Musculoskeletal pain in adolescents: a systematic review of predictive and associated factors

Musculoskeletal (MSK) pain, especially low back pain (LBP), neck and shoulder pain is common among adolescents and imposes substantial health and economic burdens. Understanding predictive factors and factors associated with MSK pain is essential for identifying at-risk adolescents and designing targeted prevention strategies. This systematic review aimed to synthesize evidence on factors associated with or predictive of MSK pain in adolescents, with predictive inferences restricted to evidence from longitudinal studies.

A systematic review was conducted, searching ProQuest, PubMed, Scopus, Web of Science, Psych info for studies published up to May 2025. Eligible studies included prospective and retrospective cohort studies, cross-sectional studies, and case-control studies. All studies examined factors associated with MSK pain in adolescents. Cohort studies were prioritized for examining predictive inferences, whereas cross-sectional studies were presented as supportive associative evidence. Data were extracted on study characteristics, patient profiles, outcomes (prevalence, incidence, severity, disability), predictors and associated factors, and measures of association. Risk of bias was assessed using the Joanna Briggs Institute (JBI). A narrative synthesis was performed due to heterogeneity in study designs and outcomes.

Our database search resulted in 5,556 articles. Out of the 35 full texts that were screened, we included 19 studies (10 prospective cohort studies, 1 retrospective cohort study, 6 cross-sectional studies, and 2 mixed cross-sectional and longitudinal study) involving 45 to 57,408 participants. Predictors and factors associated with MSK pain included anthropometric factors (e.g., height growth, OR:1.32, 95%CI:1.06-1.65), lifestyle behaviors (e.g., smoking, OR:1.69-1.88), clinical conditions (e.g., inflammatory disorders, OR:1.23-1.45; central sensitization, OR:1.02,95%CI:1.01-1.03), socioeconomic factors (e.g., parental illness, OR 0.41-0.48), and pubertal status (OR:1.34-1.61). Motor tests (e.g., sit-up, Sorensen) showed limited predictive performance for low back pain (AUC ≤ 0.760). Cohort studies provided evidence of temporal associations, while cross-sectional studies provided supportive associative evidence.

MSK pain in adolescents is associated with multiple factors, including smoking, inflammatory conditions, and central sensitization. Evidence from longitudinal studies supports some factors as predictive of future pain, whereas cross-sectional studies indicate associations. Lifestyle and psychological factors may contribute to risk, highlighting the potential value of targeted screening and interventions guided by longitudinal evidence. Future research should standardize outcome measures and investigate diverse populations, including low-income settings, to improve the generalizability of findings.