Stuart Hershman, MD, is board-certified in orthopaedic surgery. He is the director of adult spinal deformity & complex spinal reconstruction at Massachusetts General Hospital and is on the faculty at Harvard Medical School.

Backpacks are supposed to prevent back pain, not create it. But when worn incorrectly, they can cause you or your child to develop spine problems. Here are 10 tips on how to reduce or avoid back pain and other complications for kids (and adults) who wear backpacks.

Heavy packs may cause kids to change their spinal position to accommodate the load. This can result in back pain and posture problems.

Keep an eye on your child's posture, and make sure they are getting regular check-ups, which screen for problems like scoliosis.

If your child is small for their age or has experienced back pain in the past, talk to your healthcare provider about exercises that may strengthen the upper back.

Backpacks can be convenient, but it's important not to pack them too heavy. Most kids carry between 10 percent and 22 percent of their body weight in their backpacks. And that's too much.

A 2017 study published in the journal Applied Ergonomics confirmed that a child should carry no more than 10 to 15 percent of their body weight in their backpack.

For a larger child, the percentage amount is even smaller. The authors of the same study recommend carrying 1/3 less weight in their packs than children of healthy weight.

Help your child manage the number of heavy items they carry in their backpack.

By having the right backpack and using it correctly, your child may be able to reduce current pain and avoid it in the future. Make sure it is the right size for your child and that it is zipped up when they are using it.

Some backpacks come with features to make it easier to carry heavy loads. For example, a rolling backpack can make transporting heavy items easier—just make sure the school allows them.

Make sure that small or sharp items aren't pressing into your child's back. And when you carry weight out away from your body, it takes more effort, and places stress on your joints and muscles.

A good strategy is to put the heaviest items on the inside of the pack, close to your back. Carry the little things, like calculators, pens, and loose paper toward the outside.

Many people complain about neck and shoulder pain when they wear a heavy backpack.

Padded shoulder straps can help. Padded shoulder straps are generally wider than the more basic type and may help even out the distribution of the pack's weight. This, along with the cushioning provided by the padding, may help to avoid pinching of the trapezius muscle, which is common with the basic type of strap.

Whether it’s fashion or convenience that propels your child to sling their pack over one shoulder, know that such a practice can contribute to the development of poor posture habits. It can also cause one-sided pain.

Studies show that loads of 18 pounds or more may create a temporary side-to-side curve in the spine. You can help your child by placing items so there is equal weight on either side of the pack.

One thing that can make backpacks seem heavy and cumbersome is keeping the shoulder straps loose. Loose straps may lead to a shifting of the pack's contents when you move. And this may cause muscles to work harder than necessary.

But by cinching the straps to fit your frame, you can secure the pack and its contents. Balancing the load should be easier this way.

Some packs come with waist belts. Waist belts take a portion of the load off the shoulders. By supporting some of the weight lower down, where the mechanical advantage is better, you may decrease neck pain and back pain above the waist.

Ask your child whether they have aches and pains. Most of the time, children won't mention it unless you ask. But there is the chance that the back pain is a symptom of an underlying condition or disease.

Back pain during childhood may be associated with a greater risk for back pain during adulthood. If adjusting the weight (and its distribution) of the pack and counseling your child on managing the load during the day doesn’t alleviate their back pain, see a healthcare provider.

Also, explain to your child that ignoring the pain in their back or shoulders could lead to injury. Tell them to let you know right away if they experience any discomfort.

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Adeyemi AJ, Rohani JM, Abdul rani MR. Backpack-back pain complexity and the need for multifactorial safe weight recommendation. Appl Ergon. 2017;58:573-582. doi:10.1016/j.apergo.2016.04.009

Neuschwander TB, Cutrone J, Macias BR, et al. The effect of backpacks on the lumbar spine in children: a standing magnetic resonance imaging study. Spine. 2010;35(1):83-8. doi:10.1097/BRS.0b013e3181b21a5d

Kjaer P, Wedderkopp N, Korsholm L, Leboeuf-Yde C. Prevalence and tracking of back pain from childhood to adolescence. BMC Musculoskelet Disord. 2011 May 16;12:98. doi:10.1186/1471-2474-12-98

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