Text neck: An adverse postural phenomenon

Impact of structural factors around the accessory nerve on the pathogenesis of essential neck and upper-back stiffness: a sonographic investigation

INTRODUCTION

Neck and upper-back stiffness involves discomfort/ache in the trapezius muscle (TM). The pathogenesis of 'essential neck and upper-back stiffness' without obvious causes remains uncertain. In symptomatic subjects, TM hardness correlates with decreased transverse cervical artery (TCA) blood flow to the TM. Neck and upper-back stiffness could be associated with both hemodynamic and neurological factors affecting the TM. We therefore sonographically evaluated structural factors around the accessory nerve innervating the TM impacting neck and upper-back stiffness.

METHODS

Participants comprised 69 healthy young adults (33 men, 36 women; 21 ± 1 y) who completed questionnaires and underwent elastography to determine TM hardness as a strain ratio and pulsed Doppler sonography to determine TCA hemodynamics. Intermuscular length was measured as the distance between sternocleidomastoid and levator scapulae muscles around the accessory nerve. Relationships of intermuscular length with symptoms, TM hardness, and TCA hemodynamics were analyzed.

RESULTS

Intermuscular length was greater in symptomatic subjects (median 2.3 mm, interquartile range 1.5-3.1 mm) than in asymptomatic subjects (median 1.8 mm, interquartile range 1.5-2.3 mm; p = 0.032). Intermuscular length correlated positively with symptom severity (r = 0.43, p = 0.014) and negatively with strain ratio for the TM (r = -0.39, p = 0.025) and peak systolic velocity in the TCA (r = -0.40, p = 0.022). Intermuscular length contributed independently to the presence of symptoms (p = 0.025, odds ratio 2.26, 95% confidence interval 1.11-4.62).

CONCLUSION

In symptomatic subjects, symptom severity, TM hardness and TCA hemodynamics all correlated with greater intermuscular length. Structures around the accessory nerve could be associated with the pathogenesis of essential neck and upper-back stiffness.

Correlation between sagittal balance and thoracolumbar elastic energy parameters in 42 spines subject to spondylolisthesis or spinal stenosis and 21 normal spines

The curvature of the lumbar spine plays a critical role in maintaining spinal function, stability, weight distribution, and load transfer. We have developed a mathematical model of the lumbar spine curve by introducing a novel mechanism: minimization of the elastic bending energy of the spine with respect to two biomechanical parameters: dimensionless lumbosacral spinal curvature c LS and dimensionless curvature increment along the spine CI. While most of the biomechanical studies focus on a particular segment of the spine, the distinction of the presented model is that it describes the shape of the thoracolumbar spine by considering it as a whole (non-locally) and thus includes interactions between the different spinal levels in a holistic approach. From radiographs, we have assessed standard geometrical parameters: lumbar lordosis LL, pelvic incidence PI, pelvic tilt PT, sacral slope ψ0 and sagittal balance parameter SB = sagittal vertical axis (SVA)/sacrum-bicoxofemoral distance (SFD) of 42 patients with lumbar spinal stenosis (SS) or degenerative spondylolisthesis (SL) and 21 radiologically normal subjects. SB statistically significantly correlated with model parameters c L5 (r = -0.34, p = 0.009) and -CI (r = 0.33, p = 0.012) but not with standard geometrical parameters. A statistically significant difference with sufficient statistical power between the patients and the normal groups was obtained for c LS, CI, and SB but not for standard geometrical parameters. The model provides a possibility to predict changes in the thoracolumbar spine shape in surgery planning and in assessment of different spine pathologies.

Comparing repeated end range movements and Kinesio taping effects on head and neck movement pattern and discomfort in smartphone users

INTRODUCTION

Using smartphones has increased exponentially, especially after the COVID-19 pandemic. However, there is a relationship between neck flexion angle during working with a smartphone and neck musculoskeletal disorders. Therefore, this study compares the effect of Kinesio taping and Repeated End Range Movements (RERM) on head and neck flexion angles changes during texting and discomfort after texting with a smartphone.

METHOD

Twenty-four smartphone users participated in this cross-over study. All of 24 subjects were experimented with the control, RERM and taping conditions. They filled Numeric Rating Scale questionnaire before and after 30 min of texting. In addition, their head and neck flexion angles were measured during the task by photogrammetry.

