Backpack Advice Every School Aged Child Needs to Know


The research confirms that heavy backpacks can be a heavy burden on children’s posture. With Back to School right around the corner, set your pediatric patients up for success this school year by advising their parents of the risk of over packed backpacks.

Wearing backpacks that are too heavy can cause serious strain to the Posture System, compromising your pediatric patients’ biomechanics. To help your patients prevent postural distortion patterns associated with heavy backpack use, educate them of proper backpack posture tips.

Take the opportunity during Back to School month to educate your patients through a Posture Workshop and patient education materials of backpack safety. This is a conversation worth having for back pain prevention and good posture habits.

Lightening the load in their backpacks can make all the difference in their Back to School posture.

Get the Facts – Research review of Backpacks & Biomechanics

  1. The National Safety Council (2018) concludes that backpacks that are too heavy can cause back and shoulder pain and poor posture.
  2. Backpack loads carried by schoolchildren should be limited to 10% body weight due to increased forward head posture and subjective pain complaints at 15% and 20% body weight loads of backpacks (Kistner, Fiebert, & Roach, 2012).
  3. Backpack loads are responsible for a significant amount of back pain in children, which in part may be due to changes in lumbar disc height or curvature as noted on MRI studies (Neuschwander et al., 2009).
  4. Carrying backpacks increases the risk of back pain and possibly the risk of back pathology. The prevalence of school children carrying heavy backpacks is extremely high (Rodriguez-Oviedo et al., 2012).
  5. Patients have asymmetric posture while walking with a backpack and with a trolley bag. Carrying backpacks can cause forward posture. While pulling a trolley there was a significant increase in thoracic and lumbar rotation (Schmidt & Docherty, 2010).
  6. Results showed that rectus abdominis muscle activities increased progressively and disproportionably as the backpack load increased. Patients wearing backpacks with 20% of their body weight caused the most significant muscular and postural changes. Backpacks this heavy should be avoided (Al-Khabbaz, Shimada, & Hasegawa).
  7. Backpacks with a lower load placement on the spine result in less postural adaptions for children including less trunk forward lean, forward head posture, and spinal lordosis (Brackley, Stevenson, & Selinger, 2009).
  8. Education regarding backpack usage may impact the middle school aged child by improving their quality of life as noted through a decrease in reports of musculoskeletal pain by participants (Feingold & Jacobs, 2002).
  9. When carrying a modified double pack (weight in front and back), the forward head angle and forward head distance decreased when compared to carrying a backpack. These findings indicate that the modified double pack minimizes postural deviation (Kim et al. 2008).

Over loaded backpacks can cause postural distortion patterns and increase the risk of back pain and back pathology. In addition to teaching your pediatric patients healthy backpack tips, also encourage their parents to schedule their Yearly Posture Evaluation as part of their Back to School preparation.

To demonstrate the importance of backpack safety you can take a Posture Image with the backpack on, in addition to their standard Posture Image, to see if postural distortion patterns increase with backpack usage.


Healthy Backpack Tips for Your Patients

  • Do not carry backpacks that are more than 10% of your body weight

  • Always wear backpacks with two straps over the shoulders

  • Pack heavier items such as textbooks closer to your spine in the back of the backpack

  • Avoid spinal twisting while pulling a trolley bag

  • Balance the weight of your body while carrying a backpack over both hips and both feet equally from right to left

  • Avoid bending forward to compensate for the weight of the backpack

  • Balance the weight load distribution by carrying a double backpack with weight in the front and the back

  • While walking with a backpack keep your head up and pull your chin back so your ears are aligned over your shoulders


Want some Shareable Images to use for your practice?  Here you go!  Make posture a focal point this month in your practice!


Written By:

Dr. Krista Burns 

Co-Founder American Posture Institute

Dr. Krista Burns graduated with honors as a Doctor of Chiropractic from Palmer College of Chiropractic.  Passionate about furthering her education, she completed a Doctorate in Health Administration with an emphasis in Health Policy. To increase her clinical expertise she completed certifications as a Certified Posture Expert, Certified Posture Exercise Professional, and a Specialist in Functional Chiropractic Neurology.

Other articles and podcast by Dr. Burns Click HERE 




Al-Khabbaz, Y., Shimada, T., & Hasegawa, M. (2008) The effect of backpack heaviness on trunk-lower extremity muscle activities and trunk posture. Gait and Posture, 28(2) p. 297-302.

Brackley, H., Stefenson, J., & Selinger, J. (2009) Effect of backpack load placement on posture and spinal curvature in prepubescent children. Children and Ergonomics, Work, 32(3) p. 351-360.

Feingold, A. & Jacobs, K. (2002) The effect of education on backpack wearing and posture in a middle school population. Work, 18(3) p. 287-294.

Kim, M. Yi, C., Kwon, O., Cho, S., & Yoo, W. (2008) Changes in neck muscle electromyography and forward head posture of children when carrying schoolbags. Ergonomics, 51(6) p. 890-901.

Kistner, F., Fiebert, I., & Roach, K. (2012) Effect of backpack load carriage on cervical posture in primary schoolchildren. Work, 41(1) p. 99-108.

National Safety Council (2018)

Neuschwander, T., Cutrone, J., Macias, B., Cutrone, S., Murthy, G., Chambers, H., & Hargrens, A. (2009) The Effect of Backpacks on the Lumbar Spine in Children A Standing Magnetic Resonance Imaging Study. Spine, 35(1) p. 83-88.

Rodriguez-Oviedo, P., Ruano-Ravina, A., Perez-Rios, M., Garcia, F., Gomez-Fernandez, D., Fernanzez-Alonso, A., Carriera-Nunez, I., Garcia-Pacios, P., & Turiso, J. (2012) School children’s backpacks, back pain and back pathologies. Arch Dis Child, 97 p. 730–732

Schmidt, J. & Docherty, S. (2010) Comparison of the posture of school children carrying backpacks versus pulling them on trolleys. Clinical Chiropractic, 13(4) p. 253-260.