Schoolbags not linked to back pain in schoolchildren, adolescents

Schoolbag use does not appear to increase the risk of back pain in children and adolescents, according to an Australian review of previous studies.

Guidelines published by different organisations recommend limits on backpack weight for children, ranging from 5 per cent to 20 per cent of their body weight. However, there have been no reviews summarising the scientific literature, say the authors.

“According to popular opinion, schoolbags are a problem for kids. Many parents and even health professionals believe that schoolbags can be harmful for children, being the cause of their back pain,” study leader Tie Parma Yamato of the University of Sydney in New South Wales told Reuters Health in an e-mail. 

The main factors said to cause back pain in kids are the weight of the schoolbag, the way kids wear them and the design of the bag, but the lack of review evidence is concerning, said Parma Yamato. 

“Because of this, we decided to investigate the research in this area to better understand the relationship between schoolbags and back pain,” she said.

As reported in the British Journal of Sports Medicine, Parma Yamato and colleagues reviewed 69 studies related to schoolbag use and back pain. The studies involved a total of more than 72,000 children.

Five of the studies looked at schoolbag use and the development of back pain over time. One of the studies reported that children who said they have difficulty carrying their schoolbags had a higher risk of persistent back pain and another found that the perceived weight of schoolbags was associated with high back pain risk.

However, when the investigators reviewed the studies, they did not find evidence that schoolbag characteristics such as weight, design and carriage method increased the risk of developing back pain in children and adolescents.

Evidence from the other 64 studies, which did not follow kids over time, did not show any consistent pattern of association between schoolbag use and back pain.

The analysis has some limitations given that so few studies followed the children over time, and those that did were at moderate to high risk of bias.

Still, the take-home message for parents is that they should not be overly worried about schoolbags as a cause of back pain for their children, said Parma Yamato.

“People mistakenly think back pain in kids is an injury and so look for a cause of the back injury and the schoolbag is an easy target to lay blame at,” she said.

In fact, she said, “Physical activity and load are actually good for the spine, so we want kids to be physically active and to carry loads.”

People still believe in the outdated view that poor posture causes back pain and so when they see a child carrying a backpack on one shoulder they mistakenly think the posture adopted will harm them, said Parma Yamato. 

“If a child is experiencing an episode of back pain it may make sense to temporarily reduce the load if this relieves the pain, but once they recover it is fine to return to a normal load in the schoolbag,” she said.