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Are backpacks getting heavier these days? by Leo Albano and Kent Holden Physical Therapist When asked to discuss backpacks and the musculoskeletal impairments potentially caused by wearing them, we found it difficult to decide whether to address the backpack itself or the person wearing it. This issue necessitates the discussion of individual fitness, ergonomics (adapting the workplace to meet the abilities of the worker) and body mechanics (performing daily activities with the least amount of strain on the musculoskeletal system). Ignoring one of these facets would lead to an incomplete discussion.   According to the American Physical Therapy Association, “a backpack when properly worn is a better way to carry life’s necessities than a briefcase or shoulder bag, especially for long periods of time.”   When one is considering the purchase of a backpack, the “ergonomically correct” features should be recognized and pointed out. Wide shoulder straps are essential in the prevention of compression of the muscles, nerves and vessels in the thoracic outlet (front chest) region. The compression of these vital structures could lead to neck and/or shoulder pain, or upper extremity parathesias (arm numbness) that could cause long-term weakness, altered sensation or loss of coordination.   In addition to wide, comfortable shoulder straps, one should look for backpacks with a waist belt in order for the wearer to displace some forces to the abdominal and pelvic region.    The bottom part of the pack should rest in the contour of the lower back and position evenly in the middle of the back. The reason for this recommendation is that the musculature in the trunk is much stronger than the arms.    “Keeping the backpack close to the body and worn high over the strong upper back muscles reduces the amount of work required to carry the load,” states physical therapist and educator Shelley Goodgold of Simmons College in Boston, MA.    Lastly, one should make the effort to wear your backpack around the store in order to assess it for comfort before purchasing it. (Online shopping will limit the ability to perform this last point)   Another important point to consider is the amount of weight that you intend to carry around in the backpack. Oftentimes, people will report that it is necessary to carry around all of their textbooks every day. While technology in education may indeed end up reducing the quantity of textbooks, you still need to have a general idea of how many textbooks or other items that you can safely handle in your backpack. Weighing the pack on a scale might reveal that the loaded backpack is even heavier than you had predicted. Be aware of the warning signs that indicate that a backpack may be too heavy for the wearer. Struggling during the removal or mounting of the pack, red marks along the shoulders or back, tingling or numbness in the hands or arms, pain while wearing the backpack, or changes in your posture are all indicative of backpack overload.  The major muscle groups that should be strengthened in order to aid in the stabilization of the spine are the abdominals, gluteals (rear end), the lumbar paraspinals (lower back), and the parascapulars (shoulderblades). Just strengthening of these muscle groups is merely the first step; it is important to be able to use them in coordination when carrying your backpack in order to maximize the stabilizing effect on the spine.    In conclusion, common sense is the most important factor in injury prevention when wearing backpacks. Be sure to use both straps around the shoulders and the waist belt at all times (no matter how much of a dork you look like).     If you choose to wear a single strap bag it is better to wear it across your chest than dangling from your side.     Take frequent breaks throughout the day, try to avoid carrying all of your books at once, and call a physical therapist if you are experiencing any pain or discomfort before it becomes a serious problem.  Some backpack guidelines Wide, padded, and contoured shoulder straps to reduce potential pressure on the chest and shoulders and to make the backpack more comfortable to wear. A padded back to reduce pressure on the bones of the back and to prevent the pack’s contents from digging into the wearer’s back. A waist belt to help distribute some of the load to the pelvis. A suspension bar in the back of the pack to help distribute the load more evenly. Compression straps that, when tightened, compress the pack’s contents to stabilize them. Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.