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Avoid the Pain and Injury of Heavy Backpacks

Expert advice from Russell Nord, MD

September 18, 2019

a drawing of a backpack stuffed full

The American Occupational Therapy Association is celebrating National School Backpack Awareness Day on September 18, 2019. The goal of the day is to increase the understanding of how heavy backpacks can be a path to pain and injury.

No doubt backpacks are a practical way for kids to carry things around, especially for school, but if those packs are not fitted and worn properly, or if the backpacks are carrying too much weight, they might cause injuries to muscles and joints.

Medical Director of Washington Sports Medicine, Russell Nord, MD, notes, “The American Academy of Orthopaedic Surgeons (AAOS) cites Consumer Product Safety Commission data, which indicate that in 2014, more than 8,300 children between the ages of 5 and 18 were treated in hospital emergency rooms or doctors’ offices for backpack-related injuries. Those were just the ones who had problems severe enough to require medical care.”

A board-certified orthopedic surgeon and sports medicine specialist, Dr. Nord also is the father of four young children.

A Correct Fit

“As a father, backpack safety is a matter of concern for me,” he says. “I do appreciate the temptation for parents to buy bigger backpacks that their kids can ‘grow into,’ but the National Safety Council recommends that a backpack should not be wider than the child’s back. Also, the backpack should not extend more than four inches below the waist.”

While it might seem faster and easier for parents to shop alone for children’s backpacks, it is worth the extra effort to take children with you to ensure a proper fit. Dr. Nord observes that it also is important to use backpacks that have well-padded, adjustable shoulder straps and a waist strap.

“The waist strap helps make sure the pack’s load is supported by the pelvis and not just the shoulders, similar to how hikers use waist straps on their hiking backpacks,” he explains. “A chest strap also can be useful to help keep the backpack snug against the back, therefore reducing the torque to which the back is exposed.”

Dr. Nord also suggests that a padded back on the pack can promote comfort, and reflective material on the backpack can help keep children safe if they have to walk to or from school in poor lighting.

“Make sure the child uses both shoulder straps, rather than slinging the backpack over one shoulder,” he says. “Using two shoulder straps distributes the weight more evenly. When you are deciding on which backpacks are right for your children or teens, it’s good to make sure that they can adjust all the straps on their own without struggling. Specifically, small hands may have trouble opening and closing the clip for a particular waist or chest strap design, thus making it much less useful.”

The Correct Weight

Choosing the proper-size backpack is only part of the safety equation. The other primary consideration is the weight of the backpack once it contains the student’s books and other supplies.

“The American Chiropractic Association recommends that a backpack should carry only 10 percent of the child’s body weight,” says Dr. Nord. “That means, for example, a limit of 5 pounds for a 50-pound first-grader. Because your child is likely to put more things into a large backpack, bigger is not necessarily better.

“It’s a good idea to get a sense of things and weigh the backpack on your bathroom scale,” he adds. “If the backpack is too heavy, remove objects such as books that aren’t really necessary for the particular school day or for the evening’s homework assignments. Other non-school items such as laptops, cellphones and video games also can add to unnecessary weight. If the backpack is still too heavy after removing non-essential items, you can have children carry some of their books in their arms.”

Dr. Nord encourages parents to follow the advice from the AAOS to watch their children as they put on their backpacks. “You want to make sure your kids can put on their backpacks and take them off easily,” he says. “Also, when they lift their backpacks, have them bend at the knees to pick up the packs, rather than bend forward at the waist.”

In addition to causing back, neck and shoulder pain, an ill-fitting or overly heavy backpack also can contribute to poor posture, according to Dr. Nord. “It’s important to note that the wrong backpack or the weight of backpacks can – and do – contribute to posture problems and musculoskeletal pain in the back, neck and shoulders. In addition, numbness in the arms or legs could indicate nerve damage. I urge parents to take those complaints seriously and seek medical attention for their child right away.”

What About Wheels?

One question more and more parents are asking is whether they should have their children use backpacks with wheels, Dr. Nord notes. “Rolling backpacks may pose a problem on crowded sidewalks,” he cautions. “Also, because some backpacks on wheels cannot be hung up on a hook or placed on a shelf, they could clutter up the floors in classrooms and hallways, presenting a tripping hazard. Additionally, some schools do not allow rolling backpacks, so a traditional backpack may be a better idea.”

Regardless of the specific design chosen, the principles discussed above will help your child remain safe and comfortable when using a backpack.

Find out more about the work of Dr. Nord and Washington Sports Medicine here.