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Got Back Pain? Don’t Blame the Backpack

Active children and adolescents frequently develop back pain whose cause is difficult to pinpoint. Backpacks have long been blamed. Indeed, pediatricians and other healthcare professionals have declared them dangerous, and developed guidelines recommending safe carrying strategies and weight limits.

But more than two decades of research suggest the multipurpose satchels may be innocent. In a 2018 analysis of the evidence, no feature of backpacks or the way school-age children use them was connected to back pain. Researchers from the University of Sydney in Australia analyzed 69 studies involving 72,627 children and adolescents.

“Contrary to popular opinion, the findings are telling us that there is likely no link between back pain and schoolbag characteristics like weight, type and the way kids are carrying them,” said author Steven Kamper, Ph.D., in a statement from the University of Sydney.

“The findings really call into question the various guidelines that advise only carrying 10 percent of one’s body weight, and statements from professional groups that endorse particular brands of backpacks,” he added.

Back pain is common, but cause usually unknown

Estimates of how many kids develop low back pain vary widely. On average, perhaps one-third report back pain over the course of a year, with fewer cases in young children and more in teenagers.

Fortunately, back pain in kids usually goes away on its own. To the bewilderment of many doctors, however, its causes remain unknown. Researchers have explored triggers ranging from body weight and muscle strength to psychological and social problems (such as satisfaction with school) to physical activity levels and smoking.

Although no single factor has been shown to account for the development of back pain in kids, two characteristics tend to lead the list of suspects. Back pain seems to be more common as children age and among competitive athletes. Other factors may contribute, but so far, despite dozens of studies, there is not enough evidence to implicate them.

Understanding the roots of back pain is important because it can affect people across their lifespan. In one study, about a quarter of children 11-14 years old with back pain still had symptoms four years later. Other research has shown that kids with back pain are more likely to have back pain as adults, when low back pain can lead to work disability, reliance on pain medicines and other problems.

Assessing loads, carrying method and perceived weight

The Australian review on backpacks assessed 69 studies. It emphasized research that followed children and adolescents who didn’t have back pain to see which ones developed pain over time. Experts consider this type of research better at showing whether a certain factor might be responsible for causing a problem.

The studies measured loads carried in a backpack, the weight of the bag as a percentage of the child’s body weight, the bag’s design, carrying method (for example, on one or two shoulders) and more.

The authors did find a link between kids’ perception of their backpack and low back pain. Those who said a backpack felt heavier were more likely to report back pain. And those who reported difficulty carrying their packs reported back pain that persisted over time.

The authors note that the research they assessed was not perfect. But given the number of children involved in the research, the number of studies and the similarity of results across studies, they recommend future research look elsewhere to unlock the mystery of back pain in kids.

“We still don’t have a good understanding of pain in the childhood and adolescent years, and that’s why we often hear generic phrases like growing pains or adolescent pain,” said Kamper.

“For many children pain comes and goes with little worry and we would be silly to intervene medically,” he added. “However, other children go on to experience ongoing pain and disruption to their lives. We need further research to help us understand how to distinguish between these groups and what is causing the pain.”

Backpack tips

Healthcare providers who care for children and adolescents say there are some common-sense steps kids can take to improve the comfort of their backpacks. A child who has back pain that does not improve should see a provider who specializes in children’s back pain.

  • Use a backpack with wide, padded shoulder straps and a padded back
  • Choose a backpack with multiple compartments that can distribute the load
  • Carry the backpack on two shoulders, not one
  • Snug up the straps so the backpack load is closer to the body
  • Use hip and chest belts to help transfer some of the weight to the hips and torso
  • Carry only items that are needed for the day
  • To lighten loads, drop off or exchange heavier books at a locker throughout the day

(Sources for backpack tips: American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, American Occupational Therapy Association, National Safety Council)