Back Pain

By Jayson McMath, M.D.

With school in session, the familiar sight of jam-packed book bags litters the hallways and sidewalks. To some kids this can be business as usual, but to others it can be the start of a long and painful school year... literally.  About 97% of school age children use backpacks to tote study materials around school and home. Of the factors linked with back pain in schoolchildren, none has stimulated greater parental anxiety and immediate attention than the use of school backpacks. With school lockers being removed due to vandalism and security concerns, schoolchildren are having to carry a significantly greater amount of weight in their backpacks, and for a much longer period of time. Children have to carry a full day's class schedule of schoolbooks, in addition to other items and supplies, throughout the day. 
Back pain is a major economic and health issue, affecting nearly 80% of people at some time in their adult life. Nonspecific back pain affecting adolescent schoolchildren is becoming a more common medical issue. The long-term effects of this nonspecific pain have not been assessed, but some researchers are concerned that adolescents with nonspecific back pain may become adults with more long-term disability and chronic pain.

The literature is riddled with conflicting information about the causes of adolescent back pain. There are certainly many causes of back pain. Children identify sports injuries, motor vehicle accidents, and falls as much more frequent causes of their pain than the use of backpacks. We do know back pain has been associated more with females and with carrying a backpack weighing more than 20% of the student's weight. The duration for which the backpack is worn significantly influences the likelihood of back pain. The adolescent growth spurt has even been implicated as a cause making kids more susceptible to the stresses of backpacks. Other factors associated with backpack pain are walking to school with a backpack and carrying a backpack by hand.

Wearing a backpack on only one shoulder places all of the weight on the side of the body that is holding the pack. This will place undue downward pressure on the top of the shoulder. When walking with a heavy backpack on one shoulder the student will often lean to the opposite side to compensate for the weight. This places undue stress on the spine and spinal muscles. One misconception is that carrying heavy book bags unevenly can cause scoliosis. No studies have shown any connections between scoliosis and backpack use. If a child continues to complain of back pain despite modifying the use of the backpack then they should be evaluated by a physician to rule out other causes of pain.

Current Recommendations:

  • Use both backpack straps (at least 2 inches wide) - do not carry in hands
  • Carry no more than 10-15% of child's weight
  • Position backpack over upper rib cage, not on the low back
  • Use waist strap to share load of the backpack
  • Spread contents evenly in pack (use individualized compartments)
  • Avoid pointy or bulky objects pushing into back
  • Consider Xeroxing assignments from heavy books
  • Consider wheeled backpacks
  • Eliminate non-educational items from backpack
  • Consider two sets of books for home and school
  • Minimize time spent carrying Backpack with transportation
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