Back to school tips for safe backpack use. by Kristin Massamiri, Physical Therapist Wearing backpacks that are too heavy or wearing them improperly can put kids at increased risk for spinal injury.

One factor associated with musculoskeletal pain in school-age children is backpack use. While a backpack is still one of the best ways to tote homework, an overloaded or improperly worn backpack gets a failing grade, according to the California Physical Therapy Association (CPTA). Wearing backpacks that are too heavy or wearing them improperly can put kids at increased risk for spinal injury. The general guideline is that backpacks should not weigh more than 15 percent of a child’s body weight. Injury can occur when a child, in trying to adapt to a heavy load, uses harmful postures such as arching the back, leaning forward or, if only one strap is used, leaning to one side. In turn that can cause spinal compression and/or improper alignment. A too-heavy load also causes muscles and soft tissues of the back to work harder, leading to strain and fatigue. This leaves the back more vulnerable to injury. A heavy load may also cause stress and compression to the shoulders and arms. When nerves are compressed, the child may experience tingling or numbness in the arms.

Worn correctly and not overloaded, a backpack is supported by some of the strongest muscles in the body: the back and abdominal muscles. These muscle groups work together to stabilize the trunk and hold the body in proper postural alignment.

Here are a few tips for safe backpack use:

1. Wear both straps. Using only one strap, even with backpacks that have one strap that runs across the body, causes one shoulder to bear the weight of the bag. By wearing both shoulder straps, the weight of the backpack is better distributed, and a symmetrical posture is promoted. A backpack with padded, contoured shoulder straps will also help reduce pressure on the chest and shoulders.
   
2. Make sure the backpack fits. It is important to pay close attention to the way a backpack is positioned on the back and the size of the backpack should match the size of the child. Shoulder straps should fit comfortably on the shoulder and under the arms, so that the child can move freely. The bottom of the pack should rest in the contour of the lower back. The pack should fit evenly in the middle of the back, not sag down towards the buttocks.
   

1. Padded back to reduce pressure on the back and prevent the pack’s contents from digging into the back.
   
2. Waist belt to help distribute some of the load to the pelvis.
   
3. Compression straps on the side or bottom of the backpack that, when tightened, compress the contents of the backpack and stabilize the articles.
   
4. Reflective material so that the child is visible to drivers at night.
   

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