The association of backpack use and back pain in adolescents

Obesity: the new childhood disability?

This review addresses the impact of obesity on paediatric physical functioning utilizing the World Health Organization International Classification of Functioning, Disability and Health Framework (ICF). The ICF encompasses functioning (as it relates to all body functions and structures), activities (undertaking a particular task) and participation (in a life situation) with disability referring to impairments in body functions/structures, activity restrictions or participation limitations. Electronic databases were searched for peer-reviewed studies published in English prior to May 2009 that examined aspects of physical functioning in children (≤18 years). Eligible studies (N = 104) were ranked by design and synthesized descriptively. Childhood obesity was found to be associated with deficits in function, including impaired cardiorespiratory fitness and performance of motor tasks; and there was some limited evidence of increased musculoskeletal pain and decrements in muscle strength, gait and balance. Health-related quality of life and the subset of physical functioning was inversely related to weight status. However, studies investigating impacts of obesity on wider activity and participation were lacking. Further research utilizing the ICF is required to identify and better characterize the effects of paediatric obesity on physical function, activity and participation, thereby improving targets for intervention to reduce disability in this population.

Comparisons of the gait parameters of young Korean women carrying a single-strap bag

This study compared the gait parameters of young women using various methods to carry a single-strap bag during walking. Twenty-one Korean healthy women walked on a GAITRite-instrumented carpet at a self-paced speed for each of the four following conditions in random order: no bag, carrying a bag over the shoulder, carrying a bag on the forearm, and carrying a bag by the hand on the dominant (right) side. There was a significant reduction in the stride length for the contralateral leg when carrying a bag on the forearm, a significant decrease in the heel-to-heel base of support, and a significant increase in the toe angle on the ipsilateral leg when carrying a bag by hand. The results of our study suggest that, among the asymmetric bag-carrying methods preferred by Korean young women during walking, the "over-the-shoulder" method has the least effect on gait parameters relative to not carrying a bag.

Postural sway modifications induced by backpack carriage in primary school children: a case study in Italy

The aim of this investigation is to assess modifications in sway parameters introduced by backpack carriage in Italian primary school children (6-10 years old, n = 447). Two 30-s trials (without and with backpack) were performed directly at a school on a regular school day to collect data on sway area, centre of pressure path length and maximum displacement range in antero-posterior and medio-lateral directions. The results show a significant load-induced increase in all sway parameters and the existence of a linear relationship between sway area and backpack weight. Since postural sway represents an effective indicator of balance abilities, the alterations observed suggest that backpack carriage originates balance impairment and thus may increase the risk of unintentional falls in children. STATEMENT OF RELEVANCE: Loss of balance is among the primary causes of unintentional falls and postural sway represents an effective indicator of balance abilities. In this study, sway parameters were assessed in primary school children wearing backpacks. The differences that were observed show that backpack carriage potentially increases the risk of falls.

Spinal pain and nutrition in adolescents--an exploratory cross-sectional study

BACKGROUND

Spinal pain is an important health issue for adolescents resulting in functional limitations for many and increasing the risk of spinal pain in adulthood. Whilst human and animal studies suggest nutrition could influence spinal pain, this has not been investigated in adolescents. The objective of this exploratory cross sectional study was to evaluate associations between diet and adolescent spinal pain.

METHODS

This study surveyed the spinal pain (neck and back) and nutrition (specific nutrients, broad food groups, diet quality and dietary pattern) of 1424 male and female adolescents at 14 years of age, in Western Australia.

RESULTS

Back or neck pain were experienced by around half of the adolescents, with females more likely to experience spinal pain. Nutrition differed between sexes and deviated from optimal intakes. Vitamin B12, eggs, cereals and meat consumption were related to spinal pain in sex specific multivariate analyses including primary carer education level and adolescent waist girth and smoking.

CONCLUSIONS

The findings of this study suggest that certain aspects of diet may have an association with spinal pain in adolescence.

The effects of age and gender on the weight and use of schoolbags

PURPOSE

To examine age and gender differences in schoolbag use and to compare findings in Greece with those of other countries.

METHOD

Schoolbag weight and carrying characteristics were assessed in 703 boys and girls aged 6 to 14 years.

