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Meta-Analysis
. 2025 Mar 3;59(6):409-422.
doi: 10.1136/bjsports-2024-108648.

Does sedentary behaviour cause spinal pain in children and adolescents? A systematic review with meta-analysis

Laura R C Montgomery  1 , Michael Swain  2 , Amabile B Dario  3 , Mary O'Keeffe  4 , Tie P Yamato  3   5 , Jan Hartvigsen  6   7 , Simon French  2 , Christopher Williams  8   9 , Steve Kamper  3   5
Affiliations
Meta-Analysis

Does sedentary behaviour cause spinal pain in children and adolescents? A systematic review with meta-analysis

Laura R C Montgomery et al. Br J Sports Med. .

Abstract

Objective: To evaluate whether sedentary behaviour is a risk or prognostic factor for spinal pain in children and adolescents. Specifically, to estimate the (1) direction and strength of the association; (2) risk of spinal pain onset and (3) effect on spinal pain prognosis.

Design: Systematic review with meta-analysis.

Data sources: Electronic searches of MEDLINE, Embase, CINAHL and Web of Science up to 23 March 2023.

Eligibility criteria for selecting studies: Reports estimating the effect of sedentary behaviour on spinal pain in young people (≤19 years).

Results: We included 129 reports, 14 were longitudinal (n = 8 433) and 115 were cross-sectional (n > 697 590). We incorporated 86 studies into meta-analyses. (1) From cross-sectional data, we found low certainty evidence of a small positive association between sedentary behaviour and spinal pain (adjusted odds ratio 1.25 (95% CI 1.17 to 1.33), k = 44, n > 92 617). (2) From longitudinal data, we found low certainty evidence of no increased risk for the onset of spinal pain due to sedentary behaviour (adjusted risk ratio 1.07 (95% CI 0.84 to 1.35), k = 4, n = 1 292). (3) No studies assessed prognosis.

Conclusion: Cross-sectional data suggest minimally higher odds of spinal pain for children and adolescents who engage in greater sedentary behaviours. However, longitudinal data do not support a causal relationship, indicating that sedentary behaviour does not increase the risk for onset of spinal pain. Due to the low certainty of evidence, these findings must be interpreted with caution. We found no evidence of the effect sedentary behaviour has on spinal pain prognosis in children and adolescents, highlighting a considerable gap in the literature.

Keywords: Adolescent; Back; Child; Neck; Sedentary Behavior.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1. PRISMA 2020 Study selection flow diagram. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2. Pooled adjusted (aRR) and unadjusted risk ratios (cRR) estimating if sedentary behaviour increased the risk for onset of spinal pain (review objective 2). RoB; risk of bias.
Figure 3
Figure 3. Pooled unadjusted OR (cOR) estimating if sedentary behaviour increased the risk for onset of spinal pain (review objective 2). RoB, risk of bias.
See this image and copyright information in PMC

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