TO FIND OUT PREVALENCE OF MUSCULOSKELETAL PAIN BY CARRYING HEAVY HANDBAGS AMONG COLLEGE GIRLS AND ITS RELATION WITH THEIR BMI.

Background: Students aged 18-30yrs undergo rapid musculoskeletal development and an application of external forces (handbags) cause musculoskeletal disorders. Musculoskeletal pain is one of the most important pains among students. Objectives: This study was carried out to investigate the prevalence of musculoskeletal discomforts and pain in various regions of the body due to heavy handbag usage in university/college students and to examine its association with the type of handbag, handbag load, time spent carrying load, distance travelled carrying load, and the student‟s body mass index(BMI). Methods: This co-relational descriptive study was conducted on students selected from different colleges of Oxford educational institutions. The study goals were explained and obtained informed consent. Their Bag weight, Body weight and Height was measured. The data on handbag use were collected using a self administered questionnaire and erector spinae bilaterally in five static conditions: no shoulder bag, backpack, front pack, double pack. 19 students carried a load of 15% of their body weight. Results were a double pack, with the load equally distributed in a front and a backpack, showed no significant differences in EMG activity compared with unloaded standing. The activity levels of erector spinae significantly decreased while carrying a backpack and increased with a shoulder bag and a front pack. Rectus abdominis revealed significantly higher EMG levels in the backpack trial. Asymmetrical activity between the right and the left part of the back was clearly observed while carrying a shoulder bag with the weight at the right side of the body. The abdominal muscles revealed a slightly significant asymmetry for the shoulder bag and also for the backpack. The more the load on one side of the more the & more the changes in the muscle activity and Hence there is a relation between the current study & this study. the 1 strapped rucksack and the ipsilateral shoulder strap. For the left erector spinae muscle, there was significantly greater muscle activity when wearing the contralateral shoulder strap compared to the control. For the right erector spinae, significantly lower muscle activity was observed when wearing the 2 strapped rucksack compared to the ipsilateral shoulder strap and contralateral shoulder strap. There were no significant differences in muscle activity of the latissimus dorsi muscles between any of the bag conditions. These findings suggest that a two strapped rucksack should be used when carrying loads to reduce spinal muscle activity which may in turn reduce reports of back pain in female students. This study is in accordance with the current study as its context involves about the unilateral strap bag loading & the changes in the musculoskeletal system. Aminu. et al (2015) (30) :- Study was done to investigate the prevalence of musculoskeletal discomforts in various regions of the body due to bag use and to examine its association with certain perceived correlates. Procedure was this was a cross-sectional analytic study conducted among 500 participants of SRM University in Chennai, India. Data on bag use were collected using a self-administered questionnaire and discomforts using the Nordic musculoskeletal questionnaire. Results were a high percentage of respondents about 82.2% reported discomforts. Prevalence of discomforts in neck were 48.6%, shoulder 61.2%, elbow 11.8%, wrist/hand 14.2%, upper back 38.2%, lower back 29%, hips/thigh 19%, knee 17.2%, and ankle 16.6%. The average bag weight carried was 3.7kg about 6.5% respectively. Gender was associated with shoulder, elbow and hip/thigh discomforts with females being more likely to suffer discomforts than males. Body mass index (BMI) was associated with occurrence of knee and ankle/feet discomforts. Relative bag weight was associated with shoulder and low back discomforts. While frequency of schoolbag carriage was associated with ankle or feet discomforts. There was no association between manner of bag carriage, duration of bag carriage and discomforts. Majority of the respondents 72.1% perceived their bag weight as being normal and also 75.2% aware of the potential consequences of incorrect carriage of bag. This study is in context of the current study, so as taken as reference. for a handbag 13 healthy females randomized into four carrying patterns no load, 5% body 7% 10% a preferable of pressure centre of pressure towards the carrying side when (34) :- Study was done to test the predictive utility of Orebro Musculoskeletal Pain Questionnaire(OMPQ) in identifying patient at risk for developing persistent musculoskeletal pains/problems. Procedure was, 107 participants were taken from primary care units and were