The Impact of Schoolbags on Postural Health in School-Aged Children: An Updated Systematic Review

Schoolbags represent a common source of physical strain for school-aged children and may influence posture during critical years of growth. This systematic review synthesizes evidence published since the previous review (1995–2014), which mainly focused on load thresholds and did not consider postural health as a multidimensional outcome. The review protocol was prospectively registered in PROSPERO (CRD420251080328). PubMed, Web of Science, and Google Scholar were systematically searched up to 11 June 2024. Of 1013 screened articles, 12 studies met the inclusion criteria. Schoolbag weight was the most frequently investigated factor, followed by postural and spinal alterations, particularly scoliosis. Excessive loads were consistently associated with trunk inclination, postural asymmetry, lumbar strain, and musculoskeletal discomfort. Several studies reported demographic differences, with girls showing greater susceptibility to postural deviations and boys carrying heavier loads. Compared with earlier evidence, more recent studies employed improved postural assessment methods and broader outcome frameworks incorporating ergonomic and behavioral factors. Despite methodological heterogeneity, findings support limiting schoolbag weight to 10–15% of body weight. This review highlights the importance of integrating ergonomic design, carrying behaviors, and demographic modifiers into school health guidelines and provides practical recommendations for clinicians, educators, and policymakers.