Health
Heavy backpacks may harm kids, doctors warn

• Tips from doctors on backpack safety

By Beverly Creamer
Advertiser Staff Writer

Backpacks are popular among students everywhere, like these at at McKinley High. Many are now switching to pulling wheeled bags. Deborah Booker • The Honolulu Advertiser

Orthopedic surgeon Dr. Linda Rasmussen says that by October and November, she'll begin seeing the results of those heavily loaded backpacks, as teenage patients start showing up in her office complaining of back pain.

"By the time they get to see me, they've already dropped out of sports or other things," said the Windward O'ahu specialist. "Then you go searching for the problem, and more often than not it's a heavy backpack. So the No. 1 thing is to eliminate the backpack or the weight in the backpack."

Rasmussen isn't the only physician concerned about the immediate and long-term effects of overly heavy school bags. Already pediatric orthopedic surgeon Dr. Robert Durkin, with the Children's Orthopaedics of Hawai'i group based at Kapi'olani Medical Center for Women and Children, has seen a number of parents worried about their youngsters' heavy loads.

"In general, kids that carry heavier packs complain of aches and pains more often," said Durkin, also a member of Hawai'i's statewide community-based Keiki Injury Prevention Coalition. "As kids go back to school, we see a flush that come in for back pain."

Durkin reassures parents that no definitive studies have shown that heavy packs cause permanent damage such as scoliosis or fractures. Nonetheless, he sends them home with a list of backpack safety rules. (See tips, at left.)

A new survey from Los Angeles Childrens Hospital covering students from four nearby middle schools shows that more than one-quarter of the children using backpacks suffer back pain.

Two years ago a survey by the American Academy of Orthopedic Surgeons discovered more than half of the nation's

orthopedists had seen patients complaining of back and shoulder pain caused by heavy backpacks. The academy said the extra stress placed on shoulders and spine from such heavy loads was causing muscle fatigue and strain. As well, according to the Consumer Products Safety Commission, there are almost 5,000 annual emergency room visits nationwide because of injuries related to book bags and back carriers.

Dr. David Paperny, a Kaiser Permanente pediatrician in the Honolulu clinic, applies the two-finger rule to his own 13-year-old son's heavy backpack: "If I can't pick it up with the fingers on one hand, it's too heavy," he said. But many days the teen carries as much as 40 pounds in his pack.

"There seems to be this tendency of wanting to drag all their books all over," said Paperny, who is happy to see that his son's school, Mid-Pacific Institute, provides extra classroom books so they can leave one set at home, another at school, and don't have to lug books back and forth.

Paperny, a specialist in adolescent medicine, said some research suggests backpacks heavier than 10 percent of a child's body weight might reduce lung volume. But that may also depend on the child's fitness level. "If they're heavy and muscular, they can do it," said Paperny. "If not, they're more likely to be out of breath."

Studies of backpack safety are proliferating. Recently, one used magnetic resonance imaging (MRI) to examine the effects of heavy backpacks on the fluid-filled discs of the spine. The conclusion: Heavy backpacks can alter the fluid content, and that can make the wearer susceptible to such problems as herniated or slipped discs and osteoarthritis later in life.

"Youngsters are lurched forward like peasants," declares Dr. Marvin T. Arnsdorff, a Charleston, S.C., doctor who launched a national educational campaign called Backpack Safety America. "Our goal 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."

Arnsdorff emphasizes that packing a backpack properly, with the heaviest items closest to the back, and learning how to lift it by bending at the knees can help.

But he also says the overall weight in the pack must be reduced and should be less than 15 percent of the child's weight.

Rasmussen is cautionary too, and worries about future problems. She suggests young people with back pain stand up every 20 minutes to take pressure off their spines, and add a regimen of "crunches" every other night to strengthen abdominal muscles to give better support to the spine. (The spine lies just an inch under abdominal muscles.)

The quick stretch also rehydrates discs to get the normal sponginess back and brings a rush of blood to the area.

"Sitting is the most stressful thing for your back, even though everyone thinks standing is," she said. "Sitting compresses the discs so they lose some of their fluid content. It's a couple of times your body weight on your spine. So if a child sits in class for 40 minutes or an hour and then picks up the backpack, it's a double whammy. It puts double stress on the back."

At Likelike Elementary School in Kalihi, new principal Marilyn Okumura winces when she sees little ones loaded down. "I would worry that it's too heavy for them," she said, "and I wonder what distance they have to travel with heavy backpacks."

Obviously, parents are thinking the same thing, because more and more students are coming to school with rolling backpacks, she said.

While Okumura recognizes that older students have to contend with "the dork issue" that generally arises when something so traditional changes, she hopes backpacks on wheels will continue to catch on.

"I think the dork is going to be cool sometime," she said.

The rolling backpacks are becoming especially popular on the hilly Kamehameha Schools campus, where students fight not just the weight of books, but the slopes. One administrative assistant chuckles when she observes that the school almost looks like a training ground for flight attendants because of all the rolling backpacks.

Rasmussen is delighted too.

"After just a week of not lugging around a backpack, they notice a difference," the orthopedic surgeon said of her young patients. "They're just so thrilled to get their back pain under control."

Tips from doctors on backpack safety

• Pack the heaviest items close to your back, packing neatly and trying to keep items from shifting around.
• Lift your backpack as you would any heavy load: by bending at the knees and lifting with both legs. Or have a friend position it on your back.
• A backpack should be positioned with the bottom about two inches above your waist.
• Use both straps. Slinging it over one shoulder may increase the risk of back and shoulder pain.
• Carry the smallest load possible. Try to make frequent trips to your locker rather than carrying heavy books for all your classes all day long.
• Add back exercises to your daily regimen. Abdominal crunches help strengthen stomach muscles that support the spine.
• During long periods of sitting, try to stand once every 20 minutes or so to reduce the stress on spinal discs. This brief stretch helps keep fluid in the discs and increases blood flow.
• Consider using a rolling pack with wheels.
• When you purchase your next backpack, look for wide padded shoulder straps and a waist or hip strap that helps keep it closer to your back.

Reach Beverly Creamer at bcreamer@honoluluadvertiser.com or 525-8013.