School Shopping for Backpacks

What Causes Lower Back Pain in Children?
Symptoms of Back Pain (and When to See a Doctor)
Children’s Backpacks and Lower Back Pain
7 Ways to Minimize Lower Back Pain
Visiting a Chiropractor for Lower Back Pain

An upcoming school year means pens, pencils, notebooks, and other essentials that fit into a new backpack. While manufacturers often focus on style, sizes, and what you can carry, good backpacks should also be designed for optimal back support.

Tablets or other e-devices replacing heavy books at many schools means less stuff to carry. Still, your child or teen might overstuff their pack and create back problems, especially on their lower back.

Researchers define lower back pain (sometimes called lumbar back pain) as pain in the back from the level of the lowest rib down to the gluteal fold. That pain may or may not travel to the legs. [1]

Researchers estimate chronic lower back pain has increased over 100% among adults during the last decade. [2] Physical concerns aside, the increasing burden of lower back pain creates a massive financial strain, costing Americans over $90 billion a year. [3]

Lower back pain is also a common complaint among children and teens. [4] Researchers estimate that while about 30 in 100 children and adolescents experience back pain, very few go to see their doctor. [5]

Lower back pain often begins in childhood and increases with age. [6] By age 15, 20–70% of children will report some back pain. This pain can recur, often more intensely. [7] Overall, back pain occurs in 60–80 percent of people during their lifetime. [8] Children with lower back pain are more likely to have back pain during adulthood. [9]

What Causes Lower Back Pain in Children?

Low in the back, the lumbar vertebrae — 5 vertebrae linked by joint capsules, ligaments, tendons, and muscles, with extensive innervation — are the last free-moving vertebrae in the spine, while the sacral and coccygeal sections are fused and extend into the buttocks. [10]

The buttocks, groin, thighs, and legs are anchored here, and the nerves that move through the lumbar spine affect lower intestines and reproductive organs.

Lower back pain, the most common type of back pain, is not a disease but a symptom with many causes. Doctors can usually diagnose underlying causes from the type and symptoms of back pain. [11]

Nighttime back pain usually comes with fever and weight loss that could indicate a tumor or infection. Acute back pain, chronic back pain, and back pain associated with fever could likewise come with associated symptoms that suggest possible diagnoses.

Among the most common causes of lower back pain, which can occur separately or together, include:

Muscular strain, injury, or overuse [12]
Physical activity like running or jumping
Core muscle imbalances or weakness
Higher body mass index (BMI), which can indicate overweight or obesity [13]

Back pain can also impact other muscles, causing problems like tight hamstring muscles and weak abdominal muscles, especially among adolescents. [14]

While you might be tempted to blame the lower back pain on a heavy backpack or poor posture, lower back pain oftentimes doesn’t have a single culprit. In fact, one study could not find a specific cause for back pain in 78 out of 100 children. [15]

Instead, many things children do every day can contribute to lower back pain. Spending a long time watching television and over-engaging in sports can create or exacerbate back pain. The increased roundness of the back that can occur sitting slouched is a common cause of pain in the middle or thoracic spine rather than the lower back. [16]

But obesity, familial history, and being sedentary are also possible risk factors for low back pain among children. [17] Many things your child or teen does nearly every day — including carrying a backpack — can compound that lower back pain.

In most children and adolescents, the symptoms of back pain are transient and get better without treatment. Research shows that about half of all teenagers with back pain get better on their own. [18]

While lower back pain is often not a serious condition, sometimes it can signify underlying causes such as:

A slipped disc
Vertebral fractures
Spinal alignment problems
Disc herniation (pressure on the nerves or spinal cord can occur with adolescents who do weight lifting)
Spondylolysis (spinal wear and tear, which sometimes occurs in athletic teens)
Spondylolisthesis (slippage of a vertebra frontwards or backward)
Infection (a leading cause of back pain in children under 10) [19]
Very rarely, a tumor [20]

Note: Please don’t diagnose your child or adolescent or allow them to self-diagnose persistent back pain, which could underlie a more serious cause. Visit your healthcare practitioner. No one should have to live in pain.

Symptoms of Back Pain (and When to See a Doctor)

Symptoms of lower back pain vary dramatically. [21] Among them include:

Acute or chronic lower back pain (sometimes both).
Mild or severe lower back pain. (Again, severity can fluctuate.)
Lower back pain that travels to other areas such as the arms or legs.
Lower back pain that impacts sleep, school performance, mood, movement, and physical activity.
Lower back pain that sometimes gets worse or better depending on activity. Other times, pain levels change for no obvious reason.
Lower back pain that involves other symptoms like high temperature (fever), weakness, numbness, tingling, and bowel or urinary issues.

