It’s back to school time again, and each year many children get a new backpack to carry supplies, books, and homework. These carry-all backpacks often reflect the personality of the child, with many adorned with super heroes, princesses and more than a few Angry Birds.

back-to-school2While this efficient carrying case has been around for many years and has been used by millions of students both old and young, back experts such as Texas Back Institute physician Dr. Rey Bosita have noticed a problem with backpacks. They’re too heavy for some kids, and can cause long-term serious back problems.

We spent a few minutes with Dr. Bosita to get some guidelines on the proper size and use of backpacks. More on this later.

Backpacks Have a Colorful History

Backpacks, in one form or another, have been around since early humans used animal skins to carry meat from hunting trips. Just as with the school kids of today, these packs allowed prehistoric hunters to use the strong muscles in their backs to carry much more game for longer distances than if they were carrying it in their arms alone.

Historians note that the term “backpack” was coined by Americans around 1910; however, before it was known as a backpack, Europeans (specifically the Germans) called this carry-all a “rucksack,” which is a shortened version of the phrase “der Rucken” – German for “the human back.”

Up until the 1950’s, the backpack was primarily used for hunting and military purposes. These early versions were made of rugged materials and very heavy to carry. All of this changed when hiker Dick Kelty realized backpacks could serve a valuable function to the participants of his sport. He began experimenting with creating packs made of lighter materials and more compact designs. He also changed the weight distribution of the backpacks – by putting the skids of the pack in the back pockets of his hiking pants – allowing the hips to carry more of the load.

With this change, anyone who needed to carry several items while they were walking could pack these in a backpack and be on their way. It didn’t take long for parents and students to discover  these same, light-weight backpacks were ideal carrying cases for schoolbooks and homework papers.

The Problem with Backpacks


For all of its efficiency, the modern backpack has its detractors, some of whom are backspecialists. In an article published in 2012 in the New York Times, it was noted that “heavy backpacks don’t just zap children of energy that might be better used doing schoolwork or playing sports. Lugging them can also lead to chronic back pain, accidents and possibly lifelong orthopedic damage.”

In this article on the dangers of backpacks for kids, the federal Consumer Product Safety Commission calculated that “carrying a 12-pound backpack to and from school and lifting it 10 times a day for an entire school year puts a cumulative load on youngsters’ bodies of 21,600 pounds – the equivalent of six mid-sized cars.”

In a 2012 report in the “Archives of Disease in Childhood,” researchers in Spain assessed the backpacks and back health of 1,403 pupils, ages 12 to 17. More than 60 percent were carrying packs weighing more than 10 percent of their body weight, and nearly one in five had schoolbags that weighed more than 15 percent of their own weight.

This study found that “1 in 4 students said they had suffered back pain for more than 15 days during the previous year; scoliosis – curvature of the spine – accounted for 70 percent of those with pain. The remaining 30 percent had either low back pain or contractures – continuous, involuntary muscle contractions.” Girls faced a greater risk of back pain than boys, and their risk increased with age.

Clearly, there is a potential problem with backpacks and kids. In many cases, they are either too heavy for the size of the child or they are being worn by the child incorrectly. We spoke with Dr. Rey Bosita, a spine specialist with Texas Back Institute, to get an idea on the “dos and don’ts” for backpacks with kids.


Dr. Bosita noted pain often results when the weight of the pack pulls children backward, prompting them to bend forward or to arch their backs to keep the pack centered. These positions make the back muscles work harder and increase pressure on vertebrae on the discs between them.

If the child has to lean forward or seems unsteady when walking with a loaded pack, it’s too heavy.  This can lead to poor posture and shoulder pain.  Neck pain can also occur when the child is forced to look up from this position.

No parent or teacher wants a child to be injured by a backpack which is too heavy. So, what should be done to correct this situation? Dr. Bosita has some ideas.

Tips You Can Use for Back Safety and Backpacks

“The first thing we should look at is how the backpack fits the child and how he/she is standing while wearing it fully-loaded. The child should be standing straight up – with shoulders back. The backpack should be positioned in a manner that allows it to rest against the child’s back, straps a little tighter, so that the pack doesn’t sag too low,” Dr. Bosita notes.

Another important consideration for back safety is the weight of the backpack. What is the correct weight for a child’s backpack and how does a parent determine the weight of the pack? Dr. Bosita says, “The easiest way to determine the acceptable weight of the pack is to get the family scales out and weigh the child without his/her backpack. The weight of the backpack should be no more than 10 to 15 percent of the child’s weight. Therefore, if the child weighs 50 pounds, the backpack should not weigh more than 5 to 7 pounds.”

“Remember, everything adds weight to the backpack, including the pack itself, Dr. Bosita notes. “It’s a good idea to check the backpack weight with all of the materials connected to the pack (water bottles, knick knacks) and the books and school supplies being carried in the backpack (library books, binders).”

For the complete video of Dr. Bosita’s tips on backpacks, just click here 

Pack Only What’s Needed

When given the chance, younger children will stuff as many things as possible in their backpacks, much of which is not related to school work. Parents should take a minute each morning and afternoon to inventory the items being transported to and from school. If there are toys, games, handheld computer games, pet rocks, frogs and other non-academic items being packed in the bag, remind the child that these things should be left at home.

