It’s back to school time again, and each year many children get a new backpack to carry supplies, books, and homework. These carry-all backpacks often reflect the personality of the child, with many adorned with super heroes, princesses and more than a few Angry Birds.

back-to-school2While this efficient carrying case has been around for many years and has been used by millions of students both old and young, back experts such as Texas Back Institute physician Dr. Rey Bosita have noticed a problem with backpacks. They’re too heavy for some kids, and can cause long-term serious back problems.

We spent a few minutes with Dr. Bosita to get some guidelines on the proper size and use of backpacks. More on this later.

Backpacks Have a Colorful History

Backpacks, in one form or another, have been around since early humans used animal skins to carry meat from hunting trips. Just as with the school kids of today, these packs allowed prehistoric hunters to use the strong muscles in their backs to carry much more game for longer distances than if they were carrying it in their arms alone.

Historians note that the term “backpack” was coined by Americans around 1910; however, before it was known as a backpack, Europeans (specifically the Germans) called this carry-all a “rucksack,” which is a shortened version of the phrase “der Rucken” – German for “the human back.”

Up until the 1950’s, the backpack was primarily used for hunting and military purposes. These early versions were made of rugged materials and very heavy to carry. All of this changed when hiker Dick Kelty realized backpacks could serve a valuable function to the participants of his sport. He began experimenting with creating packs made of lighter materials and more compact designs. He also changed the weight distribution of the backpacks – by putting the skids of the pack in the back pockets of his hiking pants – allowing the hips to carry more of the load.

With this change, anyone who needed to carry several items while they were walking could pack these in a backpack and be on their way. It didn’t take long for parents and students to discover  these same, light-weight backpacks were ideal carrying cases for schoolbooks and homework papers.

The Problem with Backpacks

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For all of its efficiency, the modern backpack has its detractors, some of whom are backspecialists. In an article published in 2012 in the New York Times, it was noted that “heavy backpacks don’t just zap children of energy that might be better used doing schoolwork or playing sports. Lugging them can also lead to chronic back pain, accidents and possibly lifelong orthopedic damage.”

In this article on the dangers of backpacks for kids, the federal Consumer Product Safety Commission calculated that “carrying a 12-pound backpack to and from school and lifting it 10 times a day for an entire school year puts a cumulative load on youngsters’ bodies of 21,600 pounds – the equivalent of six mid-sized cars.”

In a 2012 report in the “Archives of Disease in Childhood,” researchers in Spain assessed the backpacks and back health of 1,403 pupils, ages 12 to 17. More than 60 percent were carrying packs weighing more than 10 percent of their body weight, and nearly one in five had schoolbags that weighed more than 15 percent of their own weight.

This study found that “1 in 4 students said they had suffered back pain for more than 15 days during the previous year; scoliosis – curvature of the spine – accounted for 70 percent of those with pain. The remaining 30 percent had either low back pain or contractures – continuous, involuntary muscle contractions.” Girls faced a greater risk of back pain than boys, and their risk increased with age.

Clearly, there is a potential problem with backpacks and kids. In many cases, they are either too heavy for the size of the child or they are being worn by the child incorrectly. We spoke with Dr. Rey Bosita, a spine specialist with Texas Back Institute, to get an idea on the “dos and don’ts” for backpacks with kids.

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Dr. Bosita noted pain often results when the weight of the pack pulls children backward, prompting them to bend forward or to arch their backs to keep the pack centered. These positions make the back muscles work harder and increase pressure on vertebrae on the discs between them.

If the child has to lean forward or seems unsteady when walking with a loaded pack, it’s too heavy.  This can lead to poor posture and shoulder pain.  Neck pain can also occur when the child is forced to look up from this position.

No parent or teacher wants a child to be injured by a backpack which is too heavy. So, what should be done to correct this situation? Dr. Bosita has some ideas.

Tips You Can Use for Back Safety and Backpacks

“The first thing we should look at is how the backpack fits the child and how he/she is standing while wearing it fully-loaded. The child should be standing straight up – with shoulders back. The backpack should be positioned in a manner that allows it to rest against the child’s back, straps a little tighter, so that the pack doesn’t sag too low,” Dr. Bosita notes.

