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November 2013

Backpack Fitting and Posture

by James Markwica, MS PT

More than 40 million students carry backpacks in America today. Many of these same students carry their backpacks overloaded or fit improperly resulting in a variety of injuries including neck pain, muscle spasms, tingling hands, headaches and lower back pain. This very pain may result in the increasing possibility of damage on posture and development of the spine. In 2003 the Consumer Product Safety Commission reported nearly 21,000 children were seen in emergency rooms for backpack related injuries. 

As parents there are a number of important issues you need to know in order to prevent backpack injury and promote spinal health. When choosing a new backpack, it’s recommended you select ergonomically designed features that enhance safety and comfort. The American Academy of Orthopaedic Surgeons recommends that a child’s backpack weigh no more than 15-20 percent of their own body weight. 

Picking the Backpack: Here are seven tips on choosing the best pack for your child.

  1. A padded back will minimize direct pressure on the back.
  2. Wide padded shoulder straps which will not hinder circulation to the arms which may cause numbness and tingling. 
  3. Waist and chest belts to transfer some weight from the back and shoulders to the trunk and pelvis.
  4. Multiple compartments to better distribute the weight in the backpack.
  5. Reflective material to enhance visibility at night.
  6. Lightweight backpack
  7. Correct Size: selection of the pack is important as packs come in different sizes for different aged children

Loading the Backpack: Follow these simple rules.

  1. 15 Percent Maximum Weight: This means a child who weighs 100 pounds shouldn’t wear a loaded school backpack heavier than 15 pounds.
  2. Load heaviest items closest to the child’s back.
  3. Arrange books and materials securely.
  4. Pack only necessary items that you will need for the school day.
  5. If the backpack is too heavy, consider using a book bag on wheels.

Wearing the Backpack: 

  1. Wear both straps: By wearing two shoulder straps, the weight of the backpack is better distributed, and a well-aligned symmetrical posture is promoted. 
  2. Tighten the straps: Adjust the shoulder straps so that the pack fits snugly to the child’s back while still allowing the pack to be put on and taken off easily. A pack that hangs loosely from the back can pull the child backwards and strain muscles.
  3. Put on and remove backpacks carefully. Keep the trunk of your body stable and avoid excessive twisting.
  4. Wear the backpack over the strongest mid-back muscles. Pay close attention to the way the backpack is positioned on the back. It should rest evenly in the middle of the back near the child’s center of gravity, and should not extend below the belt for than a couple of inches.
  5. Lift properly using your legs and both hands applying one strap and then the other.
  6. Encourage activity. Children who are active tend to have better muscle flexibility and strength, which makes it easier to carry a backpack. 

Once you have taken the proper steps in choosing, packing and wearing the backpack the ongoing assessment of your effort begins. It is extremely important to encourage your child or teenager to tell you about pain or discomfort that may be caused by a heavy backpack. Don’t ignore any back pain. If necessary, talk to your child and teachers to ensure that what your child is hauling back and forth to school is truly what is necessary. It may also be necessary to explain to your child that the schedule usually allows students to stop at their lockers throughout the day. Thus, giving them time to unload and reload the necessary books and supplies. If all else fails, one may always consider buying a second set of textbooks for your student to keep at home. Although this may seem unrealistic, it is a very simple solution for a child with significant pain.

We know that posture is impacted by a combination of factors including good muscle control, strength and flexibility. So, involve your children whenever possible in activities that promote good posture. Get your child moving: swimming, dance, karate, gymnastics, skating, etc. Becoming involved with sports activities helps develop muscular skills as well as self-confidence which is often a strong influence in posture. 

Seating is often a significant factor leading to slouching. Make sure your child sits in an appropriately sized child-size chair, or a pneumatically adjustable chair. Remember the “Rule of 90s”: Ears directly over the tips of your shoulders, hips flexed to 90 degrees, knees bent to 90 degrees and feet flat on the floor. Be sure the computer screen is directly in front of your face. Also, try to maintain a slight arch in your back by rolling your hips slightly forward. Feel free to assist this by placing a towel roll in the arched area. You can also try having your child sit on a physioball when completing homework or working on the computer. The instability of the ball forces core stabilization and good postural maintenance.

A couple of simple exercises for your children to practice are:

  • Sitting scapular retractions and depressions—put your ‘elbows in your back pockets’ by pinching your shoulder blades back while pushing your elbows back and down.
  • ‘Superman’ exercise—lay on stomach while lifting everything including your arms, legs, head and chest. Hold up while breathing for 3-5 seconds performing two to three sets of 10 repetitions

If you or someone you know suffers from pain as described above, it is ill-advised to begin a new exercise program without consulting first with your physician, a physical therapist, certified athletic trainer, chiropractor, physiatrist or other spine specialist who regularly treats back and neck pain. It is important to first get an accurate diagnosis for the cause of pain, as the specific exercises recommended will depend on the cause. If you would like to consult a physical therapist about an ergonomic evaluation, contact your local physical therapy clinic.

About the Author:

James Markwica, MS PT is the owner of LaMarco Physical Therapy, PC. He has worked in the outpatient setting since 2001 gaining clinical knowledge and experience in manual therapy and orthopedic, sports, spine rehabilitation for the non-, pre-/post-operative and vestibular patients. James has had the privilege to work with a wide variety of patients ranging from children to elderly adults, and professional athletes to ‘weekend warriors.’ For questions of follow-up, contact James at (518) 587-3256 or online at www.lamarcopt.com.


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