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Books in Bags Lead to Back Pain

New research has shown that heavy backpacks carried by students can pose health risks to their spines and lead to lower back pain.

Lower back pain is the leading cause of disability globally, some studies say, with an estimated 540 million people suffering from related problems at any one time. Arab students suffer along with others from back pain and overweight backpacks are putting them at risk for this ailment.

In one of the latest studies on the risks of backpacks, a team of researchers at the Vassar Brothers Medical Center, in New York, conducted a study, published in the journal Surgical Technology International, which evaluated the force on the spine produced per pound of weight in a backpack. They found that for each pound of weight added, the force on backs was seven times greater.

Poor posture can multiply the effects of overweight backpacks, said Ken Hansraj, the lead author of the study, in an interview.

Hansraj used a computerized version of a human spine to model the forces produced by carrying a backpack of varying weights under two scenarios—the first with a spine in a neutral position and the second with the spine positioned at 20 degrees forward to mimic a slouch. (In each scenario, both backpack straps were used.)

“One book equals seven books to the spine,” says Hansraj. “It’s 12 books when the spine has a forward posture of 20 degrees.”

Students should judiciously consider how much they really need to pack in their bags, advised Hansraj.

Other experts agree. “The most common cause of back pain is a mechanical problem with the bones in the spine,” said Hani Benamer, a researcher at the Neurology Department of New Cross Hospital in the United Kingdom, who was born in Libya.

Benamer conducted a study in 2009 to review the susceptibility of populations in the Arab world to multiple sclerosis, a condition that affects the brain and spinal cord with symptoms that can include back and neck pain. (Multiple sclerosis is an affliction of the nervous system, not of spinal bones.)

Benamer encourages more region-specific research. “There is poor data availability in the Arab world on this. It’s a well-recognized problem and I believe in evidence-based medicine, which is why I started my project,” says Benamer.

Doctors in Algeria have reported that students—many of primary school age—are suffering from scoliosis, an irregular curvature of the spine that can be caused by carrying heavy loads. (See a related article, “In Algeria, Heavy Backpacks Hurt Schoolchildren’s Health.”)

The few regional studies on back and spine disorders that do exist—like Benamer’s—suggest the Arab world has similar incidence rates as the West, but that the disorders are getting more common.

“We shouldn’t assume that diseases will automatically behave the same in the Arab world as elsewhere until we’ve actually studied it in the region,” says Benamer.

Hansraj says there are ways to manage the risk of heavy backpacks. “Studies have suggested a safe load of 10 percent body weight in children and adolescents.”

That figure rises to 15 to 20 percent by university age.

Hansraj advises students and parents to more carefully assess what goes in their school bags. “Pack only what is necessary. People tend to overpack and bring every possible option available in their backpacks.”

He also questions whether physical textbooks are still a good idea. “Embrace digital textbooks,” he says. Digital textbooks are easier to read, access pages and do not transmit forces on the spine.”

Replacing textbooks with tablets and smart devices is a policy that has already been deployed in some Arab countries, though with limited success. Egypt Today reported earlier this year that when the government handed out 250,000 tablets to students in six governates for a pilot program costing $22.5 million, the experiment was a flop. Many students used the devices to play video games and watch films during class time and failed to return the tablets when they left school.

If iPads aren’t a possibility, then at the very least students should be using both straps of a backpack—it allows for the equal distribution of force either side of the spine. But if one strap is used then one side gets twice the amount of force, says Hansraj.

Perhaps the most critical finding of the new study is that posture has a significant effect and backpack wearers should try to remember that as they make their way to class.

“Remember your mother saying, ‘stop slouching’?” asks Hansraj. “You would think it goes without saying, but many of us simply don’t maintain good posture, which is critical for a healthy spine.”


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