Another important consideration for back safety is the weight of the backpack. What is the correct weight for a child’s backpack and how does a parent determine the weight of the pack? Dr. Bosita says, “The easiest way to determine the acceptable weight of the pack is to get the family scales out and weigh the child without his/her backpack. The weight of the backpack should be no more than 10 to 15 percent of the child’s weight. Therefore, if the child weighs 50 pounds, the backpack should not weigh more than 5 to 7 pounds.”

“Remember, everything adds weight to the backpack, including the pack itself, Dr. Bosita notes. “It’s a good idea to check the backpack weight with all of the materials connected to the pack (water bottles, knick knacks) and the books and school supplies being carried in the backpack (library books, binders).”

For the complete video of Dr. Bosita’s tips on backpacks, just click here 

Pack Only What’s Needed

When given the chance, younger children will stuff as many things as possible in their backpacks, much of which is not related to school work. Parents should take a minute each morning and afternoon to inventory the items being transported to and from school. If there are toys, games, handheld computer games, pet rocks, frogs and other non-academic items being packed in the bag, remind the child that these things should be left at home.

If he or she disagrees about the contents of the backpack, have a Plan B. Just tell them that you want them to grow up straight and tall and a heavy backpack might keep this from happening. This has the advantage of being the truth.

And if this fails, reward them with a treat  if they keep the back pack light.

Graduation

With the sound of “Pomp and Circumstance” ringing in their ears, the graduates of 2013 will be marching up to the stage and on to their future. There is a sense of accomplishment, pride and even relief at graduations because the participants feel they have completed something important. Texas Back Institute congratulates every graduate!

With graduations, it seems as if something has concluded, when in fact the term “commencement” suggests a beginning. This idea of “conclusion vs. commencement” has of course been employed by more than one valedictorian in their one, final address to their esteemed classmates.

Traditions of Graduation

This is the time of year when seniors in high school and college who have completed their courses successfully are awarded diplomas. This tradition goes back to the 11th Century when medieval colleges in Paris and Bologna reportedly began this practice.

Over the centuries, the traditions have evolved and changed, but many have remained remarkably similar to the original ceremonies. The students, who were known as apprentices in these early graduations, learned skills from the masters of the crafts and to note this accomplishment, they were give a “testimonial of skill,” now known as a degree.

The song that most of us associate with graduation ceremonies – “Pomp and Circumstance” – is a relatively new wrinkle on this ancient celebration. It was written by Sir Edward Elgar and first performed in Liverpool, England in 1901. Its melody, a combination of solemnity and dogged determination, is the perfect accompaniment to purposeful marching of the soon-to-be graduates.

Another interesting graduation ceremony tradition involves the attire of the honored matriculates. The cap and gown, which is worn by students and (in some cases) faculty, was once called a “hood” and this is believed to be dated back to ancient Celtic Groups. Capes and hoods were worn by the Druid priests to symbolize their higher intelligence.

What’s Next?   

After the music finally stops, the mortar boards are tossed and the diplomas are filed away, what happens then? The graduate – of high school or college – must commence the next stage of his or her life. For many, this means getting more education and beginning the process of deciphering how to spend the rest of one’s life.

Texas Back Institute is internationally known for its state of the art treatment of neck and back injuries, back pain, scoliosis, artificial disc replacement, occupational and sports medicine and its exemplary physical therapy practice. However, for the past 27 years, Texas Back Institute, led by one of the organization’s founding partners, Dr. Richard Guyer, has offered a select group of medical school residents a remarkable opportunity – a one-year fellowship to focus on spine surgery.

To anyone talking with Dr. Guyer about the Texas Back Institute fellowship program, it is immediately obvious that he is just as enthusiastic as the young doctors who are chosen for the program. Much like the master craftsmen who trained the apprentices in earliest institutions of learning, there is a commitment to teaching these future surgeons that goes beyond cursory. The doctors who emerge from this program are changed forever.

With his interest in teaching, we thought Dr. Guyer might be a good source of advice for graduates of any level – high school, college or graduate school. Here is that conversation.

