Fitting your child's backpack can prevent injury

Stephen V. Rapposelli, PT, OCS

When I was a boy, we covered our schoolbooks in brown grocery store bags and carried them by hand to and from school. By high school, we had a book bag that was carried like a briefcase. It was not until college that backpacks were used. To be cool, you had to use only one strap. Times have changed. Now, fancy elastic covers adorn books, and every little child has their own backpack. Why are so many of these kids showing up in our practice with back pain?

One striking cause of childhood back pain are those backpacks. Excessive weight, improper fit, and poor technique of use are all causing kids to complain. We as parents need to be educated on what to look for when buying a backpack, how to adjust it properly to our child's build, and warning signs of possible injury.

Injury can occur when a child, in trying to adapt to a heavy load, uses faulty postures such as arching the back, bending forward or leaning to one side. These postural adaptations can cause improper spinal alignment, which hampers functioning of the disks that provide shock absorption. A too-heavy backpack load also causes muscles and soft tissues to work harder, leading to strain and fatigue. This leaves the neck, shoulders and back more vulnerable to injury.

When buying a new backpack, look for a padded back to reduce pressure on the back. Hip and chest belts transfer weight from the back and shoulders to the hips and torso. Multiple compartments distribute the weight in the backpack, keep items secure, and ease access to the contents. Compression straps stabilize the articles and compress the contents so that the items are as close to the back as possible.

Here's how to improve your child's backpack use:

• Wear both straps. Use of one strap causes one side of the body to bear the weight of the backpack. This is true even with one-strap backpacks that cross the body. By wearing two shoulder straps, the weight of the backpack is better distributed, and a well-aligned symmetrical posture is promoted.
• Wear the backpack over the strongest mid-back muscles. The size of the backpack should match the size of the child. It is also important to pay close attention to the way the backpack is positioned on the back. The backpack should rest evenly in the middle of the back. Shoulder straps should be adjusted to allow the child to put on and take off the backpack without difficulty and permit free movement of the arms. Make sure that the straps are not too loose and that the backpack does not extend below the low back.
• Lighten the load. No more than 15% of the child's bodyweight should be carried in a backpack. Choose to carry only those items that are required for the day. Each night remove articles that can be left at home. When organizing the contents of the backpack, place the heaviest items closest to the back.

How do you know when the backpack is causing problems and needs correcting?

Look for:

• Change in posture when wearing the backpack;
• Struggling when putting on or taking off the backpack;
• Pain when wearing the backpack;
• Tingling or numbness; or
• Red marks.