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Effects of a postural education program on school backpack habits related to low back pain in children

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Population based studies have demonstrated that children and adolescents often complain of low back pain. A group-randomized controlled trial was carried out to investigate the effects of a postural education program on school backpack habits related to low back pain in children aged 10–12 year.


The study sample included 137 children aged 10.7 years (SD = 0.672). Six classes from two primary schools were randomly allocated into experimental group (EG) (N = 63) or control group (CG) (N = 74). The EG received a postural education program over 6 weeks consisting of six sessions, while the CG followed the usual school curriculum. A questionnaire was fulfilled by the participants at pre-test, post-test, and 3 months after the intervention finished. The outcomes collected were: (1) try to load the minimum weight possible, (2) carry school backpack on two shoulders, (3) belief that school backpack weight does not affect to the back, and (4) the use of locker or something similar at school. A sum score was computed from the four items.


Single healthy items mostly improved after the intervention and remained improved after 3-month follow-up in EG, while no substantial changes were observed in the CG. Healthy backpack use habits score was significantly increased at post-test compared to baseline in the EG (P < 0.000), and remained significantly increased after 3-month, compared to baseline (P = 0.001). No significant changes were observed in the CG (P > 0.2).


The present study findings confirm that children are able to learn healthy backpack habits which might prevent future low back pain.

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  1. Chow DHK, Ou ZY, Wang XG et al (2010) Short-term effects of backpack load placement on spine deformation and repositioning error in schoolchildren. Ergonomics 53(1):56–64

    Article  PubMed  CAS  Google Scholar 

  2. LaFiandra M, Wagenaar RC, Holt KG et al (2003) How do load carriage and walking speed influence trunk coordination and stride parameters? J Biomech 36(1):87–95

    Article  PubMed  CAS  Google Scholar 

  3. Chow DH, Kwok ML, Cheng JC et al (2006) The effect of backpack weight on the standing posture and balance of schoolgirls with adolescent idiopathic scoliosis and normal controls. Gait Posture 24(2):173–181

    Article  PubMed  Google Scholar 

  4. Al-Khabbaz YS, Shimada T, Hasegawa M (2008) The effect of backpack heaviness on trunk-lower extremity muscle activities and trunk posture. Gait Posture 28(2):297–302

    Article  PubMed  Google Scholar 

  5. Bauer DH, Freivalds A (2009) Backpack load limit recommendation for middle school students based on physiological and psychophysical measurements. Work 32:339–350

    PubMed  Google Scholar 

  6. Negrini S, Carabalona R (2002) Backpacks on! Schoolchildren’s perceptions of load, associations with back pain and factors determining the load. Spine 27(2):187–195

    Article  PubMed  Google Scholar 

  7. Schwebel DC, Pitts DD, Stavrinos D (2009) The influence of carrying a backpack on college student pedestrian safety. Accid Anal Prev 41:352–356

    Article  PubMed  Google Scholar 

  8. Korovessis P, Koureas G, Papazisis Z (2004) Correlation between backpack weight and way of carrying, sagittal and frontal spinal curvatures, athletic activity, and dorsal and low back pain in schoolchildren and adolescents. J Spinal Disord Tech 17:33

    Article  PubMed  Google Scholar 

  9. Van Gent C, Dols JJ, de Rover CM et al (2003) The weight of schoolbags and the occurrence of neck, shoulder, and back pain in young adolescents. Spine 28(9):916–921

    PubMed  Google Scholar 

  10. Feingold AJ, Jacobs K (2002) The effect of education on backpack wearing and posture in a middle school population. Work 18:287–294

    PubMed  Google Scholar 

  11. Cardon GM, De Clercq DL, De Bourdeaudhuij IM (2002) Back education efficacy in elementary schoolchildren: a 1-year follow-up study. Spine 27:299–305

    Article  PubMed  Google Scholar 

  12. Mendez FJ, Gomez-Conesa A (2001) Postural hygiene program to prevent low back pain. Spine 26:1280–1286

    Article  PubMed  CAS  Google Scholar 

  13. Vidal J, Borras PA, Ortega FB et al (2011) Effects of postural education on daily habits in children. Int J Sports Med 32(4):303–308

