Book Bags: What Every Parent Should Know

Book Bags: What Every Parent Should Know

This section is compiled by Frank M. Painter, D.C.
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I.C.P.A. Newsletter November/December 2000

By Richard A. Pistolese

Chiropractors have long recognized the spinal health hazards of heavy backpack use. Now, research presented at the American Academy of Physical Medicine and Rehabilitation's annual meeting exposes yet another potential danger of heavy backpacks: They promote falls in students who wear them. Specifically, students who carried packs weighing 25% of their body weight exhibited balance problems while performing normal activities such as climbing stairs or opening doors, in turn upping their risk of falls. In contrast, students who carried packs weighing 15% of their body weight maintained their balance moderately well. And, those carrying 5% of their body weight were most effective at maintaining balance, compared with their peers who carried more weight.

According to the Consumer Product Safety Commission, there were over 12,700 visits to emergency rooms in 1998 for backpack-related injuries to 5- to 18-year-olds. A recent survey of 101 doctors conducted by the American Academy of Orthopedic Surgeons revealed that 58% of the orthopedists polled reported seeing kids with back or shoulder pain related to backpacks. More than 70% of the orthopedists surveyed indicated that heavy back packs can become a clinical problem in school-age children if not enough attention is made to decrease some of the weight being carried in the packs. The survey, and other reports, also indicated that a backpack could cause a clinical problem when the contents weigh 20% more than the child's body weight.

In an effort to reduce backpack related injuries, the we offer the following suggestions for parents and students. As always, have your child examined regularly by a chiropractor so that any potential spinal, or postural problems can be addressed and corrected.


  1. Look for backpacks with wide, padded shoulder straps. Narrow straps dig painfully into shoulders and can hinder circulation, causing numbness or tingling in the arms, which over time may cause weakness in the hands. Padded shoulder straps help absorb the load.

  2. Look for backpacks with "S" shaped shoulder straps, which will ergonomically contour to your child's body.

  3. Consider the weight of the backpack when empty. For example, a canvas backpack will be lighter weight than leather.

  4. Look for backpacks with a waist or chest strap. This will help keep the load close to the body and help maintain proper balance.

  5. Look for backpacks with a backpack with a built in back support.

  6. Look for backpacks with a lumbar pillow.

  7. Make sure the backpack is not too heavy. Students of all ages seem to be carrying heavier loads. Even when worn properly with both straps, leaning forward to compensate for this extra weight can affect the natural curve in the lumbar, or lower back region. Extra weight may cause a rounding of the shoulders and an increased curve in the thoracic, or upper back region. As a result, the student may experience back, shoulder and neck pain. A good rule to follow is to carry no more than 10-15% of one's body weight.


  1. Wear both shoulder straps. Slinging a backpack over one shoulder causes a person to lean to one side to compensate for the uneven weight, curving the spine. Over time, this can cause lower and upper back pain, strained shoulders and neck, and even functional scoliosis, or curvature of the spine. Teenage girls are especially susceptible to scoliosis.

  2. Distribute weight evenly across your back. The more spread out a load is, the less strain it puts on any one part of your body. Load pack so the heaviest items are right next to your back.

  3. Snug shoulder straps so the pack fits close to the upper part of your back. The further a backpack's load is from your back, the more it pulls you backward and strains muscles between your shoulders.

  4. Use the waist belt, and side/chest straps. Keep the load close to your body. Keeping the pack close to your hips also shifts "work" to your legs.

  5. The bottom should rest in the curve of your lower back and the top touch just below the big knob on your neck (vertebral prominence).

  6. Neatly pack your backpack, and try to keep items in place.

  7. Try to make frequent trips to your locker, between classes, to replace books.


1.  The effects of backpack weight on functional mobility and balance
Arch Phys Med Rehabil 2000

2.  AAOS survey of physicians at Children's Memorial Hospital, Chicago, Ill., and Alfred I. duPont Institute, Wilmington, De

3.   Weight of schoolbags in a Freiburg elementary school. Recommendations to parents and teachers
Offentl Gesundheitswes 1979; 41(5): 251-3

4.  Backpacks … Your child’s spine is at stake
ICPA Newsletter November/December 1998

5.  American Chiropractic Association Press release July 1999.  Improper use of backpacks leads to chronic back pain.

6.  Weight of backpacks carried by elementary school children: students or sherpas?
Acad Emerg Med. 2000

7.  Backpack as a daily load for schoolchildren
Lancet 1999; 1974

8.  Influence of carrying book bags on gait and posture of youths
Ergonomics 1997

9.  Strain in children caused by carrying schoolbags
Offentl Gesundheitswes 1977

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Copyright © 1996 Richard A. Pistolese
Last modified: March 22, 2002

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