07 Rajfur - Evaluation
07 Rajfur - Evaluation
A – study design, B – data collection, C – statistical analysis, D – interpretation of data, E – manuscript preparation, F – literature review, G – sourcing of funding
                                                                          ABSTRACT
  Background: Posture ergonomics is becoming an increasingly discussed issue in the literature. The effect of
  daily habits and attitudes, especially overloading ones, is an important topic of currently conducted research.
  Performing simple tasks correctly is an important aspect. The following paper deals with the topic of women’s
  handbags and the effect of carrying them on various stabilometric parameters.
  Aim of the study: This study aimed to check whether the examined women who carry a one-shoulder bag are
  affected by posture and the occurrence of pain.
  Material and methods: Forty-two women aged 20–25 years were enrolled in the study and were assigned to
  two equal comparison groups: group A – ladies carrying a purse on the right arm and group B – ladies carrying
  a purse on the left arm. The following tests were performed: evaluation of postural stability, including total
  sway path (SP) using a stabilometric platform, the degree of spinal curvature was assessed with a scoliometer,
  the degree of pelvic tilt was measured with an electronic inclinometer, and the extent of lateral head flexion
  was checked with an electronic goniometer. Back pain intensity was assessed using the VAS scale.
  Results: There appeared to be a statistically significant difference in the transfer of the center of gravity to
  the right side in group A and to the left side in group B. As for the stabilometric parameters, only the SP [mm]
  parameter achieved statistical significance. The highest correlations were observed in group A, between pain
  complaints and the range of head flexion to the right (r= –0.62). In both groups, no significant statistical dif-
  ferences were found within the groups with and without declared pain (p>0.05). However, in the intergroup
  comparison for patients without a bag (p=0.01), with their own bag (p=0.04), and with a 3 kg bag (p=0.02),
  there were statistically significant differences.
  Conclusions: A bag worn on one shoulder can provoke the occurrence of back pain. The stabilometric results
  indicate abnormalities while free-standing. Education about pain prevention and maintaining proper posture
  is important.
  Keywords: back load, carry-on luggage, back pain, body posture
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            Evaluation of the effect of the carried baggage on the selected stabilometric parameters...                  49
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              Evaluation of the effect of the carried baggage on the selected stabilometric parameters...                            51
Table 2. Distribution of % body weight to the right side in the group of subjects carrying a handbag
         In group A – ladies carrying a bag on the right                            In group B – ladies carrying a purse on the left
     shoulder, there was a statistically significant                            arm, highly statistically significant (p<0.01) differ-
     (p<0.05) difference in terms of weight transfer to                         ences were found between measurements without
     the side identical to the bag carried when the meas-                       and with their own purse (p=0.000), as well as with-
     urement values were compared without the bag on                            out and with a 3 kg purse (p=0.002). There were no
     and with their own bag (p=0.043), as well as with                          differences in the comparison of parameters with
     their own bag and a 3 kg bag (p=0.021). Compari-                           their own bags, compared to a 3 kg bag. The body
     son between the results collected during the test                          weight of the subjects in this group shifted to the left
     without the bag and with a 3 kg bag yielded high                           side after putting on their luggage.
     (p<0.01) statistical significance (p=0.000). During                            Table 3 shows the results of the percentage distri-
     testing, the subject’s body weight was shifted to the                      bution of body weight on the right side depending on
     right side.                                                                declared pain.
Table 3. Distribution of % body weight to the right side in the group of patients with different categories of pain
         In both groups, there were no significant statis-                      (50.3±2.4 vs. 53.1±3.7), with their own bag (49.5±4.7
     tical differences within the groups with and without                       vs. 52.1±4.1), and with a 3 kg bag (50.5±5.4 vs.
     declared pain (p > 0.05). However, in the intergroup                       53.1±4.6). This may be due to the fact that patients
     comparisons of patients without a bag (p=0.01), with                       with declared pain compensated for the pain by stiff-
     their own bag (p=0.04), and with a 3 kg bag (p=0.02),                      ening their postural muscles, and therefore the right-
     there were statistically significant differences. Pa-                      side tilt was minimal, or they leaned to the left.
     tients without a reported level of pain showed                                 The results of the total SP in both groups are
     greater deviation to the right, both without a bag                         shown in Table 4.
         By analyzing the arithmetic averages, it can be                        cant. In group B, the comparison of the results with-
     seen that the path determined by the projection of                         out a bag and with their own bag (p=0.000), as well
     the center of gravity in both groups shortens when                         as with a 3 kg bag (p=0.006), turned out to be highly
     luggage is added. This may suggest that adopting                           statistically significant.
     a more stable posture is performed to maintain bal-                            A summary of the arithmetic means of the meas-
     ance, despite the asymmetrical load. In group A, the                       urements of lateral head flexion range, degree of spi-
     differences between the values without and with                            nal curvature, and degree of iliac wing tilt depending
     a 3 kg bag (p=0.000), as well as their own and a 3 kg                      on the group is shown in Table 5.
     bag (p=0.016), turned out to be statistically signifi-
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Table 5. Summary of the arithmetic means of the range of right               There was no correlation in group A between the
and left head flexion, right- and left-sided Cobb angle, and the tilt    percentage load of the right or left KD and the de-
degree of the right and left iliac wings
                                                                         gree of right or left iliac wing tilt. A clear relationship
             Variables                   Group A    Group B      p*      (-0.26/0.26) was shown between the degree of right
 Range of right and left       Right     35.43      32.86        0.16    iliac wing tilt and the percentage distribution of body
 head flexion [°]              Left        33.9     31.38        0.26    weight between the right and left sides.
