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Backpacks, Back Pain, Sagittal Spinal Curves and Trunk Alignment in Adolescents: A Logistic and Multinomial Logistic Analysis

Korovessis, Panagiotis, MD, PhD; Koureas, Georgios, MD; Zacharatos, Spyridon, MD; Papazisis, Zisis, MD

doi: 10.1097/01.brs.0000150505.59690.1b
Occupational Health/Ergonomics

Study Design. Cross-sectional study using logistic and multinomial logistic analysis.

Objectives. To investigate the influence of backpack carrying on spinal profile shoulder and trunk.

Summary of Background Data. No similar investigations.

Methods. A randomly selected sample of 1263 students aged 12–18 years were asked for dorsal (DP) and low back pain (LBP) during the school period and holidays. Debrunner’s Kyphometer and Scoliometer were used to measure craniocervical angle (CCA), thoracic kyphosis, lumbar lordosis, and shoulder shift (BL). Upper trunk shift from plumbline were recorded.

Results. Girls suffer from DP more often and of much more intensity pain than boys in school period and in holidays. Backpack carrying decreased CCA and changed shoulder and upper trunk shift. Asymmetrically backpack carrying increased DP and LBP. BL-shift increased DP. DP and LBP increased with coronal trunk shift. Sagittal trunk shift increased LBP. Asymmetrically carrying of backpacks increased back pain and shoulder shift in holidays. Coronal trunk shift while carrying backpacks asymmetrically increased back pain in holidays. Asymmetric backpack carrying is associated with high intensity pain. Frontal trunk shift is associated with high intensity pain.

Conclusion. Backpack carrying, particularly asymmetrically, results in shift of upper trunk and shoulder and cervical lordosis, which furthermore seem to increase back pain in school period and holidays. Symmetric backpack carrying is recommended.

This cross-sectional study investigated the influence of backpack carrying on the sagittal spinal curves, shoulder level shift, coronal sagittal upper trunk shift, back pain in school adolescents with the use of logistic multinomial logistic analysis. Backpack carrying resulted in forward lean of the upper trunk decrease of cervical lordosis. Asymmetrically backpack carrying forced adolescents to raise the backpack bearing shoulder simultaneously to move the upper trunk contralaterally. These changes increased the incidence of back pain in the school period during the holidays, particularly in girls. Carrying of backpacks symmetrically with two straps is recommended.

From the Orthopaedic Department, Spine Unit, General Hospital “Agios Andreas” Patras, Greece.

Acknowledgment date: February 17, 2004. First revision date: February 1, 2004. Acceptance date: February 17, 2004.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Panagiotis Korovessis, MD, PhD, Spine Unit, Orthopaedic Department, General Hospital “Agios Andreas,” 26224 Patras, Greece. E-mail:

© 2005 Lippincott Williams & Wilkins, Inc.