RESULTS

Multinomial logistic regression models showed that younger students (6-8 years) were almost 5 more times more likely to carry heavier schoolbags than older students (p < 0.05). Similarly, more girls than boys carried heavier bags, and girls were twice more likely to experience fatigue symptoms when carrying schoolbags compared with boys (p < 0.05). The mean schoolbag weight was 12.4% of the student's body weight and moderately heavier than that reported for other countries.

CONCLUSIONS

Younger children are in greater need for education about schoolbag weight compared with older ones. There is also evidence that girls might experience more problems when carrying their schoolbag compared with boys.

Short-term effects of backpack load placement on spine deformation and repositioning error in schoolchildren

Backpack weight of 10-15% has been recommended as an acceptable limit for schoolchildren. However, there is still no clear guideline regarding where the backpack centre of gravity (CG) should be positioned. The changes of spinal curvature and repositioning error when carrying a backpack loaded at 15% of body weight at different CG locations (anterior or posterior at T7, T12 or L3) in schoolchildren were analysed. Both spinal curvature and repositioning error were found to be affected by backpack anterior-posterior position and CG level. A relatively smaller change was observed during anterior carriage with the least change when the backpack CG was positioned at T12. The results also suggested that alternative carriage by changing the backpack position occasionally between anterior and posterior positions might help to relieve the effects of backpack on spine. However, future study is recommended to further substantiate the beneficial effects of alternative carriage on children. STATEMENT OF RELEVANCE: Anteriorly carried backpack with centre of gravity positioned at T12 was shown to induce relatively less effect on spinal deformation and repositioning error in schoolchildren. Changing backpack carriage position occasionally may help to relieve its effects on spinal deformation. The findings are important for ergonomic schoolbag design and determining a proper load carriage method.

Effects of sex and mode of carrying schoolbags on ground reaction forces and temporal characteristics of gait

The aim of this study was to examine the effects of different modes of carrying schoolbags on children. Ten girls and eight boys walked without a bag (NO-BAG), with a bag placed low at the back (LBACK), with a back placed high at the back (HBACK) and carrying the bag using the handle (HANDBAG). Ground reaction forces and temporal characteristics were recorded. When carrying a schoolbag, children walked with shorter strides, at lower speeds, with higher double support phase and increased vertical ground reaction forces compared with the NO-BAG condition (P<0.01). Compared with normal walking biomechanics, the HANDBAG condition showed the highest alterations, whereas the LBACK the least. Carrying the schoolbag by the handle has the largest effect on gait characteristics. Wearing backpacks by adjusting the shoulder straps to a loose position may reduce schoolbag effects.

Effect of prolonged walking with backpack loads on trunk muscle activity and fatigue in children

This study investigated the effect of prolonged walking with load carriage on muscle activity and fatigue in children. Fifteen Chinese male children (age=6 years, height=120.0+/-5.4 cm, mass=22.9+/-2.6 kg) performed 20-min walking trials on treadmill (speed=1.1 ms(-1)) with different backpack loads (0%, 10%, 15% and 20% body weight). Electromyography (EMG) signals from upper trapezius (UT), lower trapezius (LT) and rectus abdominis (RA) were recorded at several time intervals (0, 5, 10, 15 and 20 min), and were normalized to the signals collected during maximum voluntary contraction. Integrated EMG signal (IEMG) was calculated to evaluate the muscle activity. Power spectral frequency analysis was applied to evaluate muscle fatigue by the shift of median power frequency (MPF). Results showed that a 15% body weight (BW) load significantly increased muscle activity at lower trapezius when the walking time reached 15 min. When a 20% BW load was being carried, increase in muscle activity was found from 5 min, and muscle fatigue was found from 15 min. In upper trapezius, increase of muscle activity was not found within the 20-min period, however, muscle fatigue was found from 10 min. No increased muscle activity or muscle fatigue was found in rectus abdominis. It is suggested that backpack loads for children should be restricted to no more than 15% body weight for walks of up to 20 min duration to avoid muscle fatigue.

