Backpacks and spinal disorders in school children.

The interest on backpacks, particularly with regard to their potential unfavourable effect on spinal disorders in school children, has dramatically increased during the last years. The aim of the present study was to look critically at the recent publications and to qualify some ''common sense-based rules''. In recent studies no or weak associations between spinal disorders in children and backpack use could be identified, which is related to the methodology of the studies. From reviewing the biomechanical and physiological effects of backpack use, it was concluded that there is evidence that carrying a heavy backpack results in trunk forward lean and that there are indications that backpack use can increase metabolic cost and alter gait kinetics in youngsters. However there is no evidence that postural, metabolic or kinetic adaptations to backpack use, cause back disorders at young age. Spinal forces based on the above mentioned postural responses can be presumed. However, the amount of work represented by the school backpacks should be compared with the physical activities performed by the same youngsters during their leisure time and is probably not as dangerous as claimed in some media. Therefore the uproar in medical and educational societies and in the media, to sensitize children, parents and educators, with weight cut-off limitations and other backpack use safety guidelines can not be justified and overmedicalizing this issue should be avoided.