|Year : 2017 | Volume
| Issue : 3 | Page : 600-605
|The effects of the manner of carrying the bags on musculoskeletal symptoms in school students in the city of Ilam, Iran
Mohsen Poursadeghiyan1, Keykaous Azrah2, Hamed Biglari3, Mohammad Hossein Ebrahimi4, Hamed Yarmohammadi5, Mohammad Mehdi Baneshi6, Mahsa Hami7, Alireza Khammar8
1 Department of Ergonomics, Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
2 Students Research Committee, Ilam University of Medical Sciences, Ilam, Iran
3 Department of Environmental Health Engineering, School of Public Health, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
4 Occupational and Environmental Health Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
5 Department of Occupational Health Engineering, Kermanshah University of Medical Sciences, Kermanshah, Iran
6 Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
7 Master of Economic Development and Planning, University of Firoozkooh Branch, Islamic Azad University, Firoozkooh, Iran
8 Department of Occupational Health Engineering, School of Health, Zabol University of Medical Sciences, Zabol, Iran
Click here for correspondence address and email
|Date of Web Publication||21-Aug-2017|
| Abstract|| |
Background: Musculoskeletal disorders are a major public health problem. Recently, there has been an increase in musculoskeletal disorder complaints among school students. Objective: The aim of this study was to identify the factors affecting students' physical stature and the manner of carrying bags by them in Ilam, Iran. Materials and Methods: A total of 244 students were randomly selected to participate in the study. A questionnaire was designed to collect required data. The Nordic Musculoskeletal Questionnaire was used to find out complaints related to back, neck, and shoulder disorders. The height was measured using a portable stadiometer. A digital scale was used to measure the weight of students and their bags. Results: About 50% of the primary students reported discomforts in shoulder. The weights of bags carried by 66.4% of students were lighter than 10% of their body weight. Most students with different physical problems had tarpaulin bags. There was a significant relationship between the manner of carrying bags and their design (P < 0.05). Conclusion: The manner of carrying bags is an important factor among primary school children because carrying of heavy bags is clearly the effective factor and may be ignored as a physical stressor for primary students.
Keywords: Carrying bag, musculoskeletal symptoms, physical stature, primary school students
|How to cite this article:|
Poursadeghiyan M, Azrah K, Biglari H, Ebrahimi MH, Yarmohammadi H, Baneshi MM, Hami M, Khammar A. The effects of the manner of carrying the bags on musculoskeletal symptoms in school students in the city of Ilam, Iran. Ann Trop Med Public Health 2017;10:600-5
|How to cite this URL:|
Poursadeghiyan M, Azrah K, Biglari H, Ebrahimi MH, Yarmohammadi H, Baneshi MM, Hami M, Khammar A. The effects of the manner of carrying the bags on musculoskeletal symptoms in school students in the city of Ilam, Iran. Ann Trop Med Public Health [serial online] 2017 [cited 2019 May 23];10:600-5. Available from: http://www.atmph.org/text.asp?2017/10/3/600/213118
| Introduction|| |
Musculoskeletal disorders are a major public health problem. In recent years, an increase in musculoskeletal disorder complaints among school students has been reported. In some conditions, people have to carry some means or devices for different purposes. The manner of carrying these things should be considered because inappropriate methods of carrying heavy objects can cause physical problems and anatomical deformities in the long term.
The growth process take places between the ages of 6 and 14; therefore, adolescents are more sensitive and susceptible to severe damages in their muscles, ligaments, and bones. Because of strength and rigidity of ligaments and muscles, the spinal column can keep its natural shape while walking, running, jumping, and carrying objects. However, carrying the heavy objects and bags, continuously and in a long time, can cause musculoskeletal disorders in the spinal column and shoulders, respectively.
Carrying heavy bags up and down the stairs and holding them in the school line can damage the children's spinal column more than adults because the spinal column in children is more susceptible to damages.
Some studies have investigated the manner of carrying schoolbag and its weight and poor posture effects on the musculoskeletal systems of students. Voll and Klimte  reported the relative weight of schoolbags of first graders to be 11.1% of the body weight, 12.5% for the second graders, and for the third and fourth graders between 12.5% and 14.3%. In a report, the National Back Pain Association studied schoolbag weights for British children and found that 13-year olds carried 10.4% of their body weight and 16-year olds 10.2%. A large proportion of French elementary, middle, and high school students,, Italian school children, and Australian high school students  carry schoolbags with loads exceeding 10% of their body weight.
