Schoolbags and Back Pain in Children Between 8 and 13 Years: A National Study
SOURCE: Br J Pain. 2017 (May); 11 (2): 81–86 ~ FULL TEXT
Karl Spiteri, Maria-Louisa Busuttil,
Samuel Aquilina, Dorothy Gauci,
Erin Camilleri, and Victor Grech
Malta Association of Physiotherapists,
Schoolbag weight in schoolchildren is a recurrent and contentious issue within the educational and health sphere. Excessive schoolbag weight can lead to back pain in children, which increases the risk of chronic back pain in adulthood. There is limited research regarding this among the Maltese paediatric population. A cross-sectional study was undertaken across all schools in Malta among students aged 8–13 years (inclusive). Data were collected using a questionnaire detailing schoolbag characteristics, self-reported pain and demographic variables, such as age and gender. Structured interviews with participants were also carried out by physiotherapists. A total of 4,005 participants were included in the study, with 20% of the total Malta schoolchildren population. Over 70% of the subjects had a schoolbag that exceeded the recommended 10% bag weight to body ratio. A total of 32% of the sample complained of back pain, with 74% of these defining it as low in intensity on the face pain scale-revised. The presence of back pain was statistically related to gender, body mass index (BMI), school and bag weight to body weight ratio. After adjusting for other factors, self-reported back pain in schoolchildren is independently linked to carrying heavy schoolbags. This link should be addressed to decrease the occurrence of back pain in this age group.
From the FULL TEXT Article:
Carrying schoolbags and school attendance is a daily routine for students. The incorrect handling of schoolbags with excessive bag weight can lead to back pain in children. [1–4] It is recommended that the total weight of the schoolbag does not exceed 10% of body weight.  The development of back pain in children is of concern since it increases the risk of developing chronic back pain in adulthood.  Studies have shown that the prevalence of low back pain in schoolchildren ranges from 25% to 55% in those aged between 10 and 15 years. [6–8] In most cases, the pain intensity is relatively low.
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Given that back pain may eventually lead to disability, decreased quality of life and time lost from work in adulthood,  a national cross-sectional study was undertaken in order to assess the prevalence of back pain in schoolchildren, as well as its association with schoolbags. A previous study in Malta on schoolbags found that 15% of pupils carry a schoolbag with a weight that is more than 20% of their body weight. 
This study took a national representative sample of schoolchildren in the Maltese Islands (Malta and the sister Island Gozo) from all education providers, namely, State schools, church-run schools and independent private schools. State schools cover 54% of students in the system, while church-run schools cover 34%. The study was carried out concurrently with the Malta Childhood National Body Mass Index Study.