It is common wisdom that most parents believe that schoolbags cause back pain. But is this really the case? This is a ‘textbook’ example of where the evidence belies common wisdom.

The prevalence of back pain in children is high in certain parts of the world and increases rapidly as they age through adolescence (Akdag, Cavlak, Cimbiz, 2011). Lots of developmental changes are occurring through this period but it is still of interest to see how much of an effect backpacks and its characteristics had on reported back pain. There are other factors such as psychosocial distress, female gender, and smoking that can contribute to back pain as well.

The evidence is shaky on the relationship between backpacks and back pain. The belief remains pervasive though culturally. There’s heightened awareness in the general public which means therapists are asked a bevy of questions about the type of backpack, how to carry them, and how much weight is safe for children.

Guidelines exist but the recommendations vary. It’s recommended that safe loads are 10-15% of the child’s bodyweight but range as low as 5% to 20%. Some studies purport that even 10% of a child’s bodyweight in a schoolbag is enough to change biomechanics, posture, and muscular strain.

Honestly though, we need to know more about the risks of school bags as the results are inconclusive.

The study I’m extrapolating from looked into the characteristics of schoolbag use (e.g., weight, duration of carriage, bag design, method of carrying bag, and weight) and if they are risk factors for back pain in children and adolescents. There was a positive association between perception of heaviness and difficulty with carrying backpacks and back pain and persistent symptoms. As for the other aspects, there is no convincing evidence that these features increase back pain in children and adolescents.


  • The takeaways should be heeded with caution. There were a huge amount of studies investigating this relationship (6597 to be exact) but most of them had high biases and were of low quality. What we can deduce though is drawing upon the vast number of studies, there is no reliable pattern between characteristics of school bags and back pain, any association is minimal at best. Research funding is best directed at investigating other factors.
  • Schoolbags do not appear to play a factor in back pain found in children and adolescents.
  • Backpack guidelines and recommendations should reconsider as it’s not based on reliable evidence.
  • Promoting other brands of bookbags over others should be reevaluated as well. Selective promotion reeks of financial endorsements.

Does this mean no children suffer from back pain carrying around huge textbooks in their bags? No. Certainly, I believe some children have trouble with carrying huge loads with them all day everyday. It just isn’t a detrimental health hazard.

Claiming that heavy backpacks are detrimental to a kid’s health is neglecting how resilient humans are. And we adapt well to life’s demands. Especially if a kid is carrying a book bag around every day. You can think of it as training or conditioning them to acclimate to the heaviness.

And yes, there’s something to be said about the amount of books required for school. But that’s a totally different topic.

My take on why some kids subjectively report back pain is the multifactorial nature of their lives at the time. School can be psychosocially taxing on a kid which is experienced as stress. And if they are already stressed to begin within, perceived heaviness of their schoolbags can feel doubly taxing. The phenomenon of back pain experienced by school children is more multifactorial rather than a purely biomechanical one. 


  1. Akdag B, Cavlak U, Cimbiz A, et al. Determination of pain intensity risk factors among school children with nonspecific low back pain. Medical Science Monitor, 2011;17:PH12–5.
  2. 2. Yamato, TP, Maher, CG, Traeger, AC, Williams, CM, Kamper SJ. Do schoolbags cause back pain in children and adolescents? A systematic review. Br J Sports Med 2018; 52:1-6
  3. Photo credit –


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