Investigating the Relationship between Postural Abnormalities and Adolescent Musculoskeletal Pain Through Biostatistical and Orthopedic Approaches: A Cross-Sectional Biostatistical and Orthopedic Investigation

Abstract

The development of postural abnormalities is now identified as a contributor to adolescents' musculoskeletal pain experience, although strong biostatistical evidence to support the association is sparse. This cross-sectional study investigated the relationship between postural abnormalities and musculoskeletal pain among 341 school-going adolescents (180 males, 52.8%; 161 females, 47.2%; mean age 14.25 ± 1.32 years) using a structured 20-item self-administered questionnaire combined with orthopedic assessment frameworks. Association of postural risk indicators with pain outcomes was analyzed using descriptive statistics, Pearson correlation, chi-square tests of independence and binary logistic regression analyses. Forward head posture was the most common postural abnormality (81.5%) and the overall prevalence of musculoskeletal pain was 78.9%, with a mean composite musculoskeletal pain score of 4.27/5. There was a moderate to strong correlation between the composite postural and pain scores (r = 0.646, p < 0.001), and the postural abnormality accounted for 41.7% of the variance in the pain scores (R² = 0.417). Taking the other extreme, high postural abnormality was significantly correlated with high pain classification as detected by Chi-square analysis (χ² = 47.79, p < 0.001). Logistic regression identified forward head posture (OR = 3.84), prolonged static neck posture (OR = 3.12), backpack overload (OR = 2.74), prolonged sitting (OR = 2.41), and hard pillow use/sleep posture (OR = 1.96) as independent predictors of high pain risk, while gender was not significant. These results suggest that postural deformities are modifiable and clinically relevant risk factors for adolescent musculoskeletal pain and justify incorporating early postural assessment, ergonomic education and physical activity programs that focus on postural improvements into school health promotion initiatives.