry a bag that exceeds 10 per cent of his or her own body weight,” says R.K. Agarwal, consultant child specialist and president of the Indian Academy of Paediatrics. “However, we often see that children carry bags that exceed five kg, and this is not counting the weight of water bottles and lunch packs.”

Aabhas’s school bag, for instance, weighs seven kg, testifies his mother. “Clearly, if a tender spine is subjected to such weights, it’s bound to develop complications in future,” says Agarwal.

There are several other reasons for severe backaches among children. “It could be a combined outcome of carrying heavy school bags, a sedentary lifestyle, and not playing enough outdoor games,” says Shabnam Agarwal, chief physiotherapist, Belle Vue Clinic, Calcutta.

Vellore-based paediatrician Gita Mathai agrees. “Apart from lack of physical exercise, back problems are also caused by poor postures, especially while watching TV, working on the computer and doing home work,” she says. “The spines of children are supple, and the problems I have seen are chiefly in the shoulders, and in the junction of the ribs and the bone in front,” she notes.

An improper diet causes problems, too. “Parents should understand that bad dietary habits lead to ill-developed muscles,” says Nair. “This creates complications during adolescence, when the body grows suddenly, and the muscles can no longer support the excess mass in the way it should. Obviously, the spine comes under stress,” he says.

That apart, Nair points out that at the college level, lower back problems have replaced sports-related injuries as the most common ailment. “It’s one indication that today’s youth are playing less and spending their time indoors,” he says.

And while being indoors, children are definitely going heavy on computer usage. Though it’s a relatively new field of research, with few figures available, a report prepared by the Internet and Mobile Association of India (IAMAI) in 2007 showed that nearly 14 per cent of India’s children between eight and 17 years were regular computer users. “Computers are bringing with them their own specific problems, caused by sitting long hours at the workstation and handling the mouse without adequate arm rest,” says Nair. He points out that in March and April — when schools have their annual examinations, and students have to study for long hours — the number of backache complaints increases dramatically.

Common symptoms related to spinal and lower back problems, as noticed in children by doctors, range from sciatica — pain caused by the compression or irritation of spinal nerves — and paraesthesia, an altered sensation that comes with a tingling or pin-prick feeling. “Back pain can also be a psychosomatic disorder,” notes Kumar. “Several children lead extremely stressful lives these days, and it has been shown through research that such stress, when expressing itself in the form of a physical disorder, tends to affect the backbone and muscles at the back more than any other part of the body. Other symptoms, such as muscular spasms and slip-discs, are not uncommon either,” he says.

The only way out, experts feel is a healthy lifestyle, complemented by adequate rest, exercise and diet. Besides, stress reduction — both mental and physical — is also of utmost importance. Experts suggest reducing the weight of a school bag, which, they say, should be straddled across both shoulders in order to distribute the weight or using a wheeled strolley. Students should arch the spine backwards from time to time while cycling, and take frequent breaks while working on computers or studying at the desk.

“Care is the only preventive measure one can take at such a young age,” says Kumar. “Or else, related disorders such as lumbar spondylitis and osteoporosis can begin to set in at an early age.” In that context, it may be no surprise that the average age for the onset of osteoporosis — in which bones get brittle and start to break — has gone down over the past decade from 60 to about 45, say experts. In a few decades from now, the dreaded disease may come knocking at school doors.

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