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9 Steps to Help Avoid Back Pain | Proper Backpack Fit for Back to School

As your kids are heading back to school and you are buying school supplies be sure to give some extra thought to which backpack is best for your child before starting the new school year.

Among children between the ages of 11 and 14 years, almost 40% complain of neck and lower back pain. Of those in pain, 80% attributed their pain to backpack use. Several ergonomic studies show immediate deleterious effects of children standing, walking, climbing stairs, and balancing with excessively heavy backpacks. Heavy backpacks can cause neck shoulder and back muscular problems such as postural compensation and strain, and makes kids more prone to injury and falling especially if the loads are unbalanced. Girls complained of neck and back pain more than boys, especially if they wore the pack with one strap. Adolescents complain more of back pain when the packs are heavier and are worn for longer periods of time, such as more than the 10 minute average from bus to class.

What is the proper fit for a backpack?

Here are some of the most important things to consider with regards to fit and safety when selecting the right backpack for your child this school year:

  1. Choose a backpack with two wide straps that are also padded and contoured for added comfort. The top of the strap should sit 1-2 inches below the shoulders. Ideally, finding a backpack that also has a chest compression strap is best.
  2. The bottom of the packpack should rest at the small of your back (at the lower lumbar), and never go 4 inches below your waistline.
  3. Plenty of lower back padding, and a waist strap.
  4. The ideal backpack will also distribute weight evenly to reduce strain on your back and shoulders.
  5. Reflective trim on the backpack is also a nice added feature to ensure safety as we head into the time change and evenings get darker earlier. Especially if your child participate in after-school sports or activities.
  6. Also, skip carrying a water bottle in your backpack or carry it empty to school and then store it in the locker.
  7. If there are 2 compartments in the pack, and load the heaviest objects in the compartment closest to the spine.
  8. Wear high and tight on the back rather than low and loose.
  9. Try the backpack on as if you were trying on a pair of shoes. Bring some books with you, load the pack, and have your student walk around the store. Function and fit should supersede looks and coolness.

What is too heavy?

Is there a maximum weight that each child should be able to carry in their backpack? Or is it based on a percentage of body weight? Is there a maximum time per day a heavy backpack should be carried?

I recommend limiting backpack weight to 10% of body weight. (A 100 pound student should carry 10 pounds). Up to 20% of body weight is the maximum load that can be carried safely, according to several medical societies (pediatrics, physical therapy and orthopedics), although there is no absolute consensus. We all know that these recommendations are ignored routinely. In the United States more than 9 out of 10 children carry backpacks that weighed more than 10% and up to 22% of their body weight. Those carrying the heaviest backpacks complained of pain 50% more than the others.

View what heavy backpacks are doing to kids' bodies here.

*Image from American Academy of Orthopaedic Surgeons.

Are There Long Term Effects of Carrying a Heavy Backpack as a Child?

The good news is, no study has ever shown that carrying a backpack that’s too heavy leads to more problems later in life or to the development of problems like disk herniations or scoliosis. It just hurts now. The bad news is, children who have headaches, backpain and anxiety now often complain of the same symptoms later in adulthood.

We Can't Blame it All on the Backpacks

Sedentary lifestyle is possibly the most important factor determining back pain among schoolchildren. Lack of physical activity contributes to loss of muscle strength and tone in the lower back. Students who complain of back pain after carrying their packs often complained of pain before carrying packs. Studies report that back pain in children is often related more to psychosomatic factors and daily experience with back pain rather than use of a backpack. Children who were deconditioned or referred to themselves as “sedentary” or felt fatigued while carrying their backpacks during the usual 10 minute walk from the bus to class, had more back pain than the children who described themselves as “fit or active”.


To all parents, here is the obvious conclusion: until all books are 100% online, students will be carrying heavy packs to and from school. So remember, max pack weight of 10% of body weight is best, never more than 20%. And kids, stay fit and get off the couch.

Have a wonderful 2018-19 school year!