Back-to-school shouldn't equal backaches

Sept. 29, 2006
Orthopedic surgeons offer tips to avoid back strain in students.

Students often look like they're going on an expedition, their backpacks laden with the needed tools for the day: textbooks, folders, sports gear, lunch, and more. It's no wonder that kids complain about back, neck, and shoulder pain during the school year. That's why the American Academy of Orthopaedic Surgeons (AAOS) warns parents to check their children's backpacks. Bags that are too heavy or are worn incorrectly could injure a child's bones, muscles, and joints.

According to the U.S. Consumer Product Safety Commission's latest statistics, about 10,000 children age 19 and under were treated at hospital emergency rooms, doctors' offices, and clinics for backpack-related injuries in 2005. Injuries such as tripping and falling over or getting hit by a backpack are common, but a large portion of these injuries — particularly chronic complaints such as those seen by orthopedic surgeons — include strains to the shoulder, neck, and back from carrying a backpack.

"Injury can occur when a child who is trying to adapt to a heavy load uses faulty posture such as arching the back, bending forward, or leaning to one side," said James H. Beaty, MD, a pediatric orthopedic surgeon and first vice president of the AAOS. "A backpack load that is too heavy also causes muscles and soft tissues to work harder, leaving the neck, shoulders, and back more vulnerable to injury," he said.

It is important for parents to limit the amount of time kids wear heavy packs and to monitor the selection, packing, and handling of their children's backpacks. The American Academy of Orthopaedic Surgeons offers the following tips to prevent backpack-related injuries in children:

• When purchasing a new backpack, look for those with different-sized compartments as well as construction features such as padding and dense material to protect against sharp, protruding objects.

• Organize the backpack to use all of its compartments. Place the heaviest items closest to the center of the back.

• Do not overload the backpack. A heavy backpack forces the wearer to bend forward.
• The maximum weight of the loaded backpack should not exceed 15 to 20 percent of a child's body weight, so pack only what is needed. For example, a child who weighs 80 pounds should carry no more than 12 to 16 pounds in the backpack. This figure may vary, however, depending on the child's body strength and fitness level.

• Use proper lifting techniques: bend at the knees and use the legs to lift the backpack, placing one shoulder strap on at a time.

• Learn back-strengthening exercises to build up the muscles used to carry a backpack.

• Purchase backpacks with two padded, adjustable shoulder straps, making sure to use both. Slinging a backpack over one shoulder or using backpacks with one shoulder strap that runs across the body does not allow weight to be distributed evenly, which can cause muscle strain.

• Use a waist/hip strap to distribute weight evenly between the back and the hips.

• Choose a backpack on wheels, if permitted by the school. However, remember that rolling backpacks must be carried up stairs and may be difficult to roll in the snow.

• Make frequent trips to the locker between classes to exchange textbooks. Do not carry around all the books needed for the day.

• Watch for the following warning signs that a backpack is too heavy: change in posture when wearing the backpack, pain while wearing the backpack, struggling when putting on or taking off the backpack, red marks on the shoulders, tingling or numbness in arms or legs.

For additional information about preventing backpack injuries and more, please visit the Academy's public and patient education Web site, Your Orthopaedic Connection ( ), or call the Public Service line at (800) 824-BONES.

An orthopedic surgeon is a physician with extensive training in the diagnosis and nonsurgical as well as surgical treatment of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles, and nerves.

With more than 29,000 members, the American Academy of Orthopaedic Surgeons or is the premier not-for-profit organization that provides education programs for orthopedic surgeons and allied health professionals, champions the interests of patients, and advances the highest quality musculoskeletal health.

Orthopedic surgeons and the Academy are the authoritative sources of information for patients and the general public on musculoskeletal conditions, treatments, and related issues. An advocate for improved patient care, the Academy is participating in the Bone and Joint Decade ( — the global initiative in the years 2002 to 2011 — to raise awareness of musculoskeletal health, stimulate research, and improve people's quality of life.