Heavy school bags? Is there going to be a hunchback epidemic?

It’s that time of the year, the holidays are winding down and the focus is on Back to School.
Parents have plenty of stress in this period – books, uniforms, first years, exam years and so
forth. The stresses vary from family to family. But the one thing that is always discussed is
the “weight of the school bag”. Surely this will affect their posture and their backs you ask
worriedly? This worry is often compounded on social media or perhaps on mainstream
media where an “expert” discusses how bad this is for children.
The thoughts of seeing the apples of our eyes turn into some sort of Quasimodo type
hunchback over the next few weeks could keep us awake at night! It does beg the question
however, how many Quasimodo’s have you seen in your life?
Thankfully, the evidence suggests that heavy school bags have no bearing on posture or
predispose back problems. In fact, the evidence hints to the opposite, carrying a weight on
your back may be good for you. So why is there such a furore over it? The reason is likely
related to the incorrect beliefs we all have, having heard it from our own parents and
perhaps from healthcare professionals unaware of the evidence.
Hunchback, is a general term describing a flexed upper back, rounded shoulders and the
appearance that a persons head is in front of their body. Kyphosis is the anatomical term
describing the natural spinal curve in the upper back. Hyperkyphosis is the term used to
describe the curve when it is over 45 degrees (under 45 degrees is generally accepted as
being in normal range). It is a relatively common posture in adults and adolescents of the
patients we examine in FCE Scan. It’s cause is unknown, however, there is likely a genetic
link. Furthermore, there are two glaringly obvious reasons why it is not related to heavy
school bags. Firstly, a child only carries a school bag for relatively short periods of time
(estimated at 10 minutes), this is not long enough to elicit a long term postural change. In
fact, here it may be argued that school itself is the problem, as children spend long periods
of time sitting in the same position at a desk. This part is key, posture is only an issue when
you are in the same position for extended periods. Secondly, and this is purely mechanical, if
we carry a heavy bag on our backs we brace our spine and bend forwards from the hips and
pelvis. This doesn’t involve flexing the upper back. If anything the opposite occurs.
Scoliosis is often mentioned as a type of postural issue that can be caused by carrying heavy
school bags over one shoulder. It is a lateral (side-bending) curve of the spine which goes
above 10 degrees, generally it is only necessary to do something about it if it goes over 20
degrees. Scoliosis affects circa 4% of the population, of that 4% only a very unlucky 10% may
require surgery. Therefore, the incidence of it requiring intervention is very low. It is more
prevalent in females and importantly, when associating the weight of school bags as a cause
of it, 80% of scoliosis is idiopathic – which means there is no known cause. The other 20%
can be age related or congenital. Therefore, school bags don’t cause scoliosis.
Some children may experience back pain, they also carry school bags. This may be a
correlation, but not a causation. Think of it like this, over the summer the child of Prague
was put out to bring back the sunshine, the one good day we did get was a correlation to
the statue being out, not as a result of it. Back pain in children can be caused by many

factors including posture or movement but also mood, stress, worry, sleep and activity
levels. The chances of the heavy school bag being an issue is very minimal.
This back to school period you have to enough to be thinking about, the weight of the
school bag doesn’t have to be one of those things.