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Our study shows the frequency of cervical pain among school going female students due to carrying  heavy bags. Random sampling was done and 200 females from 4 Government schools were included in this study. A study done by Khan et al., 2015 in Lahore has close resemblance to our findings. The result of the study shown that 29.6% have neck pain while others suffer from shoulder pain, upper and lower backache. There are various similar aspects of both the studies like most of the students are using bags with double straps while few use single strapping of bag in order to carry their equipment to the school. This study also has elucidates that students wear bag unilaterally in spite of presence of double straps which can be worn on both the sides. But different style of wearing backpack make them prone to more stress on cervical area causing the student to lean forward and lateral in order to compensate with load changing the center of gravity of the body. Both of the studies also have some contradictory outcomes like use of medication in school going students of Lahore is least while students of schools of Faisalabad are more prone to usage of medication in order to relieve their pain. Our studies enrolled the students of female gender only while above mentioned studies enrolled both the genders and studied their outcomes. Our studies only pinpoint the presence of pain in cervical area while Khan et al., 2015 also calculated the frequency of presence of pain in different regions of the body.

A research done by Shamsoddini and colleague in Tehran, Iran   elaborated that the   most common symptoms of musculoskeletal systems were shoulder pain (38.1%), neck pain (27.6%) and back pain (16.7%.).  The  way of carrying and manipulation of heavy school bag ,duration of carriage and mean of transport showed that students suffered from stress and fatigue that causes musculoskeletal discomforts in students.

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Study done by Yanto and his colleagues in Indonesia reported that  most of the school children between age 11-12 year had the highest musculoskeletal pain in shoulder area (16.4%) followed by neck (14.5%) and leg (12.7%) pain.

The study done in Taif university, Saudi Arabia showed the prevalence of neck pain( 54%) among females. A study done in University Of Tunku Abdul Rehman in 2013 showed that high prevalence of neck pain among the medical and health sciences undergraduate students in UTAR (38.5%).Another study was done to investigate  musculoskeletal symptoms in school going children.  The results of study showed that there was shoulder pain (42.1%), neck pain (24.5%), back pain (35.7%).

A study done by Paniker and Sandesh T.S  was to determine the prevalence of musculoskeletal symptoms in adolscents The results revealed that the prevalence of adolescents having pain in the class one of school was 2.93% due to carrying heavy school bags.

Haselgrove and colleagues concluded that neck pain is as prevalent as back pain in school going students. Weight of school bag , duration of carrying bag and method of transport

to school are linked with musculoskeletal discomforts. Homechores and other activities like reading, using computer etc and walking also aggravate pain.

Moreover our study as well as studies done in other countries explained that neck and shoulder pain are more prevalent in school going children.

The reason of high prevelance of musculoskeletal pain among females is unknown. But some studies concluded that females have less tolerance level and low pain thresholds as compared to males.Miller and Lindle , two different researchers explained that females have less strength as compared to males.

Study done in Greece revealed  that age and gender had a influence on weight of  school bag based on the way of carrying school bag and duration of carrying. The usage of heavy school bags differ from country to country  depending on their education system, location and culture of the nation.It was seen that girls school bags are heavier then boys of same age.

H.Matlabi et al.  revealed that weight of bag is most crucial risk factor of musculoskeletal discomforts.The results showed that 87% students carry bag which is greater then 10% of their body weight. Drazel Grabiec conducted study in 2015 in Iran with an objective to find out the harmless safe limit  of the school bag weight. This study elaborated that school bags weight should not be greater then 10-15% of weight of their body .

A study conducted by Paula and colleagues in Brazil showed that 59.6% female students carry school bag greater then 10% of their body weight and 24.45% of such students complain of MSDs. Heavy school bags are crucial risk factor and is associated with permanent change in posture and can cause developmental disorders in the spine of  growing students. According to the different studies done on this topic said that the possibility of getting postural problems  raises as age decreases because musculoskeletal systems are still in growing and developing stage.

H.Matlabi and colleagues also elaborated that location of bag on the back is also important as it can  effect posture badly .Carrying school bag on one shoulder cause the child to lean on that side and head also lean forward. This causes center of gravity to shift towards neck to equalize the weight on back. Style of wearing school bags also vary from student to student and it can also effect posture and pain. Korovessis  in 2004 investigated that carrying a heavy school bag on one shoulder is one of the reason of  neck pain in the school going children

A study done by  Singh and Koh in 2009 showed that carrying heavy school bags dramatically effect posture both static and dynamic to compensate the change in center of gravity of body.

A study conducted by Bettany and colleagues explained that posture is also effected by the type of school bag eg. Front bags causes increase in lumber lordosis and extension while shoulder and hand held nags causes reduction in lumber lordosis and increase flexion. But khyposis increases in hand held bags. Carrying bags on one shoulder causes great change in alignment of body. Carrying  front bag on both shoulders causes symmetrical shift but away from load resulting in to extension.While carrying bag on one shoulder causes asymmetrical changes resulting into changes in normal posture .

A study conducted by Jung Gyo Yoon showed that thoracic khyposis and lumber lordosis was higher in students having pain and discomfort then those without pain.

A twin study done by Stahl suggested that neck pain in  early adulthood is associathed with pain in late age. Results showed that 68% subjects having neck pain have also suffered from neck pain in school going age.

 

This study is limited to Faisalabad population. Only urban children are participants in this study. Children of rural area are not participating  in this study. It only represent these musculoskeletal discomforts  in school going population of urban area. This study does not explain the difference of rural and urban school going students and problems of students of rural areas.Our study is limited to students of Government schools. Private school students are not involved in this study.Private schools are not included because students of such schools are provided with many facilities and infrastructure of private schools are  much better then Government schools.

Another limitation of this study is that only female students are involved. Male are not included in this study.Furthermore another limitation of this study is that the weight of school bag was recorded only one day.Our study cannot explain the exact safe limit of weight of school bag with respect to body weight of student.So another study should be done to find out the exact safe limit for weight of school bag. Our study is across sectional study which is another limitation. This study does not explain the link between cause and effect of pain. It is done only to find out the prevelance of neck pain among female school going students.

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