|Year : 2015 | Volume
| Issue : 1 | Page : 29-31
Back pain in children associated with backpacks
Chandrashekhar D Aundhakar, Kaustubh U Bahatkar, Mohammed Shahid Padiyar, Deepak H Jeswani, Sylvia Colaco
Department of Paediatrics, Krishna Institute of Medical Sciences, Karad, Maharashtra, India
|Date of Web Publication||1-Dec-2014|
Kaustubh U Bahatkar
17 Chs Shubhmangal, Sidharthnagar, Goregaon (W) Mumbai - 400 104, Maharashtra
Source of Support: None, Conflict of Interest: None
Context: The school age children face daily responsibility of carrying variety of items to and fro and also around school. "Back pain" is currently emerging as a major health problem among school age group children, which can limit their daily activities. Aim: The aim was to investigate the factors that reflect the prevalence of back pain among school age group children, with particular attention on the weight of backpacks' mode of transportation to school. Materials and Methods: A total of 626 children are registered for this study between the age group of 12-16 years. They are weighed twice on the digital scale; the first time with their backpacks on and the second time without any backpacks. Questionnaire made and used to determine the presence and severity of back pain; data analyzed and descriptive statistics and multimonial regression analysis are performed to investigate the reflection of certain factors like gender, school bag carrying method, bag weight to student weight ratio, mode of transportation etc. on the occurrence of back pain. Odds ratio (OR) obtained from the analysis are used to compare the different levels of the same factor for relative occurrence of back pain. Results: Of 626 students; 172 are female, and 454 are male; 318 (50.7%) carried backpacks weighing 10-15% of their body weight. Among 626 students, 358 (57.1%) are reported to have back pain, 12.6% students required physician's visit and 18.6% students missed school because of back pain. Students carrying more than 15% of their body weight are found to have higher risk of back pain with (odds ratio = 4.3459 confidence interval = 95% 2.63-7.169, P = 0.0001). 425 students are reported to have walked to school with their backpacks on, out of which 260 (61.17%) are reported with back pain; significant association with P = 0.0004 is found among these subjects who walked to school with their back packs on. Conclusion: Carrying heavy backpacks increases the relative risk of back pain among school age group children, and prevalence of these children are found to be extremely high. Therefore, preventive and educational activities must be implemented among these school age group children.
Keywords: Back pain, backpack weight, school children
|How to cite this article:|
Aundhakar CD, Bahatkar KU, Padiyar MS, Jeswani DH, Colaco S. Back pain in children associated with backpacks. Indian J Pain 2015;29:29-31
| Introduction|| |
The school age group children face daily responsibility of carrying variety of items to school. Modern educational system demands too much from children. Among these age group children, daily physical stress associated with carrying heavy backpacks causes significant forward leaning of head and trunk, and it is assumed that daily intermittent abnormal postural adaptations could result in pain and disability. Back pain is currently viewed as a major health problem amongst the school age group children, which can hamper the daily life activities. It is reported that musculoskeletal symptoms in school age group children has multifactorial origin, but the heavy backpacks are considered as one of the most suspected ones.
Some studies have shown that heavy backpacks significantly alters the posture and gait of a child while some other studies indicate that the excessive fatigue, while carrying heavy backpacks can be associated with back pain. , Experts and various health organizations recommend that the school age group children should not carry more than 10% of their body weight. In Indian scientific literature, there exist few epidemiological studies concerning back pain among children.
Objective of this study is to investigate potential school-related risk factors for back pain in children most notably schoolbag weight expressed as a percentage of body weight (relative schoolbag weight) mode of transportation to and from school.
| Materials and Methods|| |
This was a cross-sectional analytical study among school age group children between 12 and 16 years of age for the academic year 2013-2014 in a rural school situated in western Maharashtra. The weighing day was known by academic authority only and not by school children, and it was chosen randomly. They are weighed twice on the digital scale; the first time with their backpacks on and the second time without them. Weight is obtained by placing children's backs against stadiometer with joint heels.
All students attending school on the day of survey are provided with a self-administered questionnaire, containing questions about demographic data such as name, age, sex, weight, height and address and presence and severity of back pain, activity limitations due to back pain, use of pain relief method, method of carrying backpack, time taken to get to school and method of transportation to school as well as perceptions of the load of school bag. A detail description about study, procedure and questionnaire was given to students. The purpose of questionnaire is to identify the students who are suffering from neck pain and back pain.
