While findings vary across studies, research generally agrees that some degree of spine pain is common in school-aged children—from elementary school through middle and high school. Multiple factors can contribute to spine pain in students, and one that routinely appears in the literature is backpack use. The issue is not necessarily backpack use itself, but the stress heavy, poorly fitted, or improperly worn backpacks place on a child’s developing body.

In an experiment conducted in 2015, a female volunteer walked on a treadmill for five minutes using different types of bags: a two-strap backpack, a one-strap backpack, a shoulder bag, and a cross-body messenger bag. The two-strap backpack was associated with the least spinal muscle activity, suggesting it may be the least likely to contribute to back pain. Unfortunately, a 2025 study of 384 preteens found that even among students with two-strap backpacks, about half routinely slung their backpack over one shoulder, a habit that can put uneven stress on the spine and surrounding tissues.

When a backpack is too heavy, it increases strain on the muscles, tendons, ligaments, and spinal discs of the neck, mid- and low back, and pelvis. Carrying excessive weight also affects a child’s balance and posture, forcing the body’s center of gravity to shift to accommodate the burden. Experts generally recommend that a backpack weigh no more than 10–15% of a child’s body weight. However, the 2025 study found that more than half of students exceeded this guideline. Other research has shown that for every one-kilogram increase in backpack weight, the risk of developing back pain rises by as much as 45%.

Additionally, the amount of time spent wearing a backpack can also elevate injury risk as tissues fatigue and postural adaptations accumulate. A 2016 study of more than 5,300 students across all grade levels found that even though the relative backpack weight declines as children age, the overall rate of spine pain increases over time. Further analysis revealed that the duration of backpack use increases with each grade level, making it an important risk factor for spine pain.

Of course, backpacks are not the only cause of pediatric spine pain. Other common risk factors include excessive sitting and screen time, low physical activity, poor diet, and inadequate sleep. Fortunately, proper backpack habits, regular exercise, and healthy lifestyle choices can go a long way toward reducing spine pain in students. If pain is persistent or worsening, parents and students should consult a healthcare provider, such as a chiropractor, for a thorough evaluation and guidance on safe, effective management.