Heavy loads and improper carriage are primary drivers of musculoskeletal strain in adolescents. Sumeet Garg, a pediatric spine surgeon at Children's Hospital Colorado, notes that parents should monitor children for physical cues of distress, such as leaning forward while walking or visible difficulty when lifting their bags. Persistent pain, numbness, or tingling symptoms require immediate attention rather than being dismissed as standard fatigue.

To manage these risks, the AAOS recommends a three-step routine: packing only essential items, checking how the bag sits on the child’s frame, and adjusting straps for a snug fit. Heavier items should always be placed low and toward the center of the pack to balance the weight. Students should utilize both padded shoulder straps to distribute pressure across the body's strongest muscles, and they should be encouraged to bend at the knees when lifting their gear from the floor. Regular audits of a student's daily load are necessary, as supplies and extracurricular requirements fluctuate throughout the year.