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A Weighty Issue

An overloaded backpack can damage your child’s spine and your posture

September 18 is AOTA’s National School Backpack Awareness day.

backpacks

It turns out that a weighty issue may be messing with our children’s spinal health — the ubiquitous backpack. To understand this, just slip on a heavy backpack and look in a mirror. Notice how the pack’s weight pulls you backward, forcing an unnatural and uncomfortable spinal position. Most of us compensate by slouching forward or awkwardly arching the back — two unnatural postures that can harm your spine and lead to pain.

“Children need to be very careful about overloading their backpacks,” notes Ali Ganjei, MD, Inova Spine Program Medical Director and Inova Medical Director of Physical Medicine and Rehabilitation Services. “Back pain is serious, even in children, and can lead to problems later in life.”

Children’s sedentary lifestyles are compounding the back, neck and shoulder pain from burdensome backpacks, Dr. Ganjei notes. “The combination of the two issues — not getting enough exercise and backpacks that are two heavy — are leading to serious discomfort that needs to be addressed with treatment such as physical therapy,” he says.

Adults — especially traveling ones — aren’t immune from the repercussions of carrying an overstuffed backpack, either. Signs that you need to lighten up on your backpack load include headaches; strained shoulder, neck and lower back muscles; and, in severe cases, numbness, tingling or circulation loss.

Tips to Help Ease a Heavy Load and Safety Guidelines

  1. Make sure the backpack’s size and fit are appropriate to the typical loads it will carry. Select a backpack with wide padded straps that will help distribute the weight and, if possible, get one with a waist or chest strap to provide additional support.
  2. A backpack should never weigh more than 5% to 10% of a person’s body weight. A heavier weight can cause anyone to bend forward in order to support the weight. One way to help stay within healthy weight boundaries is to downsize the backpack. Bigger is not better, since it just provides more room to pack in the pounds. 
  3. Adjust the backpack so it sits no more than four inches below the waistline. Any lower and the natural inclination is to lean forward for balance, which is an unnatural posture that can cause pain.
  4. Pack smart. Pack only the school books your child needs for the day. When packing, put the heaviest books in first so they are closest to the back and the center of gravity.
  5. Choose a backpack with individualized compartments that help balance packed contents for equal load distribution across the back. This also helps prevent a temporary side-to-side curve in the spine.
  6. Wear both backpack shoulder straps. Using one strap causes a disproportionate shift of weight to one side, which according to the American Physical Therapy Association can lead to muscle strain and spasm in the neck and lower back regions. You also want wide, padded and adjustable shoulder straps. Straps that are too loose can cause the backpack to dangle uncomfortably low and trigger spinal misalignment and pain.
  7. Brighter is better. For added safety while walking, buy a backpack that is bright in color and of reflective material so it is visible to drivers and passersby.

If you can’t get your child’s backpack to a healthier weight, it may be time for a teacher-parent conference. Perhaps your child could leave heavier books at school and bring home only lighter handout materials or workbooks.

For another option, head online and search for “weight-reducing backpack.” These new backpacks reportedly diminish spine forces and address posture problems. Are these packs true to their promises? Your call! They are out there and ready to test.


Experiencing back pain? Getting help is simple. The Inova Spine Program can help.

The Inova Spine Program has a team of interdisciplinary specialists including physicians specializing in physical medicine and rehabilitation (physiatrists), orthopedic and neurological surgeons, interventional pain specialists, radiologists and physical therapists. Nonsurgical treatment options are explored before surgery. Learn about our state-of-the-art diagnosis and treatments. When back pain just doesn’t go away, making an appointment with us can be a first step to recovery.

For more information go to inovaspine.org, or, please call 703.776.4700.

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