Photo by Resi Kling on Unsplash

 October 1, 2018

My friend Dave and I were having a conversation about low back pain and backpack use in kids. I had to admit that I had not read any recent data on this topic and felt a little ill prepared to answer the question. What does the research say?

Very little.

Back in early 2003, Brent Wiersema and colleagues looked at one year of emergency room visits with backpack related injury as a diagnosis.

The percentage of patients with back pain as the symptom of backpack use was only 11%. This seemed surprisingly low. Most of the 89% of the other the remainder injuries occurred when a patient was hit with a backpack or tripped over it. I know that that sounds ludicrous, but it was how it was reported. In one European Spine Journal study, the authors showed that the backpack spine loading was no different between groups of people with and without scoliosis. There is the sum total of the quality research available.
The American Academy of Pediatrics has a list of guidelines for backpack safety at this link and copied here:

• Choose a backpack with wide, padded shoulder straps and a padded back.
• Pack light. Organize the backpack to use all of its compartments. Pack heavier items closest to the center of the back. The backpack should never weigh more than 10 to 20 percent of your child's body weight. Go through the pack with your child weekly and remove unneeded items to keep it light. (10 percent would be better)
• Remind your child to always use both shoulder straps. Slinging a backpack over one shoulder can strain muscles.
• Adjust the pack so that the bottom sits at your child's waist. (Better - find a backpack that allows your child to adjust it and wear it resting at his or her waist)
• If your school allows, consider a rolling backpack. This type of backpack may be a good choice for students who must tote a heavy load. Remember that rolling backpacks still must be carried upstairs, they may be difficult to roll in snow, and they may not fit in some lockers. And review backpack safety with your child.

Prevention is king. Practicing daily yoga, situps and other core exercises with your kids can help build a solid core of muscles around the spine which is one of the most important ways to prevent back injury. I think that the key to this topic is to be aware of your child's backpack weight in relation to their size. If they are tall and skinny or have low muscle mass in general, the backpack could be more than their lower spine can handle. Make sure that your child tells you when they have back pain at the earliest time for intervention.

What to do if pain arises?

1) Immediately lighten the load and discuss alternate accommodations with the school until the pain resolves.

2) Seek help from a quality Chiropractor or Physical Therapist who can help with muscle and spine form and function.

3) Avoid pain medicines unless you have no choice. These medicines just mask pain and pain's job is to tell you when you are moving the wrong way for the body's physiology. If you have to use pain meds, stick to ibuprofen at appropriate doses and take it with food.

4) Massage therapy and stretching are excellent adjuncts to healing.

5) And my favorite, eat an anti inflammatory diet to lighten the inflammatory food gasoline load.



Dr. M



Pediatrics Wierssma Article
European Spine Journal Gelalis Article
Ergonomics Hong Article
American Physical Therapy Association