Improper Backpack Use May Cause Back Pain in Schoolchildren

An increasing amount of evidence suggests that carrying heavy backpacks may lead to low back pain in children and adolescents. The exact reason for this remains unclear, but some scientists have theorized that a backpack laden with books, supplies and other implements places an undue amount of stress on a child’s spine, resulting in occasional, sometimes intense pain.

Few studies, however, have examined the way children wear backpacks and what effect carrying a pack in an inharmonious fashion can have on a child’s spine.

In this cross-sectional study, investigators in Greece examined 1,252 children ages 12 to 18 who used backpacks at school. Each child was asked a series of questions about back pain while carrying their backpack to and from school and during holiday periods, along with questions about participation in sports, how they traveled to/from school, and the amount of time it took them to travel from home to school and back. In addition, the children were asked whether they carried their backpacks with one strap over one shoulder (asymmetrically) or straps over both shoulders (symmetrically), and why they carried their backpacks a particular way. Finally, the students were subjected to a series of spinal measurements both without their backpacks and while wearing their backpacks symmetrically or asymmetrically.

Among the study’s results:

* On average, girls were 5.6 times more likely to report suffering from dorsal pain than boys during the school period. No association between gender and low back pain was noted.

* Symmetrical backpack carrying caused a forward lean in the upper trunk of students and decreased cervical lordosis. Asymmetrical backpack carrying, meanwhile, resulted in students raising the backpack-bearing shoulder and shifting the upper trunk contralaterally.

* Students who carried backpacks asymmetrically were 2.9 times more likely to suffer from dorsal pain, and five times as likely to suffer from low back pain, as students who wore backpacks symmetrically.

* Students who carried backpacks asymmetrically were more than four times as likely to suffer from high-intensity pain than students who carried backpacks symmetrically.

* While there was no association between time spent carrying backpacks and back pain during the school period, there was “a significant correlation” between time spent to school and back pain during holiday periods. The authors attributed this to a possible “delayed response” to the stresses applied to the spine during school.

While the incidence of low back pain in schoolchildren varies from country to country, several studies have shown that it can range from 20% to more than 50% in some populations. Other studies have also shown that back pain at an early age may contribute to an individual experiencing pain as an adult. As a result, the importance of proper backpack use, especially among children, should not be underestimated.

Korevessis P, Koureas G, Zacharatos S, et al. Backpacks, back pain, sagittal spinal curves and trunk alignment in adolescents. Spine 2005;30(2):247-255.