Backpacks have captured a lot of attention in the public and scientific communities. The chiropractic profession has generated several commercial programs to increase the awareness of students and their parents about the risks associated with the improper use of backpacks. These efforts are based upon a number of studies conducted primarily outside the United States.
The Italian Backpack study, for instance, found that children were carrying an average of 22 percent, but up to 34.6 percent, of their body weight in their backpacks on a daily basis. Furthermore, these children expressed low back pain. Eighty-four percent of these participants reported fatigue from walking back and forth to school under the load of a backpack. Other studies in Australia, England, Sweden, and India have replicated this effect. No absolute weight limits have been set for children’s load carriage by backpack, but 10-14 percent of the child’s body weight is the proposed limit. The weights reported for most children in the studies far exceed this weight limit. Low back pain is a growing issue in adolescents, and levels are approaching those found in adults.
While backpack use cannot be blamed for all adolescent back pain, the repetitive stress of lifting and carrying a backpack could be considered a contributing factor. As much as 60 percent of school children in one study reported chronic low back pain due to backpacks. The low back pain from backpacks is associated with carrying too much weight, repeated lifting of the backpack, and long periods of carrying a heavy weight. Another factor found to affect low back pain was the mean time spent sitting, as in a classroom, or hours spent after school in front of the television or computer. The individual body mass was not considered a factor. For many children, the increased loads begin in middle school (grades 6, 7 and 8) and high school. Females were more likely to report low back pain as early as grade 8, whereas males were more likely to report the same types of pain 1-2 years later. It is hypothesized that this difference is due to the age at which the growth spurt begins.
Researchers have sought to understand why adolescents have increasing low back pain. Focus on the backpack as a reason for increased pain levels seemed to be the direction to take. For the chiropractor, research on low back pain expressed is natural. With healthcare in general moving toward a system of wellness rather than treatment, it is necessary for the chiropractor to learn why these problems exist. Chiropractic professionals have long been aware of the need for prevention and wellness.
Recent literature suggests that backpacks and the increased load they produce on the spine are not the only reason for the increase in injuries. In a recent article, investigators found that of 247 backpack-related injuries reported, only 2 percent were from wearing the bag. The remaining 89 percent appear to have occurred from tripping over the backpack (28 percent), getting hit in the face (2 percent) and lifting the backpack (39 percent). Furthermore, investigators in Great Britain and Finland have found that psychosocial/emotional factors are more predictive of new onset of low back pain than weight of backpack.