While experts say back pain is common and some symptoms are often not a huge medical concern, under these conditions you should see your doctor:

If they are under four years old.
If their back pain goes on for more than four weeks.
If their back pain stops them from doing things.
If they feel unwell, have a high temperature (fever), or experience weight loss.
If the pain gets worse.
If they have pins and needles, numbness, or weakness.
If they start developing curvature of the spine.
If they start complaining of stiffness or difficulty when they move. [22]

If your child sees a doctor for back problems, they will conduct a physical examination along with a history of back pain. To understand more how the problem developed, they will likely inquire about certain conditions. [23]

Writing down the following information ahead of time can be helpful for your visit:

Your child’s overall health
An explanation about how the pain impacts daily life
When the pain began, whether it was associated with injury or demanding activity, and whether it has improved or worsened
The specific area where pain occurs
What makes the pain worse and better
Where the pain is felt, how severe it is, and how much it interferes with school and activities

Your doctor will probably examine your child’s spine, nerves in the back, leg, and back muscles, as well as balance, flexibility, coordination, and muscle strength. [24]

Doctors can usually treat back pain without radiographic or laboratory studies for most children and adolescents without significant physical findings, short duration of pain, and a history of a minor injury.

Patients with more concerning physical findings or history might require further treatment for the affected area. [25]

Diagnosing tools for low back pain include X-rays, bone scans, computed tomography (CT) scans, magnetic resonance imaging (MRI), and positron emission tomography (PET).

Especially if they suspect inflammation or infection as a factor in lower back pain, your doctor might also conduct blood tests including a complete blood cell count (CBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). [26]

Acute strains typically resolve after rest and modifying activity. [27] To speed up the process, doctors might also recommend ice to relieve swelling and pain. A warm compress might subsequently help relax muscles and decrease muscle spasm.

While persistent pain might warrant a doctor visit, back pain doesn’t often require emergency treatment. For those times it does, the primary reasons for visits include trauma and muscle strain. [28]

Children’s Backpacks and Lower Back Pain

Using a backpack allows carrying school books and essentials to distribute the heavy load evenly across the back and shoulder muscles. Backpack overload, however, can strain the back, neck, and shoulders.

Carrying a heavy backpack can become a culprit for lower back pain. Heavy book loads or poorly distributed weight can put pressure on the lower back, shoulders, and neck. Backpacks for teens are often larger, which encourages heavier weight loads that contribute to back problems. [29] The back will compensate for any load over an extended period of time. A heavy backpack can:

Distort the natural curves in the middle and lower backs, causing muscle strain and irritation to the spine joints and the rib cage.
Lead to rounding of the shoulders.
Cause a person to lean forward, reducing balance and making it easier to fall.

Some students including athletes might overstuff their backpack with equipment, sneakers, and other accessories, compounding the problem.

Children and teens sometimes carry a backpack on one shoulder, creating additional problems to compensate for the uneven weight. The spine leans to the opposite side, stressing the middle back, ribs, and lower back more on one side than the other. [30]

This type of muscle imbalance can cause acute muscle strain, muscle spasm, and back pain. Left uncorrected, this can contribute to back problems later in life.

Altogether, this strain adds up — literally and figuratively. While researchers debate heavy backpacks and back pain, the American Academy of Pediatrics guideline recommends that backpacks not exceed 10 to 20 percent of the child’s body weight. [31]

How to Minimize Pain Caused by Backpacks

Further strategies to find the best kids’ backpack and ensure your child or adolescent properly carries a backpack to minimize strain and pain on the lower back and other regions include:

Ensure that your backpack isn’t too heavy and has equally distributed weight.
A waist strap on the backpack can add increased support.
Encouragement your child or teen to use both straps, properly positioned so the backpack sits steadily on their back.
The fit is crucial with backpacks to evenly distribute weight. [32] Adjust the shoulder straps so the backpack fits high on the back and shoulder straps are comfortable. The pack should sit above your hips and not extend past the waist.
Encourage your child or teen to re-adjust straps while wearing different thicknesses of clothing so they always fit properly.
Make sure the backpack doesn’t sway from side to side, leading to chaffing and rubbing against your back, as you walk.
Encourage them to wear a backpack judiciously. Putting it in a locker or setting it on the bus floor, for instance, can reduce strain on the back.
Alternatively, you might look for a rolling backpack for your child or adolescent.
If your child or teen suffers from constant lower back pain, look for backpacks specifically designed for back pain.
Read reviews before you purchase online to find the best kids’ backpack.
A chiropractor might also be able to recommend good backpacks for back pain.

