Physical Therapists Study and Treat the Effects of Backpacks on Teens on Nashville Medical News

Physical Therapists Study and Treat the Effects of Backpacks on Teens

By: SHARON H. FITZGERALD

In the first picture, the load in the backpack is too heavy.

If your teenager has jumped out of the car, slung an overloaded backpack over one shoulder, leaned forward to balance the load and loped through the schoolhouse door, listen up: neck and back pain may very well be the result. What’s more, physical therapists who many times treat that result believe the problem is growing and are urging pediatricians and general practitioners to be aware of the unique maladies associated with today’s backpack trend.

“Mostly what’s going on is muscle and ligament problems when children are carrying too much weight,” said John Holden, a physical therapist with the Baptist Sports Medicine Clinic in Murfreesboro. “They typically carry the backpack too low and wear the straps too long, so it’s bouncing off their buttock area when they walk. If it’s too heavy, they’re leaned forward. If the weight’s down low and they’re bouncing it off their body, then they’re getting extra stress and strain on their muscle, ligaments and even in the discs in the lower back.”

Holden said he’s treated patients as young as 12 with pain caused by improperly carried and heavy backpacks. Mercifully, he said he hasn’t treated a case where permanent damage has occurred — not yet, anyway. “The more permanent problem is that they’ve already developed bad habits, and that’s the hardest thing to break,” he said. “If they’re a slump sitter and they spend too much time front of the TV or computer and they carry a backpack too much, they’ve already developed bad habits that can lead to more problems in the lower back and lower neck area.”

Nancy Darr, an associate professor with Belmont University’s School of Physical Therapy, has conducted with colleague Gail Bursch three studies on backpack use among teenagers. The first study expanded on earlier research already published in the Journal of Pediatric Physical Therapy, which questioned students about safe practices when carrying a backpack, ideal pack weight and similar concerns. Darr’s study asked teachers similar questions. “We wanted to capture the teachers’ knowledge base,” she said.

In the second study, middle schoolers naturally walked across a GAITRite™ portable walkway system without a backpack to get a baseline measurement. The GAITRite measured speed, step length, how far apart the feet were and the cadence (number of steps per minute). Then the students walked the GAITRite again carrying a pack appropriately and at an acceptable weight. Finally, they walked with the backpack “slung down low on the behind like kids like to do and then slung over one shoulder,” Darr explained. In general, the study revealed that gait is indeed adversely affected if the backpack isn’t carried properly.

In the third study, the basic protocol of the second study was followed, but with three types of backpacks — a standard pack, a “sling” pack designed to throw over one shoulder and a messenger bag, which straps across the opposite shoulder and hangs by the hip. “We found that the standard backpack had the least effect on walking, and the messenger backpack really did all kinds of things to their walking. It made them cross their feet, and some of them even stumbled,” Darr said. “Bottom line, we found that how you carry the backpack makes a difference and the type of backpack does seem to make a difference, too.”

Darr’s first two studies have been presented at professional meetings and the third will be presented in February. She and Bursch are preparing study results for publication.

Darr said she understands that, for teenagers, it’s “totally uncool” to properly carry a backpack, yet she bemoaned the consequences. “It certainly alters their posture. They lean forward at the hips and then they hyper-extend their neck. It throws them off-balance,” she said.

Holden concurred that part of the problem is teenage perception. “I have two sons who carry backpacks that are way overweight,” he said. “The main thing that we can do is try to help them learn how to pack it correctly and make sure it fits them correctly. I know it doesn’t look cool. Every week, I’m having to tighten the straps up, but the straps should be snug so that the backpack fits between the base of the neck and a couple of inches above the waistline. That way, you’re carrying the weight where it can be distributed over the curves of your spine.”

When it comes to weight, Holden suggested loading the heaviest items first into the backpack so they are closer to the body. As far as treatment goes, he said physical therapists work on strengthening the “postural muscles” of the lower and mid back. “If a child has some real stress and strain and has problems with muscle spasms, we can massage those or use heat, and then instruct them in strengthening exercises to help them move that muscle normally and build it back to normal strength so it’s not in a spasm state all the time,” he added.

Then Holden stressed again: “It’s not just the backpacks that cause the problem. They’re also spending too much time in front of TVs and video games and computers, in chairs that are designed for adults. Those chairs aren’t supporting their lower backs, so they tend to slump forward and lean forward, which causes stress on those same structures that are stressed by carrying too much weight with the backpack.”

Tips for Proper
Backpack Use

Wear both straps. Using only one strap causes one side of the body to bear the majority of the weight of the backpack. By wearing two shoulder straps, the weight of the backpack is better distributed, and a well-aligned symmetrical posture is promoted.

Put on and remove backpacks carefully. Keep the trunk of your body stable and avoid excessive twisting.

Wear the backpack over the strongest mid-back muscles. Pay close attention to the way the backpack is positioned on the back. It should rest evenly in the middle of the back near the child’s center of gravity. Shoulder straps should be adjusted to allow the child to put on and take off the backpack without difficulty and permit free movement of the arms. Straps should not be too loose, and the backpack should not extend below the lower back.

Lighten the load. Keep the load at 10 to 15 percent or less of the child’s bodyweight. Carry only those items that are required for the day. Organize the contents of the backpack by placing the heaviest items closest to the back.