Memorandum submitted by BackCare
ABOUT BACKCARE
BackCare (registered as the National Back Pain
Association) is an independent national charity that for 40 years
has been helping people manage and prevent back pain by providing
information, promoting self-help, encouraging debate and funding
research into better back care. HRH, The Prince of Wales, is its
patron.The charity represents people who suffer with back pain,
those who treat people with back pain and those concerned with
minimising the costs (human and financial) associated with back
pain. This includes a broad range of health professionals, researchers
and employers.
Last year, as a result of increasing concern
about the incidence of back pain in young people, BackCare set
up a School Back Pain Group, comprising health professionals,
leading ergonomists and educators. After critical evaluation of
the relevant research in this field, to confirm the significance
of the problem, the group produced a review document and other
materials in support of the campaign "Protecting Young Backs".
The campaign aims to:
— raise awareness to the problem of
back pain in young people;
— lobby for health and safety legislation
to protect children's backs;
— introduce better practices in schools
and in the home; and
— educate and encourage children to
look after their backs.
Attached to the following submission are the
two publications, researched and produced by BackCare, which,
summarise the available evidence to date relating to adolescent
back pain, and lay out the ergonomic principles for the adoption
of adjustable classroom furniture. ("An Evidence-based Review
of Back Pain in Children and Young People" and "Your
Back in the Future".) Further specific references are also
attached. [11]
PUPIL BACK
PAIN
Summary of Main Points
— Around 50% school children report
back pain at some time and in 8% of adolescents this affects attendance,
concentration, handwriting, ability to participate in sport, relationships
and well being. 1, 2, 3
— There is evidence to show that adolescent
back problems persist into adult life.4 Research shows that young
people from 12-22 years of age with persistent low back pain (LBP)
during the previous year have an odds ratio of 3.5 for persistent
LBP eight years later.5
— Lower back pain is a growing problem.
LBP in 12-18-year-olds was found to be much more common in 2001
than 1991 and in 2001 than in 1999.6
— The Children's Charter and National
Healthy Schools Programme (NHSP) initiatives, which form part
of Every Child Matters, require that children "be
healthy" and "stay safe". Back Pain is currently
being considered as an issue for adoption into the Physical Activity
Toolkit, a NHSP initiative.
— Ofsted will soon be assessing schools
on their ability to provide a safe and healthy environment for
pupils and their implementation of NHSP recommendations.
— The DfES response to the Select Committee
report on Special Educational Needs (SEN) states that children
with SEN can succeed in mainstream schools provided they have
access to high quality teaching and support. The Ergonomics Society
Special Interest Group (SIG) "Ergonomics4schools", studies
and works with schools and local and central government authorities
and notes that factors causing back pain problems "are likely
to be worsened for any pupils who have physical capabilities significantly
below the average."
BackCare wants the Building Schools for the
Future and Academies Building programmes and the capital programme
for FE colleges to embrace the following educational solutions,
to reduce the risk factors for serious back problems in children
at school. These measures will not only protect children's backs
but also improve concentration and future academic achievement.
RECOMMENDATIONS
1. Furniture
Seating
Ergonomically designed adjustable classroom
chairs, or a range of three different height ergonomic chairs
in classrooms, to encourage and allow good posture. 7, 8
Desks
Height-adjustable desks, (particularly important
for IT use) with slopes for reading and writing. 7, 8
In addition classroom set-ups need to allow
for all chairs and desks to face the whiteboard/teacher to avoid
damaging twisting positions for long periods during lessons.
— A serious risk factor for back pain
is the current poor ergonomic design of classroom chairs and desks
in schools. The low, one-size plastic bucket chair and flat desk
does not allow for a safe and comfortable sitting position.8
— School children do not come in one
size, with 14 year-olds varying in height by more than half a
metre. Schoolchildren are on average 10cm (4 in) taller than 80
years ago. Chairs and desks are on average 20cm (8in) lower than
80 years ago. 9, 10
— Double lessons are becoming popular
and last for up to 80 minutes. Pupils are required to remain static
in potentially damaging positions. Sustained poor posture during
and immediately following the adolescent growth spurt (12-15 years)
is thought to be particularly damaging.
SUSTAINABILITY ISSUES
— Children's back health and well being
must be sustained.
— Current classroom furniture is inappropriate
and will not adapt to the growing size of children, more static
nature of lessons and increasing IT elements in lessons.
