The objectives of this study were to 1) describe the characteristics of the backpacks used by students 10-18 years of age, 2) describe self reported pain related to backpack use and 3) evaluate the relationship between self reported pain and perceived backpack weight, duration of backpack use and posture when wearing a backpack. A cross-sectional survey of 871 students assessed the features of the backpack carried; the self perceived backpack weight, duration and posture; and any backpack related pain. Results indicate that 99% of students surveyed carry backpacks, 83% carry their backpacks over both shoulders and the presence of adjustable shoulder straps were the most common feature of the backpacks. Half of the students perceive their backpack as heavy and 46% indicate they carry the backpack 10-20 minutes to and from school. Pain attributed to backpack use was reported by 33.5% of the students. Perceived backpack weight, duration of backpack carriage, posture, gender and school district were significantly associated with reported symptoms. Although other socioeconomic and demographic characteristics may contribute to backpack related pain, this study suggests that students perceive a relationship between backpack use, the duration of use, posture and pain supporting the suggestion that simple weight-based controls of backpacks may not be sufficient to eliminate pain perceived as due to backpack use.