Among French middle school and Australian high school students, carrying a heavy schoolbag was significantly associated with the back pain., Murphy et al. and Trevelyan and Legg  reported that there is a high prevalence of back pain among school children.,
Because of the underlying pressure, the students in Taiwan tend to show some defective postures such as scoliosis, kyphosis, and lordosis. If a posture has been continued for a long period, cumulative effects might arise., Poor posture has been reported as the most important contributing factor of shoulder and neck pain.,,,
The aim of present study was to investigate the relationship between risk factors affecting students' physical stature and their manner of carrying bags in Ilam, Iran. Determining the various disorders, their causes, and their distribution can be effective factors to plan the prevention measures for disorders in future.
Materials and Methods
This cross-sectional study was performed in Ilam, Iran, in 2014. After getting permission from Ministry of Education and principals of primary schools, 16 girls' primary schools were selected (50% of all girls' primary schools). In total, 244 students in the first to fifth grades of primary school were randomly selected for the study. The procedure of the study was explained to the participants and after that they were asked to sign a consent form. The principals helped participants to fill out consent forms. Also, parental consent was obtained for children taking part in the study. Students were randomly selected for the study and data were collected by three researchers over 5 weeks. To prevent overemphasis on musculoskeletal disorders and obtain accurate data by questionnaires, the participants were told that the focus of the study was on their manner of carrying bags.
Inclusion criteria for participation in the study were as follows: (1) students must be in primary school, and (2) able to carry schoolbags by one shoulder or both shoulders. Exclusion criteria were: (1) the presence of orthopedic, muscular, and rheumatoid problems; (2) malformation in spine and joints of upper and lower extremities.
The height and body weight of each person, the weight of their schoolbags, and the weight of any additional thing that they carried were measured (schoolbag weight expressed as % of body weight). The height was measured using a portable stadiometer (Medizintechnik). The weight was measured with digital scales (Model 10-22 S, Iran). The digital scales were calibrated using known weights prior to data collection.
Participants received a questionnaire (standardized Nordic Musculoskeletal Questionnaire) to fill out complaints about gonalgia, backache, elbow ache, neck ache, shoulder ptosis, and other problems and then the potential risk factors were assessed using the obtained information., A questionnaire contained 23 items was designed to collect required data and it was filled out with cooperation of students. Some information such as how one carries a bag, type of bag, and level of pupils were considered in the questionnaire. Filling out the questionnaire and measuring process took approximately 30 min for each student. A picture of the human body with nine body regions (neck, shoulders, upper arms, lower arms, upper back, lower back, hips/thighs, knees, and lower legs) was provided for the expression of discomfort by students.
The statistical calculations and analysis were performed using SPSS version 16 and the chi-squared test (χ2). The level of significance was set at P < 0.05.
| Results|| |
According to results, 4.5% of the students suffered from gonalgia and their average age was 9.4±1.88 years. Also, 5.3% of students (average age: 8.5±1.39), 0.8% (average age: 8.5±2.12), and 13.3% (average age: 9.22 ± 1.49) suffered from backache, elbow ache, and neck ache, respectively. And the rest of the students were healthy. About 50% of the students suffered from shoulder optosis and this symptom was the most common physical problem among the students. [Table 1] indicates the distribution of manner of carrying bags by the educational grade of the primary school students. It also showed that 13% of students carry their bags by hand and 87% carry it on their backs. There was a reduction in frequency of carrying the bags on backs with increasing educational grade. Based on the chi-squared test, there was no significant relationship between the manner of carrying bags and the educational grade (P > 0.05).
|Table 1: Istribution of the manner of carrying bags by the educational grade in subjects|
Click here to view
[Table 2] shows 7.4% of students' bags were made of leather, 14.3% silk, 65.5% tarpaulin, 11.1% plastic, and 1.6% cotton. There was no significant relationship between the manner of carrying bags and bag type (P > 0.05).
|Table 2: Distribution of the manner of carrying bags by the type of bags in subjects|
Click here to view
Results [Table 3] indicate that 88.1% of students have carried bags with two shoulder straps, 0.8% of them have used waist or chest straps, and 11.1% of students have carried their bags in other ways (e.g., nylon bags, briefcase, etc.). Most of the students used the bags with two wide shoulder straps. Statistical tests showed a significant relationship between the manner of carrying bags and their design (P < 0.05).
|Table 3: Distribution of the manner of carrying bags by the design of bags in subjects|
Click here to view
Based on the results, 66.4% of the students carried bags lighter than 10% of their body weight. 22.5% of students carried bags with 10-15% of their body weight, and 11.1% of them had the bags heavier than 15% of their body weight [Table 4].
|Table 4: Distribution of manner of carrying bags by the ratio of bag weight to body weight|
Click here to view
Although most of the students had the bags lighter than 10% of their body weight, 33.6% of them were using the bags heavier than 10% of their body weight. There was no significant relationship between the manner of carrying bags and the ratio of bag weight to the students' body weights (P > 0.05).
