Backpacks are as much a part of the school experience as pencils, lunchboxes, and homework. They carry textbooks, laptops, snacks, and sports gear — all the tools a student needs to get through the day. But as a chiropractor in Carmel, IN who treats children, teens, and adults alike, I can tell you that backpacks also carry something else: the potential to shape posture and spinal health for years to come.
This isn’t just a theoretical concern. In my work with patients at Integrated Health Solutions, I’ve seen firsthand how improperly fitted or overloaded backpacks can lead to neck pain, lower back pain, rounded shoulders, muscle imbalances, and even long-term spinal changes. The good news? Many of these problems are preventable with the right awareness and habits.
In this article, we’ll explore the surprising history of backpacks, the biomechanics of how they affect the human body, the warning signs that trouble may be brewing, and evidence-based guidelines for safe use. Whether you’re a parent, teacher, or student, this guide will help you protect growing spines and set the stage for lifelong posture health.
A Brief History of the Backpack
Humans have been carrying loads on their backs for thousands of years. Ancient hunters and gatherers strapped animal skins or woven baskets to wooden frames, using leather thongs or plant fibers to secure their cargo. Archaeologists have even discovered that Ötzi the Iceman — a 5,000-year-old mummy found in the Alps — carried a primitive wooden frame pack.
Military innovation played a major role in shaping the modern backpack. Roman legionnaires carried the loculus, a leather satchel on a wooden frame, for long marches. By the late 19th and early 20th centuries, explorers and mountaineers were adapting military designs for hiking and camping.
Two milestones changed the game:
● 1908: Norwegian inventor Ole F. Bergan created a curved wooden frame that fit more comfortably against the human back.
● 1922: Lloyd F. Nelson patented the “Trapper Nelson” pack — a wooden frame with a canvas sack — which became the gold standard for hikers.
It wasn’t until the late 1960s that backpacks entered the schoolyard. In 1967, Greg Lowe founder of Lowe Alpine, designed the first internal-frame backpack for climbing. Outdoor brands like Jansport and Eastpak soon realized that students could benefit from lighter, more comfortable packs. By the 1980s, the backpack had replaced the traditional briefcase-style book bag for most students.
Today, nearly every student carries one. And while the design has evolved, the essential challenge remains: how to carry what you need without compromising the body that carries it.
The Physics of Carrying a Load
To understand how backpacks influence posture, you need to know about the concept of center of mass — your body’s “balance point.” If your body’s weight could be condensed into a single dot, that dot would represent where your weight is perfectly balanced in all directions.
When you place a backpack on your back — especially if it’s heavy or hangs low — you shift that balance point backward. To keep yourself from falling backwards and thus getting some nasty injuries, your body responds instinctively, contracting and engaging muscles that do the opposite motions that promote leaning forward, as in bringing your head and shoulders ahead of your hips.
This forward lean triggers a chain reaction throughout the body:
● Head and neck: The cervical spine flexes forward, or rather it appears more forward increasing strain on the muscles that hold your head up. Add to this is the growing use of mobile devices at younger ages, and children’s necks are even more predisposed to forward head posture.
● Shoulders and upper back: The shoulders roll forward, stretching postural muscles and tightening the chest. This is the body’s way of “reaching” forward to counterbalance the backward pull of the backpack.
● Trunk and hips: The hip flexor muscles engage more and the abdominal wall tightens to keep the wearer from tipping backward. This happens at the expense of the lumbar postural muscles, whose job is to extend or bend the torso backward. The body recruits these back muscles not to create backward motion, but to counterbalance the pull of the hip flexors. Unfortunately, this increases compressive forces on the lumbar vertebrae.
● Pelvis: The pelvis often tips forward, altering the alignment of the entire spine. This is partly due to the hip flexors tightening from repeated over-contraction to maintain balance. Hours of sitting after wearing the backpack keep these muscles shortened, further pulling the pelvis forward.
Over time, these repeated adjustments can reduce spinal mobility, alter normal muscle length-tension relationships, and create movement patterns that place more stress on muscles, tendons, joints, and discs. It’s not a good long-term solution.
Why Children and Teens Are More at Risk
Adults have fully developed bones, muscles, and connective tissues. While they can still be injured by poor load carriage, their skeletal structures are less easily reshaped. Children and teens, on the other hand, are still growing. Their bones are forming, growth plates are active, and their neuromuscular systems are adapting to every repeated movement and posture.
If a young student carries a heavy or ill-fitting backpack every day, their body will adapt to that posture. Muscles may become chronically tight or overstretched, spinal curves may exaggerate, and balance patterns may shift. These changes can persist into adulthood — sometimes leading to chronic issues that only appear years later.
Common Warning Signs
Parents should watch for these signs that a backpack may be causing harm:
● Pain without trauma: Back, neck, shoulder, or hip pain with no recent injury.
