BACKGROUND: Nowadays, a large number of students experience spinal pain quite early in life due to heavy school bag loads. Moreover, external forces in the form of school bags may influence the normal growth, development of children and adolescents, and also maintenance of alignment of their bodies, which can pose a huge threat to postural integrity under external load. Awareness about the appropriate load and placement of backpack is thought to be important in reducing musculoskeletal complications among children's. METHODS: A systematic review of randomized controlled trials (RCTs) was conducted to determine the influence of postural deviations due to backpack load among school children's. Electronic databases were searched, and a reference list of retrieved articles were relevant to postural changes among school children with the backpack were screened. Reviewers graded the papers according to Lloyd-Smith's hierarchy of evidence scale. Papers were quality appraised using a modified Crombie tool. RESULTS: Twelve papers were identified for inclusion in this review. Methodological difference limited our ability to collate evidence. CONCLUSION: Most of the articles recommended that backpack load limit for school children should be 10–15% of body weight. However, the appropriate load limit for school children is limited due to lack of articles, the low hierarchy of evidence, and small sample size. This review constrains the use of published literature to inform good load limit of school pack among the school children.