If he or she disagrees about the contents of the backpack, have a Plan B. Just tell them that you want them to grow up straight and tall and a heavy backpack might keep this from happening. This has the advantage of being the truth.

And if this fails, reward them with a treat  if they keep the back pack light.

Is your child complaining of back pain? If your son or daughter is carrying too many books, supplies and other things around all day in a backpack, that could be the source of the problem. The reason is simple: heavy backpacks, especially if they are carried improperly, can do damage on everything from lower back, neck and shoulder pains to headaches and numbness.


Here are some things you need to know:

  • Your child should only carry about 10% and not more than 15% of his/her body weight in a backpack. Put your child on a scale with and without the pack to do a quick, easy check.
  • If your child is carrying too much weight, lighten the load – carry only what’s needed that day, leave unnecessary items at home and only bring home books that are needed for study that night.
  • Lightweight packs with two wide, padded shoulder straps are recommended. Make sure your child is using both straps to distribute the weight evenly. Be sure the straps are adjusted so the backpack rides in the middle curve of the back instead of sagging low.



  • If your child is using a backpack with wheels, that’s fine as long as your child isn’t stooping to pull it or lug it up stairs.

We all know how important it is for our children to get good sleep, eat well and be safe to be successful in school – and this includes using backpacks correctly.

David Hanna used to spend countless hours on the road, but now the retired 79-year-old truck driver was unable to drive or ride as a passenger for even the shortest distances due to almost unbearable back and leg pain.

 A former, longtime resident of Dalhart, a small town in the Texas Panhandle north of Amarillo, David and his wife moved 425 miles south to Lewisville to be closer to family. Unable to tolerate long car trips, David’s pain not only interfered with his ability to get around but, worse, it prevented him from seeing his close hometown friends from time to time.

 “Before the surgery, I couldn’t do the simple things and was cooped up at home watching western movies and CNN all day,” said David. “Doctors told me the pain in my right leg was caused by a pinched nerve, and they gave me pain medicine. But it kept getting worse and worse. The only way to control the pain was to lie flat or to put my recliner way back.”

 At the urging of his son-in-law, who was successfully treated at Texas Back Institute, David made an appointment and was examined by Dr. Michael Hisey. Because David had a pacemaker, he couldn’t undergo an MRI. Instead Dr. Hisey used 3D imaging to create a model of Mr. Hanna’s spine and found his pain was caused by a bone spur that was compressing nerves in the pelvic area.

 “This is the first time we used a model for a bone spur, but the spur was located in an unusual place. The model enabled me to perform surgery with precision and take the most minimally invasive path possible,” says Dr. Hisey

  “The pain was instantly gone after surgery,” said David. “Now, I have my freedom back and can drive, and that enables me to visit Dalhart and have coffee with my friends. I really appreciate Dr. Hisey and Texas Back Institute.”

As the weather cools off heading into the fall, maybe you’re thinking about a backpack trip you didn’t want to do during the hotter summer months. We thought it would be a good time to remind everyone of a few tips to help you protect your back and avoid back pain while enjoying this wonderful outdoor sport.

 1. Get your back in shape before you backpack. Exercises to strengthen and stretch your back as well as daily exercise will help get you in shape before you go.

 2. Stretch before you strap on your backpack and trek. There are a number of back stretches recommended by professionals. One we recommend you do slowly is to position your left foot about six inches behind you and position your right foot, toe-to-heel, behind the left foot. Then place your hands on a solid vertical object at shoulder level. Allow your body sag slowly forward, which increases the natural curve of your lower back. Now allow your back to twist slowly towards the left or right. Reverse your feet and do repeat this slow twist I the opposite direction. Make sure your motion is slow without any bouncing.

 3. Take short trips. If back pain is sometimes a problem for you, avoid long backpacking trips that require carrying heavy gear. If you’re a beginner, work your way up to longer trips that require heavier backpack loads.

 4. Plan trips with fewer obstacles, less inclines and other challenges. If you suffer from back pain or are a beginner, start with easier courses. More stringent courses can add stress to your back. If you stumble trying to cross big obstacles, the added pack weight can throw you off balance and result in injury.

 5. Lighten your load every way you can. Invest in a good, lighter weight backpack and gear. Look for multipurpose gear that allows you to leave multiple items behind. Lastly, take only what you’ll really need.

 6. Lift your backpack onto your back slowly and correctly. 1) Set one foot firmly on a solid object. 2) Slide your backpack by the shoulder straps up to your knee.  3) Put one arm into one shoulder strap. 4) Lean slightly forward and let your backpack pivot slowly around to your back. 5) Slip other arm into the other strap. 6) Adjust your backpack and all straps.

 7. Use trekking poles. These been shown to reduce the weight on your back and hips and can also help stabilize your walking over rough terrain by reducing side-to-side swaying.

 Backpacking is a great way to get exercise and enjoy the beauty of nature. Safe trekking!

Dr. Michael Duffy

Orthopedic Spine Surgeon

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