Use of school backpacks on musculoskeletal health in children and adolescents: A scoping review

The widespread use of school backpacks among children and adolescents has prompted research into their potential musculoskeletal effects. This review aims to identify the main methodological gaps and inconsistencies that limit comparability across studies, synthesize the existing evidence, and propose methodological recommendations to enhance the quality of future research. PRISMA-ScR guidelines were followed. Inclusion criteria were: (i) studies with ≥50 healthy schoolchildren; (ii) school backpack use as the exposure; and (iii) experimental or observational design, published in English, Portuguese, or Spanish within the past 10 years. Searches were conducted in PubMed, Scopus, and Web of Science (February 2025). Studies scoring ≥65% on the STROBE checklist were included. Fourteen observational studies involving participants aged 5–18 years were included (11 cross sectional, 3 longitudinal; 7 from Europe). The main backpack characteristics examined across studies were weight, type of backpack, strap design, and carrying method. While backpack weight was analyzed in most studies using diverse criteria, including absolute, estimated, and perceived load, load distribution, and number of bags; the strap-related characteristics were less frequently reported. The impact of backpack use was identified through: musculoskeletal pain (intensity, prevalence, location, chronicity, functional impact, and threshold), postural alterations (spine and lower limbs), gait, and muscle endurance. Evidence indicates an association between backpack use and musculoskeletal pain. Nonetheless, relevant methodological variability, and underreporting of key variables were identified. Future research should adopt age- and BMI-stratified designs and employ standardized assessment tools to better understand the musculoskeletal impact of backpack use and to generate more precise recommendations.