Two photographs were taken of each child, one facing the camera and one sideways on. A plumb line was used to assess the child's posture. Sideways on, the line should have fallen through ear, shoulder, hip and ankle. When the children were facing forward, it should have fallen through the nose and straight down between the feet, placed very slightly apart. Movement in each child's hips, pelvis and knees was also measured. Ms Emberson was looking for 'normal' ranges of movement.
The results were startling. Ninety per cent of the children had posture problems. Many walked badly, with their bottoms stuck out. Others had knock- knees, or walked with their knees pushed back; some had flat feet and turned-in toes.
These children are unlikely to have heard of the 'posture stripes' or 'deportment badges' that were often awarded in girls' schools as late as the Sixties, when straight backs and gracefulness were encouraged.
Ms Emberson and other physiotherapists believe that poor posture is now a serious problem, leading to increasing numbers of sports injuries in children. 'The posture of the average child leaves much to be desired,' she says. 'Poor posture causes incorrect weight bearing through the legs. This puts a strain on young limbs and muscles, leading to injury when youngsters are asked suddenly to peform athletically. The problems that I am seeing are witnessed countrywide by other chartered physios in their practices.
'Unless we get some sort of concerted approach by all those concerned - schools, coaches and parents - the problems will get worse. At the moment there is an almost total disregard for posture and many children are in danger of growing up with recurrent injuries, posture problems and an overall lack of fitness that is carried on into later life.'
Four years ago, figures from the National Back Pain Association indicated a 40 per cent increase in the annual number of working days lost through spinal problems: from 33 million in 1983 to 46.5 million in 1988. 'And these figures do not include working days lost due to soft-tissue damage, arthritis and even heart conditions,' says Ms Emberson. The NBPA argues that more attention should be paid to educating young people to take care of their backs.
Ms Emberson first grew concerned about children's posture when, as deputy superintendent physiotherapist at St Bartholomew's Hospital, London, in the late Seventies, she noticed an increase in the number of very young children referred with sports injuries. Such injuries are often due to poor posture. Sprains, strains and damage to ligaments, tendons and muscles also frequently occur when a child is asked to partake in a physical activity with an unfit body.
One cause of poor posture in children is inadequate exercise. 'The lack of regular old-fashioned PE classes, which included stretching and bending exercises, is partly to blame,' she says. Research carried out in 1987 in the South-west of England showed that children's heart rates increased more in their maths lessons than in PE.
'Very few children even walk briskly to school. They are transported by car or coach. Sadly, heavy traffic and considerations of personal safety preclude children walking in many areas,' says Ms Emberson.
'And, in the name of a more relaxed attitude, modern teaching methods allow children to sit around tables in groups. As a result the children have to twist their bodies round in order to see the teacher. They no longer sit at desks with their feet placed comfortably on the floor; neither are they expected to sit up and look straight ahead.'
She also blames changes in children's way of life, including a more casual approach to eating. 'Slouching appears to be acceptable both at home and at most schools. Children eat and watch television curled up on a chair. Poor eating, overeating, sitting incorrectly with its accompanying poor posture and lack of exercise leads to incorrect breathing and adult back and neck problems.'
Trendy clothes can also cause trouble. 'Large, baggy clothes such as shell suits are a worry. They hide weight problems and encourage slovenly walking. Fashionable unfastened trainers do not hold the heels firmly, allowing the feet to roll around. As the heel governs the way the foot hits the ground, loose trainers can only increase problems with flat feet. Trainers need to fit correctly and be fastened.
'Another problem is carrying heavy sports bags, which cause shoulder strain. Some schools insist that children carry all their books and sports gear with them all day as there is no locker provision - you see quite tiny children carrying ridiculously heavy bags, inducing strains that are bound to produce back problems as they get older. Old-fashioned satchels with two shoulder straps allow both shoulders to bear the weight. Briefcases look businesslike but once again put the burden on one side of the body.'
Even children who seem keen on sports are not necessarily fit. 'Many children who are 'sporty' are uncoordinated and inflexible and either drop out of sport or never reach their full potential. I found this when I examined a group of keen young footballers. All had posture problems, but a regime of stretching and co-ordination exercises dramatically improved their performance.'
Some children, she says, are doing too much sport without the necessary preparation. 'A 12-year-old boy was referred to me with pains in the knee area. I diagnosed these as injuries to the bone growth in both knees. When I asked what sports he did at school, I was shocked to hear that he was doing 3,000- and 1,500-metre runs, long jump and other events, plus cricket and rugby in season. No child should be doing this amount of sport, however enthusiastic they are.
'A professional athlete such as Daley Thompson has to be extremely fit for the decathlon, and warming up with exercises would be part of his daily routine. Children should also have warming-up exercises as a regular part of their sports routine.'
The term 'growing pains', she believes, can be a misnomer, often hiding real problems such as damage to bone growth. If these conditions are left untreated then the final shape of the bone may be distorted, leading to early arthritis and injury.
'But something as simple as old-fashioned exercise would help all children, including clumsy children who lack co-ordination and through lack of progress have relinquished sports early in life.'
Parents, she says, need to 'set a good example by having good posture themselves. They should encourage their children to do homework in a good light, sitting at a desk or table with books at an angle that can be read easily. This also applies to sitting when playing computer games.
'Teachers should not slouch themselves in front of their pupils. Children should be encouraged to sit up in their chairs with their feet placed squarely on the floor in front of them, and with their shoulders back when listening. They should eat at a table, again sitting up straight. Parents should prevent children slumping in front of the television for hours on end.'
She says that parents who want to help their children should encourage them to take up karate. 'It incorporates stretching exercises, discipline, general fitness and confidence. We need to emphasise to schools that all sports should encourage flexibility and co-ordination before strength and power. Otherwise our young children will become overtrained and underexercised.'
Ms Emberson is in the process of collating her findings with the help of the Department of Psychology at the University of Hertfordshire, Hatfield. She is working on a questionnaire for parents looking at factors such as a child's weight, television watching habits and social activities. She hopes that by the end of this year the results of her research will make everyone sit up.
Parents who wish to check a child's posture should consult a chartered physiotherapist. Parents can refer directly to private practitioners but must be referred by a doctor if they wish to use the NHS. The Organisation of Chartered Physiotherapists in Private Practice can be contacted on 0702 77462.
To mark Back Pain Week, 12-17 October, the British Chiropractic Association is offering a free chiropractic back pain diagnosis. Freephone 0800 212618 for automatic transfer to a clinic in your area.
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