The Weight of Schoolbags and Musculoskeletal Pain in Children of Selected Schools in Thimphu, Bhutan: A Cross-sectional Study


  • Thinley Dorji Jigme Dorji Wangchuck National Referral Hospital
  • Saran Tenzin Tamang Faculty of Medicine, University of Peradeniya
  • Sonam Yoezer Faculty of Medicine, University of Peradeniya
  • Kuenzang Wangdi Jigme Dorji Wangchuck National Referral Hospital



Ergonomics, Musculoskeletal Pain, Teens, Weight-Bearing, Adolescents


Background: The carriage of loads on the back in children, >10% of one’s body weight (BW), induces postural change and morbidity related to spinal pain. We studied the weight of schoolbags and the prevalence of musculoskeletal pain related to carrying schoolbags among children in Thimphu, Bhutan.

Methods: This was a cross-sectional study, with a multistage cluster sampling, conducted amongst grade 8 and 10 students. Data were collected using a standardized self-administered questionnaire and weights of students and schoolbags were measured. Descriptive statistics were used to present the findings. Means were compared using t test and risk factors were identified using logistic regression.

Results: There were 131 students whose schoolbags weighed >10% body weight (BW). The mean weight of schoolbags was 4.6 ±1.5 kg for grade 8 students and 4.0 ±1.5 kg for grade 10 students. Musculoskeletal pain in at least one body region was reported by 411 students. Schoolbags weighing >10% BW and carrying the bags over only one shoulder were significant risk factors for reporting musculoskeletal pain. There were 197 students whose schoolbags did not have any safety feature; students did not use them consistently even if they were present.

Conclusions: The weight of school bags that were more than the recommended ?10% BW was a strong factor in reporting musculoskeletal pain. Parents and students may be educated on the use of schoolbags with safety features. Measures such as providing storage facilities in schools may reduce the weight of bags.


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Steele E, Bialocerkowski A, Grimmer K. The postural effects of load carriage on young people -- a systematic review. BMC Musculoskelet Disord. 2003 Jun 17;4(1):12.

Brackley HM, Stevenson JM, Selinger JC. Effect of backpack load placement on posture and spinal curvature in prepubescent children. Work. 2009 May 28;32(3):351-360.

Korovessis P, Koureas G, Zacharatos S, Papazisis Z. Backpacks, back pain, sagittal spinal curves and trunk alignment in adolescents: a logistic and multinomial logistic analysis. Spine (Phila Pa 1976). 2005 Jan 15;30(2):247-55.

Negrini S, Negrini A. Postural effects of symmetrical and asymmetrical loads on the spines of schoolchildren. Scoliosis. 2007 Jul 9;2(1):8.

Walicka-Cupryś K, Skalska-Izdebska R, Rachwał M, Truszczyńska A. Influence of the Weight of a School Backpack on Spinal Curvature in the Sagittal Plane of Seven-Year-Old Children. Biomed Res Int. 2015 Aug 18;2015.

Dockrell S, Blake C, Simms C. Guidelines for schoolbag carriage: An appraisal of safe load limits for schoolbag weight and duration of carriage. Work. 2015 Jun 11;53(3):679-688.

Perrone M, Orr R, Hing W, Milne N, Pope R. The Impact of Backpack Loads on School Children: A Critical Narrative Review. Int J Environ Res Public Health. 2018 Nov 12;15(11).

Akbar F, AlBesharah M, Al-Baghli J, et al. Prevalence of low Back pain among adolescents in relation to the weight of school bags. BMC Musculoskelet Disord. 2019 Jan 22;20(1):37.

Ministry of Health. Annual Health Bulletin, 2017. Thimphu: Ministry of Health, Royal Government of Bhutan; 2017.

Hwang J, Louie PK, Phillips FM, An HS, Samartzis D. Low back pain in children: a rising concern. Eur Spine J. 2019 Feb;28(2):211-213.

Noll M, Candotti CT, da Rosa BN, Loss JF. Back pain prevalence and associated factors in children and adolescents: an epidemiological population study. Rev Saude Publica. 2016;50:31.

Mwaka ES, Munabi IG, Buwembo W, Kukkiriza J, Ochieng J. Musculoskeletal pain and school bag use: a cross-sectional study among Ugandan pupils. BMC Res Notes. 2014 Apr 9;7(1):222.

Whittfield J, Legg SJ, Hedderley DI. Schoolbag weight and musculoskeletal symptoms in New Zealand secondary schools. Appl Ergon. 2005 Mar;36(2):193-198.

Al-Saleem SA, Ali A, Ali SI, Alshamrani AA, Almulhem AM, Al-Hashem MH. A Study of School Bag Weight and Back Pain among Primary School Children in Al-Ahsa, Saudi Arabia. Epidemiol (Sunnyvale, Calif). 2016 Jan 30;6(1).

Yoon J-G. Correlations between Muscle Activities and Strap Length and Types of School Bag during Walking. J Phys Ther Sci. 2014 Dec 25;26(12):1937-1939.

Annual Education Statistics 2017. Thimphu: Ministry of Education, Royal Government of Bhutan; 2017.

Tshering G. Carrying heavy school bags adversely impacts students. The Kuensel. 2017.

Kuorinka I, Jonsson B, Kilbom A, et al. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon. 1987 Sep;18(3):233-237.

Vidal J, Borràs PA, Ponseti FJ, Cantallops J, Ortega FB, Palou P. Effects of a postural education program on school backpack habits related to low back pain in children. Eur Spine J. 2013 Apr;22(4):782-787.

Syazwan AI, Azhar MNM, Anita AR, et al. Poor sitting posture and a heavy schoolbag as contributors to musculoskeletal pain in children: an ergonomic school education intervention program. J Pain Res. 2011 Sep 14;4:287-296.

Briggs AM, Smith AJ, Straker LM, Bragge P. Thoracic spine pain in the general population: Prevalence, incidence and associated factors in children, adolescents and adults. A systematic review. BMC Musculoskelet Disord. 2009 Jun 29;10:77.

Wirth B, Knecht C, Humphreys K. Spine day 2012: spinal pain in Swiss school children-- epidemiology and risk factors. BMC Pediatr. 2013 Oct 5;13(1):159.

Nicolet T, Mannion AF, Heini P, Cedraschi C, Balagué F. No kidding: low back pain and type of container influence adolescents’ perception of load heaviness. Eur Spine J. 2014 Apr;23(4):794-799.

National Statistics Bureau. Population and Housing Census of Bhutan 2017 - National Report. Thimphu: National Statistics Bureau, Bhutan; 2018.

Eckhoff C, Straume B, Kvernmo S. Multisite musculoskeletal pain in adolescence and later mental health disorders: a population-based registry study of Norwegian youth: the NAAHS cohort study. BMJ Open. 2017 Feb 10;7(2):e012035.

Mose S, Christiansen DH, Jensen JC, Andersen JH. Widespread pain – do pain intensity and care-seeking influence sickness absence? – A population-based cohort study. BMC Musculoskelet Disord. 2016 May 4;17:197.

Kędra A, Czaprowski D. Epidemiology of Back Pain in Children and Youth Aged 10–19 from the Area of the Southeast of Poland. Biomed Res Int. 2013 Jul 31;506823.



How to Cite

Dorji, T., Tamang, S. T., Yoezer, S., & Wangdi, K. (2019). The Weight of Schoolbags and Musculoskeletal Pain in Children of Selected Schools in Thimphu, Bhutan: A Cross-sectional Study. International Journal of Medical Students, 7(2), 29–32.