Short answer
Back, neck and shoulder pain on hikes is usually from carrying weight for hours with a pack that sits too low or loads the shoulders instead of the hips. Adjusting the pack so the hip belt takes most of the load, packing heavy items close to your back, and building up to long days usually solves it.
Watch: Lower Back Pain Explained: Disc, Facet Joint, SI Joint & Piriformis Syndrome
Common causes
Shoulders carrying the load
A loose or missing hip belt puts weight on the shoulders and neck.
Heavy items packed far from the back
Water and gear at the bottom or outside pull you backwards.
Long steep days
Hours of climbing and descending with weight, after little build-up.
What usually helps right now
- Tighten the hip belt on the hip bones so it carries most of the weight.
- Pack heavy items close to your spine, between the shoulder blades.
- Use poles on long descents.
- Build up from short hikes before multi-day trails.
What to avoid
- Carrying a heavy day pack on one shoulder.
- Increasing pack weight and distance at the same time.
When to book an assessment
- Pain lasts more than a few days after hikes.
- You have a big trail coming up, such as the Otter or Hoerikwaggo.
Get urgent medical care if
- Numbness or tingling in the arms or legs that does not settle after taking the pack off.
How we treat it
- AssessHistory, movement and clinical tests, with screening for anything that needs a doctor.
- ExplainA clear diagnosis in plain language, and what recovery usually looks like.
- TreatHands-on care where it helps: joint and soft tissue work, dry needling or adjustments.
- RebuildExercises and a training plan so it holds up, with an end point.
Questions
How heavy should my backpack be?
For multi-day hiking, around 10–20% of body weight is a common guide. Fit matters as much as weight.
Why do my shoulders go numb wearing a backpack?
Tight shoulder straps can press on nerves. Loosen them and let the hip belt carry more load.