The subject has been discussed, albeit without great conviction, by school and health authorities. Even so, the recognition that the problem exists, now, through media-highlighted and worrying phenomena like bullying at school, has certainly become a question with minor priority. But the situation to which thousands of young Portuguese schoolchildren are exposed, with our assent (that of all of us, obviously, including families, society and our rulers, particularly health authorities) unfortunately granted more through indifference than ignorance, justifies this new call for attention and reflection due to its unquestionable seriousness.

From Monday to Friday, and quite often on Saturday as well, there they go, in all sizes and ages, down the street on the way to school, bending over under heavy bags, hold-alls and rucksacks, full to bursting, and completely indifferent to and unaware of the dangers that this “haulage work” might bring them.

As they often spend hours on end dragging brutal loads of books, notebooks, dictionaries and other school material (nowadays including the obligatory Magalhães computer), gym shoes and kit, coat and umbrella, lunch and/or afternoon snack, the effort expended over years in this compulsory ritual will definitely bring these developing organisms, particularly those between the ages of 6 and 15, structural damage to their skeletons that will sometimes be dramatic and irreversible.

According to the opinion of some specialists in ergonomics, physiatry and work medicine, if the load carried on the back does not exceed 10% of the body weight and the distances travelled by these young ‘Sherpas’ are not too long, the harm will never be very grave. Well, what if the weights go beyond this percentage level, which almost always happens? And what if the distances are really considerable? Because not everyone has their own means of transportation. On the other hand it is also not rare to see young people who have this to prefer walking, chatting with their colleagues during the lunch break or after classes, to the poles of attraction in the neighbourhood or the city … with their bag, hold-all or rucksack on their backs, hanging in their hands or over their shoulders for the whole time. The option to pull a rucksack or school case on wheels, which is less traumatic for the skeleton and the muscular structure, and therefore more advisable, is still not a widely accepted reality among Portuguese students. And it probably never will be, as young people seem to think that their belongings, when solidly fitted to their bodies (to their backs or to one of their shoulders), in the duffle-bag or rucksack, will be more protected, available and less likely to be stolen during their wanderings, and are also more practical and fashionable.

Each body’s resistance obviously depends on several different factors, all of which vary according to the person, which are characterised and related simply, by two different aspects:

– the general state of health
– the degree of development and solidity of the ligament, tendon-muscular and osteo-articular structures.

So assessing the degree of risk that each young person is exposed to when in these circumstances of almost daily effort and traction is not an easy task. Yet in the face of the habitual exceeding of the load carried above 10% of body weight recommended as a maximum limit, even a layman would know that this constant ergonomic aggression will definitely be harmful to one’s health.

In order to comply with the new pedagogical requirements, methods and systems, the student population has to mobilise extremely heavy “burdens”, deeply harming the spinal articulations and the lower and upper limbs, as might be expected.

Let all of us try to weigh up the saddlebags that our children have to drag off to school every day for a week and, as is obvious, bring back home … Not to mention the intervals, a little walk around the shopping mall or somewhere else of interest and we will find that they often carry a third of their body weight on their backs.

If we all become aware of the great importance of the problem, parents, doctors and teachers, we will be able to alert young people to the importance of correcting and preventing it, helping them to choose, as far as possible, the load in these bags or rucksacks, thus minimizing the risks arising.

Muscle and skeleton deformations and in particular anomalous or vicious deviations of the spine, kyphoses (hunchback), lordoses (very accentuated lumbar curving) and scolioses (“S” shaped side curvature of the spine), accompanied by pain (in the back), may be some of the problems resulting from that effort of carrying too much weight. But if the myalgia (muscular pains) and rachialgia (spine pains) are a part of these dangers, when the tension on articulations is prolonged (over years) and much higher than that which is foreseen (in terms of weight carrying), with time the risk of arthrosis also exists. Any constant, prolonged or repeated aggression on a joint, even in children and adolescents, depending, as is natural, on their genetic, biomechanical, cultural, economic and psycho-social profile may set off episodes of articular synovitis, and this often opens the door to osteoarthrothis in future life. Arthrosis, in this case determined by an overload in the articular function, is irreversibly accompanied by pain and rigidity. These serious risks, to which a large percentage of young Portuguese people are exposed in the daily, or almost daily, carrying out of their heavy school-logistic requirements, must not and cannot be undervalued anymore.

Prof. Doutor João Frada
Doctor and Retired University Professor from the Faculty of Medicine of the University of Lisbon
joaojcfrada@gmail.com

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Article published by FRADA, João. Os Aleijados de amanhã [Tomorrow’s Cripples], Revista de Medicina. 1994,2, V série, Vol.1, Nº2, 43-44. [truncated text, now updated, with a new title and some additional data and information].