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Postural Effect of Back Packs on School Children: Its Consequences on Their Body Posture

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Abstract

Students stand and move with backpacks that may be heavy, posture and balance may be altered. The purpose of this study was to determine if posture or postural stability change with back pack weight, the type of backpack worn or the location of the backpack on the spine. To measure posture and postural balance during three types of tests: static, dynamic and fall forward. Static tests were performed without a backpack, and with three backpacks, each tested in two different locations (high on the back; low on the back) with three different loads (no weight; 10% of the bodyweight; 20% of the bodyweight). Results indicate that postural stability and body position while wearing a backpack weighing 20% of the body weight are significantly different from conditions is which no backpack or a backpack with 0 or 10% of the bodyweight is worn. Standing with a back pack weighing 20% of the bodyweight results in an anterior movement of the shoulder and head, an increase in the movement of the center of pressure and an anterior, superior movement of the center of gravity. The location of the backpack also significantly altered postural stability and posture. When the backpack was worn in the high position, postural stability, as indicated by decreased movement of the center of gravity within the base of support, was greater than the low position but the head was in a more anterior position. In addition to the changes resulting from increase backpack weight and backpack location, the study found evidence that gender, body mass index and age may also alter stability and posture when wearing backpacks. These potentially at risk populations should be studied further to identify risks of injury and falls.
International Journal of Health Sciences & Research (www.ijhsr.org) 109
Vol.3; Issue: 10; October 2013
International Journal of Health Sciences and Research
www.ijhsr.org ISSN: 2249-9571
Review Article
Postural Effect of Back Packs on School Children: Its Consequences on Their
Body Posture
Avantika Rai1*, Shalini Agarwal2, Sarita Bharti1
1Research Scholar, 2Assistant Professor,
Department of Human Development & Family Studies, School for Home Science,
Babashaheb Bhim Rao Ambedakar (A Central University) Lucknow, India
*Correspondence Email: avantikahrfm@gmail.com
Received: 04/06//2013 Revised: 14/09/2013 Accepted: 17/09/2013
ABSTRACT
Students stand and move with backpacks that may be heavy, posture and balance may be altered. The
purpose of this study was to determine if posture or postural stability change with back pack weight, the
type of backpack worn or the location of the backpack on the spine. To measure posture and postural
balance during three types of tests: static, dynamic and fall forward. Static tests were performed without a
backpack, and with three backpacks, each tested in two different locations (high on the back; low on the
back) with three different loads (no weight; 10% of the bodyweight; 20% of the bodyweight). Results
indicate that postural stability and body position while wearing a backpack weighing 20% of the body
weight are significantly different from conditions is which no backpack or a backpack with 0 or 10% of
the bodyweight is worn. Standing with a back pack weighing 20% of the bodyweight results in an anterior
movement of the shoulder and head, an increase in the movement of the center of pressure and an
anterior, superior movement of the center of gravity. The location of the backpack also significantly
altered postural stability and posture. When the backpack was worn in the high position, postural stability,
as indicated by decreased movement of the center of gravity within the base of support, was greater than
the low position but the head was in a more anterior position. In addition to the changes resulting from
increase backpack weight and backpack location, the study found evidence that gender, body mass index
and age may also alter stability and posture when wearing backpacks. These potentially at risk
populations should be studied further to identify risks of injury and falls.
Keyword: Weight, location, type of backpack, postural stability.
INTRODUCTION
The word 'posture' in most common
usage almost exclusively refers to the way a
person sits or stands, and is generally termed
'good posture' or 'bad posture'.
Posture can be defined as the
position of all the body segments observed
at a specific moment. Adequate posture
occurs when the body is kept in balance with
the least expenditure of energy possible.
Inadequate posture consists of poor
interrelations between parts of the body.
These imperfect interrelations cause muscle
tension and shortening, which makes
International Journal of Health Sciences & Research (www.ijhsr.org) 110
Vol.3; Issue: 10; October 2013
appropriate joint movements more difficult
to achieve. Incorrect movements cause
injuries to the musculoskeletal system and
limit the ability to perform daily activities.
The prevalence of postural problems is
associated with pain.
Good posture is generally understood
as standing with the head balanced
effortlessly above the spine which is straight
and vertical except for the slight natural
curves in the lower back and neck i.e. it has
a slight S-shape. Such a posture is widely
recognized as being associated with good
appearance, good health, strength,
athleticism, and stamina.
By contrast the term bad posture is
most commonly used to describe the human
position in which the head and shoulders are
placed forward of the spine with the spine
curved into an excessive S-shape, or a C-
shape, and it is widely referred to as a
slouched, or hunchback posture. Bad posture
is commonly regarded as a poor appearance,
and is associated with backaches of all
types, poor health, poor breathing, tiredness,
and ready fatigability.
The Posture Theory
Forward curvature of the upper spine
places the head and shoulders forwards,
where the individual would fall in that
direction if it was not for the strain being
taken by the spine and back muscles to
prevent that, which, in the longer term,
disposes to various backaches.
Such a posture in infancy can also
put downward pressure on the chest
disposing to chest wall deformities, such as
flat or backward chest shape. The forward
posture places the weight of the head and
shoulders over and above the chest, and puts
downward pressure on the chest and ribs to
cause a variety of musculoskeletal and other
chest pains.
The forward posture also places
downward pressure on the lungs and
respiratory muscles which disposes to
breathlessness, and can affect their structure
and breathing pattern to add to the aspect of
breathlessness.
That posture also places pressure on
the air in the chest to impair the flow of
blood from the feet to the brain, and dispose
to faintness. Over a period of years it can
also affect the strength of the blood vessels
below the chest, and possibly the pattern and
regulation of blood flow, causing weak
circulation to the brain which disposes to
faintness and abnormal tiredness, and more
generally, to an impaired capacity for
physical exertion, where faintness, and other
symptoms occur at higher levels of exercise.
