SPINE (Phila Pa 1976) 2003 (May 1); 28 (9): 922–930
Sheir-Neiss GI1, Kruse RW, Rahman T, Jacobson LP, Pelli JA
Department of Research,
Alfred I. duPont Hospital for Children,
Wilmington, Delaware 19899, USA.
Study Design: A cross-sectional study comprising the first phase of an
ongoing, longitudinal prospective study was conducted.
Objective: To investigate the relation between backpack use and back pain
Summary of Background Data: The prevalence of nonspecific back pain
increases dramatically during adolescence from less than 10% in the
pre-teen-age years up to 50% in 15- to 16-year-olds. There is widespread
concern that heavy backpacks carried by adolescents contribute to the
development of back pain.
Methods: A total of 1126 children, ages 12 to 18 years, participated by completing a questionnaire about their health, activities, and backpack
use. Each child's body weight, height, and backpack weight were measured.
A child was classified as having back pain if one or more of the
following were reported during the preceding month: neck or back pain
that had interfered with school or leisure, neck or back pain with a
severity rating of 2 or more on a scale of 0 to 10, a visit to a physician
or therapist for neck or back pain, or exemption from physical education
or sports because of neck or back pain.
Results: Of 1122 backpack users, 74.4% were classified as having back pain, validated by significantly poorer general health, more limited
physical functioning, and more bodily pain. As compared with no or low
use of backpacks at school, heavy use (odds ratio, 1.98; P < 0.0001) was
independently associated with back pain. Female gender and larger body
mass index also were significantly associated with back pain. As compared
with adolescents who had no back pain, adolescents with back pain carried
significantly heavier backpacks that represented a significantly greater
percentage of their body weights.
Conclusion: The use of backpacks during the school day and backpack
weights are independently associated with back pain.