Heavy Backpacks Cause Pain

by Theresa Scully
Arch Pilates

​According to the American Physical Therapy Association (APTA) 2012 survey, low back pain affects the daily function of 69% of Americans. Furthermore, in a survey conducted in 1999, 60% of orthopedists reported back and shoulder pain in children due to heavy backpacks. Overall, non-traumatic low back pain develops due to poor posture and muscle strain. Wearing heavy backpacks and wearing them improperly can lead to back pain, shoulder and neck pain.  

There are no studies yet that address the long term affect of back pain from backpacks, but in my 14 years as an orthopedic physical therapist, I have seen postural faults and low back pain beginning in youth manifesting into chronicity in adult life. Why risk long term muscular imbalances and spinal degeneration if prevention is a choice?  The way a heavy backpack affects a young developing spine is simple. Weight is distributed unevenly on one shoulder, causing the child to compensate and shift the hips and upper back over center line to counterbalance the load.  This causes improper muscle activation and non-activation on one side of the spine and the other, causing a “scoliotic-like” spine that can cause stress and pain in the joints and muscles.  Posture is severely affected not only with this sideways shift as in one shoulder backpack carrying, but also with carrying a heavy backpack on both shoulders with rounded shoulders, forward head, severe front lean, and a flattened low back. Growing tweens and teens already have a battle with holding themselves in proper posture. The last thing they need is a heavy back pack worsening things. 

The APTA recommends limiting backpack weight to 10-15% of the body weight of the child. The American Academy of Pediatrics (AAP) recommends a lightweight backpack such as canvas with two wide, padded shoulder straps because narrow straps can dig into shoulders. A safe backpack should also have a padded back, which is comfortable and protects kids from being injured by sharp objects such as scissors, pens, wire notebooks. A waist belt and multiple compartments can also help distribute the weight more evenly.

Overall, be an advocate for your child and look for signs and symptoms of back stress. Ask your child if his/her back is sore or achy.  Perform a visual inspection before you send your child off to school and see if your child’s posture is affected by the backpack. Conference with the teacher to ensure that there is enough time in between classes to return to lockers and exchange books.
If pain in the back, neck and shoulders persist even after proper measurements have been taken. Seek the medical help of a physical therapist. Chances are pain can be reversed with proper muscular strengthening, stretching, and manual therapy.  Your therapist will include home exercises to treat muscle and postural imbalances. Such as the cat/cow stretch, hamstring stretch, mid-back stretch and upper trapezius stretch. Strengthening will include rows, scapular stabilization, and core strengthening.  Manual therapy will reduce abnormal tissue tightness relieve stress on the spine bones.  Apply ice for 10 minutes for new onset, intense pain because the cause is most likely inflammation. Use heat sparingly as heat can increase inflammation and therefore increase pain. Only use heat as a contrast to treat the inflammation. The contrast is applied with 10 minutes heat and 10 minutes ice immediately afterwards.  This contrast technique will help “pump” the swelling out of the tissue.  
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I am a firm believer that if you keep adding micro stress on a joint or muscle over time, the muscle and joint complex will break down. Just as a butter knife cutting away at a 6 inch thick climbing rope will eventually cause the fibers to fray and fracture. 

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Backpack Carrying Tips:

• Use both straps on the shoulders, symmetrically cinched comfortably
• Wear the backpack distributed evenly on the center of the midback, 2 inches above the low back and just below the skull
• Pack heaviest objects into the backpack first so they are carried closest to the body
• Distribute the weight evenly into multiple compartments, placing sharp items in smaller pockets 
• Use proper lifting mechanics by squatting with the leg muscles and keeping it close to the body
• Put only the books needed in the backpack
• Schedule a one a week backpack clean-out day
• Make frequent trips to the locker.
• Keep 2 sets of text books, one for home and one for school
• Share a “home” text book with friends or neighbors.
• Make copies of homework assignments instead of bringing the whole book home
• Pack lightly, only the necessary items
• Use an alternate bag for heavy electronics
• Remove one or 2 text books and carry in the arms supportively clutched to the chest with both arms

Backpack no-no’s:

• Wearing a loaded backpack that causes severe forward lean
• Carrying all books in the backpack
• Bending from the waist with straight legs to pick up the backpack
• Twisting and bending to pick up the backpack
• Slinging one shoulder strap onto the shoulder
• Wearing the backpack so it is hanging over the rear-end
• Placing non-important school items in the backpack