Incorrect use of a proper back pack can be just as damaging as using an improper back pack. Our growing children use their back packs for many years. Repetitive loading of heavy back packs combined with poor ergonomics can be a source of dysfunction in their body and can lead to chronic back and shoulder pain. Smart choices now are important to your child's health long after their school days are gone.

Signs that your child's back pack is inappropriate for them or that they are wearing the pack incorrectly include:

• Headaches at the base of their skull
• Neck pain or pain between their shoulder blades
• Red marks on their shoulders
• Shoulders rolled forward
• Stomach sticking out 
• Hips rolled forward
• Numbness in their arms or hands

When purchasing a new back pack one should look for:

• A lightweight bag which is the same length as your child's torso.
• A back pack that sits no higher than the top of your child's shoulders and no lower than the hip bones.
• Wide (at least 2") adjustable padded straps that do not cut into their arms or armpits.
• Chest strap
• Waist strap
• A padded back with many compartments to evenly distribute the weight

Maintain regular adjustments with your chiropractor to detect and correct spinal problems before they cause pain and dysfunction in your growing child.

Additional tips for proper back pack ergonomics:

• Place heavy items closest to their back.
• Place odd shaped items outside to prevent poking into their back.
• Elementary students should no exceed 10% of their body weight.
• Junior and Senior High students should not exceed 15% of their body weight.
• Place the back pack on their back from a table height or lift properly with the knees.
• Adjust the straps so the bottom of the back pack lies in the curve of their low back.
• Check the back pack regularly for unnecessary items.
• Carry extra books or lunches in hand.
• Use the waist strap to redistribute 50-70% of the bag's weight off their upper body and onto their pelvis.
• Have their back pack assessed with your local chiropractor for appropriateness.

When a patient is diagnosed with a lumbar disc herniation, what is the best treatment?

Best Answer: Both conservative and surgical options are backed by research. Though the ultimate decision of which route to choose should be made by the patient based on their individual goals and needs after an honest discussion with their surgeon.

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Lumbar disc herniations are a very common condition affecting the spine of young and middle-aged folks. The incidence of lumbar disc herniations within certain populations has been estimated to be greater than 50% though often the disc herniations is asymptomatic, meaning without symptoms. A disc “injury” quite often happens in the absence of any pain and you don’t even know about it. Medicare estimates that spending on lumbar discectomy procedure, a surgery to remove disc material, exceeds $300 million annually. Back pain related disorders may or may not always be the result of a disc herniation but are a common cause of disability nonetheless. The American health care system spends over $1 billion annually to address back pain conditions. 

The structure of the disc is composed of circular, basket woven-like annular fibers made of collagen, proteoglycans, and a variety of regenerative cells that surround a gel like structure called the nucleus pulposus. The disc serves to dissipate forces exerted on the spine as well as give space between the vertebra above and below the disc so the nerves have room to exit the spine. As we age, the disc tends to lose water content and height. This loss of hydration and disc collapse can increase strain on the annular fibers which may lead to bulging, a protrusion or extrusion of disc material that would be seen as a herniation. The joint made up between the two vertebral bones and disc is called the intervertebral joint. It is classified as a fibrocartilage joint and can also be referred to as a symphysis joint, similar to the pubic symphysis of the pelvis. If you know anything about symphysis joints, you know that they are EXTREMELY STRONG and they certainly don't slip out of place, giving the impression that discs are inherently weak. It takes about 740lbs of force to compress the disc height 1mm in young subjects and 460lbs of force to compress the disc height 1mm in older subjects. End story is that discs are VERY strong. 

With all that said, back pain may still occur due to disc bulging without pressure on the spinal canal or nerve roots. However back pain with radiculopathy can occur when pressure or irritation of the extruded disc material contacts the thecal sac or lumbar nerve roots. The pain commonly felt with radiculopathy can be felt as electrical, shooting, pins and needles, numbness, tingling, or weakness into the leg. Often patients will experience this as "Sciatica". Sciatica is a description of any of the symptoms above felt in the leg as a result of pressure or irritation of the specific nerve roots levels of L4, L5, or S1. The good news is that 90% of patients with lumbar disc herniations will improve without substantial medical intervention like surgery. Too many people think that once you have a disc herniation (or disc bulge), that you’ve got it for life. Discs have the ability to heal. A patient should not be fearsome of low back pain, even if pain is caused by a disc injury.

Regarding treatment, the research supports both conservative management and surgical intervention as viable options for the treatment of lumbar disc herniation even when radiculopathy is present. Surgical intervention may result in faster relief of symptoms and earlier return to function, although long-term results studies show similar outcomes regardless of type of management. It should be noted that contrary to popular belief of some including surgeons, the size of a lumbar disc herniation does not predict outcomes or the need for surgery. Research indicates from many studies, multiple medical association position statements, and my own clinical experience treating these disorders validates this notion. This is consistent with findings from a 2010 study which found that even massive disc herniations can successfully be treated conservatively. In fact, on several occasions patients with nearly complete spinal canal narrowing were successfully managed without surgery, some as great as 85.1%. Literature suggests that less than 10% of disc herniation cases ultimately require surgery.

The typical patient with lumbar disc related pain will often present to their primary care physician first. However research supports chiropractors being a great first contact for these patients. In fact, medical costs may significantly be reduced when a patient visits a chiropractor first. Initial management of these disorders should include regular movement within a patient's tolerance, exercise guidance, manipulation of the spine, proper nutrition and supplementation, and adequate sleep. A patient should not be told to completely rest. Many of these patients are able to continue lifting. In most instances, radicular symptoms will go away within six weeks. Patients with symptoms that persist beyond six weeks will often be referred for advanced imaging like magnetic resonance imaging (MRI) in order to identify the area of disc pathology and to determine if they are also candidates for more invasive treatments like  injection or surgery.

If you are suffering from back pain, please click the link below to request an appointment!