[Table 5] indicates that 45.5%, 53.8%, and 67.4% of the students, who have used tarpaulin bags, have suffered from gonaglia, backache, and shoulder optosis, respectively. Therefore, most of students with different physical problems had tarpaulin bags.
|Table 5: Distribution of physical problems by the type of bags in subjects|
Click here to view
According to results [Table 6], 81.9% of students with gonaglia problem had the bags lighter than 10% of their body weight, and 18.1% of them carried the bags heavier than 15% of their body weight. [Table 6] indicates the distribution of physical problems by the ratio of bag weight to students' body weight. There was no significant relationship between the ratio of the bag weight to the body weights and the physical problems (P > 0.05).
|Table 6: Distribution of physical problems by the ratio of bag weight to body weight in subjects|
Click here to view
Results showed that 27.3% of students with gonalgia suggested not bringing unnecessary things to school as a solution, and 30.8% of students with backache suggested designing a convenient and suitable curriculum, which has allocated the highest percentage of suggestions among student. Also, 37.5% of students with neck ache suggested reducing the volume of books, and 25.6% of students with shoulder optosis suggested not bringing all the books to school every day. All students who have suffered from any physical problems preferred one of the suggestions, which show that each student has suggested a solution to reduce the volume of the bags based on the level of their problem. Statistical analysis showed that there was no significant relationship between the ways of reducing the bag volume and the physical problems in children (P > 0.05).
In another part of the study, the distribution of body bending by the educational grade in primary school students in the city of Ilam was calculated. Data showed that 19.7% of the students in the first grade, 16.4% of the students in the second grade, 23.5% in the third grade, 19.7% in the fourth grade, and 20.8% in the fifth grade bend their bodies while carrying their bags. According to the results, bending of the body during carrying bags gets more common with increasing educational grade. Based on the chi-squared test, there was no significant relationship between the educational grade and body bending while carrying bags (P > 0.05).
| Discussion|| |
The results of this study indicated that high percentage of primary students (50%) reported discomforts in shoulder. The similar result was obtained in a study by Whittfield  and Van Gent et al. Some students in primary years of school had a little or no experience to identify their required books throughout a day and they put unnecessary books in their bags. Among the student in different grades, students of the fourth grade had the highest rate of shoulder optosis (25.6%). In a semi-practical study performed in the Baqiyatallah University of Medical sciences in Iran, it was revealed that carrying of heavy bags and heavy tools in long term caused high incidence of shoulder asymmetry among Iranian students and collegians, which is consistent with our study. In another study performed in some schools in Shiraz on physical problems caused by bag weight, it was reported that most of these problems were observed in the shoulder area.,,
The average weight of bags in students with gonalgia, backache, elbow ache, neck ache, and shoulder optosis were 2.22 ± 0.6, 2.5 ± 0.7, 3.25 ± 1.06, 3.21 ± 1.23, and 2.75 ± 1.04 kg, respectively. Also, in this study, the average weight of students' bags was 2810 ± 721 g. In a study by Whittfield et al. in New Zealand, the weight of schoolbags and the frequency of musculoskeletal symptoms among 140 students in five secondary schools were examined. The schoolbag weight for third form students (average age 13.6 years) was 13.2% of their body weight, whereas for sixth form students (average age 17.1 years) it was 10.3% of their body weight. Negrini and Carabalona  and Negrini
et al. measured students with a mean age of 11.6 years and found that their mean schoolbag weight was 9.06 kg and 9.3 kg, respectively. In another study performed in Hamedan, it was observed that the average weight of bags of primary school girls was 1970±650 g, and the average weight of bags of primary school boys was 1647± 771 g. It was revealed that 12% of students have been carrying bags heavier than the recommended standard weight. The wide range of bag weights could be attributed to the number of books and Booklets that different children carry to school each day. Moreover, some empty schoolbags may be heavier than others; though, the empty schoolbags were not weighed.
