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Monday, May 21, 2018
Carrying backpacks doesn’t cause back pain in children and teenagers
The Conversation: Children and adolescents who carry backpacks aren’t at higher
risk of developing back pain, according to a study published today in
the British Journal of Sports Medicine (BJSM). Researchers found no evidence to suggest a link between carrying a heavy backpack and back pain in these age groups. This calls into question popular opinion, as well as guidelines
published by numerous organisations recommending limits on backpack
weights for children. Globally, there’s been little agreement on what a
limit should be. Guidelines vary, with the limit being anywhere between 5% and 20% of body weight.
Children and adolescents commonly report back pain. Research shows the prevalence of complaints
by the end of adolescence reaches levels comparable with adults. There
is also evidence having back pain during adolescence predicts having
back pain as an adult.
Currently, the causes of back pain in children and adolescents are
unclear. This is because there are no strong longitudinal studies (that
follow people over a long time) that have investigated all of the
possible risk factors.
Past studies in posture
Some studies have looked at links between posture or body position
and carrying a backpack. These are based on the belief that poor posture
would be related to discomfort, which might lead to pain. Studies have
found that, for example, carrying a backpack results in changes in head posture and in the distribution of weight across the foot.
Read more:
Health Check: can bad posture give you a hunchback?
Some researchers have looked at whether it can lead to a change in the curvature of the spine. One study found no significant difference
in spinal curvature when carrying a bag on one shoulder compared to two
shoulders. But it reported trends that might suggest spinal curvature
changes with bag carrying in ways that might be detrimental to the
spine.
But accurately measuring spinal curvature is a tricky business. This
is because highly accurate measurements such as x-rays are unethical to
use in large population-based studies.
Other studies have shown the type of backpack appears to have an effect on a child’s respiratory function too. A “mono-strap” backpack caused a reduction in forced vital capacity (a measure of a person’s breathing performance or the function of the lungs).
However, none of these studies investigated relationships between backpack carrying and pain. A study found no significant difference in spinal curvature with a one-strap bag compared to two.from shutterstock.com
What about the current study?
The latest BJSM study
was a systematic review, where researchers compiled evidence from a
number of different studies. These included five prospective studies
(which followed a total of 1,799 children and adolescents over time) and
63 cross-sectional studies.
Most of the evidence for an association between back pain and
backpacks came from the cross-sectional studies. These compile
measurements taken at a single point in time and use them to compare
characteristics between specific groups of people. They are considered
weaker evidence than prospective studies, which follow individuals over
time.
Read more:
Teenage pain often dismissed as 'growing pains', but it can impact their lives
Among the 63 cross-sectional studies, four found that a heavier
backpack was associated with reports of back pain, three showed the
method of carrying was related to pain, and three found carrying a bag
for longer periods was related to having pain. One study found that 75%
of students who had back pain reported that carrying their bag
aggravated their pain.
It’s likely that current beliefs and guidelines for carrying school
bags have been based on the data from these or similar cross-sectional
studies.
With the five prospective studies, only two actually measuredbackpack weight and both found it wasn’t associated with reporting back pain. Two studies found that the perceived weight or reporting difficulty carrying the bag was associated with back pain for kids aged nine to 14.
The fifth study
didn’t report any variables about backpacks. But in a question posed to
kids (mean age of 15) with back pain asking what aggravated their pain,
carrying their backpack was not mentioned. Backpacks may aggravate existing pain.from shutterstock.com
The take-home message
The review tells us that the characteristics of a backpack don’t
cause back pain. For someone who has back pain, it may seem it worsens
when carrying a heavy bag or carrying it on one shoulder, but it’s
unlikely the backpack was the cause of the initial pain.
The Australian Physiotherapy Association
provides a message consistent with this review, recommending that
moderately loaded backpacks are not detrimental to back health.
The study authors indicate the findings from the included prospective
studies are limited. This is because identifying risk factors for back
pain wasn’t the primary aim of these studies, so the measurements used
and the timing of data collection may not have been optimal for
establishing causal relationships.
Read more:
Explainer: what is pain and what is happening when we feel it?
Studies investigating causal links between backpack wearing and back
pain don’t exist, as study designs requiring children to carry backpacks
of specific weights could not be reliably or ethically performed.
Future studies investigating the causes of back pain in children and
adolescents need to consider a wide range of possible risk and lifestyle
factors that might contribute to pain. For instance, reduced physical
activity is known to be associated with poorer health.
Parents shouldn’t be overly concerned about backpack weight causing
future problems for their children. But if carrying a heavy backpack
means a child avoids walking or cycling to school, or other forms of
incidental physical activity, this might be a reason to reduce backpack
weight.
If you or your child already has back pain that is aggravated by
carrying your bag, it makes sense to reduce its weight or carry it for
less time.