given questionnaire to complete. Their cases were followed for 6 months to assess outcome with regard to pain, Function and Absenteeism due to sickness. Results shows that 68% classified into one of the 3 groups, 81% classified under category of pain, whereas 71% classified into other two groups. From total score, cutoff score of 90 points had a sensitivity of 89% & specificity of 65% for absenteeism due to sickness. Whereas sensitivity of 74%, specificity of 79% for functional ability. In Conclusion the results are indicating that OMPQ is a clinically reliable & valid instrument. The total score was a good predictor of future absenteeism due to sickness as well as function & pain. This screening instrument is found to have satisfactory test-retest reliability(0.83) & validity in a study of 142 patients. Using a cutoff score of 105, the specificity was found to be (0.75) & sensitivity (0.88). A cutoff score of 112 correctly identified 80% of patients failing to return to work. This study helps in the current study‟s outcome result & its significance, so taken as Westman et al(2008) (35) :- Study was done to validate the OMPQ for patients with Non Acute pain problems(e.g. : 1-6mnths sick leave) & compare to other relevant questionnaires. And also for the early identification & intervention with those that run the risk of developing long term disability associated with long term work absenteeism. Method was, 158 patients with musculoskeletal pain & disability recruited to a multidisciplinary rehab project and at 3yrs follow up visits. Results obtained as, the OMPQ predicted future sick leave, health & was found to have six factors. Conclusion was, the OMPQ was a good predictor of outcome and has been used & validated in several studies for participants with mainly non acute problems. This study is helpful for the current study in outcome result & its significance, so taken as reference.

The link between load carriage and musculoskeletal pain in the neck, back and shoulders has been well documented with prevalence of back pain documented to be as high as 30-51% in students and requiring 4-31% to seek medical intervention. The actual mode of load carriage has been shown to cause different postural shifts resulting in adverse stress and strains on the surrounding spinal structures resulting in back pain (8) Today, students low mobility along with their taking on stressful situations caused by industrial life has increasingly led to psychological and physical complications, such as musculoskeletal disorders in this age group . Carrying bag is a means of applying external forces to the body and has been commonly associated with postural and gait deviations. Heavy bag load and improper bag use can be threatening to the health of students as studies have shown these factors are associated with muscle imbalance, repetitive strains to the body, intense pressure on joints and ligaments, increase in energy consumption and decrease in lung volumes (9) . In recent years, there has been increase in the incidence of musculoskeletal complaints due backpack use among college students (10) . The associated longterm discomforts or pain may lead to potential chronic pain or igin injury resulting in student"s absenteeism from lessons and low productivity thereby affecting students" wellbeing and future careers (11) .

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The recommended guidelines for bags load vary among organizations. The American Occupational Therapy Association has recommended backpack load limit not more than 10% of student"s body weight (12) while American Academy of Pediatrics recommended safety limit ranging 10 to 20% of the student"s body weight (13) However, it was suggested that these recommendations are feasible with practical goal and it is better to be limited at 10% or less (14) It is equally important that students develop an awareness of these issues in order to monitor their own practices (15) .
Factors such as backpack design, duration and frequency of carriage, inadequate distribution of weight in the backpack, method of transport to school, manner in which the weight is carried as well as improper carriage may all affect the demands on the musculoskeletal system leading to occurrence of musculoskeletal symptoms (16) .
Carrying of a shoulder bag for prolonged periods of time can have negative effects on human body. These effects include musculoskeletal misalignment, muscle spasms, and postural asymmetry. Repetitive periods of postural asymmetry can lead to asymmetric muscular activity which may contribute to the development of back pain over time. Despite the warnings about harmful musculoskeletal effects of carrying shoulder bags, students continue to use shoulder bags because of convenience and the need to get needed items to class while moving freely throughout the day (17) .
