Back to school for many kids also means back to shoulder, neck and back pain caused by hauling heavy backpacks each day.

Experts agree that selecting the right backpack and teaching kids the proper way to wear it is a must for back-to-school season.

In the last 15 years as backpacks have become the style for every student from preschool to college, occupational therapists like Barbara Kornblau started seeing children as young as 10 years old complaining of neck, back, and shoulder pain.

Back problems are usually considered a “wear-and tear” disorder developed over time, not in children still growing and developing, says Kornblau, professor of occupational therapy and public health at Nova Southeastern University (NSU), Fort Lauderdale, Fla.

“Kids didn’t complain about back pains 15 years ago,” she says. “Back problems are expected in the 50-plus age set, not children 10 years old.”

Part of the problem is that students today could never carry the amount or weight they need to take home without the help of a backpack. Books have gotten heavier over the years as schools have switched from workbooks to more cost-efficient, and reusable, hard cover books, says Kornblau.

And books aren’t the only problem. Students tend to shove as much as they can in their backpack at once. A typical child’s backpack may contain anything from textbooks, notebooks, loose paper, pencils, markers and water bottles, to an extra pair of socks, a friend’s scribbled phone number, and a melting candy bar, says Anne Rambo, associate professor of family therapy at NSU and author of the book, I Know My Child Can Do Better!

Move from elementary to high school, and Kornblau says you’ll find in backpacks cell phones, iPods, CD players, and even laptop computers.

In one study, she found children who weighed 40 pounds carrying backpacks that weighed 20 or 22 pounds, or half of their body weight, something kids are in no shape to be doing, Kornblau says.

“Combine that with the fact that kids sit in front of a computer all day with bad posture and it adds to back problems,” she says.

Kids also tend to wear backpacks improperly, which adds to the stress on their bodies, Kornblau says. Part of the problem is that the “being cool factor” interferes with what’s best for the child’s health.

“To be cool in some schools you have to wear your backpack on one shoulder,” she says. “That’s just not healthy. Every time I see that it bothers me; it hurts just to watch.”

Kids who wear their backpack on one shoulder often lean to the side, which curves the spine and leads to discomfort. Kids also often wear their backpacks down too far, which causes them to lean forward and have bad posture. Also, a bag that hangs too loosely can pull the child backwards and strain muscles.

Heavy backpacks and improper usage can cause tingling and pain in the neck, arms and shoulders and low back strain, not to mention more serious injuries such as improper alignment of the spine, stress fractures, growth problems, soft tissue problems in the neck, and exacerbation of scoliosis, says Kornblau.

In 2001, more than 7,000 emergency visits were related to backpacks and book bags with about half of those being children five to 14 years old, according to the American Occupational Therapy Association’s website.

In another study, nearly eight out of 10 middle-school students who changed how they loaded and wore their backpacks reported less pain and strain in their backs, necks and shoulders, the website reports.

The best backpack to buy is a luggage-style bag on wheels, says Rambo.

“The wheels are to prevent back and shoulder pain, and also to allow the child to take everything home at once,” she says. “That way you don’t have to deal with homework lapses: ‘I can’t do my homework because I forgot the book.’”

Many middle school and high school children may rebel against wheeling around such a clunky vehicle, so Rambo suggests using it as a bargaining tool. If they keep up their grades and don’t forget the books they need, they can use a regular backpack, she says.

“But if you start hearing ‘I can’t study because I forgot my history book’ more than once or twice, it may be time to dust off the old office on wheels,” she says.

If your child insists on an over-the-shoulder backpack, Rambo advises buying one that is big, but proportionate to the size of the child. An ideal backpack has well-padded shoulder straps and a band that buckles around the waist.

Make sure to adjust the straps so the bag fits snugly to the child’s back. The bottom of the pack should rest on the curve of the lower back and should never rest more than four inches below the child’s waistline.

Help your child with the waist belt, which will distribute the weight of the backpack more evenly, and tell them how important it is to wear the backpack on both shoulders.

Even though it may not be the coolest way to wear it, Kornblau says she tries to convince students that what’s actually cool is not to be in pain.

“If we convince everybody that not hurting is cool then we could convince a lot of them to not have back problems,” she says.

Also, a good way to help ease the load is to make sure your child isn’t hauling around more than necessary.

To do this, Rambo suggests instituting a daily “unpacking ritual” where you sit down and sort through your child’s backpack with them. To get your child to cooperate, make sure it’s a ritual that is pleasant, not punitive.

“Fix a snack for both of you and use the time to chat about your child’s day; but keep sorting,” she says. “With a younger child, you will be sorting while he helps; with a middle school or high school child, he can sort while you help.”

Dick Jones Communications