More and more often I am being told by my clients (both parents and school aged children and teenagers) that they are packing heavier and heavier school bags to carry to and from school.  Some of these parents, children and teenagers report that school bags can way anywhere up to 10 – 15 kg.  It seems that books, clothing and laptops make up the majority of the items packed into school bags.  For many individuals, a 10kg school bag can weigh anywhere between 10 – 25% of their entire body weight.  This is quite a lot when you think about how heavy the school bag is relative to their weight and then how far they need to carry the bag.

I have regularly been asked by clients about whether or not school bags can contribute to back pain in school aged children and teenagers.  The other commonly asked question is whether or not carrying school bags over one shoulder can be an issue with regards to children and teenagers developing an injury.  I have therefore tried to find out what the research says to help give us a more clear answer.  So far I have only found a few articles on PubMed, so for anyone out there that has additional research, it would be great to hear from you and have you point me in the direction of where I can source additional articles relevant to this topic.

What the research says

The article “The effect of school bag design and load on spinal posture during stair use by children” written by Hong, Y et al, 2011 reported:

  • School bag weight varies from 17% in the US to 20% in Italy and Hong Kong of the childs total body weight
  • “A symmetrical backpack or an asymmetrical single-strap athletic bag with a load not exceeding 10% should be recommended for school children in order to avoid spinal posture alteration during stair use”

The article “Low Back Pain in 15- to 16-Year-Old Children in Relation to School Furniture and Carrying of the School Bag” by Skoffer, B, 2007 reported:

  • The prevalence of “lower back pain in children increases with age, so that by the age 14–17, 11 to 71% has experienced at least 1 episode of LBP. Recurrences of LBP during childhood occur in 5 to 19%”.
  • “In the present study, no association between LBP and the weight of the school bags was found in good accordance with two other studies.  In a previous study, schoolchildren with heavy school bags, e.g., 20% or more of the body weight, reported more LBP. The effect was greater, if the children walked to school or carried the school bag in 1 hand.  In the current study, carrying the school bag on 1 shoulder was positively associated with LBP”

The article by  Bettany-Saltikov, J. et al. 2008 reported:

  • “Rucksacks are carried by approximately 92 percent of students and result in more than 7000 emergency visits in teh US alone each year.  Typically the Rucksacks are loaded between 17% to 22% of the students bodyweight”.
  • “Asymmetrical cross-body loading of satchel type bags in students has less overall impact on posture than asymmetrical same -side loading”.
  • “a 17% load is too heavy for several hours of daily Rucksack carriage”.
  • “As the use of Rucksacks within today’s population increases in popularity, it is increasingly apparent that education and correct information are essential for Rucksack safety.  Public awareness needs to be intensified, to make all students aware of the importance of carrying a Rucksack on both shoulders”.

My key take home points from all of this is that it is common for school children and teenagers to experience back pain.  School children and teenagers can carry up to 20% of their body weight in their school bags.  School bag weight should be kept to a minimum where possible as the weight of the school bag, way the bag is carried and the route to and from school (distance, environment i.e. stairs) means that loads will vary from individual to individual greatly.  There is still some debate about whether there is a relationship between heavy school bags and lower back pain.  However there was evidence to suggest that carrying a school bag on one shoulder was positively associated with LBP.

I will endeavour to update this blog again once I have some more up to date research and evidence.  This blog was written by Osteopath Heath Williams.  Heath is the director of Principle Four Osteopathy and Corporate Work Health Australia.  Principle Four Osteopathy is one of Melbourne City CBD 3000 leading Osteopathic clinics.  The clinic is located in the heart of the Melbourne CBD at 29 Somerset Place (near the corner of Little Bourke & Elizabeth St).  Appointments can be made by calling 03 9670 9290 or booking online @


 Bettany-Saltikov, J. et al.  Carrying a Rucksack on either Shoulder or the Back, Does it matter? Load induced functional scoliosis in “normal” young subjects.  Research into spinal deformities 6.  P.H. Dangerfied, IOS Press, 2008.  pp 221 – 224.

Hong, Y. et al.  The effect of school bag design and load on spinal posture during stair use by children, Ergonomics, Vol. 54, No. 12, December 2011, pp 1207–1213.

Skoffer, B.  Low Back Pain in 15- to 16-Year-Old Children in Relation to School Furniture and Carrying of the School Bag, SPINE Volume 32, Number 24, pp E713–E717, 2007.


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