Backpack and Back Pain In School Children

Increasing number of school children present with nonspecific back pain, however less than a third of these children seek medical attention for their back pain.

Back pain in children is multifactorial in origin and carrying a heavy backpack may be one of them. The prevalence of backpain in children is somehow increasing in present times and the possible reasons of rise in prevalence could be attributed to the fact that children of today when compared with past generations are more stressed, weigh more, have postural issues , have less of physical activities and on the contrary have more of sedentary activities like video games, computer and smart phone activities. All this certainly strains muscles resulting in muscle fatigue, poor muscle strength and postural issues, which can increase occurrence of back pain.

Carrying a schoolbag is a daily activity for the children and it is not unusual to see children running out to the school bus or some of them walking to school with backpacks. It has been found that many children carry a significantly greater amount of weight in their backpacks which includes school books plus tiffin , water bottle, sports and other equipment. It has also been observed that the girls carry more school bag weight than boys. Schoolbag weight in children

certainly has been a thing of great concern among the parents, school administrators and health care professionals, and this has been often highlighted in the print as well as electronic media. It is a fact that lifting heavy burdens for a

long time or distance is not good for anyone, especially children. Many studies report that use of a heavy backpack is one of the important factors causing back pain among students. Children carrying heavy backpacks have a higher risk of suffering from back, neck and shoulder pain. In one of the studies schoolbag-related problem was seen more frequently in the shoulders, neck and upper back. Regarding the limit of the weight of the backpack , somehow there has been little agreement on what should be the limit of the weight of the backpack. However, most of the studies have shown that backpack weighing more than 15 % of a child's weight is associated with back pain and a backpack weighing 10% of body weight is reasonable and safer for the back of school children to carry. It has been reported that students carrying backpacks of more than 15% of their body weight have 4.34 times higher risk of pain when compared to students carrying less than10% of their body weight. According to a study published in British Journal of pain in 2017, there is an increased risk of developing back pain with every 1% increase in bag weight to body weight ratio. Both boys and girls can be affected, however some studies report that girls are more prone to experience back pain.

The type of backpack also influences back pain among students. Improper carrying of a heavy backpack over one shoulder by only one strap causes a significant elevation of the strap bearing shoulder, lateral bending of the spine and muscle strain to compensate for uneven weight, thus causing abnormal stresses which result in pain. Carrying a heavy backpack with two straps

forces the child to compensate for the excessive load by forward lean of trunk and shallowing of the lumbar lordosis, thus putting abnormal stresses on spine. It has been reported that improperuse of the backpack can result in changes of posture and gait

In addition to the weight, the time spent and the distance of walking carrying the backpack are also important factors favouring back pain. The duration for which backpack is worn is strongly associated with back pain and its severity i.e. longer it is worn more the chances of pain and its severity also increases. Again children

who walk to and from school with the back pack are more likely to report back pain and it has been reported that chances of back pain increase when home-school walk is longer than 30 minutes. There are also reports that schoolbag-related discomfort in children could be multi-factorial in nature and psychosocial factors, a history of discomfort and no or very less physical activity are the predictors of schoolbag-related back discomfort, and as such all these factors have to be taken into consideration.

As such there are numerous reports that heavy backpacks are associated with backpain in school children. However, there have been some reports contrary to this popular opinion that evidence linking backpack weight and back pain

is inconclusive and there is a need to consider factors other than schoolbag weight that influence the use of schoolbags. A systemic review published very recently in British Journal of Sports Medicine in 2018 found no convincing

evidence that the aspects of schoolbag use like weight, design and carriage method increase the risk of back pain in children. However, further

research in the form of prospective studies with larger sample size is needed to increase the understanding of the relationship of heavy backpacks to back pain in children.

Research has also shown that children who experience back pain are certainly at a higher risk of back pain as adults. Back pain, we all know is a major cause of disability, poor quality of life and the time lost from work in adulthood, as such having a huge economic impact . This means that back pain in children has to be well taken care of. Children's School Bag Act 2006 has been a step in right direction and as per this law schoolbag should not weigh more than 10 percent of child's weight while kids in nursery and kindergarten should not carry bags. More ever, it states, the schools must provide cupboards and locker facilities to students. As it is , laws as usual are made but the main issue has been their implementation by various stake holders. It is also a fact many parents are not aware of this Act and so is the case with many of the schools. Unfortunately most of the school administrators do not take any proactive approach in this regard, rather it is somewhat being ignored by many. This is quite evident from the findings of a survey conducted by Associated Chambers of Commerce and

Industry of India (ASSOCHAM) in 2016 that over 88 per cent of children in the age group of 7-13 years carry more than 45 per cent of their weight on their backs. Again, many of the scientific studies published in our country also report

that majority of school children carry backpacks which are certainly more than 10 % of bodyweight.

WHAT NEEDS TO DONE:

We need to educate students, teachers and the parents, and make them aware of the problems created by heavy school bags. The backpack must weigh less than 10 per cent of the child's body weight. The teachers, parents and students certainly have to work together in order to achieve this goal. It is all the more important as this will help to avoid future

back problems in adulthood. Children and the parents must be educated about the importance of maintaining a correct posture. We also must stress on having more of physical activities for children as a physically fit child having strong

muscles is much less likely to suffer from back problems due to heavy school bag as compared to a child who is involved in no or very minimal physical activity. It is also important that we buy the right kind of backpack which has a well padded

back and well-padded wide double shoulder straps including a waist strap and few separate compartments. Children must clean their backpack regularly and carry only what is needed i.e. necessities. They should be taught about correct lifting and carrying technique of the backpack. Parents , children , school administrators and health professional have to be educated about the Children's School Bag Act 2006 and all the stake holders have to work proactively on its implementation. All our efforts must be to reduce the load on the back of school children so as to help reduce prevalence of back pain in the people in the future.

SUMMARY:

Many children carry a significantly greater amount of weight in their backpacks.

Children carrying heavy backpacks are at a higher risk of su?ering from back pain. The backpack must weigh less than 10 per cent of the child's body weight. Parents , teachers ,children and school administrators have to be educated about

the ill effects of heavy backpack and Children's School Bag Act 2006. We have to see that the Act is implemented proactively by all stake holders. We also need to stress on maintaining correct posture and having more of physical activities

in children for the betterment of their back and overall health. We have to take care of the back in children as back pain in children does increase the risk of chronic back pain in adulthood.

Dr M K Mam

Formerly, Vice Principal, Prof. & Head of Orthopaedics, CMC Ludhiana and President, North Zone of Indian Orthopaedic Association

DISCLAIMER:

The views expressed in the Article above are Dr. M K Mam’s personal views and kashmiribhatta.in is not responsible for the opinions expressed in the above article.

Courtesy: Dr M K Mam