RESULTS

In the RERM group, individuals felt significantly less discomfort than the control group after the task (P = 0.032). Although the slope of average head and neck flexion angles linear regression lines of all the three groups was positive before the break time, it became negative in the taping and control groups after the break time. In addition, the linear regression of average head and neck flexion angles of the RERM group was significantly different (P < 0.001).

CONCLUSION

RERM can effectively maintain normal head and neck movement pattern during and reduce neck discomfort after texting on smartphone.

Influence of Sagittal Cervical and Thoracic Range of Motion on Neck Pain Severity in Young White-Collar Workers: A Cross-Sectional Study

Background: Neck pain (NP) is a prevalent musculoskeletal disorder, especially among individuals with sedentary occupations. The interplay between cervical and thoracic spine mobility is hypothesized to contribute significantly to NP severity, yet this relationship requires further exploration. Methods: This cross-sectional study involved 179 young white-collar workers with NP lasting for at least six weeks. Participants were stratified into mild (n = 78) and moderate (n = 101) pain groups based on their scores on the Northwick Park Neck Pain Questionnaire (NPQ). Cervical and thoracic range of motion (ROM) in the sagittal plane was measured using inclinometers. NP severity was further assessed using the NPQ and the Neck Disability Index (NDI). Correlation, regression, and mediation analyses were conducted to investigate the relationship between cervical and thoracic ROM and NP severity. Results: Thoracic ROM was higher in the mild pain group (median: 47.35, IQR: 10.13) than in the moderate pain group (median: 42.10, IQR: 13.60; p < 0.001). The NDI had a negative correlation with thoracic ROM (r = -0.65; p < 0.05) and a positive correlation with cervical ROM (r = 0.84; p < 0.01). Additionally, thoracic ROM mediated the effect of cervical ROM on NP, particularly influencing NDI scores (p < 0.01). Conclusions: This study found a significant association between reduced thoracic ROM and increased NP severity, highlighting the role of thoracic spine mobility in NP among young white-collar workers. Targeted interventions for thoracic dysfunction may reduce compensatory cervical strain and improve NP management, suggesting that thoracic spine assessments should be integrated into routine clinical evaluations.

Assessing the Impact of Smartphone Use on Neck Pain and Related Symptoms Among Residents in Jeddah, Saudi Arabia: A Cross-Sectional Study

BACKGROUND

The widespread adoption of smartphones has transformed global communication but raised health concerns like Text Neck Syndrome - a musculoskeletal condition arising from prolonged device use, causing discomfort in the cervical spine. This study investigates its prevalence and associated factors among smartphone users in Jeddah, Saudi Arabia, focusing on usage patterns, symptoms, and awareness.

METHODS

This cross-sectional online survey was conducted from June 1 to June 30, 2024. Data on demographics, smartphone habits, symptoms, and Text Neck Syndrome awareness were collected using a structured questionnaire. Statistical analysis involved descriptive statistics and chi-square tests.

RESULTS

The study included 421 participants, predominantly female (279, 66.3%) and Saudi nationals (397, 94.3%). The largest age group was 21-40 years (308, 73.2%), and most were single (251, 59.6%) with a college degree (236, 56.1%). Over 42.0% of participants used smartphones for more than five hours daily, with 39.4% adopting a 30-degree neck posture. The most prevalent symptoms reported were neck pain (272, 64.6%), headaches (203, 48.2%), and shoulder pain (178, 42.3%). Awareness of Text Neck Syndrome was reported by 197 participants (46.8%), but only 60 (14.3%) had been diagnosed. Concerns about long-term complications such as osteoporosis (105, 24.9%) and prolapsed intervertebral disc (120, 28.5%) were expressed. Despite these concerns, 97.9% of participants hesitated to reduce smartphone usage due to reported symptoms.

CONCLUSION

This study highlights the significant musculoskeletal impact of smartphone use in Jeddah, underscoring the need for interventions promoting ergonomic practices and increasing awareness about associated risks. Public health strategies should focus on promoting ergonomic practices and educating users about preventive measures.

