AAbbstract

(Tomado de:
https://www.tandfonline.com/doi/full/10.1080/0014013032000157841?scroll=top&needAccess=t
rue)

Abstract

The purpose of this study was to determine the relationship between

reported spinal symptoms in an adolescent student population, and the
match between their individual anthropometric dimensions and their school
furniture. The hypothesis was that students who were too large or too small
for their school furniture, i.e. with anthropometric measurements furthest
from the group whose anthropometry was the ‘best fit’ with the furniture,
would have a higher frequency of reported symptoms. From data collected
from 1269 schoolchildren, reported spinal symptoms and anthropometric
measures were examined. Stature measures were divided into quartiles. A
standard government issue school chair and desk was measured and the
anthropometric quartile of the population having the ‘best fit’ with the
furniture was identified using standard ergonomics recommendations. Odds
ratios were calculated for spinal symptoms reported within each quartile
group. The first quartile group (the smallest students) was identified as
having the ‘best fit’ with the school furniture. An overall higher odds of
reporting low back pain was noted in students with anthropometric
dimensions in the fourth quartile (the tallest students). While it is
acknowledged that there is a multifactorial nature of causality of adolescent
spinal symptoms, it is contended that the degree of mis-match between child
anthropometry and school furniture set-up should be further examined as a
strong and plausible associate of adolescent low back pain.
Keywords: Adolescent spinal symptoms, Anthropometry, School furniture

1. Introduction

It has been reported that adolescent school children suffer significant

prevalence of musculoskeletal symptoms, including low back, neck and
shoulder pain, and headaches (Pascoe et
al. 1997Pascoe, DD, Pascoe, DE, Wang, YT, Shim, DM and Kim, C. 1997. I
nfluence of carrying book bags on gait cycle and posture of
youths. Ergonomics, 40: 631–641. ). The prevalence of low back pain
amongst adolescents has been reported as ranging from 28% to 50% of the
adolescent population (Balague et
al. 1988Balague, F, Dutoit, G and Waldburger, M. 1988. Low back pain in
schoolchildren. Scandinavian Journal of Rehabilitation Medicine, 20: 175–
179. , Kujala et
al. 1992Kujala, UM, Salminen, JJ, Taimela, S, Oksanen, A and Haakkola, L.
1992. Subject characteristics and low back pain in young athletes and
nonathletes. Medicine and Science in Sports and Exercise, 24: 627–632. ,
Olsen et
al. 1992Olsen, TL, Anderson, RL, Dearwater, SR, Kriska, AM, Cauley, JA, A
aron, DJ and Laporte, RE. 1992. The epidemiology of low back pain in an
adolescent population. American Journal of Public Health, 82: 606–608. ,
Salminen et
al. 1995Salminen, JJ, Erkintalo, M, Laine, M and Pentti, J. 1995. Low back
pain in the young, A prospective three-year follow-up study of subjects with
or without low back pain. Spine, 17: 405–411. , Burton et
al. 1996Burton, AK, Clarke, RD, McClune, TD and Tillotson, KM. 1996. The
natural history of low back pain in adolescents. Spine, 21: 2323–2328. ).
This finding was recently corroborated in the Australian setting with a cross
sectional study of 1269 randomly selected adolescents (aged 12 – 18 years)
in metropolitan high schools in South Australia finding that over 50% of
adolescent school students reported a recent event of spinal pain
(Grimmer et al. 1999aGrimmer KA Williams MT Gill TK 1999a High School
Students and Backpacks – A cross sectional Study(Adelaide: Centre for
Allied Health Research: University of South Australia), (ISBN 0 86803 627
7) , Grimmer and
Williams 2000Grimmer, KA and Williams, MT. 2000. Gender-age
environmental associates of adolescent low back pain. Applied Ergonomics,
31: 343–360. ). Data on the association between stature of adolescent
subjects and reported low back pain per school year level is currently in
press (Steele et
al. 2001Steele, S, Grimmer, K, Williams, M and Gill, T. 2001. Vertical
anthropometric measures and low back pain in high school aged
children. Physiotherapy Research International, 6: 94–105. ).

