​According to the American Physical Therapy Association (APTA) 2012 survey, low back pain affects the daily function of 69% of Americans. Furthermore, in a survey conducted in 1999, 60% of orthopedists reported back and shoulder pain in children due to heavy backpacks. Overall, non-traumatic low back pain develops due to poor posture and muscle strain. Wearing heavy backpacks and wearing them improperly can lead to back pain, shoulder and neck pain.  

There are no studies yet that address the long term affect of back pain from backpacks, but in my 14 years as an orthopedic physical therapist, I have seen postural faults and low back pain beginning in youth manifesting into chronicity in adult life. Why risk long term muscular imbalances and spinal degeneration if prevention is a choice?  The way a heavy backpack affects a young developing spine is simple. Weight is distributed unevenly on one shoulder, causing the child to compensate and shift the hips and upper back over center line to counterbalance the load.  This causes improper muscle activation and non-activation on one side of the spine and the other, causing a “scoliotic-like” spine that can cause stress and pain in the joints and muscles.  Posture is severely affected not only with this sideways shift as in one shoulder backpack carrying, but also with carrying a heavy backpack on both shoulders with rounded shoulders, forward head, severe front lean, and a flattened low back. Growing tweens and teens already have a battle with holding themselves in proper posture. The last thing they need is a heavy back pack worsening things. 

The APTA recommends limiting backpack weight to 10-15% of the body weight of the child. The American Academy of Pediatrics (AAP) recommends a lightweight backpack such as canvas with two wide, padded shoulder straps because narrow straps can dig into shoulders. A safe backpack should also have a padded back, which is comfortable and protects kids from being injured by sharp objects such as scissors, pens, wire notebooks. A waist belt and multiple compartments can also help distribute the weight more evenly.

Overall, be an advocate for your child and look for signs and symptoms of back stress. Ask your child if his/her back is sore or achy.  Perform a visual inspection before you send your child off to school and see if your child’s posture is affected by the backpack. Conference with the teacher to ensure that there is enough time in between classes to return to lockers and exchange books.
If pain in the back, neck and shoulders persist even after proper measurements have been taken. Seek the medical help of a physical therapist. Chances are pain can be reversed with proper muscular strengthening, stretching, and manual therapy.  Your therapist will include home exercises to treat muscle and postural imbalances. Such as the cat/cow stretch, hamstring stretch, mid-back stretch and upper trapezius stretch. Strengthening will include rows, scapular stabilization, and core strengthening.  Manual therapy will reduce abnormal tissue tightness relieve stress on the spine bones.  Apply ice for 10 minutes for new onset, intense pain because the cause is most likely inflammation. Use heat sparingly as heat can increase inflammation and therefore increase pain. Only use heat as a contrast to treat the inflammation. The contrast is applied with 10 minutes heat and 10 minutes ice immediately afterwards.  This contrast technique will help “pump” the swelling out of the tissue.  
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I am a firm believer that if you keep adding micro stress on a joint or muscle over time, the muscle and joint complex will break down. Just as a butter knife cutting away at a 6 inch thick climbing rope will eventually cause the fibers to fray and fracture. 

​by Dr.  Raquel Watkins, Allergist
Watkins Allergy & Asthma Clinic

        ​The common cold and chickenpox aren’t the only ailments parents should worry about this back-to-school season. Allergy and asthma are the most chronic illnesses in children, and are a leading cause of missed school days in the United States.  Asthma accounts for 10.5 million missed school days annually.  Symptoms of these conditions can also interfere with nightly sleep, concentration in the classroom and cause learning disruptions.
          According to the American College of Allergy, Asthma and Immunology (ACAAI), 28 million American children have allergies and 7.1 million suffer from asthma. There can often be many more allergy and asthma triggers in the classroom than in the home environment, causing children’s immune systems to over respond.

​         With schools commonly known as being a petri dish of germs and viruses that get passed around from child to child, parents shouldn’t just chalk up breathing difficulties and runny noses to yet another cold. Both can be signs of something more serious, such as allergies and asthma.
          To help parents understand if their child is at risk for missing school days due to allergy and asthma, Dr. Raquel Watkins, Jacksonville’s board certified allergist and the ACAAI offer the following tips.

Know what Triggers Symptoms – There are a number of inhalants in schools that can trigger allergy and asthma symptoms, such as the classroom pet, pollen and dust that has settled in the school which can contain mouse allergens. Peers with a pet at home can also trigger an allergic reaction in your little one, since these allergens can be transferred to school via clothing and backpacks. If a child says they are coughing, having difficulty breathing, have a rash, runny nose, or are sneezing, these could all be signs they are allergic to something in school. 

Know the Difference – It is easy to mistake a cough and a runny nose as signs of a common cold or respiratory infection. If symptoms are persistent, lasting more than two weeks, it’s likely due to allergies. Colds evolve, usually starting with a stuffy nose, throat irritation and low grade fever. Next comes the sneezing and a runny nose, with thickening mucus that often turns yellow or green.  Trouble breathing, wheezing, chest tightening and often a cough that won’t stop are signs of asthma.
Find Relief – Parents should make an appointment with a  board- certified allergist to have their child tested, diagnosed and treated for allergies and asthma. An allergist can also help a child understand what is causing their symptoms and how to avoid triggers. For children with particularly bothersome allergies, an allergist may prescribe immunotherapy (allergy shots) which can modify and prevent allergy development. Patients under the care of an allergist also have a 77 percent reduction in lost time from school.
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Inform, Educate and Carry – A child’s school, teachers and coaches should all be informed of any allergy and asthma conditions and have medications available. But the education shouldn’t stop there. Children should understand what triggers their symptoms and any warning signs to watch out for. If they are prescribed life-saving treatments, such as a rescue inhaler and epinephrine, they should know how to use their medication. Many schools allow students to carry medication, making communication between parents and the school the key to a healthier child.

Dr.  Raquel Watkins is a Board-Certified Allergist who treats infants, children and adults with asthma and allergies to pollen, pets, and insects as well as skin allergies.   Her office is centrally located in Bartram  Office Park, 13241 Bartram Park Blvd, Suite 2601 Jacksonville Fl 32258 http://www.watkinsclinic.com/