Heavy and improper use of backpacks has increased the rate of musculoskeletal pain in school age kids.  It is estimated that 55% of children carry backpack loads beyond the recommended weight.  In a survey studying students between the ages of 11-15 years old, 60% reported continuous pain from backpack use (Iyer et. al).  The most common musculoskeletal pain complaints from backpack use from highest to lowest are as follows (Shamsodinni et. al):

  • Upper back pain
  • Shoulder pain
  • Neck pain
  • Lower back pain

Not enough studies currently exist, but it is suspected that improper fitting/use and overloaded backpacks can contribute to permanent postural distortions, especially in the critical ages of spinal development between the ages of 11-14 years old.  

It’s been shown that carrying a backpack loaded with greater than 15% of the wearer’s body weight, will force a forward lean in posture and increase forward head posture.  Forward head posture has been associated with many pain complaints of the neck, upper back, shoulders, headaches, and lower back pain (Cheung et. al).   

Backpack safety awareness and implementation can significantly help reduce musculoskeletal pain and concerns for postural distortions in school age kids.  The recommendations are as follows:

  • Never wear a backpack that is greater than 10-15% of your body weight
  • Use both straps – using a single strap has been shown to alter posture and gait (Pascoe et. al)
  • Pack heavier items closest to the back
  • Use lockers to store books, when available
  • Use an ergonomically designed backpack:
    • Wide and cushioned shoulder pads
    • Comprehensive padding on the back
    • Not falling greater than 4” inches below the waist, but enough so some of the load is supported by the top of the buttocks  
    • Use of compression straps to redistribute the weight to the hip and pelvis and away from the shoulders
    • Multiple compartments (min of 2 main compartments with additional side compartments) for better load distribution

Many students will choose a less ergonomic but fashionable design because of familiarity with what a school bag “should look like”.  However, in a study when students were asked to compare the comfort of backpack use after walking 20 minutes on a treadmill, they all preferred the more functionally designed, ergonomic backpack with the specifications listed above (Mackie et. al).  

For successful implementation of backpack safety, coordination between parents, students, and teachers is the best strategy.  Monitoring the student’s posture while wearing their backpacks is one insightful way to tell if they are carrying too much load or improperly wearing their bags.  Checking in with them, and encouraging your kids to voice if and when they have discomfort or pain when wearing a backpack, will prevent any ongoing issues being unaddressed.  Make sure they’re using their lockers when possible, and periodically weigh the contents of their backpacks relative to their body weight.  


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Daniel Yinh

Daniel Yinh


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