Schoolbags and back pain: opinions strongest where the evidence is weakest

A letter [1 by Joshua Lasher published in Physiotherapy makes a number of unsubstantiated claims about back pain in children and teenagers;

• 1.

  The author suggests the study by Kjaer et al. [2 conclude that back pain in children is commonly caused by muscle strain or herniated discs. This was not investigated in the reported study.

• 2.

  The author suggests that the systematic review by Calvo-Munoz et al. [3 implies that pain recurs with progressively greater intensity in children. Data is not presented to allow this to be concluded.

• 3.

  The author spends considerable space detailing the dangers and impacts of carrying backpacks with respect to children’s back pain. The claims are not backed by any empirical data.

One study [4 cited in support of this view appears to be a misrepresentation, a quote from the cited study; “mechanical problems from computer use, physical activity, or heavy backpacks do not appear to be associated with back pain in school-age children.

Notwithstanding publication of unsupported claims, these views feed into a narrative that implicates mechanical and loading factors in children’s back pain. This is at odds with the body of evidence that suggests psychological factors are probably more influential [5. There is currently very little evidence to guide treatment or prevention of back pain in children and teenagers. High quality prospective studies and clinical trials are required. In the meantime, we should refrain from expressing anecdotal evidence, that could exacerbate the already profound misconceptions held about back pain.