Abstract
<jats:p>Background: Many adolescents walk considerable distances to school while carrying backpacks, which may impose repetitive mechanical strain on the developing musculoskeletal system. Excessive load, particularly when combined with prolonged walking distances, can contribute to musculoskeletal discomfort, fatigue, and postural deviations, potentially predisposing students to long-term physical complications. Objective: To investigate the impact of backpack weight and walking distance on pain intensity, perceived exertion, and postural integrity among students who walk to school regularly. Methodology: This cross-sectional design was conducted over a six-month in selected schools located around Khawaja Fareed University, Khanewal, and in two schools in Chiniot, to recruit 100 students (52 females and 48 males) aged 12–19 years who routinely walked approximately 3–5 km to school carrying backpacks. Students with pre-existing spinal deformities (scoliosis), recent fractures, musculoskeletal injuries, or neurological conditions affecting gait and posture were excluded. After obtaining verbal consent, backpack weight was measured using a calibrated digital weighing scale, and walking distance was recorded based on student reporting. Pain intensity was assessed using the Visual Analog Scale, while perceived exertion was measured using the Borg Rating of Perceived Exertion scale. Postural assessment and upper limb strain were evaluated using the Rapid Upper Limb Assessment method. All observations were systematically recorded on a structured data collection sheet. Statistical analysis included descriptive statistics and Pearson’s correlation to determine relationships between variables. Results: The mean backpack weight was 4.34±1.68 kg, while the average walking distance was 4.00±1.19 km. The mean pain score was 4.49±1.82, and the mean Rapid Upper Limb Assessment score was 4.43±1.68, indicating moderate postural risk. A strong positive correlation was observed between backpack weight and pain (r=0.878, p=0.001). Additionally, a highly significant correlation was found between perceived exertion and postural risk (r=0.944, p<0.001). Conclusion: The findings of this study indicate that a daily school commute involving an average walking distance of 4 km and a mean backpack load of 4.34 kg is significantly associated with increased musculoskeletal strain in adolescents. Strong associations were observed between backpack weight and pain intensity (r=0.87), and between perceived exertion and postural risk (r=0.94).</jats:p>