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What Steven said. As a long time back sufferer I went to a large fanny pack (about the size of a volleyball) over 10 years ago. The pack works to carry more than anything you'd need on the water and the waist strap will actually double as a wading belt and back support. Cool.
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I have been using the Fishpond Blue River pack for the past 3 seasons now and love it. My vest just seemed to get too hot andheavy for me, and I too hate the chest packs. I carry the Blue River as a side/satchel style and it's comfortable rest for my line arm as well. You can push it back or bring it around front with a simple motion just like a sling pack. Also, it fits nicely over heavy gear in the winter with minimal adjustment of the waist strap.
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For me, using a lumbar / hip pack really helps. I wade fish small streams and do a lot of hiking, crouching, bending, etc. When you crouch and bend at the waist, you are lifting any weight that is supported by your shoulders and upper back, but not weight that is carried on your hips. I use a Fishpond Waterdance pack. I can carry 4 fly boxes, the usual accessories, small camera, snack, water bottle, and light rain jacket. I wear the pack cinched tight in the lumbar position and then loosen it and swing it around front when I need something.
The only thing I don't like about this pack is that there's not a good way to carry a net. I added a "net holster" this year that I rigged up with a plastic conduit coupling (basically a short piece of plastic tubing) and some zip ties.
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I also have some issues in my column, lumbar area, from my childhood. So my usual way when I go for the day or camp. is a mid size-small back pack with many pockets. 10pounds max. weight in the right position. Of course I reduced my items to a minimalist flyfisher and that's the central point.
Also some yoga-streching exercises during the trip are the key.;)