Incorrect postural habits developed
since elementary school can generate
irreversible changes in children as ligaments
and intervertebral discs suffer a degenerative
process throughout life and do not have
regeneration mechanisms. These findings
justify the creation of prevention programs
to reduce the risk of postural changes and
back pain in schoolchildren due to
inadequate use and transport of school
backpacks. The life goal of schoolchildren is
to play, therefore any pain that deprives
them of that is a source of worry.
Such a posture also places pressure on the
stomach to cause stomach pains, indigestion,
and poor digestion, which can impede
growth.
The changes in the backpack model
and mode of transport are related to the
instructions received in the educational ses-
sion, which emphasized comfort and body
symmetry during load bearing2-6 and
recommended the bilateral shoulder use of
double-strap backpacks. This
recommendation was a result of the findings
of the first evaluation, including wheeled
backpacks with a total mass of more than
10kg when the school material required for
the day did not exceed 1.5kg (textbook,
school diary and pencil case). The wheeled
backpacks alone (between 5 and 7kg)
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Vol.3; Issue: 10; October 2013
already exceeded the safe load-bearing limit
of 3.68kg. This limit was based on the mean
values for the children’s body mass found in
the first evaluation. The video footage also
revealed that the children had to climb a
flight of stairs to reach the classrooms, and
the wheeled backpack generated overload
and asymmetry because the children stopped
pulling the wheeled backpacks and had to
carry them to overcome the obstacle.
The forward position of the head and
shoulders also, in some chest shapes, puts
downward pressure on the dagger shaped
sternum, or breastbone, where the lower tip
is pressed into the upper abdomen, to cause
soreness or pain in that local area, and
dispose to injury which would add the
problem .The forward and downward
pressure can also displace internal anatomy
and dispose to aches and pains as a result of
that secondary effect.
Such body physique also pushes the
kidneys and adrenal glands forwards,
resulting in congestion and symptoms
related to those factors, and cause strain on
the back in that area. The forward position
of the weight of the head and shoulders also
puts strain on the neck and throat, and
disposes to neck ache, sore throat, and
laryngitis, coughs, colds, and voice
problems - hoarseness, and or, temporary
voice loss.
That posture also alters the angle
between the head and neck which impedes
the flow of air and fluids along the mouth,
nasal passages, and Eustachian tubes,
causing congestion in those structures, and it
strains the jaw joint, disposing to jaw and
facial pains, and it pushes the lower teeth
forward against the upper teeth, or vice
versa, disposing to dental and gum
problems.
A study has reported that not only
the magnitude of load but also the position
of the backpack might influence efficient
posterior load carriage. Efficient load
carriage has been associated with minimal
energy expenditure and minimal spinal
tissue stress. Spinal tissue stress is related to
altered posture (i.e. posture that deviates
from gravitational alignment; Grimmer et al.
2002). The symptoms are not likely to occur
each and every time a person leans forward,
but are the result of the repetitive, constant,
or long term affects of that physique.
Regardless of any questions about the
individual aspects of the theory, such a
physique disposes to a large range and
number of ailments in the manner which I
have described.
Those problems can be prevented in
the early development of children where the
spine is pliable; in much the same way as
such a curvature can be prevented in a
young tree.
Types of posture
i. Good posture
It involves an upright spine with
slight natural forward curves in the neck and
lower spine, and broad and straight
shoulders. Significant increases in the curves
or other changes in shape are listed below.
ii. Poor posture
It’s the term used to describe an
abnormal forward curve in the upper spine
due to slouching while standing, and a C-
shaped curve along the entire spine which
can be seen from the side when a person
slouches forward in the sitting position.
Hence it is often referred to as the slouched
posture.
iii. Kyphosis
It’s a more extreme forward
curvature of the upper spine and is due to an
abnormality in the structure of the spine and
is generally referred to as the hunchback
posture. It is usually accompanied by a
corresponding forward curve in the lower
spine so that it looks like a reverse S-shape
when seen from the side.
iv. Scoliosis
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It’s the medical term for sideways
curvature of the spine which usually results
from a person using one hand to do most of
their tasks because most people are either
left or right handed. It can also result from
one leg being longer than the other.
v. Lordosis
It’s an excessive forward curve in the
lower spine and is usually associated with a
hunchback posture. Common causes are
obesity or pregnancy where the weight of
the abdomen drags the lower spine forward.
vi. Swayback
It’s the backward curvature of the
lower spine
vii. Flatback
It’s where the normal slight curves of
the spine are not present and the back is
abnormally straight.
viii. Kypholordosis
It’s the combined abnormality of a
forward stoop in the upper spine (kyphosis),
and a forward curvature of the spine
(lordosis), and usually occurs because the
stoop puts the weight of the persons head in
front of the centre of gravity with a tendency
to fall forwards, so the instinctively push
their lower spine forward to restore the
centre of gravity and maintain a
counterbalance upright position. A side view
of the body shows a spinal Colum with an S-
shape.
ix. Kyphoscoliosis
It’s the combination of a forward
curvature of the upper spine (kyphosis), and
a sideways curvature (scoliosis), where
multiple abnormalities commonly occur
because they may be due to poor nutrition
which weakens the bones or muscles, and
affects every part of the human skeleton in a
variety of ways.
x. Kyphocostosis
It’s the combination of forward
curvature of the upper spine (kyphosis), and
deformities of the rib cage (costosis) which
involves abnormalities of the chest, such as
one that is abnormally flat and shallow, or
deep and barrel shaped.
xi. Neck stoop
It can be seen from the side view in a
person with a deep chest where the rib cage
forms a triangular structure which prevents
the spine from collapsing into a C-shape, so
it remains straight, but the neck bends
sharply forwards.
