ABSTRACT
Background:
Research indicates heavy backpacks can cause students to adjust their posture, potentially harming their spine and shoulders. This study focuses on musculoskeletal pain in schoolchildren in Bangalore, attributed to backpack weight, and examines postural impacts in both urban and rural settings.
Methodology:
With consent, 500 students from various schools underwent physical measurements, including backpack weight, and provided data through questionnaires. Postural angles were assessed without backpacks to determine the impact of weight.
Findings:
On average, students carried backpacks weighing 6.53 kg, about 13.53% of their body weight. Pain was reported by 50.9% of boys and 63.9% of girls, with a higher incidence among girls from private schools (88.2%) compared to boys from government schools (51.6%).
Conclusion:
A significant link was found between heavier backpacks and decreased craniovertebral angle, head on neck (HON), and head and neck on trunk (HNOT) angles, aligning with increased pain prevalence. This underscores the health risks of heavy school backpacks and the need for weight management.
KEYWORDS: Backpack weight, impact on posture, musculoskeletal pain, schoolchildren
INTRODUCTION
Backpacks are crucial for students to carry school essentials, yet their weight, ranging from 4.5 to 18 kg, poses significant health risks. Primary students, in particular, carry heavier loads in proportion to their body weight, increasing the risk of chronic back pain, especially during growth spurts at puberty.[1] Studies across India and globally have linked backpacks exceeding 15% of a student’s body weight to postural instability and musculoskeletal problems, including cervical pain, shoulder pain, and forward leaning postures. This excessive burden is linked to poor academic outcomes, absenteeism, and altered posture and gait, further exacerbating the risk of skeletal deformities like scoliosis and kyphosis. Factors such as the duration and manner of carrying the backpack, its weight distribution, and the growth phase of the student’s skeleton compound these risks.[2] The axial and appendicular skeletons grow asynchronously, with cartilage regions being particularly vulnerable to stress and injury. Heavy backpacks necessitate postural adjustments to compensate for the displaced center of gravity, leading to strain and potential injury. This comprehensive analysis, focusing on the urban and rural school environments in Bangalore, underscores the multifactorial nature of backpack-related health issues among school-going children and the urgent need for regulatory measures and behavioral changes to mitigate these risks.[3,4]
METHODOLOGY
This study, a cross-sectional analysis, evaluated musculoskeletal pain and postural deviations in students from The Oxford Senior Secondary School and a government high school in Kaval Byrasandra. It commenced after approval from the Institutional Ethical Committee and involved 500 students from grades 8 to 10, equally divided between a private and a public school. Exclusion criteria included students with recent injuries, musculoskeletal or neurological diseases, pre-existing spinal deformities, physical handicaps, or systemic conditions like diabetes mellitus.
The research unfolded in two phases. Initially, after gaining consent and school approval, students completed questionnaires and underwent weight measurements—both with and without their backpacks—using a digital scale. This method determined the backpacks’ weight. The students’ heights and weights were also recorded, referencing WHO growth charts.[5]
The second phase focused on postural analysis. Selected students, devoid of backpacks, were positioned for photographs, marking specific anatomical points for accurate angle measurements. Photos were captured in three distinct scenarios: standing without the backpack, standing with it on both shoulders, and after climbing stairs with the backpack for 5 minutes. These images, analyzed for postural angles, aimed to identify the effects of backpack weight on posture and the potential for musculoskeletal pain.
RESULTS
Musculoskeletal pain, particularly back and neck pain, in schoolchildren is more prevalent than previously acknowledged, with a point prevalence of 10–30%. The rise in such cases may be attributed to increased academic pressures or greater awareness of the risks associated with heavy backpacks. The results have been elaborated in Tables 1 and 2, Figure 1.
Table 1.
Average weight of backpacks and body weight
| Age | Gender | Mean weight (Kgs) | % of body weight |
|---|---|---|---|
| 11 | F | 9 | 18.75 |
| 12 | M | 5.72 | 12 |
| F | 6.14 | 12.58 | |
| 13 | M | 6.68 | 13.68 |
| F | 6.06 | 12.88 | |
| 14 | M | 6.23 | 13.1 |
| F | 6.25 | 13.1 | |
| 15 | M | 7.34 | 14.29 |
| F | 7.32 | 15.07 | |
| 16 | M | 6.57 | 12.6 |
| F | 6 | 12 | |
| 17 | M | 6 | 12 |
| F | 9 | 17 |
Table 2.
Postural angles in children
| Postural angles | Pain | Number | Mean degrees | Standard deviation |
|---|---|---|---|---|
| Craniovertebral angles | Yes | 289 | 52.34 | 4.81 |
| No | 211 | 57.65 | 1.73 | |
| Head on neck angle | Yes | 289 | 146.19 | 7.91 |
| No | 211 | 153.11 | 5.17 | |
| Head and neck on trunk angle | Yes | 289 | 114.43 | 2.06 |
| No | 211 | 134.35 | 2.00 |
Figure 1.
Graphs showing association of different parameters as shown on the graphs
DISCUSSION
A 2002 Italian study highlighted the issue, showing children carrying backpacks up to 22% of their body weight, with about 30% bearing more than 30% of their weight weekly. This study reported 16% of children experienced back pain at the time, with a lifetime prevalence of 48%.[6,7]
In the current study, a significant majority of students were found to carry backpacks exceeding 10% of their body weight, a threshold considered unsafe. Over 80% of males and 85% of females carried heavier loads, leading to widespread musculoskeletal discomfort, particularly among girls in private schools (88.2%).[2] Pain distribution varied, with government school boys mainly reporting neck pain and private school boys backache. Among girls, hand pain was most reported in government schools, whereas back pain was more common in private schools.
This research also noted a decrease in postural angles among children with musculoskeletal pain, suggesting a link between pain and postural alteration. The “Italian Backpack Study” further corroborated these findings, with a significant portion of participants deeming their backpacks too heavy, which was associated with fatigue and back pain.[8]
Other studies, like those by Martha J. Sanders,[3] explored ergonomic aspects, noting changes in the craniovertebral angle due to backpack weight, particularly in younger children due to spinal immaturity. Similarly, Wiersema et al.[5] observed significant postural angle changes with backpacks weighing 15% of body weight, emphasizing the impact of heavy loads on children’s posture.[5]
CONCLUSION
These findings underscore the need for awareness and intervention strategies to mitigate the adverse effects of heavy backpacks on schoolchildren’s health, aligning with past research and highlighting the consistency and robustness of these observed patterns.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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