09/04/2007 11:47 am ET | Updated Nov 17, 2011

Backpacks Can Cause Back Woes For Kids

In the world of our kids, backpacks rule. They're not just carried to school on the street or bus, but they also patrol the hallways, used from class to class within the school building itself. The omnipresent schoolbook backpack is either cause for "functional scoliosis" or a much-maligned assist for the modern student. Increasingly the evidence points to the former, with a rising number of young children experiencing backpack-related problems.

The American Academy of Orthopedic Surgeons reported that 58% of its responding members have noted mounting evidence of how backpacks are hurting the backs and shoulders of American children. Especially noteworthy are muscle fatigue problems not usually seen among students. This is not just noteworthy, say experts, it is truly alarming. Dr. Gregory Lutz, Chief of Physiatry at the Hospital for Special Surgery in Manhattan and an expert on musculoskeletal spine and back problems remarks that "excessive loads can create injury to the lumbar discs even at younger ages."

Also sounding the alarm is the Consumer Product Safety Commission. According to CPSC data 10,062 young children, ages 5 to 14, went to emergency rooms with backpack-related injuries in 1998 alone. Incidence of troubles with backpacks dropped relative to the kids among teens, who suffered just 2,719 incidents. It seems that backpacks might be especially hazardous to younger children.

Problems don't just begin when the tikes haul their gear in the packs. In fact, just putting on the backpack seems to start the injury express on the tracks. There is a youthful tendency to slip one of the two back straps on, and then swing the bag into place to fasten the other. This causes injuries. And very often, kids don't adjust the straps properly, so the weight is distributed unevenly. Dr. Lutz describes a condition known as "backpacker's palsy" characterized by excessive pressure on a back muscle, the trapezius, causing injury to the thoracic nerve. "Patients will present with deep aching neck pain and shoulder weakness" adds Dr. Lutz.

And there is the screeching abuse that's received a fair amount of attention recently, children carrying too much weight in their backpacks. It's not uncommon to see 90-pound girls or boys carrying 30-pound bags, a three-to-one weight ratio which is not allowable except in boot camp in the United States Marine Corps. Dr. Lutz maintains that "prevention strategies are to keep the weight of the backpack to less than 15% of total body weight". Shifting back weights in the packs are also a culprit. The dynamics of gravity are bad enough, but when students run, leap, bend over and backwards, or remove the backpacks during the day, you have a recipe for trouble.

Most students take off their backpacks to deposit or remove books, usually in between classes and before the bell. This complicated and risky maneuver takes place in a beehive bustle of changing classes, usually in a crowded space with many distractions. Even mere transit has its problems, with backpacks strung hazardously across the shoulders, and balanced with a minimum of care at the very best.

Some medical and backpack experts are cynical, noting that when properly used, strapped and balanced, backpacks should cause little concern and fewer injuries.

But there are good rules to follow to keep your student injury free:

* Kids should make use of a hip strap. This bears more weight.
* Straps should be ergonomically designed and wide.
*Place the heaviest loads closer to the back.
*Use both straps.

Dr. Lutz recommends wearing the straps on both shoulders to distribute the weight evenly as well as having straps that are well padded.

Other remedies include an alternate set of books kept at home so less is carried on the bus, and exercising the back muscles more often. It might also be helpful to pack books tightly and neatly, thus avoiding awkward and hazardous shifts of materials within the backpack itself.

So while America gears up for better schools and smarter students, it would also be advisable to pay more attention to the logistics of learning...backpacks and the like.

Dr. Rock Positano is the Director of the Non-Surgical Foot and Ankle Service at the Hospital for Special Surgery in New York City and a health columnist for the New York Post.