Imagine taking 20% to 30% of your body weight and carrying it around all day on your back. Believe it or not, that is how much weight many students lug around each day of the school year. Heavy backpacks have a destructive impact on the posture and spinal health of children and adolescents alike. Growing student populations and shrinking school budgets force students out of lockers and into carrying their books with them, all day. According to a study by Simmons College in February of 2001, 55% of students carry more than the recommended guideline of 10% to 15% of their body weight in their backpacks.¹

Recommend backpacks that feature wider, cushioned straps, more padding along the back, and strapping systems to pull the load closer to the center of gravity, like backpacks offered by Airpacks.

The American Academy of Orthopaedic Surgeons stresses that too heavy or incorrectly worn backpacks may injure a child's muscles and joints.² This is just a taste of the evidence that can be found about backpack safety and the injuries associated with heavy backpacks.

A University of San Diego School of Medicine-led team found that how loads are distributed under backpack straps may help identify the source of shoulder and back pain in children. Excessive pressure on the shoulders from too much backpack weight may be causing shoulder pain, and an uneven backpack load may contribute to low back pain.

In other words, heavy backpacks that are not properly loaded may alter the spine curvature, which leads to back pain. The study, published in the Archives of Pediatric and Adolescent Medicine, concludes that the average backpack load that children are now carrying should be reduced.³

While this is not groundbreaking news in itself, the hope in the publishing of these findings is that designers and manufacturers of backpacks will use this information to design better and more ergonomic backpacks. It is important to note that previous studies have measured general pain and heavy backpacks but have not correlated load distribution and pain. The numbers garnered from this research establish how much load in a backpack is too much.

Backpack companies are taking notice; already we are seeing backpacks with design elements that are colorful, comfortable, and ergonomically designed. Manufacturers are starting to make health concerns a priority when developing backpacks. That includes wider, cushioned straps, more padding along the back, and strapping systems to pull the load closer to the center of gravity.

But many of the backpacks on the retail shelves today are simply luring in buyers with a gazillion pockets, a different assortment of colors and styles, or a cartoon character imprinted on the front. But like most items in today's market, you get what you pay for. Cheaper-priced bags cannot meet the spinal health needs of today's pack rat schoolchildren. It is important that a pack be comfortable, help carry the weight properly, and possess a long durability period. Instruct the patient to look for a pack with wide shoulder straps and a design that gets the weight inside the pack as close to the body as possible.

How to Wear a Backpack

Following are some pointers you can give to patients on how to properly wear a backpack:

• Always wear both shoulder straps. Using only one strap puts to much strain on one side of the body, causing the spine to curve to adjust for the weight.
• Tighten the straps so the backpack rests comfortably in proper position. Do not wear the backpack too low—no more then 4 inches below the waistline—because this increases weight on the shoulders.
• If a front strap exists, use it and fasten it securely. Do not overtighten, because this will force the shoulders forward and not in their natural position.
• Observe posture. If the user is leaning forward, talking short steps, or using his hands to protect his shoulders from the straps, these are all indications that the backpack is too heavy or is being worn improperly.

I evaluated many different bags to find a few that I could recommend to my patients to help with all the biomechanical concerns of the heavy loads kids are toting around. I reviewed bags like JanSport Air Juice, Ogio Legend (you can attach a skateboard to this one), and Roxy. These bags are all priced about the same, have padded shoulder straps, and are quality made, but they don't offer the ergonomic edge I am looking for in a bag.

Bags that had padded shoulder straps and had front-clipping belts to give the bags an ergonomic edge were Ground Bass Pack, High Sierra, and Eagle Creek. But for these to work properly, children must buckle the waist belt for the bag to transfer the weight to the lower part of their body, which is unlikely, making these bags about as effective as the ones without the waist strap. With children's busy lifestyles, it can be a chore just to get them to use both shoulder straps.

That is one reason I like the Airpacks bag. It is a moderately priced bag that fits the criteria of an ergonomic backpack without having to use a waist belt. The air-filled lumbar cushion creates a fulcrum at the waist like the belted bags, shifting the weight to the patient's legs. One of the tests I conduct in my office is to place the patient's current backpack with all its contents inside an Airpacks backpack. The question I get right after the pack is fitted properly on their backs is, "What did you do with all the weight?"

After the patients have been educated about which backpack to purchase, teach them how to properly use it.

Packing the Backpack

Many backpacks on the market for children might feature interesting designs, but that doesn't necessarily mean the pack is ergonomically sound.

Always load the heaviest and largest items closest to the back. Bringing the weight closer to the center of gravity helps maintain balance.

If the backpack has side pockets, evenly distribute the weight side to side. This helps to reduce strain by not having to lean to any one side.

Never place more than 15% of body weight in the backpack. For every 20 pounds of body weight, no more than 3 pounds should be added.

Lifting a Backpack

• Place the backpack on a table or similarly elevated surface, eliminating the need to bend over to pick it up.
• Slide both arms through the straps, keeping the knees slightly bent.
• Make sure that the straps are snug on the shoulders; then, with the weight evenly distributed, stand up.

Providing backpacks in your office to sell to your patients is a great way to show them you are concerned about their health and well-being. Backpacks provide a great way for you to educate patients about spinal health and can be done with attractive posters and display racks. Education programs on how to make the sale and merchandising programs exist to assist in creating a profit center within the office. You are the expert when it comes to the spinal health of your patient; you should be ready to educate, support, and correct those patients who are abusing their spines with heavy backpacks.

R. Jerry DeGrado, DC, FICC, is president of the Congress of Chiropractic State Associations (COCSA) and is COCSA's national backpack safety chairperson. He coauthored the Backpack Safety Manual for COCSA. He practices in Wichita, Kan. Contact him at .

References

1. Simmons College. Available at: www.simmons.edu/about/news/releases/2001/2_12_01_backpacks.shtml. Accessed June 12, 2007.
2. American Academy of Orthopaedic Surgeons. Available at: www6.aaos.org/news/Pemr/press_release.cfm?PRNumber=387. Accessed June 12, 2007.
3. University of California, San Diego Medical Center. Available at: health.ucsd.edu/news/2005/12_05_Macias.htm. Accessed June 12, 2007.