Are heavy backpacks responsible for back pain?

When I look at the shelf struggling to hold the weight of my textbooks I can’t believe I tried carrying some of these to class every day. I think most of us would agree that heavy backpacks can cause back pain or at least sore shoulders. Many articles have found associations between heavy backpacks and pain in school children but a recent meta-study from the British Journal of Sports Medicine disagrees.

“Evidence from cross-sectional studies aligned with that from longitudinal studies (ie, there was no consistent pattern of association between schoolbag use or type and back pain).”

Wow! Sounds like done deal, right?  We might write off kids complaining of heavy bags all together, but just last year the British Journal of Pain put out a first ever nation-wide study of the topic.

“The study was the first national study which looked into the effect of bag weight on back pain in schoolchildren in Malta. It found that bag weight contributes towards back pain in children, together with BMI, gender and grade.”

Awesome, a different study finds it as a contributing factor among other things. This conflict in science is something we’re seeing all too often these days. Who’s right? Which study or source can I actually trust? Is this a build up to a joke about the British contradicting themselves? The first two questions are hard to answer, the last is an easy no.

Who’s right?

It’s no easy task to critically appraise scholarly articles and there is even disagreement about what types of studies are more reliable. If we look at evidence hierarchies, meta-studies are considered the top tier. They compile many smaller studies into one large study to try and identify a common effect or answer a single question. This would mean we should consider there to be no pattern of heavy back packs and back pain.

However, others argue that these averaging, over-arching type studies are hard to apply to individuals as everyone is different. We won’t focus on this debate today, but a recent philosophical thesis challenged these rankings and assumptions.

“[These studies] are primarily used to provide evidence for claims about the average treatment effect, and their primary results provide no evidence about individual treatment effects… but information about average treatment effects is an insufficient basis to make recommendations.”

This argument would have us lean towards the second study. There were actual kids, with actual pain who were carrying heavy backpacks. The study did note some other factors like body mass index (BMI), gender, and grade level but that doesn’t discount the significant findings.

What to do

While the scientists and philosophers battle it out over whether heavy backpacks cause back pain or not, we should still take steps to lighten the loads children (and adults) are carrying on a regular basis. We probably don’t need a study to tell us that an 80-pound kid shouldn’t be carrying a 40-pound backpack.

Aside from the unnecessary struggle, heavy backpacks can cause changes in head posture and weight distribution across the feet. The forward lean many students will take on to counter the pull of a heavy backpack might be related to the increase in Text Neck we’re seeing in children today. Heavy loads may also be hard for small children to balance and cause them to fall. If they fall forwards, the heavy load might impart additional crushing injuries.

Steps to take

Here are some recommendations to help keep your child safe and their load, light.

  • Keep the weight below 10-15% the child’s weight.
    • An 80-pound child’s backpack should be around 8 to 12 pounds
  • Use both straps and avoid single strap bags
  • Adjust the bag so it hangs at the middle of the back, not sag to the buttocks
  • When shopping for a bag look for
    • Lightweight
    • Wide, padded shoulder straps
    • Padded back
    • Multiple compartments (helps distribute weight)
    • Waist belt (optional)

Make sure you communicate with your kids as well. Most of the ability to increase or decrease their load lies with them.

  • Encourage kids to use their locker or desk throughout the day instead of carrying all their books at once.
  • Make sure kids don’t tote unnecessary items
    • Laptops, cellphones, and video games
    • Regular, weekly cleanings can remove unneeded supplies and old papers
      • You may also find important papers they forgot to show you.
  • Encourage kids to bring home only the books needed for homework or studying each night.
  • Develop a homework plan for the week
    • A heavier pack on Friday might mean that a child is delaying homework until the weekend.
  • Use all the compartments
    • Put heavier items, such as textbooks, closest to the center of the back.

While it remains to be seen if heavy backpacks are an actual cause of childhood back pain, we should continue to take steps to reduce the load children are carrying on a regular basis.