After collection, the data being analyzed using Statistical Package for Social Sciences software version 17 (IBM), and descriptive statistics and multinomial regression are performed to investigate the reflection of certain factors like gender, school bag carrying methods, bag weight to student weight ratio etc. on the occurrence of back pain. Odds ratio (OR) obtained from analysis are used to compare the different levels of the same factor for relative risk of occurrence of back pain.
| Result|| |
Total number of students registered in this study group is 626, between the age group of 12-16 years, out of which 172 are female, and 454 are male. Mean age group of students is 14 year. Mean school bag weight is nearly 5.5 kg. In the present study, 109 (17.41%) student have their backpack weight <10% of their body weight; that is, within recommended limits. About 318 (50.7%) students have their school bags weighing 10-15% of their body weight, and 199 (31.17%) have their school bags of more than 15% of their body weight [Table 1]. 358 (57.1%) students have a history of back pain in last 12 months [Table 1]. A need for a physician visit was required for 12.6% cases, and 18.6% has missed school because of back pain. Students carrying school bags of more than 15% of body weight have a higher risk of back pain with (OR = 4.3459 confidence interval [CI] = 95% 2.63-7.169, P = 0.0001) [Table 2]. Most of the students, that is, 425 (67%) walk to school; out of which 260 (61.17%) students reported to have back pain, 126 (20.12%) students use bicycle, out of which 54% reported back pain and 75 (12.88%) used other mode of transport such as car, bus, etc. Significant association with P = 0.0004 is found between back pain and walking to school. No significant relationship is found between back pain and gender of student (OR = 1.097 CI = 0.76 to 1.55, P = 0.6334) [Table 2]. 74.12% of students declared that school bag felt heavy sometimes while 42.1% felt their school bag always heavy. Around 96.44% students carry their school bags on both shoulders.
| Discussion|| |
The interest of carrying backpack particularly with regards to children has dramatically increased in recent years. The aim of the present study is to investigate the influence of certain factors on the occurrence of musculo-skeletal pain, namely gender, ratio of school bag weight to student's weight ratio, mode of transportation to school.
The mean weight of school bag as a percentage of body weight carried by students is 14%. Other studies also have similar findings. , Children carrying the heaviest backpacks have a higher risk of suffering from back pain. Some global associations like America Occupational Therapy Association, Ontario Chiropractic Association and Global Studies recommend that the ratio should not exceed 10% of body weight. In the present study, there is also significant association with P = 0.0001 between ratio of bag weight to student weight and back pain. Students carrying backpacks of more than 15% of their body weight had 4.34 times higher risk of pain when compared to students carrying <10% of their body weight. Another study performed by Negrini and Negrini in study in Italy found that 11-year-old children carried backpacks as heavy as 20% of their body weight  and also that 58.4% has experienced back pain more than once in their lifetime. 
Many studies have found that backpacks alter posture and gait significantly, produces modifications in head-neck angle and shoulder asymmetry and even lumbar lordosis.  These biochemical alterations could induce the appearance of chronic pain and back pathologies in the long term. , Girls are more prone to experience back pain; this was observed by Grimmer et al. where girls were found to have changes in cranio-vertebral angle when carrying a back pack, and this association became stronger with age.  No such observation is found in our study. In our study, we also found a significant association with P = 0.0004 between back pain and walking to school.
| Conclusion|| |
The results obtained in our study have strong implications. The findings from this cross-sectional study indicate a need for longitudinal prospective study designed to identify etiologic and prognostic factors of back pain in adolescents. Many children carry excessively loaded backpacks, which is not allowed even for workers in employment. We strongly encourage the medical and educational community to start advising parents and school children about the risks posed by heavy school bags and the fact that this risk can be easily reduced.
| References|| |
Grimmer KA, Williams MT, Gill TK. The associations between adolescent head-on-neck posture, backpack weight, and anthropometric features. Spine (Phila Pa 1976) 1999;24:2262-7.
Mohan M, Singh U, Quddus N. Effect of backpack loading on cervical and shoulder posture in indian school children. Indian journal of physiotherapy and occupational therapy 2007;1:2.
Negrini S, Negrini A. Postural effects of symmetrical and asymmetrical loads on the spines of schoolchildren. Scoliosis 2007;2:8.
Balagué F, Dutoit G, Waldburger M. Low back pain in schoolchildren. An epidemiological study. Scand J Rehabil Med 1988;20:175-9.
Watson KD, Papageorgiou AC, Jones GT, Taylor S, Symmons DP, Silman AJ, et al.
Low back pain in schoolchildren: Occurrence and characteristics. Pain 2002;97:87-92.
Pascoe DD, Pascoe DE, Wang YT, Shim DM, Kim CK. Influence of carrying book bags on gait cycle and posture of youths. Ergonomics 1997;40:631-41.
Taimela S, Kujala UM, Salminen JJ, Viljanen T. The prevalence of low back pain among children and adolescents. A nationwide, cohort-based questionnaire survey in Finland. Spine (Phila Pa 1976) 1997;22:1132-6.
Hestbaek L, Leboeuf-Yde C, Kyvik KO, Manniche C. The course of low back pain from adolescence to adulthood: Eight-year follow-up of 9600 twins. Spine (Phila Pa 1976) 2006;31:468-72.
[Table 1], [Table 2]
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