7 Ways to Minimize Lower Back Pain

Depending on the source population and definition of pain, 9–66% of children suffer from back pain. [33] Prevention is the best strategy to minimize low back pain. These seven strategies can help.

1. Emphasize good posture.

Encourage your child to stand up straight and avoid slouching. [34] This can become easy to do with extended computer use, watching TV, and playing video games. Children and teens can learn good posture with practice. One exercise program researchers used for posture correction among students for 20 minutes, 3 times a week over 8 weeks helped reduce musculoskeletal pain. [35]

2. Be mindful of sleep.

Research shows sleep disruptions can create adverse short- and long-term health consequences. [36] Without sufficient sleep, your child is more prone to injury, poor posture, and impaired judgment that can impact lower back pain. Sleep quality and quantity matter (aim for at least 7-8 hours of quality, uninterrupted sleep nightly), but don’t overlook culprits for back pain including a worn-out mattress. [37]

3. Foster active relaxation.

Psychological factors including depression, anxiety, and chronic stress can also impact lower back pain. [38] Research shows that low back pain is more common among school-age children with high levels of psychosocial difficulties, conduct problems, or other somatic disorders. [39] (This might require a therapist to determine underlying issues.) Whether that involves meditation, mindfulness, massage, or just watching funny movies, help your kid find something that brings happiness and joy. Encourage them to do it daily.

4. Encourage stretching and core strength.

We sit too much and don’t move enough. Over-sitting creates tight, tense muscles that can manifest as low-back pain. Encourage your child to stand up every hour or so (set their phone alarm if necessary) and stretch their hamstring muscles. Research shows compared with education alone, regular exercise (in this case, 4 spinal movements) plus education can reduce low back pain in children aged eight to 11. [40] Regular low-impact walking can help. Strong core muscles can also help support your lower spine. Pilates, which focuses on core strength, can help improve pain and functional ability. [41]

5. Take an Epsom salts bath.

After a hectic day, a warm bath can provide heat therapy to achy muscles while helping your child or adolescent relax. Add one cup of Epsom salt to a warm bath to soothe sore muscles and joints while giving your young one this undervalued mineral that can lower pain and inflammation. [42]

6. Be mindful of over-exercise.

Being sedentary can contribute to low back pain, but so can over-exercise. Back pain occurs in 10–25 percent of athletes and is more common among football players and gymnasts. [43] If your child or adolescent engages in intense physical activity, be especially emphatic about self-care and optimal recovery.

7. Increase anti-inflammatory nutrients.

Inflammation can underlie back pain, and doctors sometimes prescribe pain relievers like NSAIDs. [44] An anti-inflammatory diet, supplemented with omega-3 fatty acids, can also help lower inflammation. [45] One review found that omega-3 essential fatty acids complement the pain-relieving aspects of NSAIDs, and studies show these anti-inflammatory fatty acids can successfully treat spine-related pain. [46] Look for a fish oil combined with vitamin D, which could help with pain management especially with deficiencies in this vitamin. [47]

Visiting a Chiropractor for Lower Back Pain

Lower back pain is a common motivation for a chiropractic appointment, though even that is sometimes under-utilized. [48] Chiropractic is a safe source of relief of that nagging, sometimes debilitating, lumbar-region pain. [49]

One randomized, double-blind, controlled clinical trial evaluated the levels of pain in patients with problems in their lower back before and after a lumbar adjustment. Every indicator of pain improved for the treatment group, with no changes in the control group. [50]

If your child or teen experiences back pain at any level, but especially in the lower lumbar region, visit a chiropractor. While medication may be designed to block pain, chiropractic is all about safely and effectively getting to the cause.

From a purely mechanical perspective, chiropractic care for lower back pain will typically include adjustments to these segments. Don’t forget those adjustments also have an impact on the organs you don’t feel, not just the muscles and select nerves that you do feel.

No child or teen must ever settle with lower back pain, and correcting this issue will help minimize or eliminate pain as they become adults. While most situations become better with time, a physician or chiropractor can help correct persistent lower back pain. Utilizing these strategies (including a good backpack that supports back health) can ensure your kids have a healthy, happy school year.

School Shopping for Backpacks

What Causes Lower Back Pain in Children?

Symptoms of Back Pain (and When to See a Doctor)

Children’s Backpacks and Lower Back Pain

How to Minimize Pain Caused by Backpacks