When back to school shopping this year there is one important item that requires special attention: the backpack. Backpacks that are poorly designed, overloaded or incorrectly worn may cause harmful stress to the entire spine. This growing problem is a source of shoulder, neck and low back pain in school age children.

A study reported earlier this year in Spine magazine suggests that heavy backpacks can cause major strain on children's spines which could lead to back pain due to changes in lumbar disc height or curvature.

"Over 92% of children in the United States carry backpacks that are typically loaded with 10% to 22% of their body weight," writes researcher Timothy B. Neuschwander, MD, of the University of California, San Diego. "Thirty-seven percent of children aged 11 to 14 years report back pain, the majority of whom attribute the pain to wearing a school backpack."

The study used an upright MRI scanner to image the spines of eight children, average age of 11, while standing first with an empty backpack and then backpack loads representing 10%, 20%, and 30% of the children's body weight (9, 18, and 26 pounds, respectively).

The results showed two key spinal measurements changed as the weight of the backpack increased. Heavier weights caused compression of the discs that act as a cushion between the bones of the spine. Disc compression was especially great in the lower spine at heavier backpack weights.

Heavier backpack loads were also associated with increased curvature of the lower spine. Half of the children had a significant spinal curve even with the 18-pound backpack. Most of the children had to adjust their posture to adapt to the heaviest 26-pound backpack load.

The amount of back pain reported by the children also increased as backpack load increased. At the heaviest load, the average pain score was nearly 5 out of 10 for the children.

A separate study conducted in Italy found that the average child carries a backpack that would be the equivalent of a 39-pound burden for a 176-pound man, or a 29-pound load for a 132-pound woman.

Dr. Richard Gallagher of Gallagher Chiropractic in Ballantyne, NC says ongoing use of heavy backpacks is a repetitive micro-trauma to the back and can cause muscle strain and distortion on the natural curves in the middle and lower back.

“Backpacks that are too heavy cause a child to lean forward to balance the weight on their back. The shoulders may also roll forward which could lead to a rounded upper back,” he said.

“Wearing a backpack on one shoulder or the use of a messenger-type bag may cause muscle spasms and spinal imbalances and could contribute to spinal misalignments and even scoliosis. Some literature suggests backpacks may lead to a condition called Spondylolysis, a stress fracture of the spine.”

Gallagher says it is important to catch things early and if your child complains of back pain to have him or her checked out by a professional. Children are resilient and typically respond to treatment well.

The problem has become so widespread that some states are considering that would force school districts to develop ways of reducing the weight of students' backpacks. The California State Legislature approved a bill that would require the State Board of Education to set maximum weight standards for textbooks and examine other methods for reducing total backpack weight.

One obvious solution to alleviate the heavy backpack problem would be using rolling backpacks with wheels. Although there is no district-wide rule in the Charlotte Mecklenburg School system on what students can use to carry their textbooks and supplies, many schools ban them because they consider them a safety hazard. Concerned parents should contact their child’s school to discuss what options are available to maintain spinal health.

Joy Campbell, a Neuromuscular Massage Therapist and owner of Nature’s Spa in Charlotte, NC, sees middle school and high school children on a regular basis who are already dealing with chronic neck and back pain.

“Some schools do not allow students to go to their lockers during the school day, so they have to carry around five classes worth of books around all day on their back. Not to mention the walk to the bus stop and school,” she says.

Both Gallagher and Campbell agree that having a set of books both at home and in the classroom or using electronic books would eliminate the transferring of books on a daily basis.

“Until something changes, we are going to see an increase in neck and back pain and dysfunction in younger and younger children,” concludes Campbell.

Backpack Buying Tips:

Make sure your child's backpack weighs no more than 10 percent of his or her body weight.

The backpack should never hang more than 4 inches below the waistline.

A backpack with individualized compartments helps position the contents most effectively. Try to place the heaviest items closet to the body.

Bigger is not necessarily better. The more room there is in a backpack, the more your child will carry and the heavier the backpack will be.

Wide, padded straps are very important. Non-padded straps are uncomfortable, and can dig into your child's shoulders.

The shoulder straps should be adjustable so the backpack can be fitted to your child's body. Straps that are too loose can cause the backpack to dangle uncomfortably and cause spinal misalignment and pain.

Source: American Chiropractic Association