According to the literature of a study, there are a number of students of all ages who prefer to carry one strap shoulder bags, and the majority of reports indicate that loads carried by students are greater than the recommended limits (18) . Carrying a shoulder bag throughout the duration of high school and college years has been shown to lead to back pain. The American Physical Therapy Association (APTA) suggests that "Backpacks weigh no more than 15% of the carrier"s total body weight" (19) .
Several studies also concur that an acceptable range of weight for bag carriage is between 10% -15% of the individual"s body weight. Another Factor that may aggravate or cause musculoskeletal problems resulting from shoulder bags is uneven weight distribution throughout the lower extremities. They found that disproportionate forces placed through the lumbar spine while carrying a shoulder bag are transferred disproportionately to the lower extremities. Carrying a unilateral strap shoulder bag may contribute to postural asymmetry and result in more weight bearing distributed through one lower extremity versus the other (20,21) .
Researchers from the University of California, San Diego stated that limitations in shoulder bag weights may reduce the number of national emergency room admissions per year approximately 7,500 related to shoulder bag injuries. This illustrates the importance that proper shoulder bag use be emphasized during the years of the highest growth rate, as it can be inference that the susceptibility for injuries and permanent postural abnormalities are more likely to occur during this period. Secondary ossification of the vertebrae is not complete until the mid twenties. Therefore the spine may also be susceptible to injury throughout the college and post graduate years (22) .

Need Of Study :-
There is the paucity of information regarding the musculoskeletal problems in students caused due to their loaded bags. Most of the studies were done on students using loaded backpacks leading to the musculoskeletal pain, but none studies done on handbags leading to musculoskeletal pain due to lack of awareness that handbags can lead to pain & postural problems. Hence, there arise a need and background for the genesis of this study to help the students to know the effects of loading on daily basis.  (3) :-Study was done to investigate the effects of carrying a rucksack on each shoulder or on both on 3d spinal curvature in healthy young students. A convenience of sample of 30 healthy young adults participated in this study. Procedure was a Microscribe 3dx digitizer recorded the three dimensional coordinates of 13 key anatomical landmarks along the spine in four different loading conditions. No rucksack, carrying a rucksack with 17% body weight simultaneously on both shoulders and solely on the right or left shoulder. Results were carrying load on both shoulders resulted in no difference in frontal plane angle but significantly decreased the thoracic kyphosis in the saggital plane. Carrying the load on one shoulder significantly increased the thoracic lateral curvature in the frontal plane and decreased the thoracic kyphosis in the saggital plane. This study confirms that carrying a 17% load causes significant changes in spinal alignment. This study is in relation with the current study as they have described, about postural changes due to unilateral loading & current study also involves unilateral loading leading to the msk pain.

Aim & Objectives:-
Clare Haselgrove et al (2008) (16) :-Study was done to find out the use and perceived load of school bags and the prevalence of spinal pain different between male and female students. Procedure was it was a cross sectional observational study done on 1202 students recruited from the raine cohort study. Use and perceived load of bags and spinal pain were measured by questionnaire. Results were prevalence of neck and back pain was approximately 50%. 53% 0f females reported neck pain compared with 44% of males. Almost half of participants carried their bag for more than 30 minutes per day with 85% carrying their bag over both shoulders. Bags were felt to be heavy by 54% and to cause fatigue by 51%. The current study relates in context of this study in finding out prevalence of musculoskeletal pains due to load of bags.
Motmans RR et al (2006) (17) :-Study was done to observe the trunk muscle activity in different modes of carrying bags. Procedure was Electromyography activity from rectus abdominis and erector spinae was recorded bilaterally in five static conditions: no bag, shoulder bag, backpack, front pack, double pack. 19 students carried a load of 15% of their body weight. Results were a double pack, with the load equally distributed in a front and a backpack, showed no significant differences in EMG activity compared with unloaded standing. The activity levels of erector spinae significantly decreased while carrying a backpack and increased with a shoulder bag and a front pack. Rectus abdominis revealed significantly higher EMG levels in the backpack trial. Asymmetrical activity between the right and the left part of the back muscles was clearly observed while carrying a shoulder bag with the weight at the right side of the body. The abdominal muscles revealed a slightly significant asymmetry for the shoulder bag and also for the backpack. The more the load on one side of the body, more the pain & more the changes in the muscle activity and Hence there is a relation between the current study & this study.