Many backpacks have been designed
specifically to improve load distribution,
balance, stability, and organization. One
such design is the compartmentalized
backpack, created specifically to carry and
organize textbooks. The compartmentalized
backpack has three major compartments
made of elastic materials. The structure and
elasticity of the compartments are designed
to help to keep the textbooks close to the
body’s center of mass and to keep the mass
from settling at the bottom of the backpack.
The purpose of this study was to compare a
compartmentalized backpack and a standard
backpack in relation to metabolic and
biomechanical factors.
A backpack should not weigh more
than 15% of a child’s total body weight. In
other words, a child weighing 85 pounds
should not be toting a backpack that weighs
more than 12.75 pounds. A child weighing
140 pounds should not carry a pack
weighing more than 21 pounds. The weight
of a backpack and its contents can cause a
person's posture to deteriorate. Heavy school
backpacks may also deform natural curves
in the back. If the curves are interrupted in
the lower and middle back, the result is
muscle strain and irritation to the rib cage or
spine joints. Much of this suffering is
brought by bad habits initiated during our
younger years may be because of carrying
overweight backpacks to school. (Rai, A. et
al2013)
The schoolbag is a common cause of
backache in school going children. A heavy
bag may cause a child to compensate by
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Vol.3; Issue: 10; October 2013
leaning his body forward and this can strain
muscles in his neck, shoulders and back.
The child may also find it difficult to put the
bag on and take it off, or he falls frequently
in school while carrying his schoolbag.
Carrying this weight 5 days a week
throughout the school year affects children’s
backs. Add distance and time to and from
school, extra gear and equipment, poor
daypack/schoolbag design, contents (for
example, number and size of work books,
homework copies/materials), carrying and
loading of a schoolbag - the schoolbag very
much becomes a health threat.
According to an international study, daily
backpack carrying is a frequent cause of
discomfort for school children. School
backpacks were felt to be heavy by 79.1% of
children, to cause fatigue by 65.7%, and to
cause back pain by 46.1%*.
Most students wear backpacks when
attending school or college and they use two
strap backpacks. The backpacks were filled
with books so that the weight of the bag
approximated different percentages (10%,
15%, and 20%) of each individual subject’s
body weight. In some cases, prolonged
wearing of overly heavy backpacks can lead
to posture and muscle problems, which can
cause injury and pain––indeed, the
American Occupational Therapy
Association considers that over 50 percent
of students aged 9 to 20 have chronic back
pain from over packed or poorly packed
backpacks. Knowing how to lighten your
load and keep it that way is important for
your health and comfort. The backpack was
carried on both shoulders, placed on the
trunk, and fixed to a position (at waist level)
so that the subject felt most comfortable and
stable. Once the child enters school, the
school bag becomes the indispensable
companion. A school bag full of hopes is
always the first gift given to a child as an
entrance present. However, a heavy school
bag not only weight psychologically on a
child, but also physically on the posture. In
the lower class has the heavier the school
bag. Overloading schoolbag cause muscle
fatigue, back pain and poor posture. To
protect the child from skeletal-muscular
disorders, Taiwan recently suggested that
schoolbag should be less weight than it is
now panels and water tight welded seams.
Each school year millions of children
walk to, from and around school carrying a
significantly greater amount of weight in
their backpacks and for a longer period of
time. Children have to carry a full day’s
class schedule of school books, in addition
to other items and supplies, throughout the
day1. The average student carries a
backpack weighing almost one fourth of his
or her body weight. Three out of 10 students
typically carry backpacks weighing up to
one third of their body weight at least once a
week. Carrying heavy backpacks can lead
to pain and injury that prevent students from
participating in everyday activities. It was
estimated that in 2001, there were seven
thousand injuries related to the use of
backpacks (NEISS, 2001).
Method of Carrying Backpack
Methods of carrying backpacks may
also influence pain, although this remains
controversial.( Korovessis 2004) found that
asymmetric carryinghaving strap(s) on
only one shoulderresulted in greater pain
in student participants. This was also
discovered in a study conducted by Rice
(2008). 26% of children who carried two-
strap bags reported soreness, pain, and
discomfort, whereas 50% of children who
carried one-strap bags reported pain. The
number of participants who experienced
pain from asymmetric carrying was almost
twice the number of those who carried their
backpacks symmetrically (Rice et al., 2008)
Backpacks are a convenient way to
transport items around, making them
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Vol.3; Issue: 10; October 2013
popular for military, hiking, and school
purposes. Most of the research about
backpack loads and their effects on the body
have focused on adults, specifically on
hiking and military utilization. However, it
is critical to understand the effects of
increased backpack weight on children due
to their developing bodies. Too much load
on the body changes static and dynamic
posture as the body tries to overcome the
posterior shift in the center of mass (Singh
and Koh 2009).
The carriage of posterior loads by
students has been linked with spinal pain,
and the amount of postural change produced
by load carriage has been used as a measure
of the potential to cause tissue damage. An
MRI study to document reduced disc height
and greater lumbar asymmetry in children
with low back pain. Few Indian researchers
have focused on the impact of load carriage
on high school students. But there is scarcity
of studies in rural India. Thus the present
was undertaken with the objectives of to
determine change in cervical and shoulder
posture while carrying backpack and also to
compare the same without backpack and to
find out percentage of body weight that
student’s were carrying to school in the form
of backpack.
In a study found that carrying a10-kg
backpack on one shoulder brought about an
imbalance and, after the swing children
needed a greater propulsive force to regain
balance. Carrying a 10-kg one strap
backpack also induced an asymmetric gait
for braking and propulsive foreaft forces.
This asymmetric gait was not apparent with
a two-strap backpack .It concluded that
carrying a 10-kg schoolbag affects gait
kinetics and that children should carry their
backpacks on both shoulders rather than use
a one-strap backpack.( Cottalorda et al2003)
Current backpack harness design
has more to do with the hips than the back
and shoulders. “Weight is transferred to
the hips using a padded belt connected to
the lower part of the backpack and secured
around the user‟s waist. Shoulder straps,
far from being a way to „hang‟ the pack on
you, simply keep the pack from twisting or
rotating.”
