by Matthew Dobbs, MD, orthopaedic surgeon on staff at St. Louis Children's Hospital

Backpacks come in all sizes, colors and fabrics and offer kids a fun way to express their own sense of style while helping organize books and papers. But even though backpacks are practical, they can strain muscles and joints and cause back pain if they're too heavy or used incorrectly.

According to the U.S. Consumer Products and Safety Commission, more than 7,000 children were injured last year due to overloaded backpacks, some weighing as much as 45 pounds. Experts estimate about half of all American school children carry too much weight in their backpacks, causing some kids to experience neck, shoulder and back pain.

Although experts recommend backpacks should weigh no more than 10 percent of a child's weight, the average backpack weighs in at 20 percent of his or her weight.

In fact, 10 to 19 percent of children miss school or sports activities every year because of pain caused by heavy backpacks. Furthermore, 30 to 50 percent of adolescents complain of pain related to backpack use.

To help understand how heavy backpacks can injure kids, it helps to understand how the back functions. The spine is made of 33 bones called vertebrae, and between the vertebrae are discs that act as natural shock absorbers. When a heavy weight like a backpack filled with books is incorrectly placed on the shoulders, the weight's force can pull you backward. To compensate, you often bend forward at the hips or arch the back, which can cause the spine to compress unnaturally. The heavy weight can cause shoulder, neck and back pain.

To help lighten the load, kids should limit personal items, use both straps to distribute the weight and wear backpacks over the strongest mid-back muscles. Carrying the backpack with their hands or one shoulder is not recommended. The best option is roller packs, but unfortunately most kids don't consider them cool yet.

Adolescent girls ages 11 to 16 are most at risk because they experience a growth spurt during that age bracket. Girls often weigh less than boys, but still carry the same amount of backpack weight.

Kids who walk to and from school are also more likely to suffer Back pain from heavy packs because duration of use increases the risk of injury.

The good news is that hard science shows that back pain due to overloaded backpacks is usually temporary. The extra weight doesn't cause structural or long-term damage to the spine nor does it cause scoliosis.

When we treat patients for backpack pain, we usually prescribe a 10-day supply of anti-inflammatory medicine like Motrin and suggest lifestyle changes to help reduce weight and the amount of carry time. In some cases, physical therapy maybe recommended.

Teachers and educators realize that improper backpack use is a health concern, and schools are implementing an array of methods to help alleviate the issue, from using more handouts and lighter materials to offering digital/electronic assignments to even providing duplicate set of books, one for school and one for home. The key is to keep children healthy so that they can go about their lives and do the things they want without unnecessary pain.

Here are helpful tips to help insure kids know to safely use a backpack.

  • Choose it right. Selecting the right size of backpack is key.
  • Pack it right. Pack only what is needed and limit personal effects. If the backpack forces the child to move forward to carry, it's too heavy.
  • Wear it right. Use both shoulder straps and adjust them so they're snug, but not too tight. If the backpack has a waist strap, use it.

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