 Right and left-sided          Right       4.37      1.98        0.96
 Cobb angle [°]                                                          Table 8. Results of correlation between the range of lateral head
                               Left        1.81      0.81        0.71
                                                                         flexion and perceived pain in groups A and B
 Tilt degree of the right      Right       9.66     10.61        0.37
 and left hip wings of                                                            Group A             Range of right      Range of left
 ilium [°]                     Left        8.47      9.75        0.31
                                                                           r-Spearmana correlation     head flexion       head flexion
                                                                          VAS Scale                        –0.62              –0.13
   Regardless of the preferred carrying side, the ex-
                                                                                 Group B              Range of right      Range of left
tent of right head flexion and the degree of right iliac
                                                                          r-Spearmana correlation      head flexion       head flexion
wing tilt are greater than that on the left side. The
                                                                          VAS Scale                        –0.02              –0.02
same applies to back pain curvature, but the angle is
greater in ladies carrying a purse on the right shoul-
                                                                             When comparing pain complaints with the later-
der compared to the other group.
                                                                         al head flexion range of motion in group A, there was
Table 6. Results of the correlation between the extent of iliac          a significant degree of negative correlation (–0.62)
wing tilt and the right- and left-sided Cobb angle tests in groups       between the range of head flexion to the right and
A and B                                                                  the subjects’ complaints of pain. In practice, this
                                  Tilt degree        Tilt degree         may mean that the greater the subject’s range of
         Variables              of the right hip    of the left hip      lateral head flexion to the right, the less pain they
                                 wing of ilium      wing of ilium
                                                                         experience. No correlation was shown in group B.
                 Group A r-Spearmana correlation
 Curvature of thoracic
 spine on the right side
                                       –0.25             –0.03           Discussion
 Curvature of thoracic                                                       This paper addresses a topic that affects thou-
                                       –0.39             –0.36
 spine on the left side
                                                                         sands of women around the world every day – can the
                 Group B r-Spearmana correlation
                                                                         daily carried handbag negatively affect our health?
 Curvature of thoracic
 spine on the right side
                                       –0.32             –0.24           An important aspect of our study is the weight of the
                                                                         bag and the style of carrying it. The target group of
 Curvature of thoracic
 spine on the left side
                                       –0.08             –0.00           our study was exclusively women, who use this type
                                                                         of luggage on a daily basis. Our study has shown that
    When comparing the degree of curvature of the                        the way one carries the bag can affect pain perception
spine and the tilt of the iliac wings, the highest cor-                  and body posture.
relations were shown in group A between the angle                            Abdon et al. conducted a study on a group of
of tilt of the right iliac wing and the curvature of the                 316 women. They showed a significant relationship
spine on the left side (0.39), and in group B between                    between the weight of the bag worn and pain com-
the tilt of the right iliac wing and the curvature of the                plaints in the subjects. There appeared to be a statisti-
spine on the right side (0.32).                                          cally significant relationship between the occurrence
                                                                         of pain and a bag heavier than 4% of its owner’s body
Table 7. Results of the correlation between the percentage distri-
                                                                         weight, which increased with the weight of the bag
bution of body weight to the right or left side and the degree of tilt
of the iliac wings in groups A and B                                     [13]. In our study, the average bag weight of women
                                                                         with pain was 4.11% of their body weight (with the
                                 % distribution     % distribution
         Variables               of body weight     of body weight
                                                                         average bag weight of all participants constituting
                                to the right side   to the left side     2.5% of their body weight).
                 Group A r-Spearmana correlation                             The results developed by Li et al. suggest that the
 Tilt degree of the right
                                                                         use of a properly controlled asymmetrical load may
                                       –0.13             –0.13           have an effect on reducing lateral spinal curvature.
 hip wing of ilium
 Tilt degree of the left hip                                             The weight used in their study constituted: 0%, 2.5%,
                                       –0.10             –0.10
 wing of ilium                                                           5%, 7.5%, 10%, and 12.5% of the participant’s body
                 Group B r-Spearmana correlation                         weight. Cobb’s angle decreased when the bag was
 Tilt degree of the right                                                placed on the side of the frame where the curvature
                                       –0.26             –0.26
 hip wing of ilium                                                       was present (the weight was on the opposite side).