— Extended schools initiatives will
require use of classroom furniture outside of pupil population
needs. Community use of schools will require furniture to meet
adult needs and related Health and Safety Regulations such as
Display Screen Equipment (DSE) regulations. Current chairs would
be illegal in the office situation.
— Health and Safety legislation (DSE)
regs, currently only applicable to adults, may be extended to
include school children in their place of work, particularly for
16 years and above, who may be receiving Education Maintenance
Allowance (EMA) to remain at school.
— Existing school furniture may not
comply with future Ofsted criteria for pupil back health and safety.
— Seating will need to conform to British
Standards, which will become increasingly ergonomically stringent.
— SEN considerations. The Ergonomics4schools
SIG states "Little consideration is given to the design and
sizing of educational furniture for SEN learners with problems
of posture and movement. Poor furniture may create a faster onset
of discomfort, resulting in frequent lapses of concentration.
In extreme cases, there may be a risk of injury. Sometimes the
injured party is the teacher or member of support staff who also
have to use the same furniture as the children."
SUPPORTING
EVIDENCE
— Many European, particularly Scandinavian,
Commonwealth countries and others such as India and Tunisia, are
already recommending adjustable or variable height furniture in
schools. 3, 8, 11, 12
— New European Standards for school
furniture introduced this year (BS EN 1729 Part 1 and 2 are more
ergonomically stringent and will translate into British Standards
this October 2006.
— Adopting a range of chair heights
in the classroom improved the match in pupil size to seat height
from around 25% to around 75% in one study of 12-18-year-olds.
13
— A controlled study using a simple
foam wedge insert resulted in significantly reduced frequency
and intensity of back pain in 16-18 year-olds. 14
— A UK pilot school back pain and lifestyle
study in July 2006 questioned 600 secondary school children; a
sub group of 100 students using ergonomic seat cushions, reported
a 61% improvement in comfort. Teacher assessment showed some improvement
in attention spans and decreases in "fidgetability"
among pupils.
BUDGET CONSIDERATIONS
— Ergonomic adjustable chairs may have
an original outlay three times that of currently adopted polypropylene
bucket chairs. Over a 25-year period, however, due to the sustainability
of design and materials, the lifecycle cost of individual ergonomic
adjustable height tables and chairs is actually 22% lower than
the "budget" alternative.
— Plastic bucket chairs with ergonomic
seat inserts will have a similar life span to current varieties
but are still under research and development and prices not available.
CURRENT GOVERNMENT
POSITION
Hansard
— Government has overseen and part-funded
data collection of children's sizes since the 1950's and contributed
to European Standard on School Furniture, to allow children to
be better fitted to several furniture size marks.
— Published in 2000, the DfES Furniture
and Equipment Guide has a section on design quality with ergonomic
considerations for various types of adjustable furniture.
Both information sources are available on TeacherNet,
a DfES website. The Department for Education states that the website:
"allows teachers, building professionals
and even children themselves to determine the correct size of
furniture for a particular pupil. The site offers solutions to
size mismatch—a major cause of discomfort among pupils"
[...]
"schools are free to purchase
their own furniture and equipment and to determine their own spending
priorities". Hansard 23 March 2006 Ergonomic Desks.
There is currently no compulsion for schools
or budget holders to refer to this site or incorporate ergonomic
recommendations for classroom furniture. This system fails to
get ergonomic furniture into schools.
The Department also states that:
"There has been no formal research
regarding a possible correlation either between ergonomic desks
(or school furniture as a whole) and osteopathic health or students'
learning ability but the Department is aware of the importance
as a whole of a pupils learning environment, both to their performance
and feeling of well being. Informal discussions, however, have
been held with the National Back Pain Association in the recent
past and we are aware of that organisation's concerns in this
regard". Hansard 23 March 2006 Ergonomic Desks.
IMPLEMENTATION THROUGH
BSF/ACADEMIES BUILDING
PROGRAMMES AND
THE CAPITAL
PROGRAMME FOR
FE COLLEGES
— To require Partnerships for Schools
(PfS) who manage the BSF programme, to issue policy directing
that specifications for new builds and school refurbishments,
submitted by LAs or LEPs, incorporate ergonomic classroom furniture.
— To ring-fence part of the BSF/Academies
budget for specific ergonomic furniture procurement. The practice
of moving old, lowest cost and damaging furniture into new schools
should cease.
— To incorporate the new British Standards
for school furniture into the TeacherNet website under ergonomics.
For this website to give strong and clear direction on the purchase
of and considerations relating to ergonomic furniture.
