By Robert Kaulbach

Backpacks, when used correctly, provide a convenient and easy method for students of all ages to carry books and supplies to and from school. However, many children and parents are unaware that when proper precautions are not followed, backpacks can cause more harm than good. If your child complains about back pain or sustains a neck or spinal injury, their oversized, overstuffed backpack could be the culprit!

Here are some cold, hard facts about the dangers of using a heavy and poorly fitted backpack:

* A study found that 55% of children examined carried more than 15% of their body weight in their backpack, which experts believe is unsafe.

* This same study found that 33% of the children experienced pain that caused them a visit to the doctor, made them miss school, or kept them from positive physical activities.

* Overloading a child's spine can cause arching of the back, leaning forward, or leaning to the side, if only one strap is used. These postural changes can cause spinal compression and improper alignment.

* A heavy load on the shoulders can compress the neck and the nerves to the arms causing numbness, tingling, and pain.

* The above effects of wearing a heavy backpack can be further complicated by other factors known to cause back and neck pain, such as poor study positioning, inactivity, and increased participation in athletics.

However, backpacks are not the enemy when used properly. Here are some tips for choosing and using your child's next backpack:

* Choose a well-made pack. A cheap bag does not have the features that reduce the stress on the back. Plan to spend about $40-$50.

* Good, upright posture while wearing the backpack is critical.

* Do not raise or hunch shoulders with the backpack on.

* Wear both straps. Wearing over one shoulder causes asymmetry and strain.

* Wide, padded straps reduce pressure on the shoulders that can cause irritation to the nerves of the arms.

* Backpacks with padded backs protect the back from sharp objects inside the pack.

* Match pack to the size of the child. The backpack should sit evenly on the back and not sag toward the buttocks. It should not extend 4 inches below the waistline.

* A waist belt will help distribute the load away from the spine onto the pelvis.

* Compression straps and good use of compartments reduce movement of the pack and stabilize the contents.

* Pack only what you need to carry, rather than what fits in your bag. Backpacks should weigh no more than 15% of the child's bodyweight.

* Put the heaviest items against the back and closer to the bottom, as this creates less torque on the back.

* Use compartments to distribute and stabilize items.

* Clean out old supplies, food, etc., which add weight to the pack.

* Go electronic, i.e., have children use an iPad if their teacher has reading materials available in this format.

* Do not pack unnecessary textbooks in your bag. If you don't need them, don't take them!

As parents, we cannot force our children's teachers to give less homework, but we can combat the stresses of carrying heavy backpacks by teaching our children simple strengthening exercises to help reduce the risk of injury.

In order to correct for forward head posture that a heavy backpack can create, it is important to first perform flexibility exercises for the tight muscles that become short and overactive from that position, and then reinforce it with postural strengthening exercises, such as the scapular squeeze shoulder exercise described below.

Scapular Squeeze Shoulder Exercise: It is important to activate the muscles that keep the body tall and erect. The most basic exercise would be to merely squeeze your shoulder blades back together, trying to make them touch, without elevating your shoulders. Think of this as dropping your shoulder blades into your back pockets.

Once you can accomplish this scapular squeeze, it can be made more difficult by adding resistance with either a machine row or theraband, ensuring you are initiating the movement with that same shoulder blade squeeze as before, while pulling the handles back with your arms. Perform 3 sets of 10 to 15 repetitions. If you do not have access to any equipment, you can use gravity as additional resistance. Lay flat on your stomach, with a small towel roll underneath your forehead to keep your head in a neutral position, and then squeeze your shoulder blades down and back as previously mentioned.

Robert Kaulbach, DPT, is a physical therapist at ProEx, part of the Professional Physical Therapy family.