A study investigated that the impact
of backpacks on 10 children aged 11-
13years using measurement of static posture
and gait kinematics. The children
participated in tests under four conditions:
no backpack, one-strap backpack, two-strap
backpack, and one-strap athletic bag.
(Pascoe et al) also noted that carrying one-
strap bags caused a shoulder elevation and a
curvature of the spine away from the weight
of the backpack. In their study, shoulder
elevation from a horizontal position and
lateral spinal deviation was not significantly
different between two-strap back packs and
no backpack. However, one-strap athletic
bags promoted lateral spinal bending and
shoulder elevation, while the two-strap
backpack significantly reduced the stresses
of carrying backpacks. It was concluded that
the daily physical stresses associated with
carrying athletic bags on one shoulder
significantly alter the posture and gait of
young people. These alterations of the spine
may be responsible for the perceived back
pain (51%) reported in their study. (Pascoe
et al1997)
Factors Which Affect Weight of School
Bags
There are two factors which affect weight of
school bags on children posture and
stability.
i. Direct Factor
A number of underlying
factors emerged which contribute to
the increased bulk and weight which
children must transport to school on
a daily basis. The number of
textbook, workbook and copies in
use, the size and weight of individual
International Journal of Health Sciences & Research (www.ijhsr.org) 115
Vol.3; Issue: 10; October 2013
textbooks was identified by
researcher that this issue is
increasing concern as children
progress to second level schooling.
Multi level text books containing
curriculum, additional content of
school bags likes bottles lunches
flasks sports equipments musical
instruments etc. weight of school
bags that means it’s constructed from
heavy material such as leather which
adds weight to the overload.
ii. Indirect Factor
A number of factors which
have an indirect influence on the
weight of schoolbags were also
identified such as storage facility
,curriculum, school organization and
time table requirements, lack of
awareness, children’s organizational
skills, homework requirements and
co-ordination of homework, lifting
and carrying techniques health
education programmes and so many
other factors which affect on posture
stability.
CONCLUSION
Carrying a heavy backpack can be a
source of chronic strain; and can cause
shoulder, neck and back pain in children.
Some students wear their bag on only one
shoulder, and they might walk tilted to one
side and suffer neck pain. If the bag straps
are too thin, they can dig into the shoulder
muscles and strain the neck. The problems
of schoolbags are incremental and should be
implemented in a cohesive manner in order
to reduce the weight of schoolbags to an
increasing degree. Therefore it concluded
that postural effect of back packs on school
children and its consequences on their body
posture due to many factors which affect
children’s stability in their posture way of
carrying backpacks, types of backpacks and
so on. Children’s Health and Healthy
Children advise a proper fit and lightening
the load. Leave out any items your child
does not absolutely need for that day, such
as laptops or other electronic devices, extra
books or notepads. Also ensure that children
bring only important items that they needs
for that night’s homework. While at school,
urge your child to use his locker, desk or
other storage areas so he doesn’t have to cart
around so much stuff. Awareness should be
created among health care professionals,
teachers, parents to restrict backpack load
less than 5% of bodyweight by using school
locker shelves. Improper use of backpacks is
not healthy for anyone, especially for
children who are more susceptible to injury
because their bodies are growing and
developing. Students, staff, and families
need to be educated about backpacks’
contribution to back pain and taught
appropriate interventions to reduce injury.
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How to cite this article: Avantika Rai, Shalini Agarwal, Sarita Bharti. Postural effect of back
packs on school children: Its consequences on their body posture. Int J Health Sci Res.
2013;3(10):109-116.
... Inappropriate use of backpacks is not healthy for anyone, especially for children, who are more susceptible to injury because their bodies are growing and developing [37]. Carrying a backpack weighing 10% of BW leads to a reduction in gait velocity and cadence, an increased double support time and trunk forward lean, which could be a compensatory mechanism to minimize either the induced gait instability or mechanical strain on the musculoskeletal system [44]. ...
... Consequently, health care professionals, teachers, and parents should be aware of the need to restrict the backpack weight to the minimum values to solve most of the problems related to the weight of the bag in relation to BW [36]. Therefore, students, staff, and families need to be educated about backpacks' contribution to pain and musculoskeletal complains [37]. ...
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Study aim : This study aimed to examine the effect of carrying backpacks on neck posture and ground reaction forces (GRFs) and to investigate the relationship between neck angles and GRFs during backpack carriage in schoolchildren. Material and methods : The craniohorizontal angle (CHA), craniovertebral angle (CVA), sagittal shoulder posture (SSP) and GRFs were measured in right-handed schoolchildren (14 male and 12 female) with mean age 10.17 ± 1.15 years during loaded and unloading conditions. The Qualisys motion analysis system with a force plate was used to assess the neck angles and GRFs. Results : During backpack carriage there was a significant increase in the CHA (p = 0.001), significant decrease in the CVA and SSP (p = 0.001, 0.016 respectively), no significant difference in the normalized (scaled to body weight) vertical GRFs (p > 0.05), and a significant increase in the anterior braking and posterior propulsive GRFs (p = 0.035, 0.002 respectively) compared to the unloading condition. While carrying a backpack there was a moderate negative correlation between the SSP and first vertical GRF (r = –0.464) and a strong negative correlation with the second vertical GRF (r = –0.571) and the posterior propulsive GRF (r = –0.587). Conclusion : Carrying a backpack weighing 15% of the child’s body weight changes the head posture and increases the normalized value of the anterior-posterior shear force. During backpack carriage, decreasing the SSP is associated with increasing the load acceptance, thrusting and posterior propulsive forces. Increasing the shearing force may lead to development of postural abnormities. Consequently, the ideal backpack weight should be considered by parents and teachers.
