Effects of School Backpacks on Spine Biomechanics During Daily Activities: A Narrative Review of Literature

Cazmon Suri, Iman Shojaei, Babak Bazrgari

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Objective: The purpose of this narrative review is to summarize the effects of carrying school backpacks on spine and low-back biomechanics as a risk factor for low back pain in young individuals. Background: Backpacks constitute a considerable daily load for schoolchildren. Consistently, a large number of children attribute their low back pain experience to backpack use. Method: A literature search was conducted using a combination of keywords related to the impact of carrying backpacks on lower back biomechanics. The references of each identified study were further investigated to identify additional studies. Results: Twenty-two studies met inclusion criteria. A total of 1,159 people aged 7 to 27 years were included in the studies. The added load of a backpack and the changes in spinal posture when carrying a backpack impose considerable demand on internal tissues and likely result in considerable spinal loads. The findings included results related to the effects of backpack weight and position on trunk kinematics and spine posture as well as trunk muscle activity during upright standing, walking, and ascending and descending stairs. Conclusion: Backpack-induced changes in trunk kinematics for a given activity reflect alterations in mechanical demand of the activity on the lower back that should be balanced internally by the active and passive responses of lower back tissues. Although the reported alterations in trunk muscle activities and lumbar posture are indications of changes in the active and passive response of the lower back tissues, the resultant effects on spinal load, that is, an important causal factor for low back pain, remains to be investigated in the future. A knowledge of backpack-induced changes in spinal loads can inform design of interventions aimed at reduction of spinal load via improved backpack design or limitation on carrying duration. Application: This narrative review is intended to serve as an educational article for students and trainees in ergonomics and occupational biomechanics.

Original languageEnglish
Pages (from-to)909-918
Number of pages10
JournalHuman Factors
Issue number6
StatePublished - Sep 1 2020

Bibliographical note

Funding Information:
The authors would like to acknowledge and thank Beth Axtell for her contribution as technical editor for this review. C.S. and I.S. were supported in part by an award (5R03HD086512-02) from the National Center for Medical Rehabilitation Research (NIH-NICHD) and an award from the Office of the Assistant Secretary of Defense for Health Affairs, through the Peer Reviewed Orthopaedic Research Program (award #W81XWH-14-2-0144).

Publisher Copyright:
© 2019, Human Factors and Ergonomics Society.


  • backpack
  • children
  • kinematics
  • low back pain
  • narrative review
  • posture

ASJC Scopus subject areas

  • Human Factors and Ergonomics
  • Applied Psychology
  • Behavioral Neuroscience


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