Bettany Saltikov et al (2012) (23) :-Study was done to evaluate the effect of carrying three different types of bag. Shoulder, Front and Handheld, each containing a load of 15% body weight. Procedure was the study involved 25 university students. A repeated measures design was used to record the effects of four conditions using No load, a front pack, a shoulder bag, and a handheld bag. Measurements with ISIS 2 were taken 5 minutes post loading. All of the conditions were randomized in an attempt to offset any order effects. Results showed an increase in extension and lumbar lordosis angles for the front bag, an increase in flexion and reduced lumbar lordosis in the shoulder and hand held bags, kyphosis curves were also significantly increased in the hand held bag, right unilateral load carriage also demonstrated the greatest right volumetric asymmetry. As there is greatest asymmetry in the posture due to unilateral loading, so will be greater pain in the subjects. And such there is a relation between this study & current study.
Oshea et al (2006) (24) :-Study was done to examine the changes in back shape that occurred in response to asymmetrical load carriage of handbags, either in one shoulder (same side) or across the body (cross body), in healthy young adults. Procedure was a convenience sample of 21 physiotherapy students randomly performed three trails (unloaded, same side loaded, cross body loaded) in standing with a 15% body load. The Microscribe 3dx digitizer recorded the three dimensional coordinates of 15 key anatomical landmarks on the back in the three conditions. Results were there is significantly less impact on spinal posture from cross body loading as compared to same sided loading. In accordance with this study, current study also, is to prove that there are greater musculoskeletal changes due to unilateral loading. Firouz Amani et al (2018) (25) :-Study was done to determine the prevalence of Musculoskeletal disorders and its related complications among students in Ardebil. Procedure was, it was a cross sectional descriptive study done on 787 158 students selected by random sampling using Nordic musculoskeletal pain questionnaire. Results were of all the students 55% had pains in musculoskeletal system. The most severe pain was reported in knee zone and mildest pain in pelvic zone. Overall knee pain was revealed in 29.5% and neck pain in 27.3%. There was a significant relationship between body mass index (BMI) of students and musculoskeletal pain. Additionally, a significant relationship between height and musculoskeletal features was seen. There is also a significant relationship between the type of school bag and musculoskeletal disorders. In context of this study, the current study also is to prove/ to find out the correlation between musculoskeletal pain & BMI of the subjects.
Yasmin Qureshi et al (2012) (26) :-Study was done to investigate whether there is a way to wear a unilateral strap shoulder bag that will allow more symmetrical posture alignment, preventing potentially harmful musculoskeletal effects. Procedure was 65 college students; each participant donned a unilateral strap shoulder bag two different ways on the dominant and the non dominant shoulder while standing on the postural scale analyzer to measure lower extremity weight distribution. Results were a significant improvement in lower extremity weight distribution was found in right hand dominant subjects when wearing a shoulder bag draped across the left shoulder to right hip. When individuals who are right hand dominant wear a shoulder bag draped across the left shoulder, the weight distribution through the person"s lower extremities becomes more equal indicating improved postural symmetry in static standing. Current study is in context with this study as it involves the unilateral loading & the changes in musculoskeletal system of the body.
Mackie HW et al (2005) (27) :-Study was done to determine the effects of different load carriage configurations on shoulder strap tension forces and shoulder interface pressure during simulated student"s load carriage. Procedure was a load carriage simulator was used to compare shoulder strap forces and shoulder pressure for 32 combinations of gait speed, backpack weight, load distribution, shoulder strap length and use of hip belt. The results showed that the manipulation of backpack weight, hip belt use and shoulder strap length had a strong effect on shoulder strap tension and shoulder pressure. Backpack weight had the greatest influence on shoulder strap tension and shoulder pressure, whereas hip-belt use and then shoulder strap adjustment had the next greatest effects respectively. The current study is in relation with this study as it talks about the pressure of using the strap bags & load of bags on the body & the changes according to them.
