Studies Link Backpacks, Back Pain in Kids, Adults

By John Henry Dreyfuss, MDalert.com staff.

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  • Studies link heavy backpacks with low back pain in children.
  • Chronic low back pain in children is strongly linked to chronic low back pain in adulthood.
  • Low back pain is one of the most frequent causes of missed work days and long-term disability.
  • Backpack weight should not exceed 15% to 20% of child’s body weight.
  • Societies and associations have published backpack guidelines to reduce incidence of low back pain.
  • This cost-free healthcare could prevent extensive future medical interventions.

New Data

A study of photographs of 62 children with posture and pain complaints was published in Pediatric Physical Therapy. The researchers reported that “These results indicate that typical backpack loads create worsening postural changes due to backpack loads and time spent carrying those loads, putting children at increased risk for injury and pain, the latter of which is a strong predictor for back pain in adulthood.”

In a study published in the Archives of Disease in Childhood, researchers assessed the backpacks and back health of 1,403 pupils ages 12 to 17. More than 60% of the children carried backpacks that weighed >10% of the child’s body weight. About 20% of children carried a pack that weighed >15% of the student’s body weight.

“Carrying backpacks increases the risk of back pain and possibly the risk of back pathology. The prevalence of school children carrying heavy backpacks is extremely high. Preventive and educational activities should be implemented in this age group,” the researchers concluded

An article in the New York Times reported that approximately 25% of students reported back pain lasting >15 days during the previous year. Scoliosis accounted for 70% of these pain reports. The remaining 30% were reported to have pre-existing low back pain or contractures. Girls were found to be at greater risk of developing back pain than boys. The risk correlated directly with age.

Improper use of a backpack in a child can lead to an acute injury such as a pulled, strained, or torn muscle in the back, or it initiate a course that leads to chronic back pain when the child is an adult.

What Can You Do?

What can a physician do with this information? Your advice to a child or caregiver about the safest ways to carry a backpack can make the difference between an adult lifetime of chronic low back pain, or a life free of this sometimes debilitating nuisance.

If you can convince children and caregivers to follow the rules for safe use of a backpack, you can prevent many cases of chronic low back pain that would otherwise have developed in these children as young adults.

Waist Belt, Wheeled Pack

If a child is forced to carry >20% of his or her body weight in a backpack, suggest a wheeled pack. The wheeled pack, if properly used, can nearly eliminate the possibility of pack-related back injury. (See Figure 1.)

Figure 1. Wheeled backpacks.
The second best choice is to use pack with a waist belt. (See Figure 2.) The waist belt redistributes a good deal of the weight of the pack from the shoulders to the hips. The waist belt can reduce the incidence of low back pain irrespective of the weight of the pack because it does not rest any weight directly on the spinal column. Instead the waist belt distributes the weight through the hips and pelvis and into the legs, which is the best place for it.

Figure 2. A waist band can transfer as much as 100% of the pack weight to the legs.

Official Guidelines

The National Safety Council recommends the following when selecting a backpack for a child:

  • An ergonomic design. (See Figure 3.)
  • The correct size: never wider or longer than your child's torso and never hanging more than 4 inches below the waist.
  • Padded back and shoulder straps.
  • Hip and chest belts to help transfer some of the weight to the hips and torso.
  • Multiple compartments to better distribute the weight.
  • Compression straps on the sides or bottom to stabilize the contents.
  • Reflective material.



The American Chiropractic Association offers the following checklist to help parents select the best possible backpack for their children:

  • Carry as little weight as possible in the pack.
  • Use a waist belt if the weight of the pack exceeds 15% to 20% of the child’s body weight.
  • Make sure that the load is symmetrically distributed within the pack and between the child’s shoulders.
  • Be sure that the backpack is the correct size for your child. The backpack should never be wider or longer than the child’s torso, and the pack should not hang more than 4 inches below the waistline. A backpack that hangs too low increases the weight on the shoulders, causing the child to lean forward when walking.
  • Be sure that the backpack has two wide, padded shoulder straps. Non-padded straps are not only uncomfortable, but also they can place unnecessary pressure on the neck and shoulder muscles.
  • Be absolutely sure that your child uses both straps. Lugging a heavy backpack by one strap can cause a disproportionate shift of weight to one side, leading to neck and muscle spasms, low-back pain, and poor posture.
  • The shoulder straps should be adjusted so the backpack can be fitted to your child’s body. The backpack should be evenly centered in the middle of the child's back.
  • The pack should have a padded back. A padded back not only provides increased comfort, but also protects the child from being poked by sharp edges on school supplies (pencils, rulers, notebooks, etc.) inside the pack.
  • The pack should have several compartments. A backpack with individualized compartments helps position the contents most effectively. Make sure that pointy or bulky objects are packed away from the area that will rest on the child's back, and try to place the heaviest items closest to the body.

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