Purpose : The purpose of this study was to determine the effect of book bag handling styles and types of footwear on muscle activation of erector spine muscles and calf muscles. Methods : Ten participants took off their book bags and used sneakers to walk on a treadmill for 30 minutes. The following day, 10 participants put on their backpack with 10% of the weight and used sneakers to walk on the treadmill for 30 minutes. On the last day, 10 participants put on their backpack with 10% of the weight and used formal shoes to walk on the treadmill for 30 minutes. After walking on the treadmill at 3 mph for thirty minutes, we measured muscle activation in erector spine muscles and calf muscles. Results : The results of this study showed the activation of the erector spine muscles and the calf muscles significantly increased when walking with a book bag and the activation of the erector spine muscles and the calf muscles significantly increased when walking in formal shoes. Conclusion : Using a backpack and formal shoes increase muscle activity of erector spine muscles and calf muscles. The results of this study indicate that not using a backpack and wearing sneakers are more beneficial than that using a backpack weighted 10% and wearing formal shoes and can be recommended to adult women by clinicians.