Confirming these facts, and starting a few years ago, Portuguese medicine has been all too often diagnosing pathologies of this type among schoolchildren between the age of 11 and 18, who are without any doubt the ones who suffer most from the demands of the current pedagogical system, which is supposedly intelligent and at the vanguard, and is also governed by health rules that in principle should contribute towards preventing and correcting problems and disturbances of an infectious, hygienic, dietary and biomechanical nature among the student population, as is the case of this issue. Health studies carried out among the Portuguese school population have shown that “25% to 40% of school-age children” (Matos, Simões, Carvalhosa, Reis & Canha, 2000) have back pains provoked by carrying rucksacks that are too heavy, too big in relation to their body height, badly adjusted to their backs or simply hanging off one of their shoulders.(1)

Let us meditate carefully on the issue and not undervalue the disease or “back pain” we hear about from our children. These complaints may be the first signs of that myo-skeletal overload.

The weight of the rucksack does not kill, but it wears down. It literally wears down the joints, and the spinal column is often what is most affected and damaged in this process.

Perhaps the time has come for the several official authorities responsible for teaching in Portugal to stop only worrying about assessment methods and results and to start reflecting also on this national school public health problem. We are aware that party-political pragmatism strongly dominates and determines the decisions made by those who govern us at every turn. In that sense, although the radical solution for the problem in question (myo-skeletal pathology due to excess of weight of the bag or rucksack) may imply considerable extra financial effort, it is worthwhile taking into account that, in politics also, the “nothing is lost, everything is transformed” sometimes happens for the better and the worse.

I appeal to our leaders: today’s young people are the adults of tomorrow, and everything you do not do for them today will be inexorably charged from you in the future.

“People’s memory is short”, it is said, but when one deals with the “wallet” or with health the memories linger on. And disappointment and discontent are the worst fertilizer for any electoral seed bed.

Just like what has been done in other countries facing the same problem, the Portuguese government could create and apply strategies in order to prevent and minimise these problems, which could simply involve measures like these:

- Granting schools with lockers in sufficient numbers, in order to keep their objects, books and school material.
- Providing work tables, desks and chairs that can be adjusted to all body sizes and are more anatomically adequate, so that young people do not have to bend excessively when they are drawing, handling objects, writing or reading.
- Organizing and implementing compulsory physical activities that are always rationally guided by the respective physical education teachers, always supported by health professionals who, together, should carry out a diagnostic assessment of all pupils in terms of general health, but particularly of skeletal and muscular bio-typology. This assessment will not only allow a judgement of the profile of each student in relation to their possible limitations in relation to effort (cardiac, respiratory, renal etc.), but will also make it easy to identify those who, due to the fact that they have posture and vicious skeletal deviations, with or without associated complaints, will have to be immediately guided towards adequate medical consultation (physiatry and/or orthopaedics). Through this selection process the pupils should be made aware of their physical condition and located with restrictions or without restrictions in rational physical education programmes that are sufficiently corrective and strengthening of their joints and thoracic musculature. The success of this school measure, based on the practicing of regular physical activity, which we consider to be absolutely fundamental for the correction and prevention of these posture vices, results in a gain of (greater) muscular resistance and balance, and in immediate reduction in the stress and tension exercised on the muscles and joints of the trunk, promoted by the elongation and relaxation generated by the practicing of gymnastics.

- Rucksacks, waterproof and sufficiently hermetic to rainwater, should adjust perfectly to the child’s or young person’s back, never being too big for their trunk height, and must be rigid and possess a cushioned contact surface. The straps should also be cushioned and be sufficiently wide and adaptable to the shoulders so that there is a balanced distribution of the rucksack weight on the back, and should possess an adjustable belt to fit around the waste in order to fit as snugly as possible to the back, thus avoiding movements and swinging motion with negative repercussions on the spine. The rucksack should never be carried on the hip or be slung over only one shoulder.
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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Bibliography:
(1) NORONHA, T. and VITAL, E., Fisioterapia na Saúde Escolar – dos modelos às práticas

(http://www.afisioterapia.com/artigos/down.asp?t=pdf&id=51 )