... Daily bag carrying is the most prevalent cause of discomfort in school going kids according to an international study.79.1% of the kids felt their bags are heavy.65.7% complained about fatigue and 46.1% had back pain [4]. A few investigations have been directed in schools about the pervasiveness and related variables with disarranges [5]. ...
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Jameel W et al.; Assessment of postural changes among school-going children ABSTRACT Posture is a matter a big concern. Because of increased workload the weight of school bags is also increasing day by day. The weight of bags with heavy books can develop many spinal deformities in young children. Objective: To assess the postural changes happening in school going kids because of heavy backpacks. Methods: It is a cross sectional study and was conducted on different schools in Lahore, within the time period of three months from 1 st November 2019 to 1 st February 2020. The sample size was 145 and the survey followed convenient sampling technique. Children per inclusion criteria were selected from different government schools to collect data and informed consent was taken before data collection. REEDCO scale was used to examine the postural disturbance.
... The research shows that postural problems in children are one of the most common health problems, and the scale of the problem is significant [12]. Early diagnosis of posture, striving to change social behavior of children, and a reduction in harmful factors are especially important. ...
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Introduction Physical activity may have an impact on the parameters of body posture. Scientific reports suggest that levels of physical activity are declining among society, which may result in incorrect changes in body posture. This study aimed to assess the relationship between physical activity and the parameters characterizing posture in the frontal plane in children. Material and Methods Sixty-seven primary school students aged 9 were enrolled in the study, including 29 girls and 38 boys. The posture was evaluated with the photogrammetric method. Also, anthropometric measures and the level of physical activity were investigated. Results The highest percentage of examined children was characterized by a moderate level of physical activity. Children with a high level of physical activity were characterized by the greater asymmetry of position between the right and left shoulder as compared to those with a low and a moderate level of physical activity. Conclusions There were statistically significant differences only in the height of shoulders in children with a high level of physical activity. This study should be repeated in adolescence, characterized by changes in development and a reluctance to physical activity.
... One telephonic survey was conducted to assess the knowledge and attitude of males toward vasectomy [11]. Among these studies, 4 studies were cross sectional studies which was conducted to assess the knowledge, attitude and practices of family planning among men to have been married for atleast 5 years and result showed that most husband preferred that their spouse should b sterilized [12], 2 nd study was conducted to explore the antecedent factors related to adoption of vasectomy among married men [13], 3 rd study was conducted to get insight into apathy of men towards non scalpel vasectomy [14] and 4 th study was conducted to assess the awareness , knowledge about family planning methods and to know factors influencing in selecting sterilization methods [15]. Among these studies 2 studies were descriptive cross sectional study which was conducted to determine the awareness and practice regarding vasectomy among 250 married males health workers and the result shows that 225 respondents knew about vasectomy while 25 respondents were not aware of it [16] whereas other study was conducted on males to assess the knowledge, attitude and factors associated with low utilization of vasectomy and it was found that majority of males never heard about vasectomy as contraception method [17]. ...
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Background: The population is rapidly increasing and has become a major issue for many countries of the world with the population growing at an annual rate of 1.2%. Based on this report, India became one of the earliest national government sponsored family planning programs in the developing world's since the early 1950's, but the family planning programs focused more on females and haven't focused efforts on educating males about their responsibility. With this background, systematic literature search and Meta-Analysis was carried out. Objective: To collect the data and review various studies. Methodology: The study design was systematic review. The study includes the studies those which are related to knowledge of men regarding vasectomy and the attitude of men regarding vasectomy and the study excludes the studies those are related to tubectomy. Analysis: The data was grouped and analyzed in terms of Meta analysis. Studies were identified through searches of MEDLINE, PUBMED, Elsevier and Google Scholar. Abstracted information is about the study design, population characteristics, interventions and outcomes. Conclusion: This systematic has concluded that rate of vasectomy use was low in most developing countries like India and acceptance of vasectomy is limited by several factors is poor awareness and education regarding vasectomy.
... 14(17.3%) of respondents reported having pain at the shoulders. In the study conducted by 11 , 27% of children reported having neck pain and it was significantly associated with school furniture features, emotional and conducts problem, family history of low back pain and previous treatment for musculoskeletal disorders. ...
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These days, there is a growing concern that schoolchildren are carrying too heavy school back on their backs. The use of a back pack is the most important factor causing low back pain among students. Thus, a cross sectional study was conducted on 81 schoolchildren from two different types of primary school in Kajang, Selangor. The objective of this paper is to determine the association between schoolbag weight and back pain among primary schoolchildren in Kajang, Selangor. For the method, respondents' body weight and their schoolbag weight were measured using the electronic body composition OMRON and KERN weighing scale respectively, while the height was measured using Body Meter Seca 208cm. Back pain in the past one week was assessed using questionnaire, adapted from previous studies. This studied involving 81 primary schoolchildren from two types of school which were government and private school. 74.1% of schoolchildren had the schoolbag weight more than 10% of their body weight. 32.1% of schoolchildren reported having back pain and 21.0% of them were female respondents. Back pain was detected in 24.7% government schoolchildren and 7.4% private schoolchildren. There was significant association between back pain and; relative weight (x2=9.720, p=0.002) and types of school (x2=4.949, p=0.026). As conclusion, schoolchildren that carry schoolbag heavier than that generally recommended which is not more than 10% of body weight will experienced the back pain
... 도구로 사용되는 편리한 수단이다 [1,2]. 이전 연구에서는 적절한 백팩 의 무게가 몸무게의 10%-15% 사이로 연구되어 있다 [3][4][5]. ...
... Abnormal stress on the spine due to carrying a heavy schoolbag not only produces back pain but may also cause a deformity in the developing spine. The wrong choice and use of backpack can lead to various health issues [6,[18][19][20][21]. Parents are responsible for their children's health and thus in charge of promoting their safety. ...