— To commission an updated edition
of the Governments DfES Furniture and Equipment Guide (2000) to
incorporate the new European and British Standards for school
furniture and to give strong and clear direction on the purchase
of and considerations relating to ergonomic furniture.
IMPLEMENTATION OUTSIDE
OF THE
PROGRAMMES
— The Department to fund further immediate
research (possibly through BackCare Research committee) into the
effects of reducing the risk factors for back pain at school,
on pupil back pain and learning ability.
— The Department to liase with the
HSE to address ergonomic seating in schools and specify safe seating
requirements for pupils.
2. SCHOOL LOCKERS
Every child should have access to a locker.
— The majority of children has no access
to a locker at school and may carry more than 30% of body weight
in school bags and equipment. This is a risk factor for adolescent
back pain. 3, 4 Pupils are required to carry outside clothes,
sports and technology equipment, musical instruments and books
to and from school and between classrooms. BackCare recommends
a maximum limit of 15% bodyweight.
— Lockers are important to provide
pupils with a personal space at school, which fosters a sense
of belonging and ownership, encouraging responsibility and allegiance.
With current timetables, pupils are required to move between classrooms
for different subject lessons and have little time in their designated
"form room". Desks no longer provide storage and often
there is no provision even for storage of outside clothing. Pupils
forced to carry coats around all day, will inevitably feel like
"visitors" to their own school.
— The Education (School Premises) Regulations
1999 has a requirement for locker provision see below):"
7. The buildings provided for a school shall
be adequate to permit the provision of appropriate ancillary facilities,
in particular—
(a) for the storing and drying of pupils'
outdoor clothing and for the storing of their other belongings"
Despite this legislation, schools fail to meet
this requirement.
— SEN considerations The E4S SIG states
"There is a well-known range of health hazards in schools
for pupils of all ages when carrying around heavy bags. This practice
appears necessary for reasons of security. The bags are frequently
much heavier than well-established standards would recommend and
as such are a significant source of muscular skeletal problems.
These problems are likely to be worsened for any pupils who have
physical capabilities significantly below the average".
SUPPORTING EVIDENCE
— The concern over heavy load bearing
by school children is shared by ergonomists throughout the world
and has been the subject of many studies and discussions.
— The question of inadequate locker
provision has been raised with Government on many occasions.
— In the UK, professional therapists
including physiotherapists, osteopaths and chiropractors have
all highlighted the problem of back pain resulting from heavy
school bags. Each has produced educational materials to help schoolchildren
cope with large loads. The Ergonomic Society SIG, E4S is a strong
supporter of measures to reduce weights carried by pupils.
SUSTAINABILITY ISSUES
— Children's back health and well being
must be sustained.
— There will be more stringent implementation
of legal requirements for lockers (School Premises Regs) in the
future. New and refurbished schools not designed with adequate
space and reference to locker provision will incur expensive remodelling
later.
— Health and Safety Regulations (Manual
Handling) currently apply to adults and define maximum load bearing.
These may subsequently be extended to protect school children
in their place of work, particularly 16 years and above, who may
be receiving EMA to remain at school.
— School Travel Schemes have been set
up to promote walking and cycling to school. By 2010 all schools
should have developed a School Travel Plan for safety and well
being purposes. To support this scheme, there will need to be
provision of secure storage for pupil's equipment, books and personal
items to allow them to leave these at school overnight and reduce
load carrying on the journey to school.
BUDGET CONSIDERATIONS
— The Department's recommended area
standards for secondary school buildings include an appropriate
allowance for lockers.
— Cheaper to install lockers at time
of build/refurbishment than remodelling later.
— Schools submitting an approved School
Travel Plan can access grants (Secondary £10K, Primary £6K)
towards capital expenditure linked to travel for staff and pupil,
which includes the provision of lockers.
CURRENT GOVERNMENT
POSITION
Hansard
— Questions asked as recently as this
July about statistics relating to locker provision in secondary
schools yield unsatisfactory answers:
"The Department does not have these figures,
nor figures for other types of personal storage in schools. However,
the Education (School Premises) Regulations 1999 require that
the buildings provided for a school shall be adequate to allow
for the storing and drying of pupils' outdoor clothing, and for
the storing of their other belongings. Local education authorities
are responsible for ensuring that the premises of maintained schools
conform to these regulations" Hansard 16 March 2004
Schools (Lockers)
"We do not collect information about provision
of pupil locker facilities. The Department requires school buildings
to have facilities for storing pupils' clothes and other belongings,
and the Department's recommended area standards for secondary
school buildings include an appropriate allowance. Schools make
their own decisions about the best way to provide storage; many
choose to provide lockers". Hansard 10 July 2006 Lockers.