Yuing Hu et al (2008) (28) :-Study was done to investigate the prevalence of self reported musculoskeletal discomfort and pain in university students and to examine its association with the type of backpack, backpack load; time spent carrying loads and the student's BMI. Results were a high prevalence 85% of the university students self reported musculoskeletal pain and discomfort and 84% of the participants reported knowledge of the potential consequences of incorrect backpack usage. An emerging trend between musculoskeletal symptoms and time spent carrying backpacks mean = 2.3 hr for subjects with pain, 3.4 hr for subjects with discomfort. This study is in accordance with the current study as the context is about prevalence of musculoskeletal pains & its correlation with the BMI of subjects. (29) :-Study was done to investigate the effects of different bag conditions on muscle activity of the Trapezius, Erector spinae and Latissimus dorsi muscles in female university students during walking. Procedure was twelve female university students walked on a treadmill for 5 minutes at 1.1 m/s during five conditions; control, 1 strapped rucksack, 2 strapped rucksack, ipsilateral shoulder strap and contralateral shoulder strap, each containing 10% bodyweight. Electromyography for the Trapezius, erector spinae and latissimus dorsi was recorded for the last 30s of each condition. Two-way ANOVA and paired t-tests were used to identify differences between right and left muscles and between bag conditions. Results showed that muscle activity of the left Trapezius was significantly higher than the right Trapezius during the 1 strap rucksack condition. For the left Trapezius, the 2 strapped rucksack and the control condition had significantly lower muscle activity compared to the 1 strapped rucksack and the ipsilateral shoulder strap. For the left erector spinae muscle, there was significantly greater muscle activity when wearing the contralateral shoulder strap compared to the control. For the right erector spinae, significantly lower muscle activity was observed when wearing the 2 strapped rucksack compared to the ipsilateral shoulder strap and contralateral shoulder strap. There were no significant differences in muscle activity of the latissimus dorsi muscles between any of the bag conditions. These findings suggest that a two strapped rucksack should be used when carrying loads to reduce spinal muscle activity which may in turn reduce reports of back pain in female students. This study is in accordance with the current study as its context involves about the unilateral strap bag loading & the changes in the musculoskeletal system. 788 Aminu. A. Ibrahim et al (2015) (30) :-Study was done to investigate the prevalence of musculoskeletal discomforts in various regions of the body due to bag use and to examine its association with certain perceived correlates. Procedure was this was a cross-sectional analytic study conducted among 500 participants of SRM University in Chennai, India. Data on bag use were collected using a self-administered questionnaire and discomforts using the Nordic musculoskeletal questionnaire. Results were a high percentage of respondents about 82.2% reported discomforts. Prevalence of discomforts in neck were 48.6%, shoulder 61.2%, elbow 11.8%, wrist/hand 14.2%, upper back 38.2%, lower back 29%, hips/thigh 19%, knee 17.2%, and ankle 16.6%. The average bag weight carried was 3.7kg about 6.5% respectively. Gender was associated with shoulder, elbow and hip/thigh discomforts with females being more likely to suffer discomforts than males. Body mass index (BMI) was associated with occurrence of knee and ankle/feet discomforts. Relative bag weight was associated with shoulder and low back discomforts. While frequency of schoolbag carriage was associated with ankle or feet discomforts. There was no association between manner of bag carriage, duration of bag carriage and discomforts. Majority of the respondents 72.1% perceived their bag weight as being normal and also 75.2% aware of the potential consequences of incorrect carriage of bag. This study is in context of the current study, so as taken as reference.

Rebecca Hardie et al (2015)
Phonpichit et al (2016) (31) :-Study was done to investigate the optimal weight for carrying a handbag in different ways. Procedure was this study involved 13 healthy females randomized into four carrying patterns such as no load, bag weight of 5% body weight, 7% body weight, 10% body weight, who were walking barefoot on the platform at a preferable speed. The centre of pressure was collected by the platform. In observation, the centre of pressure was towards the carrying side when carrying a greater load. Results were asymmetrical activities of the upper trapezius and erector spinae were shown. The discomfort areas were the right upper trapezius and right finger flexor muscles. Conclusion was continuously carrying a handbag greater than 10% body weight can cause musculoskeletal problems. The study is in context with the current study, about handbag load & changes in the musculoskeletal system, so as taken as reference.