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Background Heavy schoolbags and their adverse musculoskeletal effects are a cause of great concern. Parents’ awareness and knowledge about this are crucial to prevent such health problems. Thus, this study aimed to assess parents’ perceptions, knowledge, and attitudes regarding children’s schoolbags and related musculoskeletal health. Methods A cross-sectional study was conducted targeting parents with children of school age. In January 2015, a self-administered, validated questionnaire was distributed to all participants, consisting of questions about their awareness, knowledge, and attitude regarding the negative effects of carrying inappropriate schoolbags on children’s musculoskeletal health. Result A total of 616 parents (284 fathers and 332 mothers) completed the questionnaire (response rate of 100%). A total of 247 (87.3%) fathers and 301 (90.9%) mothers knew that carrying heavy schoolbags produces back problems. However, only 105 (36.9%) fathers and 107 (37.6%) mothers knew that incorrect schoolbag weight and inadequate way to carry it may impede the normal alignment and growth of the spine. Only 107 (37.6%) fathers and 96 (28.9%) mothers knew the ideal weight of the schoolbag, while 49.6% of fathers and 42.8% of mothers did not check their children’s schoolbags for unnecessary contents. Conclusion Awareness of parents about the consequences of heavy schoolbags and correct use is still limited and suboptimal. Educational sessions for parents and awareness campaigns may help to reduce the prevalence of musculoskeletal health problems among children. Electronic supplementary material The online version of this article (10.1186/s13018-019-1142-9) contains supplementary material, which is available to authorized users.
... Among the population who wear the backpacks youth make the 4 noteworthy percentage of it. However, the recommendations of safe weight of backpack which should be carried are 11 limited to school age children. Therefore, we presume that evaluating the impact of carrying a backpack on young grown-ups, changeability of gait frequency. ...
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OBJECTIVE: To find out changes induced in normal gait parameters due to backpack. METHODS: Thirty university healthy female students participated in this study through convenient sampling technique after taking consent. Participants were asked to walk twice on GAITRite® mat first without carrying backpack and then with a 3kg back pack over single shoulder. GAITRite® System version 4.7.7 was used. The individuals presented with fractures, any type of pain, orthopedic problems, neurological or musculoskeletal disorders, cerebral palsy, myelodysplasia or arthritis and congenital or spinal deformities were excluded. RESULTS: The mean age, height and weight of participants were 21.37±1.18 years, 1.62±.043 meters and 45.56±5.04 kilogram respectively. Gait was evaluated and there was decrease in the velocity on wearing the backpack on single shoulder in contrast with velocity when no backpack was worn over either left or right shoulder from 109.13±10.89 to 105.79±10.85 (p=0.001), stance parameter of gait had no significant difference when subjects worn the backpack over one shoulder in comparison when walked without carrying the backpack 61.5±1.42 to 61.36±1.53 (p=0.288). No significant changes were recorded in left double limb support and right double limb support, before and after wearing backpack 23.09±2.5 to 22.91±2.79 (p=0.489) and 22.98±2.42 to 22.69±2.78 (p=0.348) respectively. Same is the case in left single limb support and right single limb support 38.34±1.37 to 38.44±1.53 (p=0.565) and 38.68±1.59 to 38.83±1.53 (p=0.493). CONCLUSION: The study concluded that wearing backpack over one shoulder causes significant changes in velocity while no changes observed in single and double limb support. KEY WORDS: Gait (MeSH); GAITRite® system (Non-MeSH); Backpack (Non-MeSH); Velocity (Non-MeSH); Single limb support (Non-MeSH); Double limb support (Non-MeSH
... The fact that they may affect even 15% of the population raises particular concerns here [2,3]. Uncorrected body posture defects may lead to many unfavourable changes in the body and physical fitness of young people [4,5]. The highest susceptibility to the development of body posture defects occurs in the periods of progressive development of boys, i.e. around the 7th year of life and then at the age of 11-14. ...
Article
Objective: Regular judo training may induce favourable developmental changes in body posture of boys. The purpose of this work was to assess changes in body posture of 8-year-old boys training judo versus a control group in two repeated assessments. Methods: The study included 73 boys aged 8. Thirty-six of them started judo training in sports clubs at the beginning of the school year (JU). The control group included 37 boys attending first and second classes of primary schools, selected at random (NT). Body posture was assessed with the Moire's method, two times, at a 6-month's interval between the two assessments. Distributions of the values of the obtained variables were assessed with the W Shapiro–Wilk test. Non-parametric tests were used for their analysis. The median, mean and SD were calculated. To evaluate the differences between the T1 and T2 results, the Wilcoxon matched-pairs test was used, and to evaluate the intergroup differences both for the first and for the second measurement – the Mann–Whitney U test, adjusted for continuity. Results: In group JU, the time factor (T1–T2) had a significant effect (P ≤ 0.05) on changes of 6 body posture indices. In the first assessment, there was a significant difference between the JU and NT groups with respect to 5 body posture indices; in the second assessment, there were only two differences. Conclusion: Regular 6-month's judo training in the examined boys resulted in deepening of physiological spinal curvatures, progressing symmetrisation of shoulder blades and spine alignment to the C7–S1 line.