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What areas of medicine will be in high-demand in the coming years?

There are so many opportunities in medicine, especially if a young man or woman is interested in computers, science or engineering. We’ve all read that more and more kids are interested in business, finance or high technology, but the opportunities in medicine are exploding. For example, the latest high tech robotic surgery equipment is still directed by a human who is a trained physician and many of the best practitioners of this specialty were video gamers when they were kids. Genetic engineering is going to be a very hot area of medicine in the coming years and this specialty requires a very analytical mind which many youngsters who are good at math and science possess.

If someone is graduating from college and accepted to medical school, what types of specialization might they consider for spine surgery or other specialties offered by Texas Back Institute?

When I first started in medicine, young physicians would spend a couple of years in medical school before they decided which specialty interested them. Things have changed a lot since then and now that decision is often made when they are in college. The types of procedures we do at Texas Back Institute involve a wide range of medicine. We handle spine surgery for both children and adults. Our doctors deal with trauma surgery which would be required for automobile accidents and other accidents. We treat injuries that are the result of aging – wear and tear damage. We also have quite a few sports injuries that our physicians treat. So you can see there is a wide range of opportunities just in the spine area.

How did the Texas Back Institute Fellowship program come about?

I’ve found that when you teach students, you learn as much as they do and I loved teaching. In the mid 80s, I approached my colleagues here and shared my passion about teaching. I mentioned that I’d really like to build a fellowship program here for residents who wanted to specialize in spine surgery. Since our beginning in 1986, we have trained more than 100 fellows and I have been the chairman of this program for 27 years. This keeps me young and sharp! We work hard at sharing the latest research and techniques about spine surgery for these young doctors and for everyone on the Texas Back Institute staff it is very gratifying when that light bulb comes on over the head of these talented young people.

How does the TBI fellowship program work?

These doctors have been through medical school and have completed their residency program. They find us through the network of former TBI fellows and through the American Academy of Orthopedic Medicine. Once they are accepted to the fellowship program, they work with all of the surgeons on our staff. They get hands-on training in deformative and degenerative medical issues, trauma, tumors and disc replacement surgery.

What are the criteria that Texas Back Institute uses to recruit new physicians to the practice? Does completing your fellowship help in gaining a position?

The last 4 or 5 physicians that we have hired have gone through the Texas Back Institute Fellowship program, so that suggests that there is an advantage of going through this training. When we recruit new doctors for our team, we look for a young woman or man with a high degree of intelligence, an excellent bedside manner, his or her ability to synthesize a large amount of information and apply it to treatment and most importantly we look for integrity.

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From Left to Right: Dr. Rey Bosita, Dr. Rajesh Arakal, Dr. Jack Zigler, Dr. Jason Sparks (Fellow), Dr. Richard Guyer, Dr. Ralph Rashbaum, Dr. Troy Morrison (Fellow), Dr. Kirill Ilalov (Fellow), Dr. Michael Duffy, Dr. Kenny Edwards (Fellow), Dr. Andrew Block, and Dr. Dan Bradley.

Successfully completing a course of study and celebrating this accomplishment with friends and family is one of life’s great pleasures. As speakers who are chosen to impart wisdom to a group of graduates are fond of noting, this ceremony is not the conclusion, it is the beginning. Congratulations to every graduate and their families. Now, let’s get busy!

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Gracie Rasmussen is a 13-year-old athlete who loves the sport of cheerleading. Her dream had always been to compete for Cheer Athletics, a nationally renowned cheerleading powerhouse.  She worked hard to make the team, spending hours in the gym each day perfecting every tumble, dance move and stunt.  Like most of the girls, she had to ice down parts of her body that would ache after practice.  For Gracie, it was her back that hurt the most, a pain easy to dismiss after watching the cheerleaders tumble, jump, stretch and flip over and over again.

It was actually a weekend off from cheerleading, spent on the lake with her family that brought her a diagnosis of scoliosis.  Gracie and her sister, Sawyer, were riding an inner-tube being pulled by a boat on the lake, when they both fell off and jarred their backs. An X-ray on Gracie’s back confirmed much more than bruising: it illuminated a severe case of scoliosis that was bending Gracie’s spine at a 65-degree angle.