Close relationships between neck and upper-back stiffness and transverse cervical artery flow velocity

PURPOSE

Neck and upper-back stiffness is encountered in daily life, with symptoms appearing as dullness or aches predominantly in the trapezius muscle (TM). Our previous study demonstrated that TM hardness as measured with a muscle hardness meter correlates well with transverse cervical artery (TCA) flow supplying the TM. Muscle hardness meters, however, cannot measure hardness in the TM alone. Meanwhile, recent advances in ultrasound elastography have enabled the evaluation of localized hardness in targeted tissues. The present study, therefore, aimed to clarify the relationship between TM hardness as measured by elastography and TCA hemodynamics as measured on Doppler sonography, with reference to daily symptoms of upper-back stiffness.

METHODS

The study population comprised 66 healthy young adults (32 males, 34 females; mean age, 21 ± 1 years). Relationships were evaluated between TM hardness as a negative correlate of strain ratio from elastography and TCA hemodynamics on Doppler sonography. Hemodynamics in the TCA were evaluated according to the frequency of neck and upper-back stiffness.

RESULTS

TM strain ratio correlated with peak systolic velocity (PSV) in the TCA (r = 0.273, p = 0.036), particularly in symptomatic subjects (r = 0.417, p = 0.022). PSV in the TCA decreased with increasing frequency of daily symptoms (p = 0.045).

CONCLUSION

TCA hemodynamics correlated with muscle hardness when evaluating localized TM hardness. This relationship and low PSV in the TCA were evident in symptomatic subjects. These results suggest that PSV in the TCA is associated with neck and upper-back stiffness.

Association between Smartphone Addiction and Breathing Pattern in Sedentary Young College-Going Students - A Cross-Sectional Study

BACKGROUND

The number of smartphone users has progressively increased worldwide. Altered biomechanics of the cervicothoracic spine and ribcage could limit the chest wall function that affects the respiratory muscles strength, reducing diaphragm function in smartphone users. This study aimed to compare breathing patterns between smartphone-addicted and -nonaddicted user groups.

OBJECTIVE

To find the association between excessive smartphone use and breathing pattern in sedentary young college-going students.

MATERIALS AND METHODS

This cross-sectional study includes 230 participants. The participants were screened for the inclusion and exclusion criteria and were asked to fill out a Smartphone Addiction Scale questionnaire. These breathing patterns were then assessed by self-evaluation of breathing questionnaire (SEBQ), manual assessment of respiratory motion (MARM), breath-holding test, and capnography.

RESULTS

The correlation of smartphone-addicted and -nonaddicted groups with breathing patterns was performed by Spearman rank correlation. Results show no significant association between the smartphone-nonaddicted and -addicted users.

CONCLUSION

This study concluded that excessive smartphone use and breathing patterns are not associated.

Effects of error rates and target sizes on neck and shoulder biomechanical loads during augmented reality interactions

Augmented reality (AR) interactions have been associated with increased biomechanical loads on the neck and shoulders. To provide a better understanding of the factors that may impact such biomechanical loads, this repeated-measures laboratory study evaluated the effects of error rates and target sizes on neck and shoulder biomechanical loads during two standardized AR tasks (omni-directional pointing and cube placing). Twenty participants performed the two AR tasks with different error rates and target sizes. During the tasks, angles, moments, and muscle activity in the neck and shoulders were measured. The results showed that the target sizes and error rates significantly affected angles, moments, and muscle activity in the neck and shoulder regions. Specifically, the presence of errors increased neck extension, shoulder flexion angles and associated moments. Muscle activity in the neck (splenius capitis) and shoulder (anterior and medial deltoids) also increased when the errors were introduced. Moreover, interacting with larger targets resulted in greater neck extension moments and shoulder abduction angles along with higher muscle activity in the splenius capitis and upper trapezius muscles. These findings indicate the importance of reducing errors and incorporating appropriate target sizes in the AR interfaces to minimize risks of musculoskeletal discomfort and injuries in the neck and shoulders.

Defining text neck: a scoping review

BACKGROUND

Text neck is regarded as a global epidemic. Yet, there is a lack of consensus concerning the definitions of text neck which challenges researchers and clinicians alike.

PURPOSE

To investigate how text neck is defined in peer-reviewed articles.

METHODS

We conducted a scoping review to identify all articles using the terms "text neck" or "tech neck." Embase, Medline, CINAHL, PubMed and Web of Science were searched from inception to 30 April 2022. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMAScR) guidelines. No limitation was applied for language or study design. Data extraction included study characteristics and the primary outcome relating to text neck definitions.

