Health: Stand up straight, children

Back pain is no longer the preserve of the creaking middle aged. Now the young are suffering - and their posture is to blame. By Wendy Wallace

Sport is not 15-year-old Jonathan's forte. His hobbies are reading, drama and watching television. But when he discovered while on a school course that he was unable to sit in a boat without support for his back, his family realised he had a problem. "I knew he slouched," says his mother. "But I thought it was something he chose to do. Now we've found he doesn't have enough strength in his back muscles to sit up without support."

Back pain, traditionally the unhappy preserve of the middle-aged, is fast becoming a growing problem among younger people. "I'm seeing children in their early teenage years with back problems that I wouldn't expect to see until 30 or 40," says Wendy Emberson, a chartered physiotherapist with 20 years' experience. "Some children of 12 are unable to touch their toes."

Alarming numbers of today's children, she says, are stuck in a "toddler posture" of pot bellies, rounded shoulders and splayed feet. While these are quite normal in small children, they lead to back problems in those who are older.

The National Back Pain Association has expressed its concern by convening a working party on back pain among children. And the Chartered Society of Physiotherapy warned that its managers were seeing increasing numbers of children with postural back pain and associated problems. "Back pain among children is on the increase," says the society.

Much back pain in children stems from poor posture: correct this, and the pain disappears. But, for a variety of reasons, children are increasingly likely to have bad posture. At school, they are crouched round small tables instead of sitting up straight behind a desk. At home, they are more likely to be slumped safely on the couch in front of the television than out playing on the traffic-ridden streets. Even children's fashions - unlaced trainers and clothes sufficiently baggy to disguise poor posture - contribute to the syndrome, according to specialists..

"I see a lot more adolescents now with back pain," says Pete Evans of the Association of Chartered Physiotherapists in Sports Medicine. "Kids today are more and more in front of the television or the computer. They slouch in front of the TV in a banana shape, with the spine slumped and the back unsupported. Today's philosophy is even to walk with a slump, with the hands in the pockets, and that also puts strains on the back."

It is difficult to change children's habits. Jonathan has embarked on an exercise programme designed to improve his stamina and straighten his back. But, says his mother, it is not easy for him. Or her. "He goes off to school, works all day, then comes back and does homework on the computer. It's hard then not to allow him to slouch in front of the telly."

Alarmed by the number of children arriving at her Essex clinic with poor posture, Wendy Embersonembarked on a survey of the children at her son's primary school. Of the 90 six- to 11-year-olds she checked for posture - looking at components such as flat feet, knock knees, protruding bottoms, rounded shoulders - only four passed with flying colours.

Small children need splayed feet, pot bellies and round shoulders to help them keep their balance while walking is still a newly acquired skill. But by eight or nine, children should have outgrown this "toddler posture". Why are they not doing so? "Children don't rush around anything like as much as they used to," says Wendy Emberson. "Their games are more inactive. The result is that the spine is not lengthening, the pelvis is not dropping back, and the hip joints are not straightening up. They're not actually getting to the erect posture."

One of the main culprits is children's increased use of computers, whether for work or leisure. Neither schools nor parents have so far taken on the ergonomic implications of children sitting for hours at a time in front of a small screen. "In effect, they have the lifestyle of office workers," says Wendy Emberson. `But what parent is going to spend pounds and pounds on an adjustable chair?"

This is a problem exercising the minds of the National Back Pain Association, which will launch a campaign later this year to encourage schools and families to invest in decent furniture for children. They believe that the roots of widespread back problems among adults lie in childhood, and the area has been neglected for too long. "We care for children's feet and teeth - but their spines remain in the shadows," says Norma Montague, a spokesperson for the association.

The right size and style of chair at home and at school will encourage young spines into the healthy S-shape, rather than the risky C-shape. Sloping writing surfaces, firm beds that are not bounced on, and backpacks which distribute the weight of school books evenly over developing shoulders can all help.

But it is not only inactive, computer game-addicted children who are suffering back problems. Sporty ones are at risk too, if they lack flexibility. David Parrish, 16, plays in national tennis tournaments and is the under- 16 Hertfordshire tennis champion. He has had two slipped discs this year. "When he first started complaining of back pain, we ignored it," says his mother. "I couldn't believe it when we established that he'd actually been playing tennis with a slipped disc."

David was serving in an important match when he felt "a sharp pain in my back, as though someone had stabbed me, right low down." That was in January. The injury was later corrected by a physiotherapist, who also suggested he do warm-up stretches every day and before matches to prevent further injury. "I maintained it for three weeks,' says David. "Then I stopped doing them because I thought I was better. I slackened off, and my back went again last Sunday."

School sports such as football and hockey, say physiotherapists, often emphasise skill and strength over suppleness and flexibility. A new drive to introduce "health-related exercise" in schools is slowly gaining ground. "PE has been very narrowly interpreted," says Jill Elbourne, an educational exercise consultant based in Gloucestershire. "We now realise it's not just a question of throwing exercise at people and expecting them to take it up. It's giving them the knowledge and attitudes to maintain an active way of life." She suggests schools get children skipping, walking, jogging, cycling and exercising to music.

Treating a child with an acute back problem is straightforward, says Pete Evans. Ice, exercises, and "mobilisations" - combined with children's ability to heal speedily - soon put his patients back on their feet. But warding off the next incident is more difficult.

"Treating a crisis is easy," he says. "The hard part is to get them to understand that they have to look at what they're doing. Otherwise they could end up with a lifetime of problems."

The National Back Pain Association leaflet `Healthy Backs for Children' is available from the NBPA, 18 Elmtree Road, Teddington, Middlesex, TW11 8ST on receipt of a SAE and 20p.