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School Backpacks Can Be Painful Burden

Experts offer suggestions to avoid the strain

SUNDAY, Sept. 16, 2001 (HealthDayNews) -- Homework can place a heavy burden on kids in more ways than one.

Experts warn that the load can be more than just a pain in the neck if proper backpack usage isn't followed.

Injuries related to backpacks, in fact, accounted for more than 13,260 visits to hospital emergency rooms, doctors' offices and clinics last year, according to estimates and projections of the U.S. Consumer Product Safety Commission.

Although backpacks are still a highly recommended way of carrying books around, the improper use of them may defeat their purpose, explains Dr. Angela D. Smith, an orthopaedic surgeon at Children's Hospital of Philadelphia.

The problem is that many children using backpacks these days either don't use backpacks that meet the recommended parameters or dont use them appropriately, Smith says.

Among the most important recommended features are that backpacks have padded straps and a waist or hip belt. These devices prevent strain on the shoulders and help stabilize the pack in place. Straps are helpful to cinch in books that would otherwise sag out the back.

But just as important, Smith adds, is how books are placed inside the pack. If books are placed flat, or fall flat, as opposed to being upright, that's when problems with back strain can occur.

But with the load positioned lengthwise and extending away from the body, your position must be altered or aches and pains can result, adds Dr. David L. Skaggs, an assistant professor of orthopedic surgery at Children's Hospital, Los Angeles.

"The further backwards you have the weight, the more it pulls you backward, so as a result you have to lean forward," he says.

"The important thing is to have the heaviest stuff right against your back to keep the center of gravity above your pelvis," he adds.

Another problematic book-carrying practice is carrying a pack or bag on just one shoulder, says Skaggs.

"If books are being carried with only one strap, it's an asymmetrical load that's placed on the back. And we know from long-term studies that asymmetry and leaning to one side is probably linked to back pain."

Muscle strain is the main problem, explains Smith. You'll get some pain in your back and the body's response to the pain is to shut off the muscles or make them spasm. Then the muscles weaken because they've been in pain and now they can do even less work, so it becomes a downward spiral.

Smith encourages building strength in abdominal and back muscles through exercises like stomach crunches, because simply being physically fit may not help alleviate backpack pain problems.

Skaggs adds, however, that the daily chore of carrying the backpack around itself is often enough to build up the proper muscles.

"The best exercise is probably just doing it," he says.

Even proper positioning can be undermined if a backpack is simply overloaded, however, the experts say.

But proper weight limits can differ with each individual, Smith notes.

"I steer away from making any recommendations in terms of how much weight should be carried because what works for one person may be completely different for another," she says.

"My recommendations to kids are simply the same things I learned growing up about camping, and it's the same thing the Girl Scouts or Boy Scouts will tell you: Pack everything you need and then take away half of it," she adds.

What To Do

Smith makes the following recommendations to her patients and parents on choosing backpacks:

  • Participate in school physical education classes, enroll in classes outside of school, or watch videos to learn how to condition your muscles;
  • Choose a backpack on wheels if the school allows it;
  • Buy a camping quality/style backpack with the appropriate structure and design to allow for heavier weight (don't go just for what's fashionable);
  • Make sure shoulder straps are padded and use both shoulders while carrying the backpack;
  • Use a waist/hip strap to help distribute the weight evenly between the back and hips;
  • Make sure that the weight is carried close to the body and secured (belted);
  • Use the correct lifting techniques -- remember, bend with both knees when picking up a heavy backpack;
  • Place the heaviest items close to your back;
  • Neatly pack your backpack, try to keep items in place;
  • Try to make frequent trips to your locker between classes to replace books;
  • Consider purchasing a second set of books for home.

Visit the American Academy of Orthopedic Surgeons' Web site for helpful information on back pain exercises.

And here are some good tips on preventing back pain in the first place.

SOURCES: Interviews with Angela D. Smith, M.D., orthopaedic surgeon, Children's Hospital of Philadelphia; David L. Skaggs, assistant professor of orthopedic surgery, Children's Hospital, Los Angeles; American Academy of Orthopedic Surgeons press release
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