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90 percent of Polish students have back problems and flat feet. – Children do not move much, spend most of their time at computers, and carrying heavy schoolbags causes overload changes. Today’s 10-year-olds will knock at physiotherapists’ offices in about 10-15 years and in imaging diagnostics they will show changes typical of elderly people – says Krzysztof Aleksandrowicz, MD, physiotherapist, assistant professor at the Medical University in Wrocław in an interview with Edyta Brzozowska.
- Today’s 10-year-olds will be knocking at physiotherapists’ offices in about 10-15 years. Then you will see changes that are characteristic of elderly people
- Flat feet, valgus of the knees, weakening of the functions of postural muscles – this is a sad everyday reality in physiotherapeutic diagnostics. The situation is alarming, not to say dramatic
- Lots of children don’t go into PE lessons. They don’t spend time walking, running, team games. Time spent in front of the TV, with a phone, smartphone or tablet in your hands will not replace these activities and contribute to overload changes, which become the nucleus of degenerative processes
- Parents come with a “slouching” child. And it is a small clone of the same “hunched” parents. How can a son or daughter be told to adopt a correct, corrected attitude when they are setting the wrong example?
Edyta Brzozowska: The school year has begun, and with it the topic of heavy school bags returns. Some of the children are protesting, such as 11-year-old Jagoda Grzebieniak, who appealed to Minister Anna Zalewska on this matter. Are the children right to rebel?
Krzysztof Aleksandrowicz, MD, PhD, physiotherapist: Carrying heavy school bags is often the beginning of orthopedic problems. Oversized kilograms carried on the back cause overload changes in school-age children, which over time cause irreversible degenerative changes. Today’s 10-year-olds will knock at the physiotherapists’ offices in about 10-15 years and then, in the imaging diagnostics, they will be clearly visible such changes that are characteristic of elderly people. For now, they do not feel ailments, but when they start to grow rapidly, they will feel pain in the knee joints, spine joints, most often in the lumbar and thoracic sections – the interscapular area.
Which posture defects in children do you most often diagnose in your practice?
Changes in the natural curvature of the spine are very frequent – the abolition or deepening of lordosis in the lumbar and cervical sections, as well as kyphosis in the thoracic section. Unfortunately, the percentage of lateral curvatures of the spine – scoliosis, does not decrease. The number of children and adolescents with such a diagnosis is growing, and this problem is still underestimated. Flat feet, knee valgus, weakening of postural muscles are a sad everyday reality in physiotherapeutic diagnostics. About 80–90% of children who go to diagnostics require an intervention consisting in the implementation of physiotherapeutic therapy, and sometimes further, in-depth multidisciplinary diagnostics.
The situation is therefore alarming, not to say dramatic.
In addition to the overload resulting from wearing heavy schoolbags, there are also overloads resulting from the sedentary lifestyle of children: in the school desk, over lessons at home and with the head tilted over the phone or tablet.
This, unfortunately, reduces the tone of core muscles. In order for them to be fit, fulfill their function, and be able to maintain the correct posture – they should be exercised every day: during physical education classes, corrective gymnastics and during other activities, also outside school. The problem is that many children in Poland do not practice PE lessons. They do not spend time on various physical activities after school: walking, running, team games. Time spent in front of the TV, with a phone, smartphone or tablet in hand, will not replace these activities. On the contrary, it contributes to overload changes, which become the nucleus of degenerative processes.
Our mothers and grandmothers were right to keep admonishing us: “don’t slouch”?
Their wisdom also consisted in the fact that they allowed us to spend time actively in the yard, among our peers, devoting ourselves to various active games that required physical effort and toughened up young organisms. Most of the children and adolescents belonged to different sports clubs and associations where they practiced different sports. It used to be common. Today, young people are fascinated by something completely different, and only a few practice sports.
Parents do not make their children straighten anymore?
My parents often come to me with a “slouching” – as they say – a child. And I see in him a small clone of the same “hunched” parents. Then I ask: “How can you ask your son or daughter to adopt the correct, corrected attitude, if you are setting a bad example yourself?” Then I recommend joint exercises between the parent and the child in the presence of a physiotherapist who selects an individual program for the child and the parent. The problem will not be solved with a few hours of exercise a week. It should be a long-term process with a vision of what we want to achieve.
And parents willingly exclude their children from PE lessons.
That is why we are growing more and more delicate and more and more – colloquially speaking – “flabby” generation. The period of development and growth with limited physical activity causes irreversible changes in the structures of tissues responsible for shaping and developing the correct body posture. We don’t inherit this with our genes. Many try to explain their laziness and everyday neglect in the effort of working on their own health in this way.
Young people playing sports can be a cure?
Of course. However, attention should be paid to the appropriate qualification to practice various sports disciplines. I had the opportunity to observe the work of German PE teachers in primary schools. Apart from school activities, each child was – on the basis of simple fitness tests – assigned to a specific group: football, basketball, volleyball, handball. There were also teams for less physically fit children. Integration activities and exercises adapted to their abilities were organized for them. With this solution, no child felt rejected in the group. The movement and muscular systems of each of these children were trained at the level and with the intensity adjusted to their abilities. Such a model can be applied in Polish schools. It would be much cheaper than treating the effects of today’s omissions.
What solutions do you propose?
Common research in schools should be introduced. In the past, doctors’ offices operated in every facility, the children’s attitudes were monitored on a regular basis. At the moment, however, the doctor goes to the doctor only to heal the child of defects that begin to bother him, or when the parents noticed something disturbing. This, unfortunately, is another serious problem of our time: parents do not watch their children. When they come to the office and witness the examination, they are surprised to find: “oh, now I see these changes!”
However, it can be assumed immediately that the creation of doctor’s offices in schools is not very realistic.
This can be arranged even in the absence of specialist doctors. Children’s screening tests for posture defects can be performed by physical therapists. The act on the profession of physiotherapist, which has been in place for over two years, defines their competences and gives them the necessary powers. They could carry out basic examinations of children for postural defects. Waiting for a patient suffering from pain to report himself to a physical therapist is a serious mistake. And yet we can and should prevent. Instead of spending huge amounts of money on surgery and long-term therapy, sickness and rehabilitation benefits, orthopedic supplies in the future, policymakers should invest in screening and prevention.
Krzysztof Aleksandrowicz, MD, PhD – physiotherapy specialist, XNUMXst degree motor rehabilitation specialist, assistant professor at the Department of Physiotherapy, Faculty of Health Sciences, Medical University of Silesian Piasts in Wrocław.