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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.

Shamsoddini and colleagues studied about the musculoskeletal discomforts in different regions of the body in schools of Tehran, Iran. There were few contradictory outcomes while few others were similar. They mentioned about the occurrence of pain in shoulder is more as compared to other regions of the body. While second most common pain area is in cervical region that occur in response to carrying heavy bags. Our study mentions about the presence of pain in cervical region only as least studies are done pinpointing this area alone. Other associated risks were also mentioned in Tehran studies that other causative factors causing musculoskeletal discomforts are style of wearing back pack , duration of loading while travelling to the school, mode of travelling in order to reach school and travel back to the home. These factors are similar to our studies as our studies depicts similar situations that make cervical prone to stress and fatigue.

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Yanto and his colleagues studied about the effects of school bag on the students of Indonesia and enrolled the students of age only 11-12 years of age. While our studies enrolled the students between the age of 12-14 years of age and found occurrence of cervical pain among the students.

Another study was conducted among the students of Taif university in Saudi Arabia and it depicted about the pain in cervical region and that was specifically recorded among the female population only. Our study is similar to this study as it involve enrollment of cervical pain among the female students only. Another study was conducted among the students of University Of Tunku Abdul Rehman. This study was conducted in year 2013 and shown the higher  prevalence of neck pain among the medical and health sciences undergraduate students studying in UTAR. Several other musculoskeletal symptoms appear in the body in different regions like shoulder , upper and lower back ache.

There is another study that supports our study and it was done in India by Panicker and Sandesh T.S. It was supposed to determine the prevalence of musculoskeletal symptoms in adolescents between the age of 12-18 years as this is the age of developmental changes of musculoskeletal system causing symptoms of discomfort. Weight of the bag was considered the most important factor and causative agent in occurrence of changes in cranio-vertebral angle and causing pain. Another major factor is BMI of the body. If weight of the bag is greater than 10% of bodyweight than it causes stress and increased sense of perceived level of fatigue and load. These mentioned factors are similar to our studies. Maximum students carry backpack of more than 10-15% body weight that make them prone to serious illness and future deformities.

Haselgrove and his team also considered about the prevalence of neck pain as major contributor in the appearance of neck pain among the school going females. They also discussed about the method of bag usage, mode of transportation and duration of travelling as associated factors to be causing pain in cervical region. Other household chores , concentration level and studies also affected by it. Designs of furniture in the classrooms also has negative impact on the postural alignment. It is quiet similar to our studies and support its effects on the households, studies and concentration level. Moreover our study as well as studies done in other countries explained that neck are more prevalent in school going children.

Miller and Lindle did separate researches and they are also in support of our studies where they also found that females are highly prone to stress and fatigue due to lower level of tolerance as well as lower level of pain threshold. They are more sensitive to pain and postural changes as compared to the males. Females have lower strength as compared to the males. Our studies also enrolled the female population and studied the effects of backpacks on them. Gender difference also has greater impact on the outcomes and differ in both the genders.

Another study was conducted in Greece and it supported the idea of effect of age as well as gender on the posture of school going children. Weight of the bag also have direct relation on the postural alignment of the body. Style of wearing bag , duration of travelling and carrying of the bag also effect it. Curriculum and education system also differ among different countries involving their study burden and infrastructure used in the classrooms in order to continue their studies. Prolonged exposure to unfavorable environment of the classroom has direct impact on the musculoskeletal system causing appearance of pain and discomforts. It has also been depicted that girls carry more heavier bags as compared to the boys while attending schools. This difference of psychological profile also effect the outcomes while doing research studies. Different BMI of both the genders also influence the ending results.

Matlabi et al., 2014 elucidates that about 87% of the school going students carry heavier backpack as compared to ideal BMI of the body. Heavier bags cause postural mal alignment of the body. Anteriorly deviated posture in order to compensate the center of gravity of body while walking. Drazel and Grabiec explained that majority of the students carry backpacks more than ideally required for the body and mostly among them are girls. 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 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.

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 kyphosis 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 associated 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 prevalence of neck pain among female school going students.