To reduce the weight of bags in primary schools students, several ways were suggested. These include not bringing unnecessary things, reducing the volume of books, stop bringing supplemental books, making a convenient and suitable schedule for students and teachers, and to stop bringing all books every day but rather bringing the books according to the appropriate educational schedule.
Unlike some studies that reported a relationship between the back pain and the schoolbag weight, our study indicated no relationship. It could be associated with the lower weights of bags reported in our study than in others.,
Based on data, a significant relationship between the way of carrying bag and its design was found. However, 88.1% of students carried their bags by two straps on their shoulders and it is similar to finding reported by others. An investigation in the 1980s generally found carrying a schoolbag over one shoulder was the most common manner among adolescents. Most of the students carrying bags on their backs used two straps on their shoulders. Fortunately, the majority of students in this research decided to use such schoolbags because it could be the most suitable design for carriage. However, this manner of carrying bags is observed mostly among high school students and collegians, who considered it as a fashion style but it has probably been adapted by students of the lower grades. The other reason for this carrying manner may be related to the appropriate and self-conscious training by parents. Also, this change in preferred carrying manner may be due to a combination of education and the designing of more comfortable two strap schoolbags.
| Conclusion|| |
As the results showed, the manner of carrying bags by students is very important. It should not be carried on one shoulder, and students should use both of their shoulders to carry their bags. In addition, straps of the bag should not be too long because shorter straps exert less pressure on the back. Furthermore, bags with wider straps are more suitable and can be suitable to carry bags. Because of bag whit wider strap, the weight is widely distributed on the body and shoulder and neck damages is less relative to hand bags or bags carried by one shoulder. Therefore, the type of bag called “backpack” is more suitable. It is worth mentioning that the strongest muscles of body, that is, muscles of abdomen and back bear the weight of backpack.
In addition, one of the critical factors is the way of designing and making bags. In this regard, the ratio of the weight of bag to the weight of person should be considered. Although the importance of this factor has been proved, it is not considered in high number of the bags and parent often do not consider this factor. Most of the problems related to the weight of bag to the weight of body can be solved by informing parents about this factor.
Finally, we suggested some ways to students to help them prevent musculoskeletal disorders or reduce their problem. These recommendations are as follows:
Bag should not be too heavy, and it should be preferably made of light materials such as wool or vinyl.
The upper border of the bag should not be higher than the shoulder, and the lower border of the bag should not reach the hip bone.
The strap of bag, which is put on the shoulders, should have a width of 5 cm.
Too heavy bags which are too lower than the standard position make the person bends forward and exert too much pressure to the back. Both straps should be used in order to prevent damage to the spinal column.
Kinks and twists of bags in the back of students should be avoided.
The authors wish to appreciate Student Research Committee of Ilam University of Medical, and all the students who participated in this study and their families.
Financial support and sponsorship
This study was supported by grant No 1694 in University of Social Welfare and Rehabilitation Sciences.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Khandan M, Eyni Z, Ataei Manesh L, Khosravi Z, Koohpaei AR, Poursadeghiyan M, et al
. Relationship between musculoskeletal disorders and job performance among nurses and nursing aides in main educational hospital in Qom Province, 2014. Res J Med Sci 2016;10:307-12.
Koohpaei AR, Khandan M, Vosoughi Sh, Khammar A, MobinizadeV, Farrokhi M, et al
. Industrial workers' postures analysis by a new method named “loading on the upper body assessment” in Iran. Ann Trop med Public Health 2017. [In press].
Yarmohammadi H, Ziaei M, Poursadeghiyan M, Moradi M, Fathi B, Biglari H, et al
. Evaluation of occupational risk assessment of manual load carrying using KIM method on auto mechanics in Kermanshah City in 2015. Res J Med Sci 2016;10:116-9.
Voll H-J, Klimt F. translated by Theodoridis D. On strain in children caused by carrying schoolbags. (From Die beanspruchung des kindesdurchdieschultasche). Öffentliche Gesundheitswesen 1997;39:369-78.
National Back Pain Association (NBPA)School Bag Survey-Findings and Recommendations. Talkback, Teddington; 1997.
Troussier B, Marchou-Lopez S, Pironneau S, Alais E, Gerison J, Prel G, et al
. Back pain and spinal alignment abnormalities in schoolchildren. Rev Rhum Engl Ed 1999;66:370-80.
