Backpacks and Musculoskeletal Pain: Do Children with Idiopathic Scoliosis Face a Greater Risk? (Communications)

By Iyer, Shruti R. | Journal of School Health, September 2002 | Go to article overview

Backpacks and Musculoskeletal Pain: Do Children with Idiopathic Scoliosis Face a Greater Risk? (Communications)


Iyer, Shruti R., Journal of School Health


Chronic musculoskeletal pain in school children, caused by the weight of carry-on items in the school backpack, has been established as a significant problem. (1,4) Pain represents a symptom, not a sign. Though the perception of pain is very personal and subjective, several factors probably affect pain among all school children who carry backpacks including the actual weight carried, body mass index, percent body fat, muscular strength, exercise habits, smoking habits, diet and nutrition, mood, design of shoes worn, posture and gait, and presence or absence of scoliosis.

Results from my previous studies on the relationship between backpacks and back pain suggested that children with idiopathic scoliosis may be at higher risk for pain than children without scoliosis. One of my studies involved 145 adults aged 3-77 years (36 with scoliosis; 109 without scoliosis), and 388 children aged 6-22 years (37 with scoliosis; 351 without scoliosis). Overall, the adults recalled experiencing less pain when they were children compared with today's children, but the results were worse for both adults and children with scoliosis. Compared to the non-scoliosis groups, they reported more pain, more stress and sadness, and less use of vitamin supplements and exercise.

The curvature of the spine differs in children with scoliosis and children without scoliosis, changing not only the center of gravity, but also the forces applied to the musculoskeletal system. (5) Hence, the chronic pain experienced by the two groups of school children also can differ. As part of my ongoing research, I asked some questions about the two groups: How does chronic pain, and the factors affecting chronic pain, compare between students with idiopathic scoliosis and those without scoliosis? What are the differences between these two groups?

To answer these questions, I conducted another survey that included 140 children: 37 with idiopathic scoliosis and 103 without scoliosis. After obtaining IRB approval and parental consent, the children completed a questionnaire, one at a time on their own. Personal, health, and idiopathic scoliosis information, and backpack carrying habits, were reported using the questionnaire. The children were weighed with and without carry-on items in their backpacks, and their heights were measured. Isometric arm and shoulder strengths were measured using the Jackson Strength Tester. Using a Lafayette Skinfold Caliper, skinfold thickness at the right triceps and right calf were measured. (6,7) Next, the students assessed the level of chronic pain they experienced from carrying their own backpacks using the Borg Pain Scale. (8)

Findings from the survey showed that children with idiopathic scoliosis were at greater risk for pain, and differed in other ways, from children without scoliosis. Overall, the backpack carry-on habits, exercise habits, and vitamin use were comparable between the two groups.

The children with idiopathic scoliosis had much lower shoulder and arm strength than the non-scoliosis group. The mean strength of children with scoliosis, with or without back braces, was about the same. The children with idiopathic scoliosis did not carry more than a maximum of 13.7% of their body-weight, compared to a maximum of 28.4% for the non-scoliosis group. Likewise, about half of the children with idiopathic scoliosis who experienced pain carried less than 10% of their body weight in their backpacks, compared to about 19% in the non-scoliosis group.

Pain did not correlate with arm or shoulder strength, percent of body weight carried, or body mass index for either group, except shoulder strength for children with idiopathic scoliosis. While the perception of pain decreased as the weight carried decreased for the non-scoliosis group, children with idiopathic scoliosis did not show this trend. They were in chronic pain regardless of the amount of weight they carried. …

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