Academic journal article Journal of School Health

Association of Relative Backpack Weight with Reported Pain, Pain Sites, Medical Utilization, and Lost School Time in Children and Adolescents

Academic journal article Journal of School Health

Association of Relative Backpack Weight with Reported Pain, Pain Sites, Medical Utilization, and Lost School Time in Children and Adolescents

Article excerpt

In the past few years, there has been growing concern among teachers, school administrators, parents, and health care professionals over the effect of school backpacks on spinal and shoulder problems in children and adolescents, (1-7) particularly since over 40 million American students carry backpacks. (6) These reports usually suggest that the backpack load of children and adolescents should not exceed 10-15% of body weight, with most suggesting a 15% cutoff. For example, the 15% cutoff is suggested by the American Chiropractic Association, the American Physical Therapy Association, and the American Academy of Orthopedic Surgeons. (1,3,5,6,8-15) However, students at all ages often carry much heavier relative loads. (14,16-19)

While research indicates that thousands of backpack injuries result yearly from factors other than carrying the backpack (eg, tripping over them, taking them off improperly, straps getting entangled in bicycle gears, etc), (1,7,19) the primary concern of many school personnel and parents is the long-term use of heavy backpacks as the routine method of carrying books and other articles to, from, and at school. Siambanes et al (20) surveyed 3498 Southern California adolescents and found that 41.3% reported pain when carrying their backpacks, with 16.9% consulting a doctor for the pain and 16.1% reporting missing some school activity due to pain. Pain reports were associated with walking to school (but not with time spent walking to school) and with a higher relative backpack weight to student weight. Thirty-one percent of boys and 42% of girls who carried a relative weight of 15% reported pain or more. Korovessis et al (21) studied a sample of 3141 Greek students between the ages of 9 and 15 years. They reported that dorsal pain increased with increasing weight of backpacks. The authors did not analyze for relative backpack weight but found no effect of student weight as a variable on pain reports. Dorsal pain attributed to backpacks was highest for children aged 11 years, with 72% of girls and 38.5% of boys reporting pain. Lockhart et al (19) studied 127 New England seventh-grade students. Almost 25% reported difficulty in carrying backpacks due to pain, while 31% reported problems in participating in a school or leisure activity due to backpack pain. Sheir-Neiss et al (22) found in a sample of 1122 students that reported pain and impaired physical functioning increased with increasing degree of backpack usage and greater relative weight.

There is little evidence concerning the relationship between the method of carrying the backpack (1 or 2 shoulders) and reported pain. (6,19) Korovessis et al (21) reported no relationship with dorsal or low back pain, while Korovessis et al (18) found in a sample of 1263 students that asymmetric carrying was correlated with higher intensity of pain reports; again, girls were more likely to report higher pain levels. Gender differences in backpack pain research seem consistent with the general finding that for the same intensity of painful stimuli, females are more likely to report higher levels of pain than males, a finding usually interpreted as reflecting cultural and contextual effects, (20,23,24) though not every study finds gender differences in backpack-associated back pain. (5,12)

One possible problem with the research literature on back pain and backpack usage is its reliance on questionnaires to assess pain, backpack usage factors, and other variables. In addition, students have not typically been asked to rate the pain they feel while wearing their backpacks or if they attribute their pain to backpack use or not. Typically, global back pain ratings (current pain or pain history) are correlated with backpack features. (5,12,17,19,22,25) The use of global ratings could lead to an underestimation of the association between relative backpack weight and pain if previous pain reports reflected pain caused not only by backpack use but also by other possible factors, thus increasing measurement error variance and thereby reducing the estimate of the true association of backpack weight and pain. …

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