John Seivert: Does carrying heavy backpacks cause back pain?
August 13, 2018
Children and adolescents who carry backpacks are not at higher risk of developing back pain. This current evidence calls into question popular opinion by healthcare providers, and many organizations that have recommended limits on backpack weights for children. The limits recommended have ranged from 5-20 percent of body weight.
Past studies have looked at the links of posture or body position and carrying a backpack. Original findings demonstrated that the changes in head and neck posture and the changes in the weight bearing forces across the feet are associated with wearing a heavy backpack and may be a cause for back pain. Other researchers have looked at whether it can lead to a change in the spinal curves.
One study found no significant difference in spinal curvature when carrying a bag on one shoulder compared to two shoulders. But it reported trends that might suggest spinal curvature changes with bag carrying in ways that might be detrimental to the spine.
Other studies have shown the type of backpack appears to have an effect on a child's respiratory function. A single strap pack that is used to put over one shoulder caused a reduced breathing performance (i.e. vital capacity).
However, none of these studies investigated relationships between backpack carrying and pain.
The latest study (May 2018) in the British Journal of Sports Medicine was a systematic review, where researchers compiled evidence from a number of different studies. These included five prospective studies (which followed a total of 1,799 children and adolescents over time) and 63 cross-sectional studies (Note: When reading research articles, systematic reviews are the most conclusive as they review all the best research and report on the overall findings).
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Of the 63 cross-sectional studies (cross-sectional studies analyze data from a population at a specific point in time), four found that the heavier backpack was associated with reports of back pain, three showed the method of carrying the pack was related to pain, and three found carrying a bag for longer periods was related to having pain.
One study found that 75 percent of students who had back pain reported that carrying their bag aggravated their pain. It's likely that current beliefs and guidelines for carrying school bags have been based on the data from these or similar cross-sectional studies. It is hard to make conclusions about the causes of back pain and backpack wearing from cross-sectional studies.
With the five prospective studies (a study that follows a group of similar subjects over a long period of time), only two actually measured backpack weight and both found it wasn't associated with reporting back pain. Two studies found that the perceived weight of carrying the bag was associated with back pain for kids aged nine to 14.
The take home message
The current research review tells us that the characteristics of a backpack don't cause back pain. For a child that already has back pain, it may seem to worsen when carrying a heavy bag or carrying it on one shoulder, but it's unlikely the backpack was the cause of the initial pain.
Therefore, moderately loaded backpacks are not detrimental to back health. In fact, loading the spine with weight is healthy and helps grow strong bones.
Parents shouldn't be concerned about backpack weight causing future problems for their children. But if carrying a heavy backpack means a child avoids cycling or walking to school, this is a good reason to lighten the backpack.
Lastly, if a child is wearing a backpack properly and following these guidelines listed above and still has back pain, you should consult with a physical therapist to assess the situation.
John Seivert is a Doctor of Physical Therapy and he has been practicing for 34 years. He opened Body Logic Physical Therapy in Grass Valley in 2001. He has been educating Physical therapists since 1986. Contact him at firstname.lastname@example.org.
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