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Backpack associated back pain

Backpacks and Back Pain

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BackpackWhile the evidence is still out on whether heavy backpacks cause back pain in children, it is still something that is being investigated. Anecdotally,  there appears to be a relationship between back packs and kids’ lifestyles, other factors, and back pain.  A study in 2006 found that the weight of a child’s backpack was directly proportional to their likelihood of having back pain.1 When I was growing up, back pain amongst my class mates was unheard of. These days all kids have back packs of all different makes and sizes to carry a seemingly increasing amount of textbooks and homework. Perhaps combined with the more sedentary lifestyle kids have these days,  and the focus on electronic devices, I’m seeing more kids with back pain. With a little education and choosing the right back pack,  some of this pain can be avoided.

The good news is that pain that does arise from carrying heavy loads awkwardly is often self limiting and responds well to removing the load, exercises, and postural correction. Some of the signs of difficulty managing a back pack are shoulder, neck or low back pain, and occasionally pins and needles sensations in the hands. Balance can also be compromised when wearing a back pack that is too heavy leading to falls.

Recent studies have shown that loads as light as 15% of a child’s body weight can significantly alter posture and spinal curvature, thereby putting strain on growing bones and ligaments. A Study done at Queen’s University in 2009 using instruments that measure spinal curvature amongst 15 ten year olds wearing back packs in various positions found that when the back pack is not positioned properly it can have a significant effect on trunk and head posture. Initial findings suggest load should be placed lower on the back2.

Numerous factors contribute to the onset of pain, namely the weight of the back pack, the amount of time the child wears the back pack, the child’s height relative to the weight of the back pack, the perceived weight of the back pack, and the strength of the wearer. A review of the current literature strongly suggests the weight be limited to no more than 10-15% of body weight, but of course factors such as backpack design and physical fitness also influence the adaptations necessary to carry a backpack.

The Canadian Physiotherapy association provides recommendations for choosing a back pack. Wide curved shoulder straps, padded back, several compartments, compression straps to stabilize objects in the pack, and a hip belt are beneficial. Students tend to prefer backpacks that are more fashionable, various colours or sizes, those that disrupt their clothes less. It is difficult to convince children and teenagers that they need to focus on what is safe rather than what looks good.

Children need to pack only those items they absolutely need, and position the heaviest items in the bottom of the pack closest to the body. Both shoulder straps should be worn over both shoulders to distribute weight evenly across their back. Shoulder straps should fit tightly to avoid movement of the bag and a waist belt helps to distribute the weight closer to their centre of gravity.

1. Skaggs DL, Early SD, D’Ambra P, Tolo VT, Kay RM. Back pain and backpacks in school children. Journal of Pediatric Orthopaedics. 2006 May 1;26(3):358-63.
2. Brackley HM, Stevenson JM, Selinger JC Effect of backpack load placement on posture and spinal curvature in prepubescent children. Work 2009;32(3):351-60

Remember that this information is not intended as a substitute for medical advice. If you are experiencing pain, consult your family physician or physiotherapist.

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