RESULTS

Forty-one articles were included. Text neck definitions varied across studies. The most frequent components of definitions were grouped into five basis for definition: Posture (n = 38; 92.7%), with qualifying adjectives meaning incorrect posture (n = 23; 56.1%) and posture without a qualifying adjective (n = 15; 36.6%); Overuse (n = 26; 63.4%); Mechanical stress or tensions (n = 17; 41.4%); Musculoskeletal symptoms (n = 15; 36.6%) and; Tissue damage (n = 7; 17.1%).

CONCLUSION

This study showed that posture is the defining characteristic of text neck in the academic literature. For research purposes, it seems that text neck is a habit of texting on the smartphone in a flexed neck position. Since there is no scientific evidence linking text neck with neck pain regardless of the definition used, adjectives like inappropriate or incorrect should be avoided when intended to qualify posture.

Back Pain and Body Posture Evaluation Instrument for Adults (BackPEI-A): Updating and an online application

INTRODUCTION

Back Pain and Body Posture Evaluation Instrument for Adults (BackPEI-A) lags the most recent literature, as it does not assess issues related to activity increasingly present in the daily lives of people of all ages.

PURPOSE

(1) to update the BackPEI-A by including four new questions regarding the use of mobile devices; (2) to present a new graphic design of the issues related to back and neck pain to facilitate understanding of the location of these pains; (3) to test the content validity and the reliability of the new questions; and (4) to identify whether the BackPEI-A version in online form has adequate reliability.

METHODS

The content validation by evaluation of eight experts, and the reliability of the new questions and of the online version were assessed. The new questions were translated to English. Content validation was assessed by the content validity index (CVI). Reliability was assessed using the agreement percentage (%C), the kappa statistic (k), and the intraclass correlation coefficient (ICC). k > 0.4 and %C > 0.5 were assumed to include new questions.

RESULTS

The new questions showed good agreement among the experts, k > 0.4 and %C > 0.5. Both forms applied presented an average kappa of total sample ranging from moderate to good, and moderate ICC values, showing an adequate reliability.

CONCLUSION

The updated BackPEI-A is valid and reliable and allows the identification of aspects related to back and neck pain, as well as possible risk factors.

Pediatric Text Neck Syndrome

Text neck syndrome is a growing concern in the pediatric population due to the increased use of mobile devices and screens, potentially leading to long-lasting musculoskeletal issues. This case report presents a six-year-old boy with a one-month history of cephalgia and cervicalgia, who initially received insufficient care. After nine months of chiropractic intervention, the patient reported significant improvements in pain relief, neck mobility, and neurological symptoms, supported by radiographic findings. This report emphasizes the importance of early recognition and intervention in pediatric patients, as well as the role of ergonomics, exercise, and proper smartphone usage habits in preventing text neck and maintaining spinal health.

Neck and Upper Extremity Musculoskeletal Symptoms Secondary to Maladaptive Postures Caused by Cell Phones and Backpacks in School-Aged Children and Adolescents

Technology is an essential part of our lives. Nowadays, it is almost impossible to leave the house without a cell phone. Despite the wide range of benefits of cell phones and handheld electronic devices, this evolution of technology has not come without a price. The pandemic of cell phone use among children and young adolescents has led to the emergence of a set of musculoskeletal (MSK) symptoms that have not been seen before in this age group. These symptoms can range from neck and shoulder discomfort to pain, peripheral neurological symptoms of the upper extremity, and long-term complications such as disk prolapse and degenerative disk disease of the cervical spine. This clinical presentation is known as “text neck syndrome.” In addition to MSK symptoms, text neck syndrome could also include eye and ear symptoms, psychological problems, peripheral neurological symptoms, and poor academic performance. Multiple mechanisms have been discussed by which cell phone use causes MSK symptoms. Maladaptive postures, a decrease in physical activity leading to obesity, and the direct effect of electromagnetic radiation are some of the mechanisms by which long-term use of cell phones leads to the clinical presentation of text neck syndrome and its long-term consequences. The purpose of this article is to review the literature, discuss the epidemiology of cell phone use and MSK symptoms associated with its use in children and adolescents, describe its clinical presentation, explain the pathophysiology behind it, and provide preventative guidelines that can be used by this age group to allow for the continued use of these electronics without harmful effects on their posture and long-term health.

