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  • Ericka Mizuta, DPT

How to Avoid Back Pain for Children Wearing Backpacks


With the school year starting soon, many parent’s minds are on back to school shopping. There are a few things parents should know before letting children pick out their favorite pack. While backpacks are a great way for children to carry their books and homework to and from school, improperly sized, poorly designed, and incorrectly packed backpacks can lead to back pain in children. Before heading to the store, here are some tips to help with shopping:

Lighten the load. The number one rule for backpack usage is to keep the load down. While research is still developing on an appropriate load, some studies agree that loads of more than 10% of a child’s body weight may induce negative spinal changes. (1) Additionally, backpack weight has been shown to be associated with back pain in adolescents.(2,3) If a child has extra books they need to bring on that would tip the scales, have the child carry a book in their arms that day. If a child is continually carrying heavy loads, think about purchasing a backpack with a waist strap to further distribute the weight or even a rolling backpack. Lastly, if a locker is available for the child’s use, suggesting using this to decrease the load. The availability and use of school lockers has also been found to be associated with decreased levels of back pain in children.(3)

Pick a well-made backpack. Proper backpacks will have two thick, padded straps that disperse the weight across both shoulders, a hard surface along the back of the pack, and occasionally a chest or waist strap. These are especially helpful if the child has to carry heavy books. Stray away from backpacks that are flimsy or have thin straps, as these do not help disperse the load and may contribute to injuries.

Wear the backpack correctly. During wear, both straps should be used and should be tightened enough to maintain the backpack flat across the child’s back. Wearing only one strap will force side to side imbalances in the muscles which could potentially lead to pain over time.(4) If the straps are too loose, the backpack will sit lower on the child’s back, again forcing imbalances that may cause pain due to excessive spinal extension.

Pack the backpack properly. Pack the heaviest items closest to the child’s body when packing his or her bag. Light items, such as jackets, can either go on top or in the outer aspects of the bag. As stated before, try to avoid packing too much in those packs to avoid breaking the 10% rule.

If a child is complaining of low or upper back pain due to backpack use or any other activity, have the child evaluated by his or her local physical therapist. A skilled therapist can address issues such as muscle weakness, muscle length deficits, and postural control issues. While back pain is common in adolescents, it is not normal at any age and therefore should be treated by a medical professional when it occurs.

1. J Drzal-Grabiec et al. Effects of asymmetrical backpack load on spinal curvatures in children. Work. 2014 2. Moore MJ, White GL, and Moore DL. Association of relative backpack weight with reported pain, pain sites, medical utilization, and lost school time in children and adolescents. J Sch Health. 2007; 77(5): 232-9. 3. Sheir-Neiss GI, et al. The association of backpack use and back pain in adolescents. Spine (Phila PA 1976). 2003; 28(9): 922-30. 4. Schaggs DL, et al. Back pain and backpacks in school children. Journal of Pediatric Orthopedics. 2006; 26(3): 358-63. 5. Motomans RR, Tomlow S, and Vissers D. Trunk muscle activity in different modes of carrying schoolbags. Ergonomics. 2006; 49(2): 127-38.

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