Does carrying a backpack cause back pain?

 Quite commonly here at Southside Physio we see teenagers with a variety of injuries, whether it be a sports injury, ‘growing pains’, phone/tablet/gaming related or something completely different. I have noticed a couple of common themes seem to recur in the treatment room. The first being a teenager lugging in a heavy backpack (or 2), the second being a parent sitting in the corner asking whether their child’s posture has anything to do with their injury as their teenager rolls their eyes. So do these things really contribute to pain?


In a study published last week in the British Journal of Sports Medicine, they found no link between carrying a heavy backpack and having back pain.


Why is this so important?

We know that towards the end of adolescence, the prevalence of back pain is comparable to the adult population. We also know that this is a predictor of having back pain into adult years.


So, obviously, the key here is preventing back pain in adolescence, and knowing the most effective ways to treat and manage back pain across the lifespan.


In the past, we have thought that the weight of a backpack should be limited, with some people saying that the limit should be between 5 -20% of the carrier’s bodyweight. Read further to see whether or not this is still true.

So, does wearing a backpack cause poor posture? This is a tricky one to study, given that a very high proportion of teenagers wear a backpack daily. Furthermore, to study curvature would require x-rays which has its own issues as well. We do however look at posture and use some of our other clinical tests. We know that wearing a backpack does change head posture (chin poke) and the distribution of weight through the foot. None of these studies have shown any difference in teenagers who wear their backpack with one strap or 2 straps. We also don’t know from these studies that the change in posture actually results in pain.

 So what do we know now?

On a review of the research, there’s some weaker evidence that looks at the link between backpacks and back pain. Some of these show a link between heavy backpacks, method of carrying (1 shoulder v 2 shoulders) and the length of time carrying the backpack. This is where the guidelines of backpack weight are coming from – but identifying risk factors for back pain wasn’t the primary aim of these studies, so the measurements used and the data collection may not have been the best for linking the two together.


What the better evidence shows:

 * that backpack weight is not associated with back pain 

* in younger teenagers aged between 9 and 14, the perceived weight of the backpack can cause pain, ie: not the actual weight, or the percentage of body weight

* As we get older, we know that 15 year olds with back pain do not report carrying a backpack as an aggravating factor

 * that characteristics of a backpack don’t cause back pain

 * that someone who already has back pain may aggravate their

pain if their backpack is heavy or if they’re carrying it on one shoulder

 * that carrying a backpack is not the initial cause of back pain

 So if your child has back pain, or if you are concerned about their posture, or the weight of their backpack, then come on in and see one of our physios. They will be able to look at a wide range of possible risk and lifestyle factors that most likely contribute to the pain. I think the Australian Physiotherapy Association is pretty on the money when they say that physical activity is the key. We know that reduced physical activity is associated with poorer health, so if carrying a heavy backpack means that your child avoids walking or cycling to school, or other forms of incidental activity, then it is worth considering reducing the weight. If your child already has back pain, come in for an assessment and your physio will be able to give you an individualised answer and treatment plan to relieve and prevent pain.