The eSports Medicine: Pre-Participation Screening and Injuries Management-An Update

Recently, electronic sports (eSports) became one of the growing forms of new media due to the wide diffusion of games and online technologies. Even if there is still a debate about the definition and characterization of eSports, eAthletes train heavily, compete in tournaments, must abide by competition, association, and governing body rules, just like all other athletes. Furthermore, as in any other competitive discipline, there can be injuries. Aberrant sitting posture, repetitive movements, screen vision, prolonged playing hours, and a sedentary lifestyle can lead to several medical hazards in musculoskeletal, ophthalmology, neurological, and metabolic systems. Moreover, several cardiovascular changes occur in eAthletes. This paper aims to explore the different injuries that can occur in a professional eAthlete, suggesting how every high-level gamer could benefit from a pre-participation evaluation and a correct injury prevention strategy.

Relationship between musculoskeletal discomfort and cell phone use among young adults: A cross-sectional survey

BACKGROUND

Cell phone usage is highly prevalent among young adults. They are used for multiple purposes including communication, studies, social networking and entertainment. However, its excessive usage has been associated with adverse health outcomes.

OBJECTIVE

The objective was to find the association of cell phone usage with musculoskeletal discomfort (MSD) and its associated factors.

METHODS

A cross-sectional study was conducted on young adult students from a low-middle income country over a period of 3 months from December 2018 to February 2019. A structured questionnaire based on the Disabilities of the Arm, Shoulder and Hand (QuickDASH scoring) was used to record the musculoskeletal discomfort.

RESULTS

Out of 803 questionnaires, data of 754 (94%) were entered and the remaining questionnaires (n = 49) were discarded due to incomplete answers. The mean age was 20.83 (1.62) years. In our study, there were 194 (25.7%) males and 560 (74.3%) female participants. Neck and shoulder were the most frequently affected regions. A significant difference in QuickDASH score was observed between genders (p-value p ≤ 0.001). Left-handed individuals scored significantly higher on QuickDASH score compared to right-handed individuals (p < 0.05). Increased musculoskeletal discomfort was reported by individuals with daily cell phone use of more than four hours (p < 0.05). A positive significant correlation was found between continuous one hour cell-phone use and higher mean QuickDASH scores (correlation coefficient 0.124, p value 0.001). Shorter eye-to-screen distance was significantly associated with MSD (p < 0.05).

CONCLUSION

Musculoskeletal discomfort is associated with the female gender, duration of cell phone use and a small eye-to-screen distance.

Influence of the Text Neck Posture on the Static Dental Occlusion

Background and Objectives: The excessive use of smartphones for various tasks led to a new adverse postural phenomenon called text neck. The aim of this study was to investigate the effect of the text neck posture (TNP) on static occlusion by using the T-Scan III occlusal diagnostic system. Materials and Methods: Nineteen subjects (aged 20 to 24 years) were considered for this research. They had normal values for anterior overbite and overjet, Angle Class I occlusion, no posterior crossbite, and no signs or symptoms of cervical or temporo-mandibular disorders. Occlusal registrations were performed with the T-Scan III system in a normal, neutral head posture (NHP), as well as in the TNP. The investigated parameters were: occlusion time (OT), asymmetry index of the occlusal force (AOF), percent of the maximum movie force (%MMF), and the time elapsed from the last occlusal contact until the maximum intercuspation (MAT-OTB). The last three parameters were analyzed in the maximum area frame (MA) of the registrations. For the statistical analysis of the recorded data, the Wilcoxon Signed Ranks test and the Spearman’s correlation coefficient were used. Results: The following values were obtained in NHP and in TNP: for AOF, 14.88 ± 10.39% and 18.04 ± 12.83%, respectively; for OT, 1.34 ± 1.84 s and 1.32 ± 1.8 s, respectively; for the %MMF, 97.5 ± 2.83% and 96.31 ± 3.17%, respectively; for MAT-OTB, 2.08 ± 1.82 s and 1.45 ± 2.3 s, respectively. There were no statistically significant differences between the static occlusal parameters measured in NHP and those in TNP. However, the high values of the AOF and OT in NHP revealed an imbalance of the occlusal force distribution between the right and left side in maximum intercuspation (MI), as well as a lack of simultaneity of static occlusal contacts. Furthermore, there was a significant, direct, and strong correlation between OT and AOF in NHP. Conclusions: The NHP should not be used as the starting position in TNP simulations in T-Scan studies, so as to avoid statistically insignificant differences between static occlusion in NHP and TNP. The healthy standing subjects, with normal occlusal relationships from the clinical point of view, revealed an occlusal instability in NHP when examined with the T-Scan.

