Back to school can mean many things: new teacher, new courses, new friends, and new clothes. The return to the classroom may also involve a new backpack and for some, back pain.
"Shoulder and back pain can be related to backpack use. Usually, the pain is muscular," says Rita Damignani, a physical therapist in the Department of Rehabilitation Services at Toronto's Hospital for Sick Children (SickKids). "The good news is there doesn't seem to be evidence to suggest it can lead to bigger problems. But we don't really know."
While back pain is common in adults, this phenomenon is not restricted to grown-ups. According to a recent study, the number of adolescents reporting back pain is nearly that of adults. Although back pain can be caused by many factors, some research shows that backpack usage can either be a cause of back pain or exacerbate existing back pain. Both the weight of the pack and the amount of time wearing the pack have been linked to back pain. Other studies show that girls report more backpack-related pain than boys, as do overweight teens.
For the most part, the patients Damignani sees at the rehabilitation department are not there because of pain caused by backpacks, but "if a child comes in complaining of shoulder or back pain, we always discuss backpack use." Damignani says there are clues to help find out if the backpack is a problem. "If they don't wear the pack over the weekend and are fine but the pain is back on Monday, it might be the backpack," she says, adding "if pain is persistent, they should see their family doctor."
Avoiding backpack pain
Backpacks can cause problems both through excessive weight and through amount and type of usage. "In terms of weight, when loaded, the pack should weigh no more than 10 to 15 per cent of body weight," says Damignani. "The lighter it is when empty, the better it is."
When it comes to wearing the backpack, there are several strategies that can reduce the chances of injury or pain.
"Good backpacks should have wide padded shoulder straps so the padding helps absorb the load," says Damignani, "and a waist or chest strap to keep the load close to the body. That way it's your back and hips carrying the load. It also helps with balance. If it is hanging off them it is hard to maintain a proper balance."
Damignani also suggests keeping the heaviest items closest to the back and more towards the bottom. "If the heaviest items are at the top, it can throw your balance off." The pack itself should rest below the bottom of the neck and above the curve at the bottom of the spine.
Damignani says that some of the challenge is getting children to follow the rules, which are sometimes at odds with what is considered 'cool' fashion.
"A lot of kids carry the pack slung on one side only. They should be wearing both shoulder straps," she says, admitting that convincing teens to wear a pack properly can be a challenge. "The best thing to do is to explain why they should wear it like that. That's the only way to help."
The North American Spine Society and the American Academy of Orthopaedic Surgeons offer the following advice when it comes to backpacks:
Choosing a backpack:
Consider a pack with a padded lower back. Called a lumbar pillow, this helps protect against sharp edges on objects inside the pack and increases comfort.
Consider a waist strap which can distribute the weight of a heavy load more evenly.
Consider a rolling backpack with wheels. This may be a good choice for students who must carry a heavy load. Rolling backpacks should be carried up stairs.
Choose a backpack with tide padded shoulder straps.
Choose a lightweight backpack.
Using a backpack
Pack light. A loaded pack should not weigh more than 10% to 15% of the child's body weight. As a general rule, this amounts to about two to four kilograms (about five to 10 pounds) for elementary students and about seven kilograms (about 15 pounds) for older students.
Try to distribute the weight evenly. Organize the pack so that heavy items are close to the wearer's back.
Use both straps and adjust them snugly on the shoulders. Readjust the straps every time the pack is loaded. Straps should be well padded.
Be active in order to strengthen the muscles in and around the back and neck.
Practice proper posture and bend at the knees not the waist.
Take the backpack off to give your muscles a break when you can; for example, on the bus or when standing still.
Consider only taking needed books between classes and leave everything else in the locker at school.