Adult studies have identified strong links between various musculoskeletal

disorders and exposure to highly repetitive or static work, awkward postures,
localized contact pressures and adverse environmental conditions (van
Wely 1970van Wely, P. 1970. Design and disease. Applied Ergonomics,
1: 262–269. , Silverstein et
al. 1986Silverstein, BA, Fine, LJ and Armstrong, TJ. 1986. Hand wrist
cumulative disorders in industry. British Journal of Industrial Medicine,
43: 779–784. , Grandjean 1987Grandjean E 1987 Ergonomics in the
Computerised Office(London: Taylor and Francis) , Keyersling et
al. 1991Keyersling, WM, Armstrong, TJ and Punnett, L. 1991. Ergonomic job
analysis: a structured approach for identifying risk factors associated with
overexertion injuries and disorders. Applied Occupational Environment and
Hygiene, 6: 353–363. ). Such excessive demands, forced upon a person in a
work situation, can be described as resulting from a mis-match in the
Human – Machine – Environment (HME) system. This mis-match in the HME
System can occur between a person and the physical demands of the task,
the individual workstation set up, the wider workspace design, the physical
environment and/or the work organisation (Wilson 1995Wilson JR 1995 A
framework and a context for ergonomics methodology in J. R. Wilson and E.
N Corlett. (eds): Evaluation of Human Work, 2nd edn, (London: Taylor and
Francis) 1 39 ).

Adolescent school students are a unique occupational group as aspects of

their HME system are affected by their stage of development. The physical
characteristics of the adolescent alters significantly as he/she undergoes
musculoskeletal development and maturity (Tanner et
al. 1976Tanner, JM, Whitehouse, RH, Marubiini, E and Resele, LF. 1976. Ad
olescent growth in boys and girls. Annals of Human Biology, 3: 109–126. ).
Anthropometrical characteristics such as stature, weight and strength have
been shown to vary significantly amongst the adolescent population
(Pheasant 1996Pheasant S 1996 Bodyspace 2nd edn, (London: Taylor and
Francis) ), a result of differing developmental rates. This adolescent
developmental process results in an immature musculoskeletal system
potentially more susceptible to injury from imposed stresses (Tanner et
al. 1976Tanner, JM, Whitehouse, RH, Marubiini, E and Resele, LF. 1976. Ad
olescent growth in boys and girls. Annals of Human Biology, 3: 109–126. ).
Along with the developmental changes affecting the musculoskeletal system,
the adolescent student is also subject to significant changes in their sexual
and emotional development. The effect that these tumultuous changes in
overall development have on the HME system remains unclear.

This study addresses one aspect of the HME system for the adolescent
student, the individual workstation elements, in an ongoing effort to identify
potential causative elements for the high level of reported adolescent
symptoms. Considering just the academic side of adolescence, the main
elements of the student's workstation that may be significant for the
development of musculoskeletal symptoms include:

1 The load carriage system used to transport educational/sporting

. equipment. Students are required to transport their ‘tools of trade’,
including books, laptop computers, folders etc., throughout the day,
between classes and between school and home. This involves carrying
significant loads in a load carrying arrangement such as a backpack or
school bag, and may include lifting loads to and from a storage locker. It
has been reported that students carry between 2% and 30% of body
 weight at school with up to 99.4% of students preferring a backpack
arrangement for load transport (Pascoe et
al. 1997Pascoe, DD, Pascoe, DE, Wang, YT, Shim, DM and Kim, C. 1997.
Influence of carrying book bags on gait cycle and posture of
youths. Ergonomics, 40: 631–641. , Grimmer et
al. 1999aGrimmer KA Williams MT Gill TK 1999a High School Students
and Backpacks – A cross sectional Study(Adelaide: Centre for Allied
Health Research: University of South Australia), (ISBN 0 86803 627 7) ).
Mechanical over-loading of the spine and musculoskeletal system has
been linked to injury (Keyersling et
al. 1991Keyersling, WM, Armstrong, TJ and Punnett, L. 1991. Ergonomic
job analysis: a structured approach for identifying risk factors associated
with overexertion injuries and disorders. Applied Occupational Environment
and Hygiene, 6: 353–363. ).
2 The locker system used in some school environments to store books and
. other required materials. Use of the storage lockers involves lifting loads
to/from the locker, often repeatedly during the day. Given the weights
reportedly carried in backpacks by students, the weights lifted to/from
lockers could range between 2 and 20 kg (Grimmer et
al. 1999aGrimmer KA Williams MT Gill TK 1999a High School Students
and Backpacks – A cross sectional Study(Adelaide: Centre for Allied
Health Research: University of South Australia), (ISBN 0 86803 627 7) ).
Lifting has been implicated as a risk for the development of low back pain
(Ayoub 1987Ayoub MM 1987 The problem of manual materials handling in
S. S. Asfour (ed) Human Factors IV, Trends in Ergonomics, (New York:
Elsevier Science Publishers B.V.) ).
3 The chair/desk set-up at which the student sits. The adolescent student is
. exposed to extended periods of time in seated postures, both at school
and home, which, with the advent and increasing popularity of computer
based entertainment, appears to be increasing. Whilst seated, the student
interacts with paper-based hardcopy on a desk surface, or with
keyboard/mouse input device and monitor at a computer workstation. Poor
seating postures have been implicated in the development of neck and
shoulder pain (Freudenthal et al. 1991Freudenthal, A, van
Riel, MPJM, Molenbroek, JFM and Snijders, CJ. 1991. The effect on sitting
posture of a desk with a ten degree inclination using an adjustable chair
and table. Applied Ergonomics, 22: 329–336. ) and low back pain
(Punnet et
al. 1991Punnet, L, Fine, LJ, Keyersling, WM and Herrin, GD. 1991. Back
disorders and nonneutral trunk postures of automobile assembly
workers. Scandinavian Journal of Work, Environment and Health, 17: 337–
346. ).
The author's research team is continuing to work on evaluating the effects of
environmental, academic, physical and recreational exposures on the
adolescent student (Grimmer et
al. 1999bGrimmer, K, Williams, M and Gill, T. 1999b. The relationship
between adolescent head-on-neck posture, backpack weight and
anthropometric features. Spine, 21: 2262–2267. , Grimmer and
Williams 2000Grimmer, KA and Williams, MT. 2000. Gender-age
environmental associates of adolescent low back pain. Applied Ergonomics,
31: 343–360. , Steele et
al. 2001Steele, S, Grimmer, K, Williams, M and Gill, T. 2001. Vertical
anthropometric measures and low back pain in high school aged
children. Physiotherapy Research International, 6: 94–105. ). This paper
focuses on the chair/desk set up to which the student is exposed in the
classroom during the day. The investigations are premised on reports in the
ergonomics literature that poorly designed furniture is linked to an increase
in musculoskeletal symptoms
(Grandjean 1987Grandjean E 1987 Ergonomics in the Computerised
Office(London: Taylor and Francis) ).