Virtual and augmented reality and other ICT at work: Differences in self-assessed technological characteristics and perceived digital stress

BACKGROUND: A main goal in the advancing digitalization is to offer employees support in coping with large amounts of information and to process it context-sensitively and according to their needs. Augmented reality (AR) as an emerging technology has great potential in this regard. OBJECTIVES: The aim of this work is to generally highlight the strengths and weaknesses of various technologies and in particular to point out the potential of AR-based technologies. METHOD: A comparison of different technologies by assessing various technology characteristics and the level of digital stress caused by the use of these technologies was conducted based on survey data. RESULTS: The results of the conducted study show that technologies such as stationary PC, laptop or smartphone are assessed better in terms of various technology characteristics than AR. Furthermore, digitally induced stress is reported when using AR. CONCLUSION: AR as a mobile digital assistance system still seems to fall short of its potential for human-centered work design. One reason for this may be the low degree of popularity of AR and the not fully developed technological maturity.

Preventing the progression of text neck in a young man: A case report

Text neck describes an overuse injury of the cervical spine resulting from the repetitive stress of prolonged forward head flexion while looking down on a mobile screen. This case report describes a 24-year-old young man who presented with a 12-month history of head and neck pain and paresthesia of the right upper limb. The patient worked as a YouTuber and has been editing and posting videos on the website for three years. One year prior to referral for chiropractic assessment, the patient first visited his family physician for similar complaints. Based on cervical radiographs, the diagnosis of cervical spondylosis was given. Previous management included pain medication and muscle relaxants. Interventions included repeated physical therapy, cervical traction, and acupuncture, with some temporary relief during the subsequent year. However, severe flare-up of the symptoms occurred, which was brought about by working for extended periods on his smartphone, for which the patient sought chiropractic attention. X-ray imaging showed cervical kyphosis with C5 vertebral rotation, hypertonicity of the paraspinal muscles, and paresthesia in the right C6 dermatome distribution, which were consistent with text neck syndrome associated with cervical spondylosis and right C6 radiculopathy. The intervention consisted of improving posture while texting, cervical manipulation, and extension traction therapy. After 9 months of treatment sessions, the symptomatic and functional improvement was reflected by the radiographic changes in the cervical curve correction and the normalized paraspinal muscle tension on surface electromyology. Frequent breaks along with correct posture while using smartphones will be the key entities to prevent the occurrence of text neck syndrome.

Sedentary behavior is associated with musculoskeletal pain in adolescents: A cross sectional study

BACKGROUND

High prevalence of back pain has been observed in adolescents. Sedentary behavior (SB) is considered a risk factor for musculoskeletal pain. The association between back pain and SB in the pediatric/adolescent population is not well established.

OBJECTIVE

To investigate the association between SB and low back and neck pain in adolescents according to sex.

METHODS

This is a cross-sectional study with children and adolescents aged 10-17 years, randomly recruited from public and private schools in Presidente Prudente, Brazil. All students enrolled in the selected schools were eligible to participate. SB was evaluated by adding the number of hours of use of screen devices, such as television, computer, video game, and smartphone/tablet. To assess neck and low back pain, the Nordic Musculoskeletal Questionnaire was used. Physical activity and socioeconomic status were assessed by the Baecke Questionnaire and the Brazilian Criteria for Economic Classification (ABEP), respectively. Odds ratio (OR) from Binary Logistic Regression in the unadjusted and adjusted model (physical activity, abdominal obesity, and socioeconomic status) showed the relationship between musculoskeletal pain and SB.

RESULTS

A total of 1011 adolescents (557 girls) with a mean ± standard deviation age of 13.2±2.4 years were included. Moderate (OR = 1.80; 95%CI: 1.00, 3.23) and high (OR = 1.91; 95%CI: 1.02, 3.53) SB were associated with neck pain in girls. In boys, moderate SB [OR = 2.75; 95%CI: 1.31, 5.78) were associated with neck pain. Moderate (OR = 2.73; 95%CI: 1.45, 5.02) and high (OR = 2.49; 95%CI: 1.30, 4.76) SB were associated with low back pain only in girls.

CONCLUSION

Moderate and high SB were associated with neck pain in girls and boys, while moderate and high SB were associated with low back pain only in girls.