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August 31, 2004 > Back packs and Adolescent Back Pain

Back packs and Adolescent Back Pain

The new school year is upon us and our children are heading back to school. Students will begin to hit the books again but the transportation of these books is becoming a public safety concern. New research indicates that backpacks may play a part in back pain in our adolescents. Here are some numbers to help you realize the severity of this situation. According to the Consumer Product Safety Commission (CPSC) there were over 12,700 visits to emergency rooms in 1998 for backpack- related injuries to 5-18 year olds. The CPSC also reports that backpack - related injuries are up 330% since 1996.

By the end of the teen years, close to 60% of our children experience at least one low back pain episode. The American Academy of Orthopedics stated that backpack injuries are a significant problem for children. These statistics are the beginning of an epidemic some professionals are calling "Backpack Syndrome."

The proper weight of backpacks has been researched and a child should only be carrying a backpack that weighs 10%-15% of their own body weight. When the weight exceeds 15% of the child's body weight, complications begin to occur. Common sense leads to the conclusion that if an unequally distributed load - using one strap or just to heavy an amount - is a continued day after day on a growing spine, changes in that spine are likely to occur. The old saying, "As the twig bends, so grows the tree" is applicable.

The first concern is when backpacks are over 10%-15% of the child's body weight. This increased load, repeated day after day, puts a lot of stress on adolescent spinal structures. Spinal development is in progress as are periods of rapid growth. Incorrect stress on allows unhealthy postural and structural changes to occur. Some conditions found from this type of stress are: Muskuloskeletal Strain (e.g. spondyloysis, fracture, herniated disc), Developmental (e.g. Schuerman's Dx.), Infectious ( e.g. diskitis), and Neoplastic ( e.g. lukemia, osteoblastoma).1

The second concern is of backpacks worn with only one strap. Use of one strap, shifting weight back and forth, can lead to neck and muscle spasms, low back pain, walking improperly, lateral spinal bending, functional scoliosis and elevation of the shoulder.

The third concern is an increase of falls caused because of the weight of the backpacks. The American Academy of Physical Medicine and Rehabilitation presented students who carried backpacks averaging 25% of their body weight and had problems balancing. This was observed when they were climbing stairs and opening doors. The study revealed backpacks carried that were 25% of the child's body weight had trouble balancing and suffered an increased number of falls. At loads of 15% of their body weight, they maintained balance. The best balance was maintained with loads of 5%.2

The fourth concern is the postural misalignment. Imbalance can cause a condition called a vertebral subluxation. This is a condition where the bones (vertebra) are misaligned and impinge on the nerve traveling next to it. This condition can be symptomatic or not, but either way it distorts and interferes with the messages from the brain to other nerves. This disorder predisposes patients to a number of ailments, such as neck and back pain, headaches and osteoarthritis. As a chiropractor this issue concerns me. Especially when statistics show that children with back pain are susceptible back pain as adults. According to the U.S. Department of Human Health and Services, back pain leads to more than 19 million doctor visits a year.'

A misguided solution I often hear is to substitute the backpack with a roller bag. These are not as safe as originally thought. The problem is the empty roller bag itself weighs up to 80% more than the average empty backpack. Although they are not carried on the child's body, they have a tendency to be filled with more items and can end up being 50 lbs. heavier than the backpack. A roller bag, throughout the day, needs to be picked up over curbs, up and down stairs etc., putting an even heavier strain on the growing spine.

Here are safety guidelines parents and children can follow to prevent these spinal injuries:

1. Backpack should not exceed 10%-15% of your child's body weight.
users weight backpack weight
50 lbs. no more than 7.5 lbs.
80 lbs. no more than 12 lbs.
100 lbs. no more than 15 lbs.
130 lbs. no more than 19.5 lbs.

The extra weight causes the child to have a foward head lean altering their posture and decreases lung volume.

2. Make sure the backpack is sturdy and appropriately sized. Some manufacturers offer special child-sized versions for ages 5-10.
3. Avoid using only one strap or buying backpacks/athletic bags with one strap. Wearing two straps distributes the weight evenly. This will greatly reduce the stress on the spine.
4. Put heavy items on the bottom and against the back to maintain better posture.
5. Have your child regularly checked by a chiropractor so potential spinal and/or postural problems can be addressed and corrected.
6. Look for a backpack with waist or chest straps. This will keep the load close to the body and help maintain proper balance.
7. Choose backpacks with thick padded shoulder straps. Non-padded straps dig into the shoulders and can cause back pain, muscle strains or nerve impingement. You also want the straps to avoid pressure on the nerves around the armpits.
8. Choose a backpack with lumbar support. This will help with good posture, essential for proper spinal health.
9. Look for backpacks with "S" shaped shoulder straps which will ergonomically contour to your child's body.

Here are some simple rules when lifting a backpack:

1. face the backpack before you lift it.
2. bend at the knees and lift with your legs, NOT YOUR BACK!
3. keep the pack close to your body.
4. carefully put one shoulder strap on at a time. Never sling the pack onto one shoulder.
5. CARRY ONLY WHAT YOU NEED.

In conclusion if your child wears a backpack, weigh it to make sure it is no more than 10-15 % of body weight. Taking precautions may save the health of your child's spine.


1. Pistolese, Richard, Books Bags: What Every Parent Should Know. I.C.P.A. Newsletter Nov/Dec 2000.
2. Weir, Erica, Avoiding the back-to-school backache. CMAJ*JAMC, Sept.17, 2002;167(6).

All of the information provided herein is done for educational purposes only. The information in this article is not intended to replace the attention or advice of a physician and /or health care professional. Any person who wishes to pursue a course and/or action to prevent, treat and/or manage their own, or any other person's, health concerns should always first consult a qualified health professional. None of the information or statements contained in this article is to be used in place of medical advice from a health professional, or a medical practitioner. Nothing in this article is meant to imply a person should take actions toward medical or chiropractic treatment without the consent and/or supervision of his/her doctor and/or specialist.

Dr. Staci Talan, has her practice located in Fremont. She is a graduate from Sacramento State University where she earned her B.A. in Psychology. She proceeded on to Life Chiropractic College-West in Hayward where she earned her Doctorate in Chiropractic. She is a Certified Industrial Disability Evaluator and an active member of the California Chiropractic Association. She also is active in the Centerville Business Association, Irvington Business Association and the Fremont Chamber of Commerce. Dr. Talan is currently studying to become certified in the Bradley Method of natural childbirth

 
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