“I was just so impressed with Dr. Lieberman,” said Lynn Rasmussen, Gracie’s mom. “He spoke directly to her.  He looked her in the eye and told her exactly what was going on. He worked her in and within two weeks, she was having surgery.”

“Gracie’s eight-hour surgery was an instrumentation correction fusion for idiopathic scoliosis – essentially, we realigned her spine and locked everything where it needed to be by using computer-navigated robotic assistance for the placement of the hardware,” noted Dr. Lieberman. “We use tools like this to achieve the best accuracy, effectiveness and efficiency we can for patients who need a procedure like this.”

Cheerleaders are known for their positive attitudes and strong spirits.  But it was faith, Gracie says, that pulled her through: “I was really nervous about the surgery, but I knew that I needed it. I had just made Cheer Athletics team – it was my dream to go there.  I just prayed about it.” A strong Christian faith and friends at her church, Prestonwood North Baptist Church, Gracie said, helped her through surgery and recovery. She spent eight days in the hospital at Texas Health Presbyterian Hospital Plano and continues physical therapy at home.

Almost a year post-surgery, it was mom Lynn who was the most nervous as her daughter prepared to do her first back flip on the mat at the gym where Gracie practices.

“I couldn’t believe it when she did it,” she recalled. “I was jumping up and down and saying, ‘Gracie, you did it! You did it! And she looked at me and rolled her eyes and said, ‘Mom, I’ve done this, like, a thousand times before.’ But I was thinking, ‘Yes, but you got it back!’ Nothing prepares you for watching your child relearn everything they knew, from lifting their head to walking to tumbling.”

Gracie’s passion for cheering pushed her to work hard through her recovery to continue the sport she loves so much.  Her coaches credit her strong work ethic and muscle memory for allowing her to get back onto the mat so quickly post-surgery.

“Tumbling is a lot easier now,” notes Gracie, when talking about her recovery and her return to her sport. “It’s straighter and it’s easier.” Gracie never knew that it was a curve in her spine that was causing her to veer off to the side during tumbling passes, something she had struggled to control. Even just months after her surgery, she felt that her back was stronger and that things were coming easier than they did before.

“Gracie is an athlete,” said Dr. Lieberman. “While we want the best outcome we can for all patients, we know that flexibility is particularly important for these young men and women.”

Gracie, who loves English and writing, is looking forward to writing the ending to this chapter in her life, which she hopes includes a spot on her high school cheerleading squad. One day, she wants to help others by going into the field of physical therapy or sports medicine, and she is excited to share her story with other patients who may be going through a similar experience with a diagnosis of scoliosis.

Her advice for them?

“Just trust the doctors and know that you will be stronger than you ever were.”

Spoken like a true cheerleader.

Day 6: March 23rd, 2013

Here is a 13 year old cutie that will be having surgery this week.  She has a 60 degree thoracic scoliosis. For anyone not familiar, that means she is at very high risk for progression and will likely develop an 80, 90 or 100 degree curve over the next 2 to 3 years if left untreated.  Her surgery will be relatively straight forward now, and much more difficult (with possibly the need for more levels of fusion) and higher risk if done in the future.

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Her name is Mareg, which is a common name here.  Wish her (and me) luck.

Ted Belanger

Uganda Mission 2012

July 24, 2012

Uganda Day 2

Contributed by Rachelle Lieberman

Today is our second day in Uganda and we are hitting the ground running.  The words “jammed packed” have several meanings for us today.  Our schedule is packed with appointments.  We were at Mulago hospital by 8 am this morning. Immediately we began to examine all the prospective patients for this year.  We also followed up with patients who had surgeries in previous years.

Below is a picture of some of the patients in the spine ward.

    

Izzy with Stella a patient he operated on in 2010 who is doing great!!!

 Izzy examines one of the kids from the orphanage.