— It is estimated that more than 50%
of pupils have no access to lockers or other secure personal storage
space at school. Local authorities are not currently enforcing
legislation.
IMPLEMENTATION THROUGH
BSF/ACADEMIES BUILDING
PROGRAMMES AND
CAPITAL PROGRAMME
FOR FE COLLEGES
— To require Partnerships for Schools
(PfS), managing the BSF programme, to issue policy directing that
specifications for new builds and school refurbishments submitted
by LAs or LEPs, incorporate the provision of locker space for
all pupils.
— To ring-fence part of the BSF/Academies
budget for specific locker procurement.
— To properly enforce existing regulation
covering the provision of lockers in schools.
IMPLEMENTATION OUTSIDE
OF THE
PROGRAMMES
— The Department to liase with the
HSE to address maximum loads to be carried by children. BackCare
calls for a maximum of 15% of body weight for pupils.
3. OTHER RISK
FACTORS/ISSUES
These are not covered by the terms of reference
of the inquiry, in so much as they are curricula issues, not managed
through the BSF programme. BackCare however welcomes the opportunity
to submit evidence relating to these issues and their importance
as risk factors for pupil back pain.
— Adequate physical activity—Essential
for children's health, reduces the risk of back pain and carries
many other health benefits. BackCare supports initiatives to increase
PE and sport in schools and recommend one hour of moderate intensity
physical activity per day.
— Schools should incorporate regular
stretching and postural change during long lessons—a 30-minute
stretch and wriggle rule should be discreetly observed.
— Personal Social Health and Citizenship
Education (PSHCE) curriculum to incorporate back health and safety
education, teaching pupils good posture, back safety and the importance
of regular exercise in supporting and strengthening the back.
Good habits started off in school will be taken home and go forward
with children into their adult life.
— Ergonomically designed backpacks
to be a compulsory part of school uniform or equipment lists and
pupils educated and encouraged to use appropriately.
— Health and Safety assessment of all
risk factors for pupil back pain in the school environment and
legislation introduced to protect young people.
REFERENCES
1 Burton K, et al, (1996) The natural
history of low back pain in adolescents. Spine. 21, 2323-2328.
2 Jones M, et al, (2001) Low back pain
in children. Paediatric Exercise Science 316.
3 Grimmer K, et al, (2003) Spinal Health
Policy for Schools in South Australia. www.unisa.edu.au/cahe
4 Croft P, et al, (2001) Risk factors
for neck pain: a longitudinal study in the general population.
Pain 93, 317-325.
5 Hestbaek L, Leboeuf-Yde C, Kyvik KO, Manniche
C The course of low back pain from adolescence to adulthood:
eight-year follow-up of 9,600 twins. Spine 2006 February 15;31(4):468-72.
6 Hakala P, Rimpela A, Salminen J J, Virtanen
S M, Rimpela M (2002) Back, neck and shoulder pain in Finnish
adolescents: national cross sectional surveys. British Medical
Journal. 325, 743-747.
7 Corlett E, et al, (1994) Seating
and access to work. In "Hard facts about soft machines"
eds. Leuder R and Noro K. Taylor Francis pp335-345 Taylor Francis.
8 Mandal A. (1987) The influence of furniture
height on back pain. Behaviour and Information Tech 6 (3).
9 Mandal A. (1982) Correct height of school
furniture. Human Factors (USA) 24 (3).
10 Mandal A. (1981) The seated man (Homo sedens)
Applied Ergonomics 12 (1).
11 Beija I, et al, (2005) Low back
pain in a cohort of 622 Tunisian schoolchildren and adolescents:
an epidemiological study. Eur Spine J, 14:331-336.
12 Grimmer K, Williams M (2000) Gender-age
environmental associates of adolescent low back pain. Applied
Ergonomics. 31, 343-360.
13 Gouvali M. et al, (2006) Match between
school furniture dimensions and children's anthropometry.
Applied Ergonomics, 37: 765-773.
14 Candy E et al, (2004) Does the Introduction
of a simple wedge on school seating reduce the incidence and intensity
of back pain? International Journal of Therapy and Rehabilitation,
11:462-465.
October 2006
11 Not printed. Back
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