The effects of load carriage and bracing on the balance of schoolgirls with adolescent idiopathic scoliosis

The balance function of children is known to be affected by carriage of a school backpack. Children with adolescent idiopathic scoliosis (AIS) tend to show poorer balance performance, and are typically treated by bracing, which further affects balance. The objective of this study is to examine the combined effects of school backpack carriage and bracing on girls with AIS. A force platform was used to record center of pressure (COP) motion in 20 schoolgirls undergoing thoraco-lumbar-sacral orthosis (TLSO brace) treatment for AIS. COP data were recorded with and without brace while carrying a backpack loaded at 0, 7.5, 10, 12.5 and 15% of the participant's bodyweight (BW). Ten participants stood on a solid base and ten stood on a foam base, while all participants kept their eyes closed throughout. Sway parameters were analyzed by repeated measures ANOVA. No effect of bracing was found for the participants standing on the solid base, but wearing the brace significantly increased the sway area, displacement and medio-lateral amplitude in the participants standing on the foam base. The medio-lateral sway amplitude of participants standing on the solid base significantly increased with backpack load, whereas significant increases in antero-posterior sway amplitude, sway path length, sway area per second and short term diffusion coefficient were found in participants standing on the foam base. The poorer balance performance exhibited by participants with AIS when visual and somatosensory input is challenged appears to be exacerbated by wearing a TLSO brace, but no interactive effect between bracing and backpack loading was found.

Back pain and backpacks in school children

OBJECTIVE

Back pain in adults is common and well studied. In contrast, back pain in children has received comparatively little scientific study, despite recent media attention. The purpose of this study is to see what factors influence the prevalence of back pain in middle school children, with particular attention to the weight of children's backpacks and the availability of school lockers.

METHODS

A population-based sample of 1540 children ages 11-14 years in a large metropolitan area was studied. A questionnaire was used to determine presence and severity of back pain, availability of lockers, backpack use, use of 1 or 2 straps to carry backpack, activity limitations due to back pain, and use of pain medication for back pain. Gender, age, weight of the child, and weight of his or her backpack were recorded. Results of scoliosis screening were evaluated with regard to the above information. Data were analyzed using the chi test and univariate or multivariate logistic regression analysis as appropriate.

RESULTS

Overall, 37% of the children reported back pain. Backpacks were used by 97% of children, hence there were too few students not using backpacks to treat backpack use as an independent variable. Multivariate analysis found back pain associated with use of a heavier backpack (P=0.001), younger age (P<0.001), female sex (P<0.001), and a positive screening examination for scoliosis (P=0.009). Children with lockers available reported less back pain (P=0.016). The use of 1 or 2 straps to carry the backpack did not have a significant association with back pain (P=0.588). Of the children who reported back pain, 34% limited their activity due to the pain, 14% use medication for pain relief, and 82% believed their backpack either caused or worsened their pain.

CONCLUSIONS

The incidence of back pain in early adolescence approaches that seen in adults. Recommendations for an "acceptable" weight of backpacks cannot be made from this study, as the weights of students' backpacks seem directly proportional to the likelihood of back pain. This study identifies 2 factors associated with self-reported back pain in early adolescents that are amenable to change: availability of school lockers and lighter backpacks. These findings may be useful in advising families and influencing school policies.

[Risk factors for back pain in children and adolescents]

Factors that have led to the increasing prevalence of back pain amongst children and adolescents living in industrialized nations are mostly unknown. The following literature review was aimed at determining the risk factors for back pain amongst children and adolescents. We searched both PUBMED and MEDLINE between the years 1985 and 2003 for the keywords "children or adolescents" and "back pain". Only data published in original articles were used. The risk for suffering back pain is influenced by physical, behavioural, emotional and social factors. The effects of physical activity, sitting, muscle status, weight of schoolbags, exercise, television and computer use, as well as age and gender on the development of back pain in children and adolescents were examined. Associations between continuous or recurring back pain and psychosocial factors (lifestyle, emotional factors, social relationships) could be demonstrated. There was no relationship between changes of the spine seen by radiological tests and the development of chronic back pain. Longitudinal epidemiological studies are urgently needed to delineate the risk factors for the development as well as the natural history of chronic back pain in the young.