● Visible marks: Red marks or deep indentations where straps rest.
● Posture changes: Forward head position, rounded shoulders, or leaning forward while walking.
● Neurological symptoms: Tingling or numbness in the arms or hands.
Sometimes these patterns are not noticed immediately because many students don’t develop symptoms right away. That’s why early observation and periodic checks are so important.
Proper Backpack Guidelines
Making sure your student has a properly fitted and weighted backpack can be vital for their current and future quality of life. The following guidelines can help reduce the strain of wearing a backpack and lower the risk of long-term biomechanical changes.
Evidence-based recommendations include:
● Weight limit: Keep the backpack at or below 10–15% of the student’s body weight.
● Load placement: Place heavier items close to the spine to minimize leverage forces. Make sure to use all of the pockets to distribute the weight evenly. So when looking to purchase a backpack, consider the pockets!
● Strap adjustment: Shoulder straps should hold the pack high and close to the back, with the top 1–2 inches below the shoulders.
● Padding and width: Straps should be padded and at least 2 inches wide to distribute pressure.
● Chest and waist straps: Use them to stabilize the load and shift weight to the hips.
● Width: The backpack should not be wider than the student’s shoulders.
● Both straps: Always use both. If a sling bag is used, alternate sides frequently.
● Side bags: If you only have a side bag, make sure the bag and shoulder strap are on opposite sides when worn and alternate sides daily.
The Long-Term Consequences of Neglect
As a chiropractor in Carmel, Indiana, I’ve treated many adults whose current pain began with habits formed in school. One patient, now in his early 40s, had recurring back pain that traced back to his backpack habits as a teenager.
He had a locker but rarely used it, believing that carrying a heavy backpack was a good workout and made him stronger. It was also convenient — carrying everything meant he didn’t have to go out of his way to his locker.
This habit continued for years, wearing out multiple backpacks from the constant heavy load. During his senior year, he took a weight training class and learned the Olympic lifts. One day, while attempting a one-rep max squat, he felt a pop in his back. The pain faded in a couple of days, but returned whenever he squatted or did similar leg exercises.
By college, he had to use his locker more because he couldn’t tolerate carrying heavy loads like before. In the process of figuring out what he wanted to do, he stumbled onto a job with a chiropractor where he experienced a different type of treatment that was effective in decreasing his low back pain so much that he decided he wanted to become a chiropractic physician.
Later, while in chiropractic school, a clinician noticed an unusual spinal curve during an evaluation and recommended X-rays. The images revealed that he had lost the normal curve in his neck and that one of the last bones in his lower back had slipped forward!.
It was explained to him that this happened because of the repeated compressive pressure his spinal muscles exerted on the spinal vertebrae over time which literally “squished” forward his lowest spinal vertebrae–making his low back very unstable.. This increased exertion of the postural muscles was in large part due to improper back pack practices and poor lifting mechanics. The poor lifting mechanics was partially a result of the compensations his body went through from prolonged poor back pack usage making his back susceptible to injury and his repeated pain with leg squatting exercises.
Fortunately, through proper treatment and strengthening, he was able to stabilize the region and return to squatting exercises. His experience is a clear reminder that prevention is always better than correction.
Prevention Is Easier Than Correction
The good news is that proper habits now can prevent problems later. So please do your future child’s adult life a favor, Check your child’s backpack weight weekly. A good tip here is weigh them with and without the back pack and take the difference in weight to find the weight of the backpack. Make sure that is 10-15% of their total body weight (weight of back pack/student’s body weight). Watch for posture changes especially when they wear it and how their posture changes when they are not wearing it. Teach them how to adjust straps and load their pack properly (heavy books in the back of the pack). If the back pack is looking the same size or larger than the student, it is probably a sign that the backpack they have is not the right one. Lastly schedule periodic posture assessments with a chiropractor in Indianapolis or Carmel who has a good understanding of biomechanics and posture. They will be able to help identify current problems and help prevent future back pain and suffering.
Final Thoughts
A backpack is a tool — and like any tool, its benefit or harm depends on how it’s used. With smart choices and periodic professional checks, students can carry what they need without compromising their posture or spinal health.
They don’t need to be in pain in order to warrant attention to their spinal support and backpack usage. Be preventative and your child’s backpack is helping, not harming, by scheduling a fitting and posture check at Integrated Health Solutions. We take the time to listen and understand not only our patient’s pain but also how this is interfering with their current and future life. We then provide specialized assessments to pinpoint postural instabilities/problems and then we empower our patients along with treatments, exercises, ergonomic tips and other related information that get quick results while facilitating habits that will help maintain and or prevent future hardship.
Whether you need a chiropractor after a car accident, a chiropractor for lower back pain, or ongoing back pain chiropractic care, our team here at Integrated Health Solution can help keep growing spines healthy for decades to come.
Content provided by Dr. Andrew Sanders
