Do school bags cause back pain in children?

So let's have a look at a fairly topical subject, as many parents soon will either be buying, or looking at their child's school bag for after the summer break. It is widely bounded around in clinics by various therapists in various clinical settings in what now is almost conventional wisdom, that heavy school bags cause back pain, shoulder pain, even paresthesia. Postural changes commonly associated are forward head posture, increased anterior pelvic tilt, forward trunk lean, and an increased amount of force on the lumbosacral spine.

Current recommendations suggest that backpack weight should only be at 10%-15% of your child’s body weight! That’s a pretty impossible task and this recommendation wouldn't look out of place as a new budget airline policy for carry on luggage, it is that frugal!

Parents are often now guilty of nagging their children for carrying the pack over a single shoulder and worrying about the weight, but is it really that bad? Well the state of California seemed to think so, even passing a bill to limit the weight of children's packs!

A systematic review published in the British Journal of Sports Medicine* reviewed 69 studies with a total of 72,627 children relating to school bag use and back pain.

School bag characteristics such as weight, design and carriage method do not increase the risk of developing back pain in children and adolescents.

People rather unsurprisingly think of back pain in children as an injury and so look for a cause, making the school bag an easy target. It did however find some links to psychological perception of the school bag being heavy and increased back pain.

Load is actually good for the spine, so we want children to be physically active and to carry loads.

So it would appear those daily paper rounds as a youth where not just character building, but physically beneficial!

This whole industry is worth millions, to youtube bloggers illustrating how to pack and distribute heavy items, to companies selling highly engineered specific school backpacks for heavy loads. With austerity we have even seen parent led campaigns, as backpack loads have been going up because budget cuts have prevented schools from providing enough lockers, or a double set of books for the home and classroom.

So with that in mind it would appear that you can put the weighing scales away and follow the advice, that if a child is experiencing an episode of back pain it may make sense to temporarily reduce the load if this relieves the pain, but once they recover it is fine to return to a normal load in the schoolbag.

If you believe something to the contrary then let us know?

*Yamato TP, Maher CG, Traeger AC, et al Do school bags cause back pain in children and adolescents? A systematic reviewBritish Journal of Sports Medicine 2018;52:1241-1245.