Original Articles Vol. 3 No. 3 (2026): Bioscience Insights Published 2026-10-13

ASSOCIATION OF RELATIVE SCHOOL BAG WEIGHT WITH CRANIOVERTEBRAL ANGLE AND NECK DISABILITY IN SCHOOLCHILDREN: A CROSS-SECTIONAL STUDY

Authors

  • Nasir Mehmood Department of Physical Therapy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan Pakistan Author
  • Quratulain Amin Department of Physical Therapy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan Pakistan Author
  • Muqadas Akram Department of Physical Therapy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan Pakistan Author
  • Maria Kanwal Department of Physical Therapy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan Pakistan Author
  • Laiba Arshad Department of Physical Therapy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan Pakistan Author
  • Rauf Ahmad Department of Physical Therapy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan Pakistan Author
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Abstract

Background: Heavy school bags are a modifiable load imposed during rapid spinal growth, yet Pakistani evidence linking the load children carry to both cervical posture and neck function is scarce.

Objective: To determine the relative school bag weight carried by schoolchildren in Bahawalpur, Pakistan, and to examine its association with craniovertebral angle (CVA) and neck disability.

Methods: This analytical cross-sectional study enrolled 277 students of grades 6-10 from government and private schools in Bahawalpur through stratified random sampling between October 2025 and January 2026. Body and bag weights were measured with a calibrated digital scale, and relative bag weight was expressed as a percentage of body weight (%BW). CVA was measured in habitual sitting posture, without the bag, using smartphone photogrammetry analyzed in MicroDicom for angle measurement and neck disability with a nine-item modified Neck Disability Index (NDI). Pearson correlation and independent-samples t-tests (>15% vs ≤15% BW) were applied.

Results: Participants (50.5% boys) had a mean age of 13.48 ± 1.73 years. Mean bag weight was 5.54 ± 1.89 kg, equivalent to 12.18 ± 5.07% BW (range 1.6–29.0%) and 185 (66.7%) students carried more than 15% BW. Mean CVA was 46.45 ± 4.40° and mean NDI score was 12.18 ± 4.57. Relative bag weight correlated negatively with CVA (r = −0.910, p < 0.001) and positively with NDI (r = 0.967, p < 0.001), and CVA was inversely correlated with NDI (r = −0.885, p < 0.001). Compared with peers carrying ≤15% BW, students carrying >15% BW had a smaller CVA (mean difference 7.23°, 95% CI 6.44–8.01; p < 0.001) and higher NDI scores (mean difference 7.79 points, 95% CI 7.01–8.57; p < 0.001).

Conclusion: Heavier relative bag loads were associated with a more forward head posture and greater neck disability. Although causality cannot be inferred and unusually strong associations need independent replication, the findings support bag-weight policies, ergonomic education and postural screening in Punjab schools.

Keywords

  • Adolescent; Forward head posture; Musculoskeletal pain; Neck Disability Index; Posture; School bag.

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