Association of Study Posture Variability, Backpack Carrying Pattern, Late Night Study Habits, and Study Break Frequency with Musculoskeletal Discomfort and Fatigue Among Students: An Observational Study

Abstract Background: Musculoskeletal discomfort among students has become increasingly prevalent due to prolonged sitting, poor postural habits, and demanding academic schedules. However, limited evidence exists on the combined influence of postural variability, backpack carrying patterns, late night study habits, and break frequency on these outcomes. Objective: This study aimed to investigate the association between study posture variability, backpack carrying patterns, late-night study habits, study break frequency, and musculoskeletal discomfort and fatigue among physiotherapy students. Methods: A cross-sectional observational study was conducted at Devender College of Physiotherapy among 100 students aged 18–25 years over three months (September 2025 to January 2026). Musculoskeletal discomfort was assessed using the Visual Analog Scale (VAS) and Nordic Musculoskeletal Questionnaire (NMQ). Postural analysis employed plumb line assessment, flexible ruler measurements, and digital posture software. Structured questionnaires captured study habits, backpack carrying patterns, and academic workload. Statistical analysis included chi-square tests for categorical associations and Pearson/Spearman correlations for continuous variables. Results: Neck pain (68%) and lower back pain (62%) were the most prevalent complaints. Significant associations emerged between forward head posture and neck discomfort (χ² = 8.94, p = 0.003), slouched posture and lower back pain (χ² = 7.82, p = 0.005), and study duration exceeding six hours with increased fatigue (r = 0.58, p < 0.001). Asymmetrical backpack carrying demonstrated significant association with shoulder pain (χ² = 6.45, p = 0.011). Late-night study habits correlated with elevated discomfort across all regions (r = 0.52, p < 0.001). Students taking breaks every 30–45 minutes reported 34% lower pain intensity compared to those with break intervals exceeding 90 minutes (VAS: 3.2 ± 1.8 versus 5.1 ± 2.3, p < 0.001). Conclusions: Study posture variability, asymmetrical backpack carrying, reduced study break frequency, and late-night study habits independently contributed to musculoskeletal discomfort among students. Implementing ergonomic interventions including structured posture modifications, appropriate backpack management, strategic study scheduling, and frequent microbreaks may significantly reduce symptom prevalence and severity.