Does Sitting Too Much Cause Neck or Back Pain in Children and Teenagers? A Study Summary

Posted on by bjsm

Key words: Sitting, screen time, back pain 

This blog is based on our recent systematic review and meta-analysis (1). Our study explored whether spending too much time sitting causes neck or back pain in children and teenagers or if it makes existing neck or back pain worse.

Why is this study important?
Childhood and adolescence is a period where we develop the foundations for future health (2). The amount of time children and teenagers spend sedentary has risen over the past two decades; this includes time spent sitting watching television, using the computer, travelling in a car, or on mobile phones (3-5).

Neck and back pain have become increasingly common through childhood and adolescence, and there are concerns that sedentary behaviour could cause or worsen neck or back pain in children and teenagers. Neck and back pain can diminish a young person’s quality of life and participation in activities they may enjoy, such as school, sports, and socialising with family and friends (5,6). In addition, teenagers who suffer chronic neck and back pain are more likely to have ongoing pain as adults (7).

Some people believe cutting down on sedentary time could help prevent neck and back pain from occurring or manage existing neck and back pain in children and teenagers. We wanted to know if these beliefs are backed by evidence.

How did the study go about this?

We searched relevant research databases up to 23 March 2023 to find studies that aimed to answer the following questions:

  1. Are sedentary behaviours associated (i.e., linked) with neck or back pain?
  2. Does sedentary behaviour increase the risk of developing neck or back pain in the future?
  3. Does sedentary behaviour make existing neck or back pain worse over time?

We brought together results from similar studies and analysed them to answer these questions. We also checked how well the studies were conducted and judged the overall strength of the combined evidence.

What did the study find?

  1. From 115 cross-sectional studies, we found a small association between neck or back pain with more sedentary time. But these types of studies do not tell us what comes first, so we can’t tell if sedentary behaviours cause back pain—it could be the other way around and that back pain causes people to be more sedentary.
  2. From 14 higher-quality longitudinal studies, evidence suggest that sedentary time is probably not a key factor causing neck or back pain in the future. The research shows a wide range, from 16% lower risk to 35% higher risk, which reduces how confident we can be about the results.
  3. We found no longitudinal studies exploring whether sedentary behaviour may make existing neck or back pain worse.

What are the key take-home points?

Current research suggests that being sedentary, or sitting a lot, doesn’t notably cause of neck or back pain in children and teenagers. Although reducing sedentary time has many health benefits, it probably won’t greatly reduce the risk of developing neck and back pain in young people. 

While some cross-sectional studies found a small association between more sedentary time and neck and back pain, the relationship between the two could be caused by another factor, or neck and back pain may lead children and teenagers to be more sedentary. 

Future research may be more helpful if it focuses on whether sedentary behavior affects how young people recover from existing back or neck pain where there is currently no evidence available. This information would help in creating advice for children and teenagers with neck and back pain and inform better health policies or recommendations.

Authors: Laura RC  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, Steven J Kamper 3, 5

Affiliations:

  1. The University of Sydney, School of Public Health, Faculty of Medicine and Health, Sydney, AU
  2. Macquarie University, Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Sydney, AU
  3. The University of Sydney, School of Health Sciences, Faculty of Medicine and Health, Sydney, AU
  4. University College Dublin, School of Public Health, Physiotherapy and Sports Science, Dublin, IE
  5. Nepean Blue Mountains Local Health District, Sydney, Australia
  6. University of Southern Denmark, Center for Muscle and Joint Health, Department of Sports and Clinical Biomechanics, Odense, DK
  7. Chiropractic Knowledge Hub, Odense, DK
  8. The University of Sydney, University Centre for Rural Health, Faculty of Medicine and Health
    Lismore, AU 
  9. Research and Knowledge Translation Directorate, Mid North Coast Local Health District, Post Macquarie, AU

References:

  1. Montgomery LRC, Swain M, Dario AB, et al. Does sedentary behaviour cause spinal pain in children and adolescents? A systematic review with meta-analysis. British Journal of Sports Medicine. 2024:bjsports-2024-108648. doi:10.1136/bjsports-2024-108648
  2. Sawyer SM, Azzopardi PS, Wickremarathne D, Patton GC. The age of adolescence. Lancet Child Adolesc Health. Mar 2018;2(3):223-228. doi:10.1016/S2352-4642(18)30022-1
  3. Bucksch J, Sigmundova D, Hamrik Z, et al. International Trends in Adolescent Screen-Time Behaviors From 2002 to 2010. Article. The Journal of adolescent health : official publication of the Society for Adolescent Medicine. Apr 2016;58(4):417-425. doi:10.1016/j.jadohealth.2015.11.014
  4. Madigan S, Eirich R, Pador P, McArthur BA, Neville RD. Assessment of Changes in Child and Adolescent Screen Time During the COVID-19 Pandemic: A Systematic Review and Meta-analysis. JAMA Pediatr. Dec 1 2022;176(12):1188-1198. doi:10.1001/jamapediatrics.2022.4116
  5. O’Sullivan PB, Beales DJ, Smith AJ, Straker LM. Low back pain in 17 year olds has substantial impact and represents an important public health disorder: a cross-sectional study. BMC Public Health. Feb 5 2012;12:100. doi:10.1186/1471-2458-12-100
  6. Lauridsen HH, Stolpe AB, Myburgh C, Hestbaek L. What are important consequences in children with non-specific spinal pain? A qualitative study of Danish children aged 9-12 years. BMJ Open. Oct 20 2020;10(10):e037315. doi:10.1136/bmjopen-2020-03731
  7. Oiestad BE, Hilde G, Tveter AT, et al. Risk factors for episodes of back pain in emerging adults. A systematic review. Review. Eur J Pain. Jan 2020;24(1):19-38. doi:10.1002/ejp.1474

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