Physical therapists give the A-B-C's of smart backpack use

While a backpack is still one of the best ways to tote homework, an overloaded or improperly worn backpack gets a failing grade, according to the New York Physical Therapy Association.

Improper backpack use can cause injury, especially to children with young, growing muscles and joints. A study led by American Physical Therapy Association member Shelley Goodgold, PT, associate professor of physical therapy at Simmons College in Boston, found that 55 percent of the children surveyed carried backpack loads heavier than 15 percent of their body weight, the maximum safe weight for children recommended by most experts.

"It is disturbing to find children carrying backpacks heavier than the recommended weight limit, particularly given the vulnerability of youths' musculoskeletal systems during these growing years," Goodgold said.

New York Physical Therapy Association member Gabe Yankowitz, PT, of VanBeveren & Yankowitz Physical Therapy and LaFayette Physical Therapy concurs with Goodgold. "We are seeing more and more youngsters with back and neck complaints every year, and these problems can very often be traced directly to the use of heavy and improperly designed backpacks," he says.

Injury can occur when a child, in trying to adapt to a heavy load, uses harmful postures such as arching the back, leaning forward or, if only one strap is used, leaning to one side. According to physical therapists, these postural adaptations can cause spinal compression and/or improper alignment, and may hamper the proper functioning of the disks between the vertebrae that provide shock absorption. A too-heavy load also causes muscles and soft tissues of the back to work harder, leading to strain and fatigue. This leaves the back more vulnerable to injury. A heavy load may also cause stress or compression to the shoulders and arms. When nerves are compressed, the child may experience tingling or numbness in the arms.

Worn correctly and not overloaded, a backpack is supported by some of the strongest muscles in the body; the back and abdominal muscles. These muscle groups work together to stabilize the trunk and hold the body in proper postural alignment.

In Goodgold's study, one-third of the children reported experiencing back pain that had caused them to visit a doctor, miss school, or abstain from physical activities. "While we do not have scientific evidence proving that heavy backpacks cause serious back or other musculoskeletal damage," Goodgold said, "we do know that children who have back pain usually have recurrent problems, and we know that the risk of future back problems increases when a person has had one episode."

Tips for safe backpack use

•Wear both straps. Using only one strap, even with backpacks that have one strap that runs across the body, causes one shoulder to bear the weight of the bag. By wearing both shoulder straps, the weight of the pack is better distributed, and a symmetrical posture is promoted. A backpack that has padded, contoured shoulder straps will also help reduce pressure on the chest and shoulders.

According to APTA, examples of backpacks with desirable shoulder straps are the Lands' End Collegiate (TM) and Collegiate Junior (TM) backpacks, sized especially for children.

•Make sure the backpack fits. It is important to pay close attention to the way a backpack is positioned on the back, and the size of the backpack should match the size of the child. Shoulder straps should fit comfortably on the shoulder and under the arms, so that the arms can move freely. The bottom of the pack should rest in the contour of the lower back. The pack should "sit" evenly in the middle of the back, not "sag down" toward the buttocks.

Physical therapists recommend
the following features when selecting a backpack:

•A padded back to reduce pressure on the back and prevent the pack's contents from digging into the child's back;

•A waist belt to help distribute some of the load to the pelvis;

•Compression straps on the sides or bottom of the backpack that, when tightened, compress the contents of the backpack and stabilize the articles;

•Reflective material so that the child is visible to drivers at night.

Some children may find backpacks with wheels a good option. Goodgold cautions, however, that wheeled backpacks may present problems, such as getting them up and down stairs or trying to fit them into cramped locker spaces. If a wheeled backpack is chosen, Goodgold says to be sure that the extended handle is long enough so that the child is not forced to twist and bend, and that the wheels are sufficiently large so that the backpack doesn't shake or topple. It is also wise to consider the weight of the backpack when empty. For example, a standard canvas backpack will be lighter in weight than one with wheels.

Know the signs backpack is too heavy

•Pain when wearing backpack;

•Tingling or numbness in the arms; and

•Red marks on the shoulders.

Above all, urge your children to tell you if they are in pain or have discomfort before a problem becomes serious," Goodgold said.

The New York Physical Therapy Association (NYPTA) is a non-profit professional organization composed of approximately 5,000 licensed physical therapists (PTs), physical therapist assistants (PTAs) and PT/PTA students. The NYPTA is dedicated to serving the public's health interests, improving the standard of health for people of all ages, and advancing the interests of physical therapists in the State of New York.