The effect of load carriage on the gait of girls with adolescent idiopathic scoliosis and normal controls

Adolescent idiopathic scoliosis (AIS) and load-bearing both appear to place similar demands on gait, but no data regarding the combined effects of load-bearing gait in subjects with AIS could be found. The gait patterns of 22 normal adolescent girls and 28 girls with mild AIS (Cobb angle<25 degrees ) were recorded at backpack loads of 0, 7.5, 10, 12.5 and 15% body weight. Temporal-distance and joint kinematic, moment and power parameters were analyzed by repeated measures ANOVA. Findings showed that backpack carriage places an increased demand on the musculature of the lower limb and results in a gait characterized by reduced pelvic motion and greater hip flexion-extension. AIS has a generally similar effect on gait kinematics as backpack carriage, with AIS subjects having significantly longer double support durations, shorter single support durations and lower knee joint power generation and absorption than normal subjects. No interaction between backpack load and AIS was found however, although investigation of parameters indicating a critical response to load showed that this typically occurred at lower backpack loads (7.5% body weight) in the AIS group. Overall, both AIS and load-bearing place increased demands on gait, but carriage of a loaded backpack does not appear to cause any greater demand on subjects with AIS than normal controls.

Low back pain prevention's effects in schoolchildren. What is the evidence?

Given the high prevalence rates of back pain, as early as in childhood, there has been a call for early preventive interventions. To determine which interventions are used to prevent back problems in schoolchildren, as well as what the evidence is for their utility, the literature was searched to locate all investigations that used subjects under the age of 18 and not seeking treatment. Included investigations were specifically designed as an intervention for low back pain (LBP) prevention. Additionally, a literature search was performed for modifiable risk factors for LBP in schoolchildren. The literature-update search was performed within the scope of the "COST Action B13" of the European Commission, approved for the development of European guidelines for the management of LBP. It was concluded that intervention studies in schoolchildren focusing on back-pain prevention are promising but too limited to formulate evidence-based guidelines. On the other hand, since the literature shows that back-pain reports about schoolchildren are mainly associated with psychosocial factors, the scope for LBP prevention in schoolchildren may be limited. However, schoolchildren are receptive to back-care-related knowledge and postural habits, which may play a preventive role for back pain in adulthood. Further studies with a follow-up into adulthood are needed to evaluate the long-term effect of early interventions and the possible detrimental effect of spinal loading at young age.

Cartable et pathologie rachidienne

Back pain has become a real public health concern both for adults and children. In general, patients complain of moderate pain. While the topic was long ignored by the scientific community, the number of publications has increased over the last three Years. We reviewed the literature to separate real evidence from speculations. Recognized risk factors for spinal pain are: female gender, poor general status, family history of back pain, particular psychological patterns, time spent sitting watching television, history of spinal trauma, intense physical activity, practicing competition sports, and age (more frequent in adolescents than children). Several recent papers have drawn attention to the role of the weight of the school backpack in children, particularly when its weight exceeds 20% of the child's body weight. Many children carry heavy backpacks which for some may weigh 30% to 40% of their body weight. Several groups have estimated that the maximum should be 10% of the body weight. It appears that time spent carrying the backpack as well as its weight is an important factor favoring back pain. Backpacks can injury the head or face, as well as the hands, the elbow, the wrist, the shoulder, the foot and the ankle. Back trauma is observed as the sixth most common injury. The 'weak point' is the shoulder and not the back. A poorly positioned backpack can modify posture and gait. Carrying the backpack with two shoulder straps affects posture and gait less than carrying it on one shoulder. The posture of the spine changes when the weight of the backpack increases. This is probably one of the reasons why many parents who consult believe that there is a relationship between the weight of the backpack and scoliosis or kyphosis, observed in many of their children. It is proven that adolescents who suffer from back pain will probably have chronic back pain as adults, but there is not evidence to our knowledge demonstrating a relationship between the development of spinal deviation and the weight of the backpack. Recent studies have been conducted to design backpacks allowing a better weight distribution and comfort. This type of backpack appears to have a limited benefit. Furthermore, the question of mode must not be ignored for children and adolescents. Backpacks with one sack in front and one in back certainly provide better weight distribution but are they acceptable for children and adolescents?