 Tilt degree of the left hip
                                       –0.19             –0.19
                                                                         This relationship occurred bilaterally [14]. In our
 wing of ilium
                                                                         study, the angle of spinal curvature was measured
     only in the free position, without loads. The results                    Limitations of the study
     showed that individuals wearing a bag on the right
     shoulder on a daily basis had a higher average Cobb                           When analyzing the results of our study, it
     angle for right-sided curvatures (4.37°) compared to                     should be noted that the paper contains several
     those wearing a bag on the opposite shoulder (1.98°).                    limitations. It is certainly worthwhile to expand
     The situation is similar for left-sided curvatures.                      future studies by adding more precise measure-
         According to Otrębska et al., the way a load is                      ment tools (e.g., superficial electromyography, 3D
     carried has a significant impact on the activity of in-                  gait assessment). The small number of participants
     dividual muscles. The authors of their study demon-                      and their young age also constitute study limita-
                                                                              tions. The study design should be continued with
     strated that asymmetrical loads can have an adverse
                                                                              more participants, as well as other age groups.
     effect on the human body, especially when perform-
                                                                              The study also did not include information on the
     ing everyday activities such as carrying a bag on one’s
                                                                              physical activity of the respondents, which affects
     shoulder and a handbag on the forearm. The study
                                                                              functioning in daily life. These comments certainly
     indicated that the quadriceps muscle was more ac-
                                                                              represent the limitations of our publication. There is
     tive on the loaded side, while the latissimus dorsi
                                                                              still a need to have other research centers continue
     muscle, the erector spinae muscle, and the gluteus
                                                                              their studies in the future and verify the results ob-
     medius muscle showed increased activity on the side
                                                                              tained. There is little literature available on the re-
     opposite the load in most subjects. The erector spinae
                                                                              search presented in our paper.
     muscle is responsible for maintaining the balance of
     the torso [15]. Its highest activity was observed when
     carrying a bag on one shoulder, as indicated in the                      Clinical implications
     study by Hardie R et al. [7]. As stated in the study by                      There is little research on the effects of handbag
     Grimmer et al., in such situations, the center of grav-                  carrying on posture and the incidence of back pain
     ity is pushed furthest to the side, which may cause                      in women. The study’s findings discussed in our pa-
     a greater tendency for the spinal column to lean later-                  per confirm the importance of this issue. It is impor-
     ally [16].                                                               tant to continually educate people about prevention,
         In our study, patients with declared pain compen-                    to reduce the risk of back pain in people of all ages
     sated for the pain they felt by stiffening their pos-                    from carrying bags over one shoulder. One should
     tural muscles, and therefore, their right-side tilt was                  avoid carrying the bag asymmetrically, especially in
     minimal, or they leaned to the left.                                     cases of people who have experienced pain. Carrying
         Carrying various types of hand luggage asym-                         a backpack and evenly distributing the weight can be
     metrically may adversely affect body posture and                         a safe alternative. In addition, shifting the bag regu-
     provoke pain. As studies show, asymmetrically bear-                      larly from one side to the other can have a positive
     ing loads can have an adverse effect on the human                        impact on one’s health.
     body [17,18]. Nevertheless, according to a study
     conducted by Pascoe et al., the vast majority of stu-
                                                                              Conclusions
     dents (72.3%) choose to carry their bags on a single
     shoulder [19].                                                               After analyzing the results of our study, we con-
         In their study, Hardie et al. suggested that a two-                  clude that the way women carry their handbags, tak-
     strap backpack should be used to carry loads to re-                      ing into account their weight, has a significant effect
     duce spinal muscle activity, which in turn may reduce                    on their posture, range of motion, and back pain. The
     reports of back pain [7].                                                method of carrying luggage and its weight can cause
         Other researchers have also reported that asym-                      negative health effects. Education about pain preven-
     metrical carrying in children and adolescents is a                       tion and maintaining proper posture is important. It
     risk factor for back pain, and, as a result, may in-                     is reasonable to implement the principles of luggage
     fluence the occurrence of spinal pain in adulthood                       ergonomics as an element of pain prevention as early
     [20,21].                                                                 as in school-aged children.
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           Sources of funding:
           The research was funded by the authors.
           Conflicts of interests:
           The authors report that there were no conflicts of interest.
           Corresponding author:
           Joanna Rajfur
           Email: joanna.rajfur@uni.opole.pl
           Uniwersytet Opolski, Instytut Nauk Medycznych
           ul. Katowicka 68, 45-060 Opole, Poland
           Other authors/contact:
           Katarzyna Rajfur
           Email: katarzyna.rajfur@uni.opole.pl
           Natalia Roden
           Email: rnatalia014@gmail.com
           Beata Fras-Łabanc
           Email: beata.fraslabanc@uni.opole.pl                                                  Received: 17 November 2023
           Paweł Dolibog                                                                         Reviewed: 14 December 2023
           Email: pawel.dolibog@uni.opole.pl                                                     Accepted: 20 December 2023