After carrying books in a one-strap backpack, Asian studies and pre-law sophomore Sheila Singh decided last year to purchase a new backpack for her heavy class days.
Singh uses two different backpacks during the week. For her lighter load of books on Tuesday and Thursday class days, she wears a one-strap bag.
"Last year I used to carry the [one-strap] bag," she said. "My neck and shoulder would hurt on the side the strap was on, so I bought the JanSport backpack for my Monday, Wednesday, Friday classes because I have five classes back-to-back."
After carrying books all around campus, students realize that the types of backpacks they use makes a difference.
Several clinical studies have shown that there is a correlation between back injuries and the weight people carry on their backs, said Dr. Matthew Ruiz, a chiropractor at Hall Chiropractic.
Often, though, students do not have time think about how carrying their backpacks can place strain on their backs.
"A lot of people just throw all kinds of weight in their bags," Ruiz said. "They just exceed the capacity of the bag, and it's going to cause fatigue and strain on their backs."
Ruiz explained that the weight students carry in their backpacks can affect their spines.
"We have curves in our spine," he said. "In our neck, our spine curves forward; in the mid-back, it curves toward the back; and in the low back, it curves forward again. You want to maintain these curves in the spine. You want to make sure you utilize proper posture when you are wearing the backpack. Posture is so important."
Awais Shaikh, an undeclared natural sciences freshman who uses a one-strap backpack, said he tries to keep the amount of weight he carries fairly low to avoid pain.
"Occasionally, when I have a lot of weight to carry, it tends to hurt me," he said. "It's not as comfortable. When it's light my back doesn't bother me."
When the curves are not maintained, a student can experience pain, Ruiz said.
"Basically, the pain can vary anywhere from your neck to the lower back, depending on where the stress of the load is - from the top of the neck to the base of the spine," he said.
Students carrying extra weight can have strains, tears or sprains of muscle tendons and ligaments that surround and support the spine. Ruiz said in extreme cases, one can have injuries to the discs between the bones of the spine. Students' chances of injury increase with greater distances they walk with their backpacks.
"As those muscles fatigue, you get tired; your posture is going to be even worse," he said. "It's going to increase the probability of sustaining an injury." 
Students also contribute to injuries in their necks by looking down when reading, Ruiz said. They place extra stress on their necks when they do not read at chin level, which can lead to muscle spasms and headaches. Ruiz suggests students buy a bookstand to maintain the neck's natural forward curve.
"The biomechanic stress on the neck when it's out of alignment has been shown in clinical research to cause degeneration of the spine," he said. "It's known as DJD, Degenerative Joint Disease. It is preventable with chiropractic care."
Ruiz also stressed the importance of lifting with the legs.
"Most injuries to the lower back occur in forward flections, that's just bending forward and lifting," he said. "If people are bending over to lift up their backpack, the most clinically proven common way to have an injury to the low back is to bend forward and lift. Always keep your spine erect; you want to maintain proper posture. Always bend with your legs not with your back."
To help relieve some stress from the back, students should make sure the straps of the backpack are tightened and that the load is not too heavy, Ruiz said. Also, be sure not to wear only one strap all the time, he added.
"One strap is going to cause a lot of strain on the muscles that keep the spine erect - shoulder muscles and neck muscles," Ruiz said. "It can also cause headaches."
Tabitha Holloway, a biology sophomore, said a two-strap backpack is in order when she's carrying heavier items.
"At least two books and two notebooks in it always," she said. "If I have to bring three books I carry my other backpack."
But Ruiz said the ideal backpack is a bag with belts going across the chest and across the waist. The bag should also have wide shoulder straps.
"The wider shoulder straps, also the strap that goes across the chest to give lateral support, and straps that go around the waist will help bring the weight in close to our hips," he said. "That's ideally where the weight should be - centered around the hips, two inches below the naval."
Dr. Mark Chassay, a UT staff physician and team physician for women's athletics, agrees with Ruiz on the ideal backpack. He said wider straps will widen the distribution of the weight and help relieve stress on the neck.
"If you hold five pounds in your hand out in front of you, you would get tired faster than if you held it at your chest," he said. "The waist strap will bring the load in line with your body and will help keep things more stable. The waist strap can help the lower back."
Chassay said about 75 percent of all back injuries occur in the lower back, with 20 to 25 percent happening in the upper back. He advises students to be aware of how much weight they carry.
"About 5 to 10 percent of your body weight is going to be a problem," he said. "Mix it up a bit - don't carry a lot of books. Try to carry some in your hands."
Students can wear their backpacks in different positions to redistribute the weight throughout the day, Chassay said.
"Some people will wear their bags the opposite way to redistribute the weight," he said. "They might want to redistribute the weight every once in awhile. Maybe put it on one shoulder for awhile or tote it around a bit on wheels."
Once students realize they are carrying too much, they should look for alternatives, Chassay said.
"We can put less in the backpack and carry some in our arms," he said. "Once students become aware, they will carry less books during the day and go home to get books for the night or redistribute the weight."
Chassay advises students to reduce the pressure on their backs and see a physician or call the UT Nurse Advice Line should they experience pain. He also suggests strengthening the back. Handouts about back strengthening are available at the University Health Center in the Student Services Building.
"You can do more exercises to strengthen your back," Chassay said. "So the pain can be recurring, but can also decrease if you strengthen your back."
Students should always think about how much weight they are carrying, he said.
"The important thing is to think about it," Chassay said. "Be aware of the weight. You forget you do it every day."
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