‘Back on Track’ – development of a school-based back care education programme

Abstract

There is a high prevalence of back and neck pain among school children,1 with estimations that 50% of 14-year-olds have experienced back pain.2 Adolescent back pain sufferers are more likely to experience back pain as an adult, and problems can begin at primary school age.3,4 It is widely understood that the risk for back pain in young people is mul- tifactorial; however, the school environ- ment is an important consideration as children spend 30% of their time there.5,6Abertawe Bro-Morgannwg University Health Board serves a population of 500,000 individuals in South Wales. The percentage of paediatric referrals to physiotherapy for back and neck pain increased from 2.1% in September 2011 to 4.5% in March 2012. A project was introduced to ascertain whether local school children's backs are 'fit for the future'. The aims of the project were to investigate the prevalence of back and/or neck pain in school children in the Neath/ Port Talbot locality, identify the possible contributing risk fac- tors and raise awareness of the importance of applying practical back care education in the school environment.In June 2012, a questionnaire-based study was undertaken with a purposive sample of 204 young people from two primary schools (n = 78) and one senior school (n = 126) in the local area, spanning pupils aged from 7 to 15 years. The questionnaire addressed some key risk factors predisposing young people to back and neck pain and included school bag weight, school furniture, general lifestyle, and previous back pain.7,8 It is recognised that psychosocial factors may play a significant role in the development of back pain in young people;5,6 however, investigating such issues was beyond the scope of this physiotherapy-led initiative, and attempting to discuss sensitive subject matter with pupils could be seen as inappropriate within the school environment.Results of the questionnaire found that a total of 72% of the primary school sample reported back and/or neck pain in the past year and 36% within the last week prior to the questionnaire taking place. A total of 64% of the secondary school-aged pupils reported back and/or neck pain in the past year and 33% in past week. A total of 89% of pupils ques- tioned had not reported their back/neck pain to anyone, but 78% wanted teach- ing on how to keep their backs healthy.A number of questions addressed some of the school activity-related risk factors associated with back and neck pain in young people. For primary school children, sitting in assembly and sitting on the floor were the most problematic activities reported. For secondary school children, it was carry- ing their school bag; 15% of 11- to 12-year-olds carried a bag that weighed 10% of their body weight or greater. The literature recommends no more than 10%-15% of body weight.9These results may suggest that grow- ing spines are being affected, and back and neck pain in young people is a prob- lem which needs further investigation. The information obtained also supports the knowledge that many possible risk factors for back/neck pain in children are school-related, such as bag weight, uncomfortable seating and prolonged periods of sitting.10These results led to several local and national press releases along with a BBC Radio Wales live interview during August 2012 in time with pupils' return to school. There was also the opportunity to pre- sent the findings to Neath/Port Talbot primary and secondary school teachers during the Autumn term of 2012. Following on from this, a resource pack entitled 'Back on Track - a school-based back care education programme' evolved as a collaborative with a physio- therapist in England.A comprehensive school in Port Talbot was willing for 'Back on Track' to be piloted with Year 8 pupils aged 12/13 years who had participated in the initial questionnaire. In the spring/summer term 2013, paediatric physiotherapists delivered 'Back on Track' to 106 pupils as part of their pastoral care curriculum. …