Lordosis is the inward curve of the spine in the lower back. Maintaining a slight sway upright creates proper posture, along with balanced shoulder blades rather than rolled forward. While standing, feet should be flat on the floor, and the chin should parallel the floor. While sitting, the back should be straight, with shoulders slightly pulled back.
Dr. Michael Israel, director of Sports Medicine at Arkansas Children's Hospital in Little Rock and associate professor of Orthopedics at the University of Arkansas for Medical Sciences, said poor posture is a common cause of back pain in adolescents and back pain is one of the most common reasons patients are evaluated in ACH's Orthopedics and Sports Medicine Clinic. It's crucial to determine if the pain is from an underlying issue with the curve in their spine or neuromuscular abnormality to achieve the best treatment plan.
"The increased use of technology/screens in schools and our daily lives has contributed to an increase in neck and back complaints," Israel said. "Utilization of screens including laptops and phones cause hunched shoulders and flexion of the neck that can lead to inflammation of the neck ligaments, muscular weakness and even increased curvature of the spine. Some have coined these physical findings as 'text neck.'"
Israel pointed to recent studies that state more than 50 percent of school-age children and adolescents complain of back pain at some point, and one-third of children 10 to 18 years old have suffered back pain in the last year.
Dr. David Bumpass, an orthopedic spine surgeon at Arkansas Children’s Hospital in Little Rock and Arkansas Children’s Northwest, said classroom desk setups could be challenging for proper posture. Angling a computer properly or putting an iPad on a stand can help. He is also an associate professor of Orthopaedics at the University of Arkansas for Medical Sciences.
"Putting the screen in as much of an upright position as they can so they can maintain a more level gaze or slightly downward gaze rather than the screen flat on their desk, like they would if it was just an iPad or something lying on the desk. That would be more advantageous to encourage good mechanics," he said.
Like adults, children should get up, stretch or change positions every 45 to 60 minutes throughout the day to alleviate neck and back pain. It also allows them to refocus their energy to decrease muscle tension.
Video gamers who sit for long stretches, especially those who play eSports, should also consider taking breaks for physical activity or exercise. Bumpass said surgery-wise, it's rare to find something "seriously wrong" from poor posture.
As children grow into their teens, aerobics, strength and resistance training can keep core muscles strong, making it easier to maintain good posture without experiencing muscle fatigue. It's particularly important for student-athletes, as poor posture can impact athletic performance.
"Increased muscular pain can occur due to increased workload of smaller muscle groups in the back and neck. Prolonged postural issues can lead to decreased pulmonary function, which affects strength and stamina in athletes. Lastly, poor posture increases the level of circulating cortisol (stress hormone) which can negatively impact the mental health of our student-athletes," Israel said.
For some, Israel said treating pain from poor posture can include a physical therapy regimen with a physical therapist or an at-home exercise program focused on muscle strength, flexibility and balance. Lifestyle modifications, including minimizing screen time, can also help.
"Sleep hygiene can play a role in the treatment plan as well. Common advice includes avoidance of screens in bed and the utilization of a pillow between the legs during sleep," Israel said.
An ill-fitting backpack can cause neck and back pain. The straps of a backpack should be tight enough for the bag to sit straight against a child's back. Wearing both straps on their shoulders is recommended to ensure even weight distribution. Israel said as an estimated guide, a backpack should be no more than 10 percent of a child's recommended body weight for their age. It should be no more than 20 percent of the child's body weight based on age if it's a rolling backpack.
Bad posture does not directly lead to any muscular or skeletal deformity as children grow, Bumpass said, but it can impact their quality of life if they have increased pain.
If the pain goes beyond soreness and it wakes a child up at night or is associated with fever, chills, weight loss, neurological issues, like numbness or weakness in the arms or legs, or if pain worsens over time, parents should consult a physician.
What your child can expect from an ACH appointment for back pain
Dr. Michael Israel, director of sports medicine at Arkansas Children's Hospital in Little Rock, explained what to expect during a routine evaluation for back pain at Arkansas Children’s Orthopedics and Sports Medicine Clinic:
Detailed family and personal medical history
- X-rays to rule out significant spinal curve abnormalities
- Assessment of a child’s strength and motion of the spine, arms and legs
- Detailed discussion of daily activities, including length of screen time, what movements make symptoms worse, etc. This can determine if further testing is necessary. The doctor can then develop a personalized treatment plan.