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Health A to Z  —  5 minutes

Back-to-school tips for dealing with a heavy pack

September 6th, 2019

With kinesiologist Hugo LeBire, a health and fitness specialist at Biron Occupational Health, and Raymond Lepage, our senior scientific advisor

With the new school year beginning, parents may worry about the long term impacts of their children lugging hefty backpacks full of books.

Avoiding back pain in the first place comes down to common sense. Prevention and education should come before treatment – be on their backs so that they don’t hurt theirs! It’s interesting to note that what our children can carry on the sports field (such as heavy golf clubs) is more heavily regulated than what they carry every day in their pack. Here’s a few easy tips to avoid long term problems.

Buy the right pack

Choose a pack with wider straps, and a good sternum support to prevent it slouching down their back. Don’t just let them pick the one that looks cool! I bought my daughter a pack with an extension handle and wheels, just like an airport roller. On days that the pack is heavy or she has to walk further, she simply extends the handle and rolls it.

Teach them how to organize

The same principles of weight distribution apply to packing as they do when you go hiking. Teach your child not to just throw everything in as they think of it – keep heavier items closer to the body and lower in the pack.

Teach proper lifthing technique

By default, your child will probably lift their pack straight from the floor and flip it round onto their back. This causes a flexion rotation that’s a sure path to injury. Instead, have them face the bag, and using the knees, lift from the floor to a desk. Then, turn around and place it on the back without the dangerous twist rotation.

The science of the schoolbag

There’s real science behind worry about backpack weight leading to back pain among children in adolescents, backed up by recent studies. According to an American study on backpack weight in 345 fifth to eighth graders, published in 2002 [1], half carried a load greater than 15% of their body weight. This figure was as high as 21% for sixth year students. Another American study in 2003 indicated that heavy packs might explain the huge increase in prevalence of back pain from less than 10% in pre-teens up to 50% in 15–16-year-olds. This study seemed to indicate that the use of a backpack and the weight carried were independently associated with back pain. It showed that females tended to suffer greater back pain, and body mass was also a key factor [2].

Ideal weight

From these early studies, a general recommendation emerged to keep the weight of the backpack below 10% of body weight [3].

In other words, for a typical Canadian 5th-grader weighing 34 kg, the research suggested that the combined weight of the backpack and content should never exceed 3.4 kg.

However, numerous studies since been published which question this simple relation between pack weight and back pain. A 2018 meta-analysis of 69 different studies, covering 72,627 students, was unable to confirm any relationship between heavy backpacks and back pain. Interestingly, it did show that there seemed to be a relationship between back pain and the “perception” of weight – in other words, a child who doesn’t like school will often tend to find their pack to be too heavy [4].

Other factors

Beyond body weight, there are other factors to consider, including height, posture, and lifestyle – exercise, sleep, and so forth. Distress and other psychological factors (fatigue, lack of interest in school, etc.) seem more important than the weight of the backpack in many cases [5].

Nevertheless, even if a backpack’s weight is not the principal cause of back pain in children, it is very probably an aggravating factor and worth considering. A well-designed pack should also alleviate some of the strain.

  1. Goodgold, Shelley, Moira Corcoran, Diana Gamache, Jennifer Gillis, Jennifer Guerin, and Jennifer Quinn Coyle. “Backpack Use in Children.” Pediatric Physical Therapy 14, no. 3 (2002): 122–31.
  2. Sheir-Neiss, Geraldine I., Richard W. Kruse, Tariq Rahman, Lisa P. Jacobson, and Jennifer A. Pelli. “The Association of Backpack Use and Back Pain in Adolescents.” Spine 28, no. 9 (2003): 922–30.
  3. Mackenzie, William G., Jayanth S. Sampath, Richard W. Kruse, and Geraldine J. Sheir-Neiss. “Backpacks in Children.” Clinical Orthopaedics and Related Research 409 (2003): 78–84.
  4. Yamato, Tiê Parma, Chris G Maher, Adrian C Traeger, Christopher M Wiliams, and Steve J Kamper. “Do Schoolbags Cause Back Pain in Children and Adolescents? A Systematic Review.” British Journal of Sports Medicine 52, no. 19 (February 2018): 1241–45.
  5. Kamper, Steven J., Tie Parma Yamato, and Christopher M. Williams. “The Prevalence, Risk Factors, Prognosis and Treatment for Back Pain in Children and Adolescents: An Overview of Systematic Reviews.” Best Practice & Research Clinical Rheumatology 30, no. 6 (2016): 1021–36. OpenUrl