Farshad Arghavani et al (2014) (32) :-Study was done to identify the risk factors associated with musculoskeletal disorders by comparing the prevalence of musculoskeletal pains among the students while carrying heavy bags. Procedure was 800 students marked their painful areas on body maps. Results were 54.1% female, 45.9% male. 48.9% weight on both shoulders.40.4% on their right shoulder. 10.6% on their left shoulder. 68.02% often had pain on their right. While 31.98% had pain on their left side.10.8% never felt pain, 42.3% rarely felt pain, 32.3% mostly and 14.5% always had pain. This study proves that there was greater pain on unilateral loading, so the current study is in context with this study.
Rina Koshi et al (2014) (33) :-Study was to investigate the prevalence of neck, shoulder and back pain in students using bags. A co-relational research was conducted in Mangalore which included 580 students. Procedure was their bag weight, body weight and height were measured and the subjects having pain either in the neck, shoulder or back were given McGill Melzack pain questionnaire to be filled. Results were, Descriptive analysis revealed that the percentage of bag weight on body weight ratio is more in females compared to males. 6.03% of subjects carried bag weight weighing more than 15%, out of which 8.57% subjects complained of pain either in the neck, shoulder or back. The correlation between bag weight and pain was analyzed using Karl Pearson"s correlation which is perfect positive. Analysis of correlation between BMI with percentage of bag weight in males is more compared to females. The prevalence of students having pain was 2.93% due to bags. This study is similar in context of the current study, so taken as reference.
Linton et al (2003) (34) :-Study was done to test the predictive utility of Orebro Musculoskeletal Pain Questionnaire(OMPQ) in identifying patient at risk for developing persistent musculoskeletal pains/problems. Procedure was, 107 participants were taken from primary care units and were given questionnaire to complete. Their cases were followed for 6 months to assess outcome with regard to pain, Function and Absenteeism due to sickness. Results shows that 68% classified into one of the 3 groups, 81% classified under category of pain, whereas 71% classified into other two groups. From total score, cutoff score of 90 points had a sensitivity of 89% & specificity of 65% for absenteeism due to sickness. Whereas sensitivity of 74%, specificity of 79% for functional ability. In Conclusion the results are indicating that OMPQ is a clinically reliable & valid instrument. The total score was a good predictor of future absenteeism due to sickness as well as function & pain. This screening instrument is found to have satisfactory test-retest reliability(0.83) & validity in a study of 142 patients. Using a cutoff score of 105, the specificity was found to be (0.75) & sensitivity (0.88). A cutoff score of 112 correctly identified 80% of patients 789 failing to return to work. This study helps in the current study"s outcome result & its significance, so taken as reference.
Westman et al(2008) (35) :-Study was done to validate the OMPQ for patients with Non Acute pain problems(e.g. : 1-6mnths sick leave) & compare to other relevant questionnaires. And also for the early identification & intervention with those that run the risk of developing long term disability associated with long term work absenteeism. Method was, 158 patients with musculoskeletal pain & disability recruited to a multidisciplinary rehab project and at 3yrs follow up visits. Results obtained as, the OMPQ predicted future sick leave, health & was found to have six factors. Conclusion was, the OMPQ was a good predictor of outcome and has been used & validated in several studies for participants with mainly non acute problems. This study is helpful for the current study in outcome result & its significance, so taken as reference.

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Potential respondents were registered students of Oxford Educational Institutions and were approached in their lecture theatres or classes after a prior informed consent was obtained from the college authorities and ethical approval obtained from the research ethical committee of oxford educational institutions. Informed consent was obtained from the participants after explaining the procedure and benefits of the study to avoid any bias. They were ensured that confidentiality of the data would be maintained.
