During the first few months of the year, you may have noticed your children leaning forward to help them balance against the weight of their backpacks. This is often a cause of worry for parents as they wonder if their children’s posture and heavy backpacks will affect their growth and causing them pain. It is a valid concern.
Many children are carrying excessively heavy backpacks for their size. For some, the bags may weigh up to 45% of their body weight or more.1 Even athletic adults who are using backpacks for the purpose of fitness walking (“rucking”) are recommended to begin with no more than 10%! Packs should not exceed 10% of the child’s body weight; excessive load can lead to spine maladaptation over time, such as scoliosis and kyphosis. Studies have linked backpacks with back pain progressing from childhood to adulthood.
Tips for correct use of backpacks
Improper positioning of heavy backpacks can hunch the neck and upper back, strain the shoulders, and cause lower back tightness and fatigue. This is especially true for children who have not yet developed their core muscle strength. In addition, changes in upper torso posture will cause compensatory changes in the hips and knees, as well as maladaptation in gait pattern.
Firstly, not all backpacks are created equal. Just like clothing and shoes, be mindful of the fit and sizing in relation to the child. A backpack should have two broad shoulder straps and a waist strap (preferably also a thick one). It should be made of a lighter fabric than those used by adults and hikers. The backpack should be of a similar length to the child’s torso and should not extend below the belt line..
Secondly, don’t just toss a backpack onto a child’s shoulders. The backpack should be strapped close to the body, with minimal gap between the pack and the child’s back. Use the waist strap. Take advantage of the pack’s compartments to position the heaviest items (books, etc) low and close to the body’s center of gravity.
The worst configuration would be an overly large backpack packed loosely with heavy items. This allows for increased swaying and frequent changes in the weight distribution of the bag, forcing the child to compensate constantly. Studies performed on military recruits showed that loaded backpacks increased postural sway even in fit adults, increasing the likelihood of falls and injury. Imagine the effect on a small child, undergoing this daily strain during the crucial years of musculoskeletal development.
Backpacks and the lower limbs
Medical research has been turning its attention to the role of heavy backpacks on children’s spines, but those of us who specialize in musculoskeletal disorders and sports medicine also know that back pain is multi-factorial. How backpacks affect the lower limbs can also influence a child’s overall posture and spine health.
With a poorly-fitted and loaded backpack, children often adopt a posture with excessive anterior pelvic tilt and knee hyperextension. In turn, the feet also have to struggle to account for the altered center of gravity, postural sway, and walking pattern. It is not so much the direct weight of the backpack which alters foot biomechanics, but rather the need to compensate for maladaptive changes in posture and gait. This leads to fatigue and pain of the soft tissue stabilizing the feet and ankles, further exacerbating poor overall posture under load.
Foot orthotics improve postural control
Studies have shown that orthotic insoles can improve dynamic balance and postural control, from adults with ankle instability to children with joint hypermobility. When a backpack stuffed with books simply cannot be avoided, a well-fitted backpack together with orthotic insoles can be a preventative strategy to mitigate any adverse effects on the child’s growth, from the top down and from the bottom up.
Often this requires the expertise of a podiatrist to assess and tailor-design a pair of bespoke customized insoles for children, especially if there is a presence of musculoskeletal pain. Most pains are not “growing pains”; no report of pain from a child should be neglected.
The body’s musculoskeletal system creates a closed kinetic chain when in motion; every joint would influence its neighbour, all the way to the top. Together with the correct use of fitted backpacks controlling the proximal influence on the child’s posture, properly-designed foot orthotics would correct the distal influence.
*This post was originally published in January 2018 and was updated in March 2019.