As the time approaches for our children to return to school, the inevitable trips to the mall to purchase school supplies begin. Along with buying the required books, calculators and pens, parents and children are looking to buy cool, new backpacks to carry all these supplies to school. Kids are usually most concerned with what the backpack looks like (decorated with their favourite animated character or the “right” brand). However, it is important that, as parents, you consider the overall design and size of the backpack to ensure your child is able to wear the backpack comfortably and without experiencing injury.
What are the issues?
Although backpacks are a practical way to carry schoolbooks and supplies, if they are too heavy, poorly fit, or the wrong size, injuries to muscles and joints can occur and a child can develop pain when wearing them.
Many children have reported pain related to wearing a backpack.1,2,3,4 Studies have reported that 33 - 48% of students studied experienced pain in one or more areas of their body when wearing a backpack.1,2 Students have also reported increased discomfort when carrying heavier loads3 and with increased time spent carrying a backpack.4,6 It’s not just discomfort that is at issue, carrying a heavier backpack can alter posture, decrease reaction times when walking and increase the risk of falls.5,6,7
Although experts don’t agree on a safe upper limit of weight that kids should carry in their backpacks, most researchers support a range of 5-15% of body weight as a reasonable target.4,5,6,7 Even young students carry heavy backpacks,8 which is a cause for concern because the ratio of backpack weight relative to the child’s weight is increased when compared with older, heavier students. Some grade one student’s backpacks weigh as much as 5.5kg (12 lbs).8 For the average first grade student that may be equivalent to about 24% of his/her body weight.
Common problems associated with backpacks
Poor posture: as the weight of the backpack increases, the wearer must either arch their back or lean forward from the hips to carry the weight. Either of these postures can cause mid or low back pain. Carrying a backpack using only one strap over the shoulder also puts unequal strain on the shoulders and upper back.
Acute and chronic back pain: there appears to be a high rate of acute and chronic low back pain (16%) related to backpacks putting strain on the back muscles and the spine.1
Shoulder/neck pain: it appears that the right shoulder (most children carry the backpack on the right side if only using one strap) is most susceptible to acute and chronic pain (19%) and that the incidence of neck pain is also very high in backpack users at 17%.1
Numbness and tingling in the arms/hands:9 backpacks with narrow or tight straps may dig into the shoulder and affect both the circulation and nerve supply to the arm.
Poor balance/falls: carrying a heavy backpack, especially on one shoulder, changes the way a child walks and can alter his/her balance.4,5,6,7
What can you do?
The backpack needs to fit between the shoulders and waistline and be no wider than shoulder-width.7,10
Choose shoulder straps that are wide and padded to reduce pinching9 and spaced widely to help decrease the work of neck muscles supporting the weight.11
Backpacks with two or more compartments allow for more even weight distribution.3
A backpack with a padded back increases comfort.9
Choose a backpack with a waist belt3
Wear it right
Adjust the shoulder straps so that the bottom edge of the backpack sits at or just above the waistline.10
Use of a waist strap may distribute some of the load from the shoulders to the hips.3
Use both shoulder straps.4
Put the heaviest items low and close to the body.3,9
Use all compartments to distribute the weight more evenly.9
Help your child adjust their backpack and what they are carrying.
Lighten the load
Only carry what is needed.9 Encourage your child to leave things at home or at school whenever possible and carry only the books needed for homework.
When buying, choose the lightest possible backpack that fits correctly.9
If your child has access to a locker encourage them to use it and only carry what they must from one class to the next.
If the backpack is particularly heavy, teach your child how to lift it properly and help them put it on if possible.
How do we know if problems are already present?
Observe your child for potential problem signs and check with your child to make sure that they are comfortable carrying their backpack. Some ways to identify early warning signs are:
Observe your child to see if they are having difficulty getting into the backpack, carrying very heavy backpacks and/or carrying the backpack on one shoulder.
Listen to your child for complaints of pain in the back, shoulders or neck, or numbness in the arm or hands.
Watch your child walk to see if they are having to walk bent over, tipped sideways or if they seem to have difficulty on stairs or uneven surfaces.
Pay attention if your child seems to be falling more often and try to determine if this may be related to wearing a backpack.
Although this discussion was focused on children using school backpacks, the information provided is applicable to anyone who uses a backpack for work or recreational activities. If you, your child, or any family member is experiencing pain or numbness contact a physiotherapist or other health-care provider. A physiotherapist could also provide advice on choosing and/or fitting a school or recreational backpack properly.
Azabagic S, Spahic R, Pranjic N, Mulic M. Epidemiology of musculoskeletal disorders in primary school children in Bosnia and Herzegovina. Mater Sociomed. 2016;28(3):164–167. doi:10.5455/msm.2016.28.164-167.
Talbott NR, Bhattacharya A, Davis KG, Shukla R, Levin L. School backpacks: It’s more than just a weight problem. Work: A Journal of Prevention, Assessment and Rehabilitation. 2009; 34(4): 481-94.
Golriz S, Walker B. Can load carriage system weight, design and placement affect pain and discomfort? A systematic review. Journal of Back and Musculoskeletal Rehabilitation 2011; 24: 1-16.
Dockrell S, Simms C, Blake C. Schoolbag weight limit: Can it be defined? Journal of School Health. 2013; 83(5): 368-377.
Bryant BP, Bryant JB. Relative weights of the backpacks of elementary-aged children. The Journal of School Nursing. 2014; 30(1): 19-23.
Kistner F, Fiebert I, Roach K. Effect of backpack load carriage on cervical posture in primary school children. Work: A Journal of Prevention, Assessment and Rehabilitation. 2012; 41(1): 99-108.
Chen YL, Mu YC. Effects of backpack load and position on body strains in male schoolchildren while walking. PLoS One. 2018;13(3):e0193648. Published 2018 Mar 21. doi:10.1371/journal.pone.0193648
Lasota A. Schoolbag weight carriage by primary school pupils. Work. 2014; 48: 21-26.
American Academy of Pediatrics. (2015) Safety and Prevention: Backpack Safety. Available at https://www.healthychildren.org/English/safety-prevention/at-play/Pages/Backpack-Safety.aspx.
Chullino M. Children and backpack safety. The South Carolina Nurse. 2013; November-December: 8.
Kim MH, Yoo, WG. Effect of the spacing of backpack shoulder straps on cervical muscle activity, acromion and scapular position, and upper trapezius pain. Journal of Physical Therapy Science. 2013; 25: 685-686.American Academy of Pediatrics: Backpack Safety. Available at https://www.healthychildren.org/English/safety-prevention/at-play/Pages/Backpack-Safety.aspx
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