The handbag weight, body weight and height of the participants were then collected. A standard scale was used to measure the handbags (Digital luggage weighing scale), body weight is measured through Digital weighing scale and height through Inch tape. Using this data, BMI was computed in kg/m 2 and the relative handbag weight was estimated as a percentage of the student body weight. 2 Questionnaires were administered on the respondents in this study. The 2 nd questionnaire was developed by Linton & Boersma. The questionnaire is the most popular survey tool for detecting Musculoskeletal disorders(MSDs) & was previously used previously in related studies. Data on MSDs was collected using this prevalidated questionnaire OMPQ(Orebro Musculoskeletal Pain Questionnaire). It predicts longterm disability and failure to return to work when completed 4 to 12 weeks following a soft tissue injury. A cut-off score of 105 has been found to predict those who will recover with 95% accuracy, those who will have no further sick leave in the next 6 months with 81% accuracy, those who will have long-term sick leave with 67% accuracy & A cut-off score of 130 correctly predicted 86% of those who failed to return to work.
The respondents were asked to answer the questionnaire appropriately if they had experienced any pain or discomfort in the last 1 month to 1yr in different parts of the body such as neck, shoulder, upper limbs, upper & lower back, and lower limbs due to heavy bag usage. The questionnaire was explained keeping in mind other factors that can lead to MSDs. The purpose of the questionnaire and how it should be answered was explained.
The questionnaire was pretested using a convenience sample of 10 students from the Faculty of Physiotherapy to improve comprehensibility and clarity of the questions and instructions. In addition potential problems with item interpretation were identified and resolved. The questionnaires were distributed and collected at the spot after filling up.
The data thus obtained was then subjected to statistical analysis using MS Excel in order to determine the prevalence of musculoskeletal pain in college going students due to the weight of handbags and to find out the relation between BMI and percentage of bag weight of subjects with pain. For analysis, results were presented as Mean, Range, Standard Deviation for Quantitative variables and were summarized by absolute Frequencies and Percentages for Categorical variables. P values of 0.05 or less were considered statistically significant.

Results & Statistical Analysis:-
Out of 120 students participated in the study, 100 students had musculoskeletal pains. The statistical results of the baseline characteristics of participants are shown in the table below, where N represents the no. of samples.  ) 100 BMI was calculated by percentages to find out the prevalence in the students in which underweight <18 were(14%), normal weight 18-24(69%), overweight 25-29(13%), obese >30(4%). The results were shown through the graph given below.

Graph 1 :-BMI Categories & Percentages of Subjects
According to the obtained results, overall prevalence of pain in the musculoskeletal system in last 1 month was 83.3% and others did not report any similar pain due to bag. The most severe pain is reported in the Neck(25%) followed by Low back pain(23%), Shoulder pain(21%) & Upper back pain(19%), whereas least pain reported in the Leg pain(8%) & Arm pain(4%) respectively. These results are statistically shown through Percentages to find out the prevalence in the students in the chart/graph below.

Graph 2 :-Pain Regions & Percentages of samples
The girls 34% carried their handbag with overall average weight of 3kg(3.29±1.12). The remaining bag weight and the percentage of samples carrying the loads were represented through the graph/chart mentioned below.

Discussion:-
Determining the prevalence of musculoskeletal disorders is the first step in the prevention, diagnosis and treatment of the MSDs in adolescents and even adults. The purpose of this study was to determine the prevalence of musculoskeletal pain and its relation to the BMI of college girls those who are using heavy handbags. According to this study a significant relationship between Bag weight, Pain, BMI & Carrying duration was seen(p <0.005). In a study by Yue et al which has examined the association between demographic factors including Age, Height, BMI with the prevalence of musculoskeletal pain, a significant relationship between the above factors was observed. Likewise in another study by Azuan & colleagues, a significant correlation of BMI, Weight of the bag, students Height with musculoskeletal pain was seen too.

