Back to school season is upon us! Returning to the classroom and the social aspects of school can be exciting and fun for many kids and teens. However, just like getting used to waking up early, there is an adjustment period for the musculoskeletal system as well.

Physical therapists often hear kids complain of back and neck pain upon returning to school. These complaints are commonly a result of poor ergonomics, like an ill-fitting backpack or bad posture. Also with the return of school sports, we tend to see an increase in acute injuries, such as ligament tears, fractures and concussions.

EXCEL West Milford Clinic Director, Angela Lazarevska Choleski, PT, DPT, is sharing her expert PT tips on how to stay healthy through this school year. Read below to learn how you can combat the back to school blues.


What are some tips for making backpack wearing pain free?

The most important tip is to choose the right size backpack for your child. The school supply list increases every year, but backpack size should not. When choosing the right backpack, make sure the bottom of the backpack sits about two inches above the waist. Nothing makes me cringe more than when I see a preschooler wearing a backpack that goes to the bottom of his/her buttocks. Large backpacks contribute to poor posture and back pain.

In addition to the size of the backpack, it is very important that the bag has wide straps. Straps should be at least two inches side with sufficient padding. The straps should also fit the backpack snugly to the child. Where the backpack lays on the child should also have several compartments of padding. This part of the backpack act as support and help to distribute the weight evenly. If there is a waist belt on the backpack, your child should wear it for additional support.

The weight of the backpack is also a huge contributor to poor posture and back pain. Ideally, a loaded backpack should not weigh more than 10-15% of your child’s body weight. Look for the signs:

  • Is your child struggle to put the backpack on his/her shoulders?
  • Does he/she complain of numbness and tingling in arms and hands?
  • Did you notice an immediate change in their posture (hunched back, forward shoulders, downward gaze) when they put their backpack on?

These are red flags that your child’s backpack is too heavy. If their bag is too heavy, kids should try to find opportunities to unload the backpack at a locker or desk during the day. Also, the heaviest school supplies should be packed into the bottom of the backpack and the lightest items are at the top. When the bag is filled in that manner, the weight distribution helps pull the shoulders back, thus improving posture.


What are some tips for combating bad posture while sitting in desks?

Children, just like adults should follow the 90-degree rule. If possible, elbows, hips and knees should all be bent at a 90-degree angle and the feet should be placed flat on the floor, never dangling. Reading material should be placed at an eye level in front of them. Wrongly placed reading material can cause strain on the neck.

Children should also not be expected to sit for too long, so encouraging breaks is key! Quick but frequent standing or walking breaks opportunities can be very beneficial to avoid muscle fatigue and bad posture from extending sitting.


For kids starting or returning to school sports, what advice do you have for taking care of their body?

First, all kids should be active – whether it be participation in sports or a walk around the block after school. Just like adults, kids need to take care of their bodies to prevent injuries. Movement is medicine!

In addition, for any athlete – school age or not – hydration is a key! On average, a child 5 to 7 years old should drink about 5 glasses of water a day, while an 8- to 12-year-old child should shoot for about 7 glasses. Teens ages 13 and up should try to drink 8 glasses or more a day. Those numbers should increase if the child is physically active and if the weather is hot and humid.

It is also very important to incorporate a stretching routine before and after playing any sport to avoid injuries. Stretching improves mobility and blood flow and helps the body warm up prior to activity. After activity, stretching helps to decrease the heart rate and cool down the body.

At the end of the day, injuries will happen. The important part is to make sure that children are properly healed before returning to sport. A child should visit a physical therapist to make sure that he or she has the appropriate strength, range of motion, agility and endurance that is necessary to get back in the game.



If your child is back to school and experiencing any of the physical aches and pains typically associated with the start of the school year, reaching out to a physical therapist can help. A good PT will not only address the symptoms but can also determine the cause of the issue to help prevent it happening again in the future. And best of all, you don’t need a prescription from a doctor to get started.

We hope these tips help your student EXCEL through this school year!

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