Recognition of the importance of desk/chair design in occupational

musculoskeletal health has generated significant work in the area of office
based clerical/administrative type ergonomics, with a range of
recommendations on furniture design being published
(Grandjean 1987Grandjean E 1987 Ergonomics in the Computerised
Office(London: Taylor and Francis) ,
Pheasant 1996Pheasant S 1996 Bodyspace 2nd edn, (London: Taylor and
Francis) ). Optimal furniture design recommendations are often based on the
relationship of the furniture dimensions with the anthropometrics of the
seated person. Given the range of anthropometric dimensions of the adult
population, it is often recommended that optimal furniture design should
allow for adjustability to suit the user.

Despite the wide range of anthropometric dimensions that exist in the

adolescent student population, students are often exposed to fixed-
dimension furniture throughout their adolescent school life, with little
opportunity for adjustability to suit their own changing anthropometry. If
prolonged sitting at school furniture is a risk factor for the development of
musculoskeletal symptoms, and there exists an optimal relationship between
the anthropometric dimensions of the student population and the dimensions
of the fixed furniture, then this should be demonstrated in higher reports of
symptoms amongst individuals, who reflect a mis-match in this relationship.

Ergonomics recommendations used in this study to identify the

appropriateness of furniture dimensions for an individual are based on
recommendations presented by Grandjean
(1987Grandjean E 1987 Ergonomics in the Computerised Office(London:
Taylor and Francis) ) and Pheasant (1996Pheasant S 1996 Bodyspace 2nd
edn, (London: Taylor and Francis) ). These recommendations include:

1.The measured chair seat pan height should be as close as possible or

slightly less than the shod popliteal height of the sitter. If seat pan
height were greater than the shod popliteal height of the sitter their feet
would be unable to reach the ground in the seated position. This may
lead to an increase in tissue pressure on the posterior aspect of the
thighs. If the measured chair seat pan height were significantly lower
than the shod popliteal height of the sitter, the sitter would be required
to assume a position of greater hip flexion than 90 degrees to
accommodate this mismatch. This would increase the degree of
lumbar flexion involved in sitting
(Pheasant 1996Pheasant S 1996 Bodyspace 2nd edn, (London: Taylor
and Francis) ).
2.The measured depth of the chair seat pan should be less than the
buttock to popliteal length of the sitter. If seat pan depth were greater
than the buttock to popliteal length of the sitter he/she would be unable
to utilize the backrest of the seat to support the lumbar spine in sitting.
There may also be a tendency to increased pressure over the posterior
calf muscle. If the seat pan depth were significantly less than the
buttock to popliteal length of the sitter, the thighs would not be
supported in the sitting posture
(Pheasant 1996Pheasant S 1996 Bodyspace 2nd edn, (London: Taylor
and Francis) ).
3.The sitting elbow height of the participant should approximate the
vertical distance from the table surface to the seat surface. If this
distance were significantly greater than the sitting elbow height of the
participant he/she would be required to work with both arms in a
degree of abduction or scapular elevation to compensate for the higher
work surface. If the seat to table distance were significantly lower than
the sitting elbow height of the sitter, the sitter would be required to
stoop to work effectively at the desk
(Grandjean 1987Grandjean E 1987 Ergonomics in the Computerised
Office(London: Taylor and Francis) ).

