Practical Advice for Parents and Students to Prevent Injury

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BACKPACK “WORST CASE SCENARIO”improperly worn backpack

According to doctors and physical therapists, backpacks that are overloaded or worn improperly can, over time, cause painful misalignment and harmful compression of the spine. Excessive weight (defined as more than 10-15% of body weight) and unevenly distributed loads can prevent disks from working properly as ‘shock absorbers’ for vertebrae, and can result in shoulder, neck, and back pain. Studies have also confirmed that heavy backpacks can actually alter the shape of a young person’s spine.

Research published in the journals Spine and Science Daily confirm that repeated use of heavy backpacks may result in disc compression, lower back asymmetry or curvature, and injury to the soft tissues of the shoulder that can lead to nerve damage. The harm caused to nerves may range from simple irritation to impeding movement of hands and dexterity of fingers.

SIGNS OF TROUBLEchildren boarding school bus with backpacks

  • struggling to get the backpack on or off
  • increased forward head posture, rounded shoulders
  • strained muscles and pain in the shoulder, neck, and lower back
  • numbness or tingling caused by straps
  • headaches


Large, overloaded backpacks create safety hazards in tight spaces (like school buses), where children’s movement and balance are impeded, and they can cause tripping hazards both on and off students. Smaller, lighter backpacks are better all-around choices for school kids.Properly worn backpacks with both shoulder straps


A backpack should be worn with both shoulder straps to distribute weight evenly, and it should fit close to the body, resting in the middle of the back (not sagging toward buttocks). It’s best to place heavy items closer to the body or at the bottom of the bag, rather than in outside pockets.

Rule of Thumb for Maximum Loads

Student Weight (lbs.)406080100120140
Max Load (lbs.)4-66-98-1210-1512-1814-21



  • Encourage kids to use their cubby, desk, or locker for items that don’t need to go home—including textbooks that are not needed for homework.
  • Create a weekly routine for sorting through backpacks and eliminating excess cargo.


Boy wearing backpack correctly

Choose a backpack that meets these criteria:

  • lightweight
  • two wide, padded shoulder straps
  • a padded back, and hip/chest belt (for larger packs)
  • multiple compartments to distribute weight.
  • reflective material for added visibility

Keep in mind that a smaller pack will be less likely to collect extra “stuff” that adds to the burden, and that while wheeled bags are great for airports, they are generally heavier, and can often be difficult to use on stairs and in buses.

Rucking? Not for kids!

heavy military backpackSoldiers must often march (or even run) while carrying packs weighing from 40 to 90 pounds or more, which can mean loads of as much as 25-50% of their body weight. That’s extreme, and soldiers commonly suffer injuries to shoulders, neck, and back as a result.


ABCs of Smart Backpack Use (APTA)
Backpack Safety (National Safety Council)

Other Cioffredi Resources

Pediatric Physical Therapy
Pediatric PT Success Story: Sofia Tomek