Monthly Pain Update – August 2025

Spinal Pain in Schoolkids from Backpack Use

While findings vary across studies, research generally agrees that some degree of spine pain is common in school-aged children—from elementary school through middle and high school. Multiple factors can contribute to spine pain in students, and one that routinely appears in the literature is backpack use. The issue is not necessarily backpack use itself, but the stress heavy, poorly fitted, or improperly worn backpacks place on a child’s developing body.

In an experiment conducted in 2015, a female volunteer walked on a treadmill for five minutes using different types of bags: a two-strap backpack, a one-strap backpack, a shoulder bag, and a cross-body messenger bag. The two-strap backpack was associated with the least spinal muscle activity, suggesting it may be the least likely to contribute to back pain. Unfortunately, a 2025 study of 384 preteens found that even among students with two-strap backpacks, about half routinely slung their backpack over one shoulder, a habit that can put uneven stress on the spine and surrounding tissues.

When a backpack is too heavy, it increases strain on the muscles, tendons, ligaments, and spinal discs of the neck, mid- and low back, and pelvis. Carrying excessive weight also affects a child’s balance and posture, forcing the body’s center of gravity to shift to accommodate the burden. Experts generally recommend that a backpack weigh no more than 10–15% of a child’s body weight. However, the 2025 study found that more than half of students exceeded this guideline. Other research has shown that for every one-kilogram increase in backpack weight, the risk of developing back pain rises by as much as 45%.

Additionally, the amount of time spent wearing a backpack can also elevate injury risk as tissues fatigue and postural adaptations accumulate. A 2016 study of more than 5,300 students across all grade levels found that even though the relative backpack weight declines as children age, the overall rate of spine pain increases over time. Further analysis revealed that the duration of backpack use increases with each grade level, making it an important risk factor for spine pain.

Of course, backpacks are not the only cause of pediatric spine pain. Other common risk factors include excessive sitting and screen time, low physical activity, poor diet, and inadequate sleep. Fortunately, proper backpack habits, regular exercise, and healthy lifestyle choices can go a long way toward reducing spine pain in students. If pain is persistent or worsening, parents and students should consult a healthcare provider, such as a chiropractor, for a thorough evaluation and guidance on safe, effective management.

Cumulative Trauma Disorders of the Upper Extremities

Cumulative trauma disorders (CTDs) are a broad diagnostic category characterized by musculoskeletal injuries that develop gradually due to microtraumas that cannot fully heal because of repeated stress, force, or awkward postures over time. Since many occupations and hobbies involve repetitive motions, CTDs commonly affect the arms and hands. Examples include:

• Carpal tunnel syndrome results from compression of the median nerve as it passes through the wrist, leading to symptoms in the thumb, index, middle finger, and thumb-side of the ring finger. When the median nerve is hindered higher up in the forearm near the pronator teres muscle, the condition is referred to as pronator teres syndrome.
• Cubital tunnel syndrome stems from compression of the ulnar nerve at the elbow and causes symptoms in the pinkie finger and pinkie-side of the ring finger, as well as along the inner forearm. The ulnar nerve can also be compressed at the wrist (this is called Guyon’s canal syndrome) and results in a similar pattern of symptoms in the hand.
• De Quervain’s tenosynovitis is the inflammation of the thumb tendons (abductor pollicis longus and extensor pollicis brevis), producing pain and tenderness on the thumb side of the wrist and thumb.
• Trigger finger (stenosing tenosynovitis) is the locking or catching of one or more fingers due to tendon sheath inflammation, with pain often located at the base of the affected finger or thumb.
• Lateral epicondylitis (tennis elbow) is caused by inflammation of the extensor tendons at the lateral elbow that causes pain with gripping and wrist extension in the outer elbow and top of the forearm.
• Medial epicondylitis (golfer’s elbow) is due to inflammation of the flexor tendons at the inner elbow leading to pain along the inner elbow and forearm during wrist flexion and gripping.
• Rotator cuff tendinopathy is associated with inflammation or degeneration of the shoulder tendons and is felt as aching in the shoulder and upper arm, particularly with overhead motions.
• Bicipital tendinopathy is inflammation of the biceps tendon at the shoulder that produces pain when lifting and reaching.
• Thoracic outlet syndrome describes compression of the brachial plexus and/or subclavian vessels at the thoracic outlet, leading to diffuse symptoms including pain, numbness, or tingling from the neck down into the hand.