Conclusion:-
Musculoskeletal discomfort/pain was reported among students of oxford educational institutions with overall prevalence of 83.3%. This study discovered a high prevalence of Musculoskeletal pain with Bag weight & Carrying duration, found to be predictors of discomforts. In most cases, this pain doesn"t come from any particular illness/discomfort. It should be used more double strap bags than other type of single strap bags. Handbags have fewer consequences. Students are recommended not to use bags more than 20mins. In case they use handbags & shoulder bags, they better use them alternatively on both shoulders. Accordingly more and comprehensive studies in this field are needed for the future. Future studies should explore more factors related to handbag use and investigate their long-term effect and association with MSDs or pain since musculoskeletal symptoms have multi factorial origin. This will help to formulate a better treatment plan for patients with all the musculoskeletal pains, mainly the shoulder and neck pains. Procedure: I have been explained that this study is conducted without any interventions. The study involves 120 participants. Risk and discomfort : I know there are no risks involved in participating in the study. If I feel any discomfort during intervention period Indu Priya. G will take appropriate care to safeguard the welfare and best interests of the subjects. Benefits: This study will help to inform the subjects about the Effects of Heavy Handbags on Musculoskeletal system and Pain caused by it in relation with their BMI. The information so obtained shall provide insight into further research for establishment of data in context to Indian population. The current study data shall provide guidance for physical therapists to plan a better patient specified treatment for multiple body pains/discomforts. This study will not provide any direct benefit to me. Confidentiality: I understand that the medical information produced by this study will be confidential. Apart from the investigator no one will ever access to the data without my consent. If the data are used for the publication in the medical literature or for teaching purpose no name will be used. Photography consent document: I…………………………… have been explained by Indu Priya. G, that photograph are required in order to illustrate various aspect of the study for the thesis and other article, and at presentation and conference. These images may also be converted to electronic format for use in multimedia presentation and document accessible to other by computer for the purpose of sharing the result of the study and for promoting this research. By giving my consent I authorize her to use any of the photographs taken in printed format, in slides for presentation, and in electronic format. If the photograph is use the face will be taped to prevent identification. Request for more information: I understand that I am encouraged to discuss any concerns regarding this study at any time. Indu Priya. G is available to answer my question to the best of her knowledge. A copy of this consent form will be given to me for my careful reading. Refusal or withdrawal of participation:: I understand that my participation is voluntary and I may withdraw consent and discontinue participation any time without fear of prejudice. My decision whether or not to participate will not affect relationship with any agency, health care provider, etc. I also understand that she may terminate my participation in the study after she has explained the reason for doing so. Non commercialization: The data collected will not be distributed for monetary benefit. Investigator:
(10 -X) 0 1 2 3 4 5 6 7 8 9 10 Can"t decrease it at all Can decrease it completely 12. How tense or anxious have you felt in the past week? Circle one. 0 1 2 3 4 5 6 7 8 9 10 Absolutely calm and relaxed As tense and anxious as I"ve ever felt 13. How much have you been bothered by feeling depressed in the past week? Circle one. 0 1 2 3 4 5 6 7 8 9 10 Not at all Extremely 14. In your view, how large is the risk that your current pain may become persistent? Circle one. 0 1 2 3 4 5 6 7 8 9 10 No risk Very large risk 15. In your estimation, what are the chances that you will be able to work in six months? Circle one. (10x) 0 1 2 3 4 5 6 7 8 9 10 No chance Very large chance 16. If you take into consideration your work routines, management, salary, promotion possibilities and work mates, how satisfied are you with your job? Circle one. Can"t do it because of pain problem Can do it without pain being a problem 21. I can walk for an hour.
(10x) 0 1 2 3 4 5 6 7 8 9 10 Can"t do it because of pain problem Can do it without pain being a problem 22. I can do ordinary household chores.
(10x) 0 1 2 3 4 5 6 7 8 9 10 Can"t do it because of pain problem Can do it without pain being a problem 23. I can do the weekly shopping.
(10x) 0 1 2 3 4 5 6 7 8 9 10 Can"t do it because of pain problem Can do it without pain being a problem 24. I can sleep at night.