    Article  PubMed  CAS  Google Scholar 

  14. Kovacs FM, Gestoso M, Gil del Real MT et al (2003) Risk factors for non-specific low back pain in schoolchildren and their parents: a population based study. Pain 103:259–268

    Article  PubMed  Google Scholar 

  15. Cardon G, De Bourdeaudhuij I, De Clercq D (2002) Knowledge and perceptions about back education among elementary school students, teachers, and parents in Belgium. J Sch Health 72:100–106

    Article  PubMed  Google Scholar 

  16. Goodgold SA, Nielsen D (2003) Effectiveness of a school-based backpack health promotion program: backpack Intelligence. Work 21:113–123

    PubMed  Google Scholar 

  17. Skaggs DL, Early SD, D’Ambra P et al (2006) Back pain and backpack in school children. J Pediatr Orthop 26:358–363

    Article  PubMed  Google Scholar 

  18. Chiang HY, Jacobs K, Orsmond G (2006) Gender-age environmental associates of middle school students’ low back pain. Work 26:19–28

    PubMed  Google Scholar 

  19. Diepenmaat AC, van der Wal MF, de Vet HC et al (2006) Neck/shoulder, low back, and arm pain in relation to computer use, physical activity, stress, and depression among Dutch adolescents. Pediatrics 117:412–416

    Article  PubMed  CAS  Google Scholar 

  20. Siambanes D, Martinez JW, Butler EW et al (2004) Influence of school backpacks on adolescent back pain. J Pediatr Orthop 24:211–217

    Article  PubMed  Google Scholar 

  21. Palou P, Kovacs FM, Vidal J et al (2010) Validation of a questionnaire to determine risk factors for back pain in 10–12 year-old school children. Gazz Med Ital Arch Sci Med 169(5):199–205

    Google Scholar 

  22. Burton AK, Balague F, Cardon G et al (2006) Chapter 2. European guidelines for prevention in low back pain: November 2004. Eur Spine J 15(suppl 2):S136–S168

    Article  PubMed  Google Scholar 

  23. Geldhof E, Cardon G, De Bourdeaudhuij I et al (2007) Effects of back posture education on elementary schoolchildren’s back function. Eur Spine J 16:829–839

    Article  PubMed  Google Scholar 

  24. van Tulder M, Becker A, Bekkering T et al (2006) Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 15(suppl 2):S169–S191

    Article  PubMed  Google Scholar 

  25. Moore MJ, White GL, Moore DL (2007) Association of relative backpack weight with reported pain, pain sites, medical utilization, and lost school time in children and adolescents. J Sch Health 77(5):232–239

    Article  PubMed  Google Scholar 

  26. Jones GT, Watson KD, Silman AJ et al (2003) Predictors of low back pain in British schoolchildren: a population-based prospective cohort study. Pediatrics 111:822–828

    Article  PubMed  Google Scholar 

  27. Costa-Black KM, Loisel P, Anema JR et al (2010) Back pain and work. Best Pract Res Clin Rheumatol 24:227–240

    Article  PubMed  Google Scholar 

  28. Maniakis A, Gray A (2000) The economic burden of back pain in the UK. Pain 84:95–103

    Article  Google Scholar 

  29. Cardon G, Balague F (2004) Low back pain prevention’s effects in schoolchildren. What is the evidence? Eur Spine J 13:663–679

    Article  PubMed  Google Scholar 

  30. Forjuoh SN, Little D, Schuchmann JA et al (2003) Parental knowledge of school backpack weight and contents. Arch Dis Child 88:18–19

    Article  PubMed  CAS  Google Scholar 

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No grant or external financial supports were received for this research. CEIP Establiments and CEIP Gabriel Comas I Ribas, both are primary schools from Majorca, and their students and staff are thanked for their contribution to this research.

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Correspondence to Josep Vidal.

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Vidal, J., Borràs, P.A., Ponseti, F.J. et al. Effects of a postural education program on school backpack habits related to low back pain in children. Eur Spine J 22, 782–787 (2013).

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