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Background: Postural skills are fundamental in motor activities, so far no evidence of a direct relationship has been found, it is therefore recommended to consider the following directions, the higher the level of sports competition, the better the body posture; or better athletes also have a better body posture. Around the age of 11-14 years, it is a period of aggressive development, if the rapid growth of the bone system is not associated and symmetrical with the development of soft tissues serious postural deficiencies may develop in table tennis players. Methods: We used the web camera – photographic method (38) related to the Sensor Medica software that allows the acquisition of images in order to detect postural deficiencies and we considered it necessary to have a clear image of the level of technical�tactical training of female juniors III using 5 tests specific to topspin attack in order to assess the influence of body posture on such tests. Eighteen female juniors III (the mean ± SD age, height and weight were 11.1 ± 0.2 years, 147.7 ± 2.6 cm, 39.0 ± 2.0 kg). Descriptive statistical analysis was performed on the procedures for establishing the normality of data distribution, Levene's Test for Equality of Variances, the t test for independent samples. The confidence interval was set at 95% (p < 0.05), Results and Conclusions: Since Sig. (2-tailed) or p < α = 0.001 and taking into account that the confidence interval limits for the difference between the sample mean and the reference value (95% CI for the mean difference) do not contain the zero value, it is accepted that there are statistically significant differences between the shoulder inclination for the female athletes in the sample studied and the reference value. We identified that at the level of alignment between anatomical landmarks, the percentage of deficiency of the entire lot of female juniors III in the case of shoulders is 100% and at the level of PSIS is 66%, which validates several studies that stated that in this period of aggressive growth correlated with repetitive unilateral executions specific to the topspin attack lead to postural deficiencies. In terms of the influence of body posture on the quality level, we identified that Group 1 – (without PSIS imbalance) has a higher average overall efficiency of the 5 tests (11.33) compared to Group 2 (8.58), even if from a statistical point of view these differences are not significant. Keywords: Body posture, Asimmetry, Topspin attack, Table tennis, Sensor Medica,
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Students and backpacks are a common sight today. Backpacks come in all sizes, colors, fabrics, and shapes and help children's of all ages express their own personal sense of style. Many packs feature multiple compartments that help students stay organized while they carry their books and papers from home to school and back again. Backpacks are, though, they can strain muscles and joints and may cause back pain if they're too heavy or are used incorrectly. Many students carry school backpacks that exceed 10 percent to 15 percent of their body weight, which puts them at risk for back pain and related disorders. Improper backpack use can also lead to poor posture. Girls and younger kids may be especially at risk for backpack-related injuries because they're smaller and may carry loads that are heavier in proportion to their body weight. Carrying backpacks increases the risk of back pain and possibly the risk of back pathology. The prevalence of school children carrying heavy backpacks is extremely high. The daily physical stresses associated with carrying backpacks cause significant forward lean of the head and trunk. It is assumed that daily intermittent abnormal postural adaptations could result in pain and disability in school going children. American Occupational Therapy Association (AOTA) and the America Academy of Pediatrics advise that students should carry no more than 15% or 10-20% of their bodyweight.
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The purpose of this study was to determine the effect of different methods of backpack carrying on gait kinetics in children, using a new treadmill that allowed three-dimensional measurement of right and left leg ground reaction forces (GRFs). Forty-one healthy children, with a mean age of 12 years, participated in this study. The mean height was 152 cm and the mean weight 40 kg. The three trials consisted of walking on the treadmill at the speed of 3.5 km/h, first without a backpack and then carrying a 10 kg school bag on the right shoulder or on both shoulders. For each carrying condition GRFs were recorded, averaged, and analyzed for 30 steps. Stride, stance, double stance, thirteen specific GRF parameters and the symmetry index were measured. The right leg produced higher propulsive fore-aft forces than the left one, whatever the walking conditions. For the two maximum peaks and the average vertical force during stance, a statistical difference was found between walking without a backpack and carrying a backpack on one or two shoulders (one or two shoulder carrying > no backpack) but never between one-shoulder and two-shoulder carrying. The children increased their stance and double stance when walking with a backpack compared with walking without a pack. The symmetry index increased with one-strap carrying (compared with no backpack and two-strap carrying) for the maximum force during the breaking phase (Fy1) when it decreased for the maximum propulsive horizontal force before taking-off (Fy2). Children should be advised to carry their backpack on two shoulders rather than use a one-strap backpack.
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The author describes the orthopedic approach to the evaluation and management of the child presenting with back pain, discusses several common conditions that cause back pain in children, and reviews a logical and cost-effective sequence of imaging studies for the investigation of various childhood back disorders.
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Backpack loads for school children have increased over the last two decades raising concerns among medical practitioners and parents about the possible detrimental effects. Gait instability induced due to backpack load carriage is of concern especially for young children with insufficient motor control skills to resist falls. The present study investigated the impact of backpack load carriage and its vertical position on the back on temporal-spatial and kinematic parameters associated with gait and postural stability for static and dynamic conditions. 17 participants with mean age 9.65 (+/-1.58) years, mean height 134.41 (+/-11.01) cm and mean mass 31.09 (+/-7.01) kg participated in the study. For dynamic conditions, the participants walked on an instrumented treadmill with 10%, 15% and 20% bodyweight (BW) loads on two locations on the back. Kinematic and temporal-spatial data was collected on the participants. Walking velocity, cadence and double support time for 20% load condition were significantly different compared to the unloaded condition indicating that gait changes may have occurred to minimize gait destabilization. Placing load low on the back affected the spatiotemporal parameters more than when loads were placed high on the back. The findings on spatiotemporal parameters indicate that a reduction in gait velocity and cadence and an increase in double support time for the 20% lower configuration could be a compensatory mechanism for children to minimize either the induced gait instability or mechanical strain on the musculoskeletal system in terms of possible higher lower limb joint moments or both. Results also showed higher forward trunk lean for dynamic conditions compared to static conditions indicating differences in strategies employed to maintain balance for static and dynamic conditions.
