Over the next month or so, our kids will be heading back to school. As we prepare them for the year ahead, one thing that is often overlooked is the need for a good backpack. Many schools no longer provide locker space; so a full day�s worth of books are being carried from class to class as well as to and from school. These are heavy loads for a developing body. A good, general rule of thumb is that children should not carry more than 10 to 15% of their body weight. Yet, a study by the American Physical Therapy Association found that over 50% of children are carrying more than the recommended weight. The use of improperly used backpacks may be contributing to pain and fatigue in school aged children and increasing their risk for spinal injury and back pain (Is Your Child's Backpack Making the Grade? Physical Therapists Offer Tips to Lighten the Load on Children's Backs; August 3, 2006).The U.S. National Safety Council issued a list of warning signs that your child's backpack may be too heavy:

1. A difference in posture when wearing the backpack.
   
2. Significant difficulty in putting the backpack on or taking it off.
3. Complaints of pain or discomfort when the backpack is on.
   
4. Red marks on the skin from the backpack straps.
   
5. Feelings of numbness or a tingling sensation, especially in the back or shoulders.

Here is a summary of 5 tips for reducing the injury risk of backpack use (Cedars-Sinai Medical Center News - Backpack Safety Tips, August 15, 2006).

1. Keep backpack use limited to necessities only. Only keep needed books and supplies in the backpack to limit the weight being carried. Help your child clean out the backpack frequently to remove items that do not need to be brought to school.
   
2. Distribute weight evenly. The weight of the backpack should be evenly distributed with both straps used. Holding the backpack slung over one shoulder can pull the child to one side causing the shoulder muscles to develop unevenly, promoting poor posture, and causing strain on the shoulder, neck and back. A backpack that is too heavy or has the weight is distributed unevenly pulls the child backward causing the child to bend forward at the hips or arch his or her back promoting compression of the spine.
   
3. Recognize signs that the backpack is too heavy. Look at your child�s posture when he or she is wearing the backpack. Are the shoulders uneven? Is the head pushed forward? Is the child bending at the hip? These are all signs that the pack is too heavy or unevenly distributed.
   
4. Select the proper backpack. Look for ergonomic design, multiple compartments that can help distribute weight, padded straps that distribute the pressure across the shoulders, backpacks with wheels (make sure that it is sturdy, does not topple over, and has a long enough handle that the child does not have to slouch over to pull it). The American Physical Therapy Association also recommends that the backpack have hip and chest belts to transfer some of the backpack weight from the back and shoulders to the hips and torso and reflective material to enhance visibility of the child to drivers at night.
   
5. Pick up the backpack properly. Teach your child to pick up the backpack using good body mechanics. Bend at the knees and lift with the legs and the hips, not with the back. Grasp the backpack with both hands.

Marji Hajic is an Occupational Therapist and a Certified Hand Therapist practicing in Santa Barbara, California. For more information on hand and upper extremity injuries, prevention and recovery, visit Hand Health Resources.