1. http://journals.tbzmed.ac.ir/HPP/Manuscript/HPP-1-76.

pdf
In recent years, there has been an increasing attention to the amount of loads carried
by schoolchildren to and from school [1-10]. The mean school bag weight reported in
previous studies in other countries has a range between 4.7 kg and 9.3 kg [1, 3, 1117]. Effectively, the relative load carried by school children expressed as percentage
of body weight (% BW) in these studies represents a range between 10% and 22%
BW.
The relative load carried by schoolchildren (expressed as % BW) has been considered
in ergonomic studies as one of the contributory factors for developing
musculoskeletal problems among this age group. A school bag weight limit of 10% to
15% of body weight has been suggested as a maximum load for school students
Furthermore, it has been noted that carrying loads exceeding 10% of body weight
should be avoided as these loads in- duce significant changes in electromyography,
kinematics and subjective assessments
There is evidence that the prevalence of musculoskeletal problems in schoolchildren
and adolescents is increasing [7, 13, 20-25]. Previous research has shown that
carrying heavy school bags can affect the musculoskeletal system of children and are
likely to cause different problems such as changes in head/neck and spinal posture and
increase the neck and trunk muscle activity levels [26-30]. Carrying heavy school
bags may be an additional factor contributing to musculoskeletal complaints in
schoolchildren. In a study of 140 high school students (mean age 13.6 years) in New
Zealand in 2005, it was found that the musculoskeletal symptoms due to school bag
carriage were experienced by 77.1% of the students and the symptoms were most
prevalent in the neck, shoulder, upper back and low back, respectively
2. http://search.proquest.com/docview/196864895/fulltext?accountid=48149
Somatic complaints (such as headaches, stomach aches, and musculoskeletal pain)
have also previously been associated with emotional, disruptive, anxiety, and
depressive disorders in a population of 4500 children aged 9-16 years

3.
http://www.skhs.queensu.ca/ergbio/publications/peer_review/brackley_work_2009.pd
f
Within developed nations, backpack use amongst schoolchildren has become the most
popular means of transporting belongings to and from school. Howev- er, there is a
growing public concern that overloaded childrens and adolescents backpacks may
lead to the development of back pain and other musculoskeletal injuries.

4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3983861/pdf/1756-0500-7-222.pdf
In addition to low back pain children also experienced pain in the upper body
involving the neck, shoulders and upper back. Pain in these areas is associated with
carrying heavy loads [5,16]. Carrying a heavy school bag for long periods of time
could result in repetitive stress injuries to the grow- ing body. This follows the shifting
of the childs centre of gravity in the direction of the load when carrying a backpack
[5,18]. To compensate, the child will typically leans in a direction opposite to the
force. For example, to compensate for a heavy backpack worn low over the sacrum,
the individual typically moves the head and trunk forward.

5. http://www.yorku.ca/alison3/kine4565/KINE%204565%20Presentation%20Article
%20Back%20Pain-2.pdf
Furthermore, significant postural changes can occur when carrying a bag over one
shoulder (Korovessis et al 2005, Negrini and Carabalona 2002) and postural
deviations have been shown to be associated with spinal pain (Adams and Dolan
2005). Hence, carrying a bag over one shoulder has been hypothesised to contribute to
back and neck pain, but there is little direct evidence to support this theory
(Siambanes et al 2004, van Gent et al 2003, Watson et al 2003).

6. http://www.intechopen.com/books/pain-in-perspective/the-epidemiology-of-shoulder-pain-anarrative-review-of-the-literature

IntheUK,symptomsassociatedwithshoulderproblemsareasignificant
causeofmorbidityanddisabilityinthegeneralpopulation.Thereported
overallprevalenceofshoulderpainintheUKpopulationisestimatedat
7%,[21]whichincreasesaccordingtosomeauthorsto26%intheelderly.
[20]Shoulderproblemscanleadtoaninabilitytoworkandperform
domesticandsocialactivities,aswellasleadingtoseriouseconomic
hardshipforaffectedindividualsandtheirfamilies.During1995,
musculoskeletaldisordersaccountedfor9.9milliondaysofsickleavein
theUK,ofwhich4.2million(42%)wererelatedtotheupperlimband
neckarea.[22]Shoulderdisordersrepresentthethirdmostcommon
musculoskeletalpresentationtogeneralpractice,[23]yetmanymore
patientsdonotconsulttheirgeneralpractitioner(GP).Thus,intheUK,
theestimatedproportionseekingtreatmentisbetween20and50%.
[24,25]

7. http://www.patient.co.uk/doctor/Shoulder-Pain.htm

Shoulder pain is the third most common cause of musculoskeletal

consultation in primary care.
1% of adults with new shoulder pain consult their GP each year.
Self-reported prevalence of shoulder pain is between 16% and
26%.
8. http://www.mayoclinic.org/symptoms/shoulder-pain/basics/definition/sym-20050696

Shoulder pain includes any pain that arises in or around

your shoulder. Shoulder pain may originate in the joint
itself, or from any of the many surrounding muscles,
ligaments or tendons. Shoulder pain usually worsens with
activities or movement of your arm or shoulder.
Certain diseases and conditions affecting structures in
your chest or abdomen, such as heart disease or
gallbladder disease, also may cause shoulder pain.
Shoulder pain that arises from some other structure is
called "referred pain." Referred shoulder pain usually
doesn't worsen when you move your shoulder.

9. http://www.webmd.com/a-to-z-guides/shoulder-problems-and-injuries-prevention
10. http://www.shoulderdoc.co.uk/article.asp?section=857
11. http://www.healthcommunities.com/shoulder-pain/overview.shtml
12. http://en.wikipedia.org/wiki/Shoulder

"labrum tear Johns Hopkins Orthopaedic Surgery".

www.hopkinsortho.org. Retrieved 2010-05-16.
13. http://www.innerbody.com/image_skelfov/skel12_new.html
14.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1323385/pdf/jathtrain0000
3-0018.pdf

15. http://emedicine.medscape.com/article/1899211-overview#showall
16. http://www.nebraskamed.com/health-library/3d-medicalatlas/228/anatomy-of-the-shoulder

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