Back pain is commonly seen in adults; 80% of the adult population complains of back pain at some point in time.  Traditionally complaints have been much less frequent in young children but seem to be increasing.

Backpack SafetyWhen a child complains of back pain, physicians recommend an aggressive workup of the symptoms. Numerous etiologies contribute to back pain in children ranging from disease and injury, lack of conditioning, and now data suggests that heavy backpacks can play a role.

Tamara A. Topoleski, M.D., a board certified Orthopaedic Surgeon with a specialty in pediatrics at the Orlando Orthopaedic Center, recommends that when parents bring children to the office with complaints of back pain, several questions should be asked.

  • Where is the pain located?
  • When does the pain occur?
  • Does anything make it better or worse?
  • Any associated illness or fever?

Basic diagnostic tests and a thorough physical exam are appropriate. If other etiologies have been excluded, questions regarding backpack use may be helpful.

Back pain in children can be the result of injuries related to rough contact sports, such as football, but non-contact sports that require lumbar hyperextension such as gymnastics, tumbling, and dance can also lead to injuries and back pain.  Adequately stretching before engaging in any sport or new activity is critical.  Such stretching exercise is also recommended for students who spend hours sitting at a desk or computer working on school work.  When pediatric patients complain of discomfort or pain after strenuous activity, lack of simple stretching may be to blame.

Tamara A. Topoleski, M.D.

Tamara A. Topoleski, M.D.

However, if the symptoms continue, the source could be something more serious; other sources of pain, including neoplasm, infection, or fracture must be considered.  Stress fractures of the lower spine, known as spondylosis are frequently diagnosed in athletes with persistent complaints of activity related back pain.

Parents often think their children are protected from back injuries and back pain if they encourage academics over sports. Recent media attention, combined with larger populations filling the hallways of our schools and decreased the availability of school lockers have triggered consideration of a possible relationship between backpack use and back pain.

Heavy backpacks can be a factor leading to back pain in the absence of traditional causes of childhood pain.  Recent studies have suggested that the weight of some backpacks can be 20 to 40 % of a child’s body weight.  Studies have indicated that the greater the percentage of back pack weight to a child’s weight is related to increased complaints of back pain.

Some studies show that excessive back pack weight and improper wear may be contributing to the rise in back pain within the school age patient population. The extra weight that some students carry on their backs combined with improper mechanics can cause enormous strain to the spine, not unlike that seen with athletic injuries. If symptoms seem to be related to backpack use, here are several tips you may offer to facilitate symptomatic relief.

First, clean out the backpack and remove all non-essential and nonacademic items. Studies have indicated that between 10-30% of the backpack weight could be attributed to non-academic items. Always use both shoulder straps and place the heaviest objects first so that they are carried closer to the body.

Adjust straps so that the bottom of the backpack sits above the hips and at the waist level.  A recent study has demonstrated a significant increase in shoulder pressure and back pain when backpacks are carried low on the buttocks, even when both shoulder straps are used.

Accurately diagnosing the cause of back pain is very important in the pediatric population. Backpack use may be considered as the source of pain but only after all other etiologies have been excluded.

Article by Emily Garcia
Originally Published in FloridaMD Magazine, September 2011.

Backpack Safety, Tips, and Advice from Dr. Topoleski

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