For parents of students beginning the new school year, sending them back to school may be sending their backs into a lifetime of pain and health problems.

The problem, according to Dr. Marvin T. Arnsdorff, co-founder of the Charleston, SC-based Backpack Safety America, is the overloaded and improperly carried backpacks shouldered by thousands of school children as they trudge their way to and from school.

"Youngsters are lurched forward like peasants," Dr. Arnsdorff said. "Some of these children are carrying nearly 40 pounds of books and other things in their packs."

The purpose of Backpack Safety America is to call attention to a problem "that is only going to get worse unless we correct it in the children’s early school years," Dr. Arnsdorff said.

How widespread is the problem? New research reveals an alarming danger associated with childhood backpack use. By the end of their teen years, for example, more than half of youths experience at least one low back pain episode (Spine 1998; 23:228-34). According to the research, this increase may be due, at least in part, to the improper use of backpacks.

The Consumer Products Safety Commission estimates that 4,928 emergency room visits each year result from injuries related to book bags and back carriers. These can lead into longer-term problems, as evidenced by a recent scientific experiment which found that carrying a backpack alters the mobility of the spine and leads to restricted movement, a risk factor for back pain (Surg Radiol Anat. 1999; 21: 109-13).

One study used magnetic resonance imaging (MRI) to examine the effects of backpacks on the fluid-filled cushions between the bones of the spine. Researchers concluded that backpacks alter the fluid content, making the wearer of the backpack a prime candidate for disorders such as herniated ("slipped") disc and osteoarthritis later in life (Spine 1999; 24:1316-21).

But you don’t need to be a scientist to understand the effect of backpacks on young spines; watch children in any schoolyard struggle to walk while bent sideways under the weight of an overloaded backpack on one shoulder. You’ll quickly realize the potential danger of this commonplace item.

Is it time to get rid of the backpacks? "The backpack itself is not the cause of this epidemic of back problems among students," said Dr. Arnsdorff. "The primary cause stems from improper packing, lifting and carrying by children wearing and using the packs."

Dr. Arnsdorff offers Backpack Safety America to address the problem. The program contains an 8-minute backpack safety video and packet of backpack safety posters. Participating health care professionals present the program to local schools free of charge as educational tools.

"Our goal," Dr. Arnsdorff said, "is to help educate children at an early age to do everyday activities in biomechanically correct ways so they don’t end up with spinal or repetitive stress injuries later in life."

A certified injury prevention specialist, Dr. Arnsdorff likens the spinal column damage some children have suffered because of the misused backpacks to industrial accidents. "We need to do the same thing in the schools that we do in the factories, warehouses, and offices and that’s have a comprehensive educational program that brings together all the different elements of potential risks and solutions. The fact is that a workforce educated on injury prevention is less likely to be injured on the job."

"We feel the same attention should be given preventive techniques for reducing back injuries that is given dental care, for example," Dr. Arnsdorff said. "There’s really no early intervention for spinal problems."

Dr. Arnsdorff said the typical backpack "might contain textbooks, binders, calculators, personal computers, lunch boxes, a change of clothing, sports equipment, cosmetics, yo-yos, electronic games and more."

Borrow a child’s calculator and do the math. If a child carries a backpack weighing just 12 pounds (a very conservative figure for most students) and lifts it 10 times per day for a 180-day school year, he or she will have lifted and carried 21,600 pounds. That’s nearly 11 tons a child will lift and carry in the course of one school year, the equivalent of six mid-sized automobiles.

"Common sense tells us that a heavy load, distributed improperly or unevenly, day after day, is indeed going to cause stress to a growing spinal column," Dr. Arnsdorff said. "The old adage ‘as the twig is bent, so grows the tree’ comes to mind. I am seeing a growing concern about the improper use of backpacks and the relatively scarce amount of instructional and preventative information available to young people."

There has been growing discussion by some members of the Virginia-based International Chiropractors Association of the increase in adolescent back pain, according to Molly Rangnath, deputy executive director of the association’s Council on Chiropractic Pediatrics. She said the group’s members have been increasingly talking about those (backpack-related) kinds of injuries. "It’s not unlike the same problem we see in women who carry heavy purses on one shoulder. There will be problems because of this."

"Right now there’s nobody saying that it’s cool and smart to carry a backpack correctly," Dr. Arnsdorff said. "We need to tell children at a very early age that it’s cool and smart to take care of themselves. It could eliminate a lot of pain and grief later in life. Billions of dollars in workers compensation are lost every year due to back, neck and repetitive stress injuries. Most of those are because of bad habits learned in childhood, habits than can be prevented by education at an early age."

Dr. Arnsdorff offers the following basic backpack safety tips:

o Make sure the backpack is sturdy and appropriately sized. Some manufacturers offer special child-sized versions for children ages 5 to 10. These packs weigh less than a pound and have shorter back lengths and widths so they do not slip around on the back.

o Consider more than looks when choosing a backpack. An ill-fitting pack can cause back pain, muscle strain or nerve impingement. You want to have padded shoulder straps to avoid pressure on the nerves around the armpits. Some backpacks have waist straps designed to stabilize the load. These should be used whenever possible.

o The proper maximum weight for loaded backpacks should not exceed 15 percent of the child’s body weight. For example, an 80-pound child should not carry more than 12 pounds in a pack. If the pack forces the carrier to bend forward, it is overloaded.

o In loading, it is obvious that excessive backpack weight can cause problems. Prioritizing the pack's content is very important. Avoid loading unnecessary items. It is important to balance the weight of the contents or the body will shift into unnatural postures to compensate.

o Often ignored is the act of lifting and positioning the backpack. Lifting 20 pounds improperly can cause damage. Follow these simple steps: 1) Face the backpack before you lift it. 2) Bend at the knees. 3) Using both hands, check the weight of the pack. 4) Lift with your legs, not your back. 5) Carefully put one should strap on at a time; never sling the pack onto one shoulder.

o Use both shoulder straps. Make them snug but not too tight. Carrying the backpack on one shoulder, while fashionable, can cause long term neck, shoulder, back and postural problems. Use the stabilizing strap around the waist.

© 2005 Body Mechanics, Inc. All rights reserved.
For more information on Backpack Safety America/International, visit www.backpacksafe.com or call 1-800-672-4277.