Background Individuals aged 30–60 years have a high possibility of experiencing low back pain. However, children and adolescents are not exempted from this problem. This study aimed to determine the relationship between backpack usage and the frequency of low back pain in pre-university students. Methods A total of 101 currently enrolled pre-university students were recruited for this cross-sectional study. They answered a questionnaire about their demographic details and their frequency of backpack usage. Their backpacks were weighed for four consecutive school days. The Roland–Morris Disability Questionnaire and Body Discomfort Chart were used to rate discomfort levels. Results The use and weight of a backpack were not significantly associated with low back pain, as indicated by the Roland–Morris Disability Questionnaire and Body Discomfort Chart (p > 0.05). Conclusion This study did not find an association between the use of a backpack and low back pain in Malaysian pre-university students.