Back Pack Pain

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The bell rings to signal the end of class, each student grabs their backpack to go to the next class. With only 5 minutes between classes, the students don’t have time to go to their locker and hit the bathroom. So, they have a “portable locker,” aka their back pack.

Some students may get a backpack big enough to hold the books for a 6 or 7 period day. Textbooks are not light, that means they may be carrying 20 to 40 pounds on their back between classes. Some students may even have a laptop computer in their bag. Carrying this much weight can cause health problems for the growing child, especially if the pack is not worn properly.

Most students will wear their pack too low, down near their buttocks. Some will wear only one shoulder strap. Some children may also weigh their backpacks down with too much weight (based on their strength).

Wearing a backpack on only one shoulder places all of the weight on the side of the body that is holding the pack. This will place undue downward pressure on the top of the shoulder. The weight is then dispersed down to the hip, knee and ankle.

When walking with a heavy backpack on one shoulder the student will often lean to the opposite side to compensate for the weight. This places undue stress on the spine and spinal muscles.

Due to the heavy load on the back the student will also walk and stand with their trunk leaning forward. The weight placed on the back causes the center of gravity to shift so the student compensates by leaning forward. This also increases harmful stress on the spine and spinal muscles.

The side that is carrying the load may experience muscle spasms trying to hold up the bag. The student may also compensate by hiking up the opposite shoulder. This can lead to stress related injuries on the opposite side.

A 1988 study performed by the Hong Kong Society for Child Health and Development (812 students) showed that 4.54% of third thru sixth graders had mild to serious spinal deformities. The students in the study with the worst back problems stated that they carried their back packs on only one shoulder. The study also concluded that the backpacks were too heavy for the size of the students carrying them.

A 1994 Scandinavian study showed a high probability for spinal problems in children who carry backpacks, no matter how they wear them. The study found that 53.7% of children who carried their packs on one shoulder complained of back pain. 45% of two shoulder pack wearers complained of back pain. Interestingly, the highest level of back pain, 68.6%, carried the bag in one hand. The study also concluded that females were more likely to experience backpack related pain than were boys.

The one-shoulder carry is becoming a bigger problem with the advent of one shoulder strap back packs.  Even though these back packs center the back pack on the back, they still place the weight on only one shoulder. Also, these packs can be slung over one shoulder without the pack being placed on the back.

Dr. Charlotte Alexander, Houston, TX orthopaedic surgeon, conducted a study in 1999 of 100 physicians in Chicago and Wilmington, DE. The study showed that almost 60% of children’s orthopaedic office visits for back and shoulder pain were the result of carrying too heavy of a backpack. These findings were presented at an October 1999 press conference held by the American Academy of Orthopaedic Surgeons.

The injuries seen today in the doctors office may have long term implications. Currently there are not any scientific studies of consequence to determine the possible short-term or long-term consequences of carrying back packs. We just do not know if there is a cause-and-effect relationship between heavy backpacks and long term disabling injuries.

To decrease back and shoulder strain due to inappropriate back packs the following steps can be taken.

• Make sure a child’s backpack weighs no more than 10% of their body weight. A 100 pound child should carry NO MORE than a 10 pound pack.

• A backpack with individualized compartments will help to position contents effectively to spread out the weight.

• Use both shoulder straps.

• Make sure pointed or bulky objects are not in contact with the back of the wearer.

• Use padded shoulder straps to better dissipate weight over the shoulders (they don’t dig in as much).

• Use adjustable shoulder straps to position the back pack over the upper rib cage, not on the low back.

• If the pack is still too heavy, talk to the students teachers to determine whether heavier items can be left at school, or if lighter objects such as hand-outs can be substituted for heavier books.

• Speak with the kids to let them know the importance of a properly worn backpack.

• Use a waist strap, if available, to help disperse the load of the backpack.

• If the load can not be decreased, purchase a backpack with wheels. Pulling a heavy load is easier on the spine.

Pascoe, D. et al. “Influence of Carrying Book Bags on Gait Cycle and Posture of Youths.” Ergonomics, vol. 40, No. 6, 631-641, 1997.

“The Weight of School Bags and its Relation to Spinal Deformity.” Hong Kong Society for Child Health and Development, the Dept. of Orthopaedic Surgery, University of Hong Kong, the Duchess of Kent Children’s Hospital, May 1988.

Trousller, et al. “Back Pain in School Children: A study among 1178 pupils.” Scand. J Rehabilitation. Med 26:143-146, 1994.

General Back Rehabilitation Sheet In PDF Format

Your personal physician should be consulted to determine which exercises are applicable for your particular condition.

©2000 - 2006 David Edell

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Last Update for AthleticAdvisor.com: 06/04/2006 12:01:52 PM