2. Method
2.1. Measures

Data on stature (standing height, without shoes), and recent reports of spinal
pain (neck, thoracic and low back) and headache were extracted from a
larger data set which had been collected from 1269 randomly selected
adolescents in twelve volunteer metropolitan Adelaide schools between
March and June, 1998. These students used standard issue school furniture
on a daily basis at school. This data set also contained information on other
attributes of the adolescent sample, including anthropometric features
(shoulder width, leg length etc.), school bag choice, design and weight,
posture (with and without a backpack) and regularity of participation in
physical activity. The data set had been collected using standard protocols
and equipment, which have been described elsewhere (Grimmer et
al. 1999aGrimmer KA Williams MT Gill TK 1999a High School Students and
Backpacks – A cross sectional Study(Adelaide: Centre for Allied Health
Research: University of South Australia), (ISBN 0 86803 627 7) , Grimmer
and Williams 2000Grimmer, KA and Williams, MT. 2000. Gender-age
environmental associates of adolescent low back pain. Applied Ergonomics,
31: 343–360. ).

The dimensions of a standard issue Australian Government high school

chair and desk were determined. The furniture measured for this study is
typical of the furniture used by public schools in the Adelaide metropolitan
region. During data collection on the 1269 school children, the furniture used
was observed to be standardized across the majority of the schools.
Unfortunately, it was not feasible in this study to examine the furniture used
by the adolescent student at home.

Girls and boys were considered separately in analysis, on an a priori basis of

differences in prevalence of spinal pain and its determinants (Grimmer and
Williams 2000Grimmer, KA and Williams, MT. 2000. Gender-age
environmental associates of adolescent low back pain. Applied Ergonomics,
31: 343–360. ). School year levels were considered as a proxy for an age
(exposure) effect. In the South Australian school system, students in the first
three years of high school (years 8 – 10) sit in class for no longer than 50 min
at a time. They move regularly from class to class during the school day.
The older children (in Years 11, 12), however, sit for longer class sessions
(up to 2 h) and also spend considerable periods of time studying and in front
of computers. It could be argued that these students therefore have a
greater exposure to school furniture, not only by length of current time using
furniture, but also by a cumulative effect over the previous years. Thus the
potential differences in exposure in the school year levels were considered
in analysis as a binary variable (Years 8 – 10, Years 11 – 12).
Stature was categorised in quartiles to allow comparison of spinal pain
reports along the range of anthropometric dimensions. The proportion of
younger and older boys and girls within each quartile was calculated, as
were the proportions reporting recent spinal pain (headache, neck, upper
back and lumbar pain).

Each specific anthropometric derivative was also expressed as quartiles for

ease of analysis. The specific anthropometric dimension was matched with
the relevant furniture dimension based on the ergonomics recommendations
discussed previously. The quartile of ‘best fit’ based on the approximation of
furniture dimension with anthropometric dimension was identified for each of
the ergonomics recommendations.

The odds ratios of events of headache, neck, thoracic and lumbar pain
occurring within each quartile for each subset of subjects (younger and older
boys and girls) was calculated using logistic regression models, in which the
quartile of ‘best fit’ was designated as the comparison group.

3. Results

The distribution of younger and older girls and boys in the quartile divisions
of stature is illustrated in figure 1. The disproportionate number of girls
compared with boys in the highest 25% division is clearly illustrated.

The most appropriate match between chair height and

population anthropometrics occurred in the first quartile, e.g.
chair height (450 mm) was below optimal for shod popliteal
height of students in the second, third and fourth quartiles.
2. Chair seat pan depth
was below optimal for
buttock – popliteal
length in second, third
and fourth quartiles.
3. Desk height was below
optimal height for
sitting elbow height in
second, third and fourth
quartiles.