 We ended up examining over 40 people in a matter of five hours. Today was undoubtedly another emotional day for all, but the look on the kid’s and parent’s faces when they find out they are going to get the surgery they need makes it all worthwhile!

Doctors examine a patient in the Mulago Spine Ward.

After all the patients were seen we then planned out the entire first week of surgeries as well as some of the second week. It is truly amazing to think about how many lives we are going to touch in just two weeks.

Izzy giving Dr. Nyatti a book Dr. Jack Zigler authored about spine trauma.

When I said earlier our day was jammed, I didn’t just mean at the hospital, I also meant the traffic! We were stuck in multiple traffic jams while traveling back and forth between the hospital, apartment, and dinner. To paint you a picture, imagine a small town with only a stoplight or two.  Sometimes they work, sometimes they don’t.  Now imagine no driving lanes and no rules of the road – other than honking your horn gives you the right of way. This was slightly stressful for those of us on our first trip to Uganda, but it didn’t seem to faze the mission veterans.

We have another full day tomorrow starting at 7:15 am. Two surgeries scheduled on the books so far, as well as lots of other meetings and organizing to do. More to come soon…

Uganda Spine Mission 2012

It is that time of year again when Dr. Lieberman and his team travel to provide spine care for the citizens of Uganda.  This year Dr. Lieberman’s team consists of the following members:

1) Izzy Lieberman (spine surgeon) Dallas

2) Brian Failla (equipment manager) Ft lauderdale

3) Paul Holman (spine surgeon) Houston

4) Krzysztof Kusza (anaesthesia) Poland

5) Zbigniew Szkulmowski (anaesthesia) Poland

6) Ejovi Ughwanogho (spine fellow) Dallas

7) Sherri LaCivita (scrub technician) Dallas

8) Elizabeth Wolhfarth (scrub technician) Ft lauderdale

9) Negozi Akotaobi (physical therapist) Dallas

10) Jason Ehrhardt (monitoring tech) Dallas

11) Rob Davis (equipment manager) Dallas

12) Rachelle Lieberman (teacher) Boulder, CO

13) Erin Sadler (medical student) Toronto

Today’s post was contributed by Erin Sadler.  Enjoy!

Day 1 – Arrival to Entebbe, Kampala

 The team all congregated at Heathrow Terminal 5 for a 9:15 pm departure to Entebbe International Airport.  After some brief introductions the team seemed to quickly mesh well together and a warm dynamic was almost instantly evident. The team this year is quite large with thirteen members with various backgrounds, from the United States, Canada, and Poland. After boarding the plane many of us were exhausted from our travels that brought us to Heathrow, and thus tried our best to take advantage of the 8 hour overnight flight to Entebbe and get some sleep!

We landed in Entebbe at 745 hrs after a few hiccups from the flight deck in their attempt to land with heavy tail winds. We were all pleasantly surprised by the beautiful weather with temperatures in the mid 20s (68 degrees fahrenheit). We all gathered our gear, minus a lost bag from Poland, and made our way to meet our buses that would be responsible for our transportation for the next 2 weeks. We loaded up the buses quickly and began our journey to Kampala. Along the route there was much to be seen and taken in. The first glimpse of the fertile Ugandan landscape, the vibrant Ugandan people everywhere you look, the pop-up stalls along the road, and the many handmade bed frames for sale along the roadside, without any mattress stores in sight kept us all entertained throughout the journey.

 We arrived at the Golf Course Apartments in Kampala where we will be staying for the next 2 weeks. These accommodations are very comfortable and well outfitted to suit our needs. Between the thirteen members of the team there are two apartments.  Once we had moved our luggage in and had a chance to refresh ourselves and brush our teeth for the first time in too long, we were once again off into Kampala to do some shopping to buy food items for breakfasts and other necessities like water, hand sanitizer, and the odd bottle of wine!  One hefty shopping bill later, and buses packed to the brim we headed back to the apartments to unload and organize ourselves before taking off again to go visit the two hospitals we will be working at.

The first hospital we visited was Case Hospital, which is a private hospital, relatively affluent with decent equipment, services and patient care; quite similar to a standard hospital in North America.

Izzy unpacking more surgical equipment.