When a patient presents with upper-extremity pain or dysfunction, it’s important to conduct a thorough examination from the neck to the hand to identify all potential contributors. Cumulative trauma disorders often overlap or co-occur, so a comprehensive evaluation is critical. Only then can a chiropractor tailor appropriate, conservative treatments to achieve the best possible outcome for the patient.

Conservative Treatment for ACL Rupture

The anterior cruciate ligament (ACL) is a strong band of connective tissue inside the knee joint that connects the femur (thigh bone) to the tibia (shin bone). Its primary role is to help stabilize the knee by preventing excessive forward movement and rotation of the tibia. Unlike muscles, ligaments like the ACL are not designed to stretch, so they provide passive stability while the muscles and tendons control movement.

Most ACL injuries occur without direct contact. Common mechanisms include sudden deceleration, rapid pivoting, landing awkwardly from a jump, hyperextension, or twisting the knee with the foot firmly planted. A partial tear is often referred to as a sprain, while a complete tear is a rupture.

When deciding between surgical or conservative management of an ACL rupture, the best candidates for surgery tend to be younger, highly active athletes—especially those in sports involving pivoting and cutting movements. Surgery can restore knee stability and may reduce the risk of secondary damage like meniscal tears or cartilage wear that can eventually lead to osteoarthritis. However, it’s important to note that surgery is not a quick fix; post-operative rehabilitation often takes 9-12 months before an athlete can fully return to sport.

In contrast, most less-active individuals or older patients can respond well to conservative care. Long-term outcomes of surgery versus non-surgery tend to be similar for these patients, and non-surgical treatment avoids surgical risks and recovery time. Recent research also suggests that some full tears can heal with a structured rehabilitation program.

Conservative care is multimodal and tailored to the individual. Interventions may include bracing and activity modification to offload the knee; progressive exercises to restore strength, balance, and joint control; and manual therapies like mobilization, myofascial release, and trigger point therapy to improve mobility. Treatment may also address biomechanical issues elsewhere in the kinetic chain—such as foot pronation or hip weakness—that can contribute to knee instability.

Chiropractors, working alongside physical therapists, massage therapists, sports medicine doctors, and orthopedic specialists, are well equipped to support patients with ACL rupture. They can help them reduce pain, optimize knee stability, and achieve their personal goals, whether that’s returning to sport or carrying out their normal activities of daily living.

Chiropractic Care for Chronic Jaw Pain

Temporomandibular disorder (TMD) is a condition that affects the jaw joint and surrounding muscles, often causing pain, stiffness, clicking, and difficulty moving the jaw. It’s estimated that between 50% and 66% of adults will experience at least one short-lived episode of TMD in their lifetime that resolves on its own. However, approximately 5–12% may go on to have severe or persistent symptoms that require intervention from a healthcare provider. While dentists and medical doctors are often the first point of contact, there’s a growing interest in the research community about the role of chiropractic care in managing TMD.

The temporomandibular joint is formed by the articulation of the temporal bone of the cranium and the mandible, or jawbone, which allows the jaw to open and close, move left and right, and slide forward and backward. It’s a synovial joint with a fibrocartilage disk that separates the joint into two compartments. The muscles of mastication and the hyoid muscles control these motions. The masseter and temporalis help close the jaw, with assistance from the medial pterygoid. The lateral pterygoid supports protrusion. If the movement or function of any of these tissues is altered, the joint can become restricted and painful.

TMD can arise suddenly after trauma, such as whiplash or a direct blow, but it more often develops gradually over time as a result of microtrauma, muscle tension, joint wear, bruxism, repeated clenching, and chronic stress. In these cases, the tissues surrounding the joint send continuous pain signals to the central nervous system, which can sensitize the nervous system and cause pain and stiffness to persist long after the tissues have begun to heal.

A review of guidelines from December 2023 emphasized the value of conservative therapies often provided in chiropractic offices for managing chronic TMD including manipulative, mobilization, and trigger point therapy; supervised exercises; and gentle stretching—all with the aim to improve joint mobility and reduce pain. Hands-on care can also help decrease pain catastrophizing, the tendency to describe pain in exaggerated terms, and reduce kinesiophobia, the fear of movement that can lead to further guarding and stiffness.

In addition to treating the jaw itself, research continues to highlight a connection between TMD and cervical spine dysfunction. Many patients with TMD also have neck pain or restricted neck movement—something doctors of chiropractic have long treated with great success. A May 2023 systematic review of five studies concluded that improving mobility in the cervical spine can decrease jaw pain, sensitivity, and functional limitations. This underscores the need for a holistic approach because dysfunction in one region can contribute to dysfunction in another. Addressing not only the jaw but also the neck and surrounding structures can help produce better, more lasting outcomes for the TMD patient.