It can be seen therefore that, for the furniture dimensions measured, the
quartile of ‘best fit’ was the first (equating to approximately the 25th
percentile of the population).
The odds ratios within each quartile for each subset of subjects (younger
and older boys and girls) was calculated using the first quartile as the
comparison group.

4. Discussion

The interaction of adolescents and their environment presents a complex

model with both external and internal factors affecting this relationship. This
paper attempts to investigate one aspect of this relationship, the effect of
anthropometric/furniture interactions on the symptoms reported by individual
adolescents.

The assumption for this study was that there exists an optimal
anthropometric/furniture dimension relationship, and that deviations from this
optimal relationship would result in increased symptoms, due to
anthropometric and furniture mis-match. This optimal relationship will
depend on the subject's anthropometric dimensions, which are highly
variable in the adolescent population within and between year groups, and
the specific dimensions of the furniture with which the student interacts.

The findings indicate that taller students were more at risk of developing
spinal pain, in particular students in year 8 to 10, and girls in years 11 and
12 in the fourth quartile of anthropometric dimensions.

It has been reported that too low a seat height may lead to increased angles
of lumbar flexion during sitting and predispose the seated person to
increased risk of low back pain
(Pheasant 1996Pheasant S 1996 Bodyspace 2nd edn, (London: Taylor and
Francis) ). Desk heights that are too low have been reported to predispose
the user to thoracic/neck pain due to the need to flex forward to interact with
the desk surface (Grandjean 1987Grandjean E 1987 Ergonomics in the
Computerised Office(London: Taylor and Francis) ). These
recommendations appear to be supported by the results of this study.

The school furniture measured in this study was similar to reported school
furniture dimensions of schools in New Zealand (Bruynel and
Stotter 1985Bruynel L Stotter GMM 1985 Anthropometric data of students in
relation to their school furniture New Zealand Journal of
Physiotherapy December 7 11 ) and Denmark (Aargard-Hansen and Storr-
Paulsen 1995Aargard-Hansen, J and Storr-Paulsen, A. 1995. A comparative
study of three different kinds of school furniture. Ergonomics, 38: 1025–
1035. ).

The school furniture measured in this study failed standard ergonomics

recommendations for the design of furniture to fit the user in the population
of users. Workstation design parameters should endeavour to match the
anthropometric characteristics of the 50th percentile of the user population at
least, to minimize mis-matches in the HME. The school furniture observed in
this study was more suited to the extreme of the user population (25th
percentile and shorter). This finding supports the conclusions of Mandal
(1997Mandel, AC. 1997. Changing standards for school
furniture. Ergonomics in Design, 5(2): 28–31. ) who has advocated the
adoption of higher school furniture in European schools. Molenbroek et al.
(2003Molenbroek, JFM, Kroon-
Ramaekers, YMT and Snijders, CJ. 2003. Revision of the design of a
standard for the dimensions of school furniture. Ergonomics, 46: 681–694. )
suggested that the mismatch between students and their furniture was the
result of furniture dimension guidelines based on child stature, rather than
specific body segment dimensions.

It is interesting to note the absence of a significantly increased odds of

thoracic pain in the years 11/12 students despite a similar anthropometric
mismatch existing as for the years 8 – 10 students. This may reflect the
influence of a range of other factors in adolescence, including differences in
musculoskeletal maturation, psychosocial influence of self reporting of
symptoms in this group, influence of extra-academic activities etc. affecting
the capacity of the younger students to withstand the stresses of such a
mismatch. The increased risk of neck pain and headaches in year 11/12 girls
compared with similar sized and aged boys may reflect the influence of
postural changes observed in taller developing females, and potentially
reflect compensatory mechanisms related to habitual adjustment to furniture
size.

Findings from this study suggest that school furniture may have a role to
play in the development of symptoms in adolescent students. It also
highlights the role other factors, intrinsic to the adolescent student, may play
in affecting the relationship between the student and his/her furniture. The
high levels of reported symptoms in the adolescent population require a
review of school workstation design, using ergonomics standards that are
applied to other occupational workstations. In this study the furniture
measured failed to comply with these standards. In line with
recommendations of Mandel (1997Mandel, AC. 1997. Changing standards
for school furniture. Ergonomics in Design, 5(2): 28–31. ) the design of
school furniture should be reviewed and updated. When reviewing school
 based furniture design, consideration should be given to the increasing use
of Information Technology in the educational environment (Zandvliet and
Straker 2001Zandvliet, DB and Straker, L. 2001. Physical and psychosocial
aspects of the learning environment in information technology rich
classrooms. Ergonomics, 44: 838–857. ).

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