Conversely, we then went to Mulago Hospital, which is the national public hospital; located on a sprawling campus of single story bunker-like buildings that serve as different wards. We specifically visited the Spine Ward, where we will be performing operations in the theatre, and the Orthopedic Ward.

Some surgical equipment at Case.

The spinal ward at Melago.

 

Supplies at the spinal ward in Melago.

Both were equally eye-opening: wide open rooms with several beds lined up side by side, filled with patients, and more surprising, the patient beds were surrounded by families. It was very interesting to see the dynamic of patient care in the Mulago setting, where the families seem to be the primary care givers despite the inpatient nature of the hospital accommodations. The families were huddled around the patients, sometimes having created a small area near the patient`s bed where they have essentially set up a temporary squatting home, feeding them self-prepared food, bathing them, and really the only people in the hospital providing vigilant care to these patients. Futhermore, the familial presence extends beyond the hospital walls, where as you walk outside you notice families have found a space to call their own on the hospital property and are essentially squatting there as their loved one remains in hospital. As I toured these poorly faciliated wards, I couldn`t help but question how these native Ugandans view us: as foreigners who are coming to try and help, or perhaps do they question our role in their medical care? To continue this enlightening cultural experience, we then went to walk through a nearby slum in Kampala. As a group we walked through narrow dirt alleyways for streets, which were covered in garbarge and had waste water running down the middle, as beautiful friendly people waved and smiled at us through the hanging laundry, and curtained doorways fondly yelling “Muzungu” as we passed them by. This was unlike anything I have ever experienced before in my life, and not because I haven’t seen images like this on television or in other popular media outlets, but I think I was most taken by the joy and sense of community that I felt in this incredibly extreme and impoverished environment. I guess I expected to feel sadder and helplessness, which I definitely did feel, but these negative feelings were overwhelmed by my feeling that although these people live in the most horrific conditions, their sense of community is really quite powerful and uplifting. Moreover, the throngs of beautiful children with toothy grinned smiles from ear to ear was also quite a powerful sight, for there seemed to be such a sense of responsibility of the older children to look after the young, and the spirit of the child was so clearly evident, it outshone any despair that they, or more likely I, was feeling.

Boy from the slums.

Ejovi playing soccer with some of the kids.

Picture of the slums.

As we got into our buses and drove 5 minutes down the road into our plush apartments it became very apparent how contrastingly different Ugandan life can be, just simply a few blocks apart. We couldn’t help but feel incredibly spoiled as we spent the rest of the afternoon cooling off by the pool, and then heading to an amazing Indian restaurant for a lively dinner and some delicious curries. Before everyone fell asleep at the table, we headed home to spend our first night in Kampala, and have sweet dreams of the upcoming days of hard, yet extremely meaningful work to come!

Our group at dinner.

Stay tuned for more updates!

June is Scoliosis Awareness Month

In honor of this special month we want to share more about our scoliosis and spine tumor center and some facts about scoliosis with you.

 

Dr. Isador Lieberman is our scoliosis and spine tumor specialists and on a daily basis he treats patients who are affected by scoliosis. Below are 5 things Dr. Lieberman wants you to know about scoliosis.

  • In 85% of cases the cause of scoliosis is not known,  although we know there is a familial predisposition.
  • The mother to daughter inheritance rate for scoliosis is 1 in 4 or 25%, father  to daughter is 1 in 10 or 10%,  mother to son is 1 in 10 or 10% and father to son is less than 1 in 20 or 5%.
  • 3% of the people on the planet have a scoliosis curve that measures greater than 10 degrees, although the vast majority do not progress and only require observation.
  • Book bags, sports, sitting slouched do not cause scoliosis.
  • Scoliosis may be associated with back discomfort, however is not associated with debilitating back pain or neurological issues unless some other problem is also present.

Regardless of the extent of the scoliosis a general exercise program and maintenance of bone health is important.

Nikki Miller, a patient of Dr. Lieberman’s, shares her about her struggle with scoliosis and how she was finally able to find relief.

If you have been diagnosed with scoliosis please feel free to share your story in the comments section.

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