Do Heavy Backpacks Cause Back Pain in Teens?

Many students carry heavy backpacks, but two studies in the May 1 issue of the journal Spine disagree as to whether these heavy loads increase the risk of back pain. An American study says yes, heavy backpacks are one of several factors contributing to back pain in teens. But a study from the Netherlands finds no link, suggesting that psychosomatic factors play a more important role.

The U.S. study, led by Geraldine I. Sheir-Neiss of Alfred I. duPont Hospital for Children in Wilmington, Del., included 1,126 students, aged 12 to 18 years. Overall, 74 percent of the students reported back pain. Back pain was more frequent in girls and in older students.

The students' backpacks were heavy: average weight was 18 pounds, or 14 percent of the students' body weight. In this study, students with heavier backpacks had higher rates of back pain. Other factors also increased back pain risk, including poorer general health and higher body mass index.

At some of the schools in the American study, students were not allowed to carry backpacks between classes. Students at these schools had lower rates of back pain.

The Dutch study, led by Dr. Charlotte van Gent of Regional Health Centre RegioArnhem, evaluated neck, shoulder, and back pain in 745 secondary school students. Forty-five percent of students reported pain, including a six percent rate of severe neck or shoulder pain and a seven percent rate of severe back pain.

As in the American study, the backpacks were heavy: average weight was about 17 pounds, equal to 15 percent of the children's body weight. However, backpack weight was unrelated to the presence of back, neck, or shoulder pain. Instead, pain was more strongly related to psychosomatic factors, including general symptoms of listless, tiredness, and stress-related headaches.

Dutch students who perceived their backpack as heavy were more likely to have back, neck, or shoulder pain, but the actual weight of the pack had no effect. Again, pain was more frequent in girls than boys.

There is growing concern about the problem of back pain in children and adolescents, and the possible contribution of heavy backpacks. Some authorities have recommended that backpack weights be limited to ten percent of students' body weight. Both new studies confirm that students routinely carry backpacks in excess of this recommended weight.

Both studies also report high rates of back pain among teens, especially girls. However, they differ as to whether heavy backpacks actually increase the risk of back pain. Because of differences in study design and definitions, the conflicting results are difficult to interpret. However, both research groups agree on the need for follow-up studies to clarify the role of backpack weight and other factors contributing to the development of back pain over time. The U.S. researchers plan additional follow-up of the students in their study, which should help to meet this need.

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