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The purposes of this study were to identify the incidence of postural abnormalities of the thoracic, cervical, and shoulder regions in two age groups of healthy subjects and to explore whether these abnormalities were associated with pain. Eighty-eight healthy subjects, aged 20 to 50 years, were asked to answer a pain questionnaire and to stand by a plumb line for postural assessment of forward head, rounded shoulders, and kyphosis. Subjects were divided into two age groups: a 20- to 35-year-old group (mean = 25, SD = 63) and a 36- to 50-year-old group (mean = 47, SD = 2.6). Interrater and intrarater reliability (Cohen's Kappa coefficients) for postural assessment were established at .611 and .825, respectively. Frequency counts revealed postural abnormalities were prevalent (forward head = 66%, kyphosis = 38%, right rounded shoulder = 73%, left rounded shoulder = 66%). No relationship was found between the severity of postural abnormality and the severity and frequency of pain. Subjects with more severe postural abnormalities, however, had a significantly increased incidence of pain, as determined by chi-square analysis (critical chi 2 = 6, df = 2, P less than .05). Subjects with kyphosis and rounded shoulders had an increased incidence of interscapular pain, and those with a forward-head posture had an increased incidence of cervical, interscapular, and headache pain.
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To investigate the frequency, pattern, and sequence of early degenerative changes in the lumbar spine. On the basis of a survey of 1,503 14-year-old schoolchildren, a randomized sample of 40 subjects with low-back pain (LBP) and 40 asymptomatic subjects were invited to undergo magnetic resonance (MR) imaging of the lumbar spine at 15 and at 18 years of age. Altogether, 62 subjects participated in both studies. The frequency of disk degeneration at follow-up was greater in the patients with LBP (increased from 42% to 58%) than among the asymptomatic subjects (from 19% to 26%) (P = .01). No such difference was found with disk protrusion, although disk protrusion was seen only in subjects with LBP at baseline examination (19%). Degenerative changes emerge rapidly after the adolescent growth spurt. The MR imaging appearance of the degenerative processes is similar regardless of symptoms, although these processes are more common in symptomatic adolescents and develop at an earlier age. There appears to be a positive correlation between degenerative lumbar disk disease and LBP in adolescence.
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The purpose of this investigation was to determine the impact of different methods of carrying book bags on static posture and gait kinematics of youths aged 11-13 years. Surveys identified group descriptive characteristics of subjects and book bags. Ten subjects representing the best composite of the mean characteristics of this population were filmed for both static posture and dynamic conditions of one stride length. Subjects participated in four conditions: without bag (WO), one-strap backpack (1BP), two-strap backpack (2BP), and one-strap athletic bag (ATH). Lateral spinal deviation was not significantly different between 2BP and WO. However, differences (+/-SE) were observed between 1BP (8.5 +/- 0.7 degrees) and ATH (8.3 +/- 2.4 degrees) as compared with WO (1.9 +/- 0.5 degrees). Shoulder elevation from a horizontal position showed no difference between WO and 2BP. Without bag (2.0 +/- 0.9 degrees) was different from 1BP (17.6 +/- 1.8 degrees) and ATH (15.6 +/- 2.1 degrees). 1BP was also different from 2BP (3.4 +/- 1.1 degrees). Bag carrying significantly decreased stride length (1.59 +/- 0.04 m) and increased stride frequency (57.36 +/- 1.6 cycles/min) compared to WO (1.72 +/- 0.06 m; 54.64 +/- 1.2 cycles/min, respectively), thereby reducing the support phase of the gait. One-strap bags (1BP, ATH) promoted lateral spinal bending and shoulder elevation, while the two-strap backpack significantly reduced these book bag carrying stresses. ATH promoted greater angular motion of the head and trunk as compared to backpack book bags. Carrying a backpack (1BP, 2BP) promoted significant forward lean of head and trunk compared to ATH or WO. In conclusion, the daily physical stresses associated with carrying book bags on one shoulder (1BP, ATH) significantly alters the posture and gait of youth.
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Children and adolescents occasionally have back symptoms, but rarely come to a physician's office for more severe back pain. When a child or adolescent appears in the clinic with complaints of back pain, a careful detailed evaluation is appropriate. The incidence of findings in children with significant back pain is high; therefore, a detailed history, physical examination, and evaluation are needed. It is also legitimate to continue monitoring children even if no obvious cause is initially identified because often a diagnosis subsequently will be made.
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A cross-sectional study was conducted. To investigate schoolchildren's subjective perceptions of their daily backpack loads, to ascertain whether an association exists between these sensations or the load itself and back pain, and to identify the school, family, and personal factors that determine the backpack load, and that might, with a view to primary prevention, be addressed with specific interventions. Backpack carrying has been shown to constitute a considerable daily "occupational" load of the spine in schoolchildren. Although society perceives backpack carrying as a problem, the scientific community currently offers very few answers. The backpack load borne by schoolchildren exceeds, proportionally, the legal load-bearing limits set for adults, and the association with low back pain is questioned. All the backpacks of the 237 year 6 children in a school catchment area of Milan were weighed on six school days. The data were analyzed in groups according to the schools and classes involved, the single children, and the days of the week. A validated questionnaire also was administered to 115 schoolchildren (54 boys and 61 girls; average age, 11.7 years) whose anthropometric characteristics and loads carried daily were known. The associations among features of backpack carrying, subjective perceptions of the load (fatigue, feeling it to be heavy, pain) and back pain (point and life prevalence) were assessed and verified. School backpacks are felt to be heavy by 79.1% of children, to cause fatigue by 65.7%, and to cause back pain by 46.1%. Fatigue during and time spent backpack carrying, but not the backpack's weight, are associated with back pain. The determining factors were found to be classes (e.g., range, 8.87-10.59 kg), days of the week (e.g., range, 5.75-12.74 kg.), and single students (e.g., range, 4.2-9.5 kg.), but not individual schools. Daily backpack carrying is a frequent cause of discomfort for schoolchildren. There is an association between this load and back pain, although the relationship is not direct. The results suggest the existence of personal physical and psychological factors that need to be investigated. Reduction of the daily backpack load borne by schoolchildren is recommended both on the basis of the current results and because it exceeds, proportionally, the legal load limits set for adults. All the different parties involved (school system, parents, children) play a role, and if the aim is to reduce this "weight of culture," all should be targeted through specific interventions. Recommendations are supplied for the achievement of this aim.