Whiplash and Central Sensitization

Whiplash-associated disorder (WAD) is a term used to describe the constellation of physical and psychosocial symptoms that can follow the sudden acceleration–deceleration of the head and neck, most commonly from a motor vehicle collision. Although many patients recover quickly, up to half may go on to experience chronic pain and other symptoms for months or even years. Given the substantial burden WAD can cause individuals and society, research has focused on identifying why some patients recover and others do not so that those at higher risk can receive more comprehensive, early interventions in hopes of avoiding chronicity. One important factor is central sensitization.

Central sensitization is a process in which the central nervous system becomes hypersensitive and amplifies pain signals, sometimes making normally non-painful stimuli feel painful. This can occur after injury to tissues that send sensory input (the cervical facet joints and capsules, neck muscles, intervertebral disks and their ligaments, nerve roots and dorsal root ganglia, and the dura mater, for example), direct injury to the spinal cord, or neuroplastic changes in the brain in response to ongoing pain.

In WAD patients, direct spinal cord injury is rare, but soft-tissue injury in the neck is common. Persistent pain and stress after the injury may also contribute to changes in brain processing. This is why prompt care is so important — not only to help tissues heal but also to reduce the risk that ongoing pain will lead to long-term sensitization. Estimates suggest that about one-third of acute WAD patients show signs of central sensitization, which can appear as early as one day and up to two weeks post-accident. Interestingly, a February 2023 study found that these symptoms tend to appear faster after rear-end collisions than front-end collisions.

Chiropractic care for WAD often involves a multimodal approach including spinal manipulation and mobilization, soft tissue therapy, trigger point release, and physiotherapy exercises to help restore neck mobility, reduce pain, and decrease painful nerve signaling. Chiropractors also encourage patients to remain active within pain tolerances; advise on ice, heat, anti-inflammatory supplements, and/or dietary modifications; and prescribe exercises to improve posture and strength. When necessary, a doctor of chiropractic will collaborate with medical physicians or specialists to ensure the patient receives the most appropriate care to support as full a recovery as possible.

Ultra-Processed Foods and Whole Body Health

Ultra-processed foods are industrially formulated products made mostly from refined substances, additives, and preservatives, with little or no whole food content. These foods usually contain long lists of ingredients that are probably more familiar to food scientists than to the average consumer. Because they’re designed to taste good and require no preparation, they often replace whole foods and have become a significant part of what people eat every day. In fact, ultra-processed foods now account for nearly two-thirds of the average American adult’s daily energy consumption, and for children, that figure can be as high as seventy percent.

The term “empty calories” is often used to describe ultra-processed foods because they lack essential nutrients like fiber, vitamins, minerals, and protein, all of which are stripped away during processing. Even when these lost nutrients are added back, they are not necessarily absorbed by the body in the same way they would be if they came from the original whole food. Ultra-processed foods also tend to be high in sugar, salt, unhealthy fats, and additives that the body isn’t designed to process in large amounts. This can put stress on the gut and other organs and contribute to low-grade inflammation. Because these foods are so calorie-dense, it’s very easy to overconsume them (that is, eat more calories than your body requires) without feeling full.

Several studies have linked a diet high in ultra-processed foods to serious health problems such as obesity, type 2 diabetes, high blood pressure, heart disease, depression, cognitive decline, inflammatory bowel disease, some cancers, and more. Research also shows that ultra-processed foods can lead to worse outcomes for people who already have heart disease or cancer and may even increase the risk of dying earlier from any cause. Writing in the February 2022 issue of the American Journal of Clinical Nutrition, researcher Dr. Gary Fraser noted, “If you're interested in living longer or to your maximal potential, you'd be wise to avoid a diet filled with ultra-processed foods and replace them with less processed or unprocessed foods…It's as simple as that.”

Unfortunately, the convenience of ultra-processed foods has helped them take up more and more space in the typical diet. But there’s good news too. You don’t need to go cold turkey, and small changes can make a big difference. Swapping a sugary snack for an apple or a soda for water or unsweetened tea is an easy first step. Even learning to plan meals and prepare simple, wholesome foods can help. In fact, two December 2024 studies found that people who took weekly classes on meal planning and healthy eating significantly cut their consumption of ultra-processed foods, lost weight, and reported feeling better overall.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.