Viry P, Creveuil C, Marcelli C. Nonspecific back pain in children: A search for associated factors in 14-year-old school children. Rev Rhum Engl Ed 1999;66:381-8.
Negrini S, Carabalona R, Sibilla P. Backpack as a daily load for school children. Lancet 1999;354:1974.
Grimmer K, Williams M. Gender-age environmental associates of adolescent low back pain. Appl Ergon 2000;31:343-60.
Murphy S, Buckle P, Stubbs D. A cross sectional study of self-reported back and neck pain among English school children and associated physical and psychological risk factors. Appl Ergon 2007;38:797-804.
Trevelyan FC, Legg SJ. The prevalence and characteristics of back pain amongst schoolchildren in New Zealand. Ergonomics 2010;53:1455-60.
Lee PS, Chen JM. Scoliosis. Chinese Public Health J 1998;17:2-9.
Szer IS, Musculoskeletal pain syndromes that affect adolescents. Arch Pediatr Adolesc Med 1996;150:740-7.
Smith MS. Psychosomatic symptoms in adolescence. Med Clin North Am 1990;74:1121-35.
Tola S, Riihimaki H, Videman T, Viikari-Juntura E, Hanninen K. Neck and shoulder symptoms among men in machine operating, dynamic physical work and sedentary work. Scand J Work Environ Health 1988;14:299-305.
Moradi M, Poursadeghiyan M, Khammar A, Hami M, Darsnj A, Yarmohammadi H. REBA method for the ergonomic risk assessment of auto mechanics postural stress caused by working conditions in Kermanshah. Ann Trop Med Public Health 2017;10:589-594. [Full text]
Hertzberg M, Wegman DH. Prevalence rates and odds ratios of shoulder-neck diseases in different occupational groups. Br J Ind Med 1987;44:602-10.
Van Gent C, Dols J, de Rover C, Hira Sing R, de Vet H. The weight of school bags and the occurrence of neck, shoulder, and back pain in young adolescents. Spine 2003;9:916-21.
Shamsoddini AR, Hollisaz MT, Hafezi R. Backpack weight and musculoskeletal symptoms in secondary school students, Tehran, Iran. Iran J Publ Health 2010;39:120-5.
Kuorinka I, Jonsson B, Kilbom A, et al.
Standardized Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon 1987;18:233-7.
Kuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-Sørensen F, Andersson G, et al
. Standardized Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon 1987;18:233-37.
Emdadi M, Emdadi S. Weight of school bag and its contents in relation to body weight elementary school students. Payesh J 2004;3:185-91.
Whittfield Legg SJ, Hedderley D. Schoolbag weight and musculoskeletal symptoms in New Zealand secondary schools. Appl Ergon 2005;36:193-8.
Van Gent C, Dols J, De Rover C, Hira SR, De Vet H. The weight of schoolbags and the occurrence of neck, shoulder, and back pain in young adolescents. Spine 2003;28:916-21.
Beheshtipoor N, Jahanbin I, Haghnegahdar A, Sarafzar A. Study of relationship between physical complaints and weight of school bag in elementary and secondary school students of Shiraz. Med Res J 2005;10:29-38.
Negrini S, Carabalona R. Backpacks on Schoolchildren's perceptions of load, associations with back pain and factors determining the load. Spine 2002;27:187-95.
Negrini S, Carabolona R, Sibilla P. Backpack as a daily load for school children. The Lancet 1999;354:1974.
Viry P, Creveuil C, Marcelli C. Non-specific back pain in children: A search for associated factors in 14 year old school children. Revue du Rhumatisme 1999;66:381-8.
Whittfield J, Legg S, Hedderley D. The weight and use of schoolbags in New Zealand secondary schools. Ergonomics 2001;44:819-24.
Pascoe D, Pascoe D, Wang Y, Shim DM, Kim C. Influence of carrying book bags on gait cycle and posture of youths. Ergonomics 1997;40:631-41.
Haselgrove C, Straker L, Smith A, O'Sullivan P, Perry M, Sloan N. Perceived school bag load, duration of carriage, and method of transport to school are associated with spinal pain in adolescents: an observational study. Aust J Physiother 2008;54:193-200.
Department of Occupational Health Engineering, School of Health, Zabol University of Medical Sciences, Zabol
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]
| Article Access Statistics|
| Viewed||1153 |
| Printed||16 |
| Emailed||0 |
| PDF Downloaded||18 |
| Comments ||[Add] |