A systematic review of the relationship between sitting and upper quadrant musculoskeletal pain in children and adolescents

Man Ther. 2013 Aug;18(4):281-8. doi: 10.1016/j.math.2012.11.003. Epub 2013 Jan 5.


Background: Upper quadrant musculoskeletal pain (UQMP) is a common health problem in children and adolescents. The upper quadrant refers to the occiput, cervical and upper thoracic spine including the clavicles and scapulae. The current literature, which indicates that sitting, in terms of sedentary activities and sitting spinal posture, is a possible risk factor of UQMP, is controversial. This systematic review is aimed at ascertaining whether there is evidence for sitting as a risk factor for UQMP, and determining the different elements of sitting that are related to UQMP experienced by children and adolescents.

Methods: Six electronic databases, BioMed Central (2007-2011), CINAHL (2007-2011), Proquest (2007-2011), Pubmed (2007-2011), Science Direct (2007-2011) and SCOPUS (1960-2011) were searched. The eligible papers were appraised using a standardised critical appraisal tool, the Critical Appraisal Tool for Quantitative Studies (Law et al., 1998).

Results: Ten papers were eligible for the review. Four papers reported significant positive associations between sitting and UQMP in children and adolescents. Five elements of sitting were identified as relating to UQMP. Those were sitting duration; activities while sitting; activities while sitting and sitting duration; dynamism; and postural angles.

Conclusion: There is unequivocal evidence that sitting and UQMP are related in children and adolescents. End of range postural angles should be considered as possible risk factors and these elements of sitting should be explored in future research.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Age Factors
  • Cervical Vertebrae / physiopathology
  • Child
  • Clavicle / physiopathology
  • Female
  • Humans
  • Male
  • Musculoskeletal Pain / epidemiology
  • Musculoskeletal Pain / physiopathology*
  • Pain Measurement*
  • Posture*
  • Range of Motion, Articular / physiology
  • Scapula / physiopathology
  • Severity of Illness Index
  • Sex Factors
  • Spinal Diseases / epidemiology
  • Spinal Diseases / physiopathology*
  • Thoracic Vertebrae / physiopathology