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Kids and Backpacks: How Heavy is Too Heavy?

Our spines have 33 vertebrae, small bones along the spinal column, and between 24 of those vertebrae are intervertebral discs that help protect the spinal cord by absorbing shock. For children, heavy school backpacks that pull the force of gravity and alter their posture can put them at risk for neck, shoulder and back pain. Dr. Michael Paloski, a pediatric spine surgeon with OrthoCarolina Pediatrics, shared some of the most common concerns when it comes to kids and backpacks.

Backpacks seem to get heavier every year for our kids. Can the weight of a backpack physically affect a child or teenager?

Backpacks can cause discomfort to the back, neck and shoulders that may last from weeks to months.   Studies show that bookbags that are greater than 10% of the student’s body weight place them at higher risk for adverse health risks. (1) With appropriate modifications, exercises and rest, the pain should not lead to lifelong issues.  But for parents, recognizing their child’s pack is too heavy is the first step in eliminating the problem. 

I recommend each parent periodically check their child’s backpack to ensure they are carrying the least amount of items necessary.  It is important to understand that heavy bookbags do not cause scoliosis (curving of the spine), but may worsen back pain that the student with scoliosis may experience due to muscle imbalance and fatigue. 

(1) Eur Spine J. 2013 Apr;22(4):782-7. doi: 10.1007/s00586-012-2558-7. Epub 2012 Nov 10.

Effects of a postural education program on school backpack habits related to low back pain in children.

Vidal J1Borràs PAPonseti FJCantallops JOrtega FBPalou P.


What physical risks or injuries are there for children who carry heavy packs?

Even when wearing a backpack appropriately, heavy bags can lead to strains and fatigue injuries of muscles, muscle spasms, and pinched nerves.  A study by Neuschwander et al(1) in 2010 showed changes in lumbar disc height and greater lumbar asymmetry with increasing backpack loads in adolescents.  Although rare, another risk of heavy backpacks is a stress fracture of the spine, called spondylolysis.

(1) Spine (Phila Pa 1976). 2010 Jan 1;35(1):83-8. doi: 10.1097/BRS.0b013e3181b21a5d.

The effect of backpacks on the lumbar spine in children: a standing magnetic resonance imaging study.

Neuschwander TB1Cutrone JMacias BRCutrone SMurthy GChambers HHargens AR.


How can a heavy backpack affect posture?

With conventional double-strap backpacks, a bag that is too heavy can cause the students to lean forward and hunch their back to keep balanced.  Those that carry the bag only on one shoulder are at a similar risk because their center of gravity shifts laterally toward the bag.  The muscles quickly can become unbalanced and fatigued and lead to poor posture.

How parents help reduce the load of a pack for children?

Sometimes it is difficult to reduce the load because the student needs to carry all of their books between classes.  If this is the case, reduce extraneous supplies from the bookbag and only keep in the minimum (pens, pencils, calculator, etc).  If possible, utilize the locker between classes to store heavier books.  It helps to even carry a book or two in your arms to take a few extra pounds off the back and help balance out the weight and center of gravity.  Some schools will loan extra books to have at home so the student does not need to carry the book(s) between home and school.  If your child has a heavy backpack, check with your school to see if this is an option.

As far as the actual backpack, what kind of pack should parents purchase?

Rolling backpacks are the best, but unfortunately some schools do not allow these due to their size and the possibility that other students may trip on them in the hallways.  Some schools will allow them with a note from their doctor.  The next best backpacks to get are the classic double-strapped bag.  Be sure the bag is the right size for the child.  Although some bags may be more stylish or trendy than others, having the right size and fit will make a big difference.  Looking for bags with padded straps is a good thing, too.

How can teachers help reduce the load?

Teachers can do their share by keeping books for use in the class.  Utilizing e-technology (computers, tablets, etc.) is extremely helpful, but sometimes not feasible.  Teachers and schools can also implement educational programs to their students on the proper way to load, lift and carry their bookbags.  One study showed an 87.5% compliance rate with appropriate backpack wear by students after just one informational session. (1) Check with your school on their possibility of integrating these suggestions into the classrooms.

(1) Work. 2002;18(3):287-94.

The effect of education on backpack wearing and posture in a middle school population.

Feingold AJ1Jacobs K.


What is the proper way to wear a backpack?

For classic backpacks, it is best to evenly distributing the weight across the shoulder by wearing both straps at the same time. (1)  If the bag is too high on the back, the students lean forward to compensate.  If the bag is sagging too low, the opposite effect occurs and the students lean backward.  Adjust the straps to where the bottom of the bag rests along the small of the back. In the image with this article you’ll see the SKILLS acronym (2), a backpack safety skills checklist that can be used in selecting a bookbag.





For bags with only one strap such as gym bags I recommend alternating the shoulder from which the bag is hanging.  If possible, give the back and shoulders a rest every now and then and carry the gym bag by the handles. 

For rolling bags, make sure the handle is extended as long as possible so the student does not have to bend down to pull the bag.  This ensures the student is walking with a healthy, upright posture.

(1)  Spine (Phila Pa 1976). 2005 Jan 15;30(2):247-55.

Backpacks, back pain, sagittal spinal curves and trunk alignment in adolescents: a logistic and multinomial logistic analysis.

Korovessis P1, Koureas G, Zacharatos S, Papazisis Z.

(2)  Parental knowledge of school backpack weight and contents.

Forjuoh SN, Little D, Schuchmann JA, Lane BL. Arch Dis Child. 2003 Jan;88(1):18-9.


Michael D. Paloski, DO, MBA is a pediatric spine surgeon with OrthoCarolina. His specialties include trauma, spinal deformity, neuromuscular diseases, and minimally invasive surgery. He is also an osteopathic physician, treating and helping prevent pediatric injuries and conditions. Dr. Paloski completed his advanced specialty training and research in pediatric orthopedics at The Johns Hopkins Hospital. 


Thanks for posting this information! I really hope that my child uses his locker regularly while he's at school. Usually, I see him carrying a huge backpack full of heavy books and folders that are stuffed with papers. I'm really worried that carrying all of those things around will cause back problems that will affect him when he's older. He's complained how his back has been feeling really stiff and painful lately. Maybe he should see a physical therapist to improve his back pain. I liked your tip for teachers to keep books in class so that students can be allowed to do work in class rather than carry their books home to do homework. It seems like a good idea for me to suggest that to the school board.
- Deanna R. Jones
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