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Take A Load Off!
Backpack Safety for Spinal Health

A heavy backpack won't cause scoliosis, but carrying it carelessly could lead to back pain or neck pain. Here are some spine-saving tips for backpack safety.

Your child's backpack should never exceed 10-15% of his or her body weight.

With an overabundance of homework often the norm and locker space equally in short supply, backpacks have become a popular means for carrying books, school supplies and all those other "must-haves" kids need to get through their day.

When carried correctly, in a way that keeps the weight distributed evenly across the back, they're a great way to keep stuff handy and can even help strengthen the muscles that help support the spine. Carried incorrectly—overloaded, for example, or routinely slung over one shoulder—a backpack can strain muscles and joints, leading to back and neck pain.

According to the American Physical Therapy Association, the weight of a backpack should never exceed 10-15% of a child's body weight. Because many of today's backpacks are so well-constructed—roomy, durable, and with compartments and pockets to hold everything but the proverbial kitchen sink—this can be an easy target to miss. To get an idea of the extent of the overloading, an Italian study revealed the weight of the average child's backpack to be closer to 22-27% of body weight, the equivalent of a 39-pound burden on a 176-pound man or a 29-pound load carried by a 132-pound woman.1 Imagine toting around a large bag of dog food or an economy-sized bag of kitty litter all day, and you get the picture.

How Backpacks Can Hurt

To understand how a heavy or improperly worn backpack can affect a child's spine, it's important to understand how the spine works. Humans are born with 33 separate vertebrae, or bones, that make up the spine and support the majority of the weight imposed on it. Between the vertebrae are spinal discs that function as shock absorbers and joints. They are designed to absorb the stresses carried by the spine while allowing the vertebral bodies to move with respect to each other.

When stresses placed on the spine exceed its ability to absorb them, spinal imbalance—and injury—can be the result. A heavy backpack, for example, can pull a child backward, causing the child to compensate by either bending forward or arching their back, compressing the spine. Slinging a backpack over one shoulder can also cause a child to lean too far to the other side to offset the weight. Over time, this overcompensation can lead to poor posture, muscle strain and pain in the back, neck and shoulders. Backpacks with tight, narrow straps that dig into the skin can interfere with circulation and nerve function, causing tingling, numbness and weakness in the arms and hands.

Warning signs a backpack is too heavy:

  • Change in posture when wearing the backpack.
  • Struggling when putting on or taking off the backpack.
  • Pain when wearing the backpack.
  • Red marks.
  • Tingling or numbness.

According to a survey conducted by the North American Spine Society, 42.6% of NASS member physicians had treated children or teens suffering from back pain or spine trauma caused by overloaded or improperly used backpacks. The diagnoses ranged from cervical, thoracic and lumbar strain to spondylolysis, a stress fracture in the vertebra.

What Can You Do?

When carried correctly, backpacks can be a safe, efficient way for kids to carry the things they need. When choosing a backpack, the American Academy of Pediatrics recommends looking for the following:

  • Lightweight yet durable construction that doesn't add to the load. (Leather, for example, looks cool but is a lot heavier than nylon or canvas.)
  • Two wide, padded shoulder straps, as narrow straps tend to dig into the shoulders.
  • A padded back, which not only boosts comfort, but also protects against sharp objects in the pack.
  • A waist strap, to help distribute weight more evenly across the body.
  • Multiple compartments, which can also help distribute weight more evenly.

Although a rolling backpack with wheels can be a good option, it's important to remember that it may be difficult to pull up stairs or roll across grass or through snow. Check with the school before buying one; many don't allow them because they can pose a tripping hazard in hallways.

To prevent injury when using a backpack:

  • Pack lightly. The combined weight of the backpack and its contents should not exceed 10-15% of the child's body weight. Girls and younger children should aim for the lower end of the percentage range.
  • Organize. Pack heavier items closest to the back. Pack items in compartments so that the weight is evenly distributed.
  • Use both shoulder straps to distribute the weight evenly across the back. Shoulder straps should be adjusted to allow the child to put on and take off the backpack without difficulty and permit free movement of the arms.
  • Tighten the straps to keep the backpack close to the body. The backpack should rest evenly in the middle of the back. Make sure the backpack does not extend below the low back
  • Use a locker (if available). Don't carry everything needed for the day all the time. And unless that laptop, iPod, makeup bag, or (for the little ones) favorite action figure is REALLY needed, leave it at home.
  • Squat down, bending at the knees, not at the waist, when lifting or lowering a heavy backpack.
  • Do back strengthening exercises to build up the muscles that support the spine.

Adults can also help. If you're a parent, the American Academy of Orthopaedic Surgeons recommends the following:

  • Encourage your child to tell you about any pain or other symptoms he or she may be experiencing because of a heavy backpack. Be on the alert for any outward signs of discomfort.
  • If your child mentions back or neck pain, pay attention and don't ignore their complaints. If the pain persists, make an appointment with the pediatrician.
  • Although a backpack won't cause scoliosis, it can disguise a spinal curve that may be developing. Onset most commonly takes place during the "growing years" of 9-15, so be sure that your child is screened regularly for the condition.
  • If the homework load seems to be excessive, talk to your child's teacher or school administrators.
  • Ensure that the school provides lockers, and allows enough time for students to stop by their lockers throughout the day.
  • If possible, consider buying a second set of textbooks to keep at home.


1 Negrini S, Carabalona R. Backpacks on! Schoolchildren's perceptions of load, associations with back pain and factors determining the load. Spine. 2002 Jan 15;27(2):187-95.

IRN 8049

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  • Published: April 02, 2009
  • Updated: April 03, 2009