Do schoolbags cause back pain in children and adolescents? A systematic review

Br J Sports Med. 2018 Oct;52(19):1241-1245. doi: 10.1136/bjsports-2017-098927. Epub 2018 May 2.


Objective: To investigate whether characteristics of schoolbag use are risk factors for back pain in children and adolescents.

Data sources: Electronic searches of MEDLINE, EMBASE and CINAHL databases up to April 2016.

Eligibility criteria for selecting studies: Prospective cohort studies, cross-sectional and randomised controlled trials conducted with children or adolescents. The primary outcome was an episode of back pain and the secondary outcomes were an episode of care seeking and school absence due to back pain. We weighted evidence from longitudinal studies above that from cross-sectional. The risk of bias of the longitudinal studies was assessed by a modified version of the Quality in Prognosis Studies tool.

Results: We included 69 studies (n=72 627), of which five were prospective longitudinal and 64 cross-sectional or retrospective. We found evidence from five prospective studies that schoolbag characteristics such as weight, design and carriage method do not increase the risk of developing back pain in children and adolescents. The included studies were at moderate to high risk of bias. Evidence from cross-sectional studies aligned with that from longitudinal studies (ie, there was no consistent pattern of association between schoolbag use or type and back pain). We were unable to pool results due to different variables and inconsistent results.

Summary/conclusion: There is no convincing evidence that aspects of schoolbag use increase the risk of back pain in children and adolescents.

Keywords: adolescent; children; paediatrics; school; spine.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Back Pain / etiology*
  • Child
  • Humans
  • Lifting / adverse effects*
  • Schools
  • Weight-Bearing*