Whole-body biomechanical and lifestyle predictors of pediatric musculoskeletal pain: a multi-center cross-sectional study

Background Musculoskeletal (MSK) pain is increasingly recognized as a cause of functional impairment in school-age children, yet its lifestyle and biomechanical correlates remain under-investigated in clinical populations. Objectives To determine the 1-month prevalence and anatomical distribution of activity-limiting MSK pain among children aged 8–15 years and to identify lifestyle and biomechanical factors independently associated with its presence and impact. Methods A cross-sectional study was conducted across multiple pediatric physiotherapy and orthopedic outpatient clinics in Saudi Arabia, involving 550 of 683 consecutively screened children (mean age: 11.45 ± 2.01 years; 50.55% male). Ethical approval was obtained from the Research Ethics Committee of King Khalid University (REC#234-2023). Data were collected on screen time, physical activity, backpack load, Beighton score (joint hypermobility), Foot Posture Index-6 (FPI-6), BMI, lower-limb strength, and Y-Balance test. Pain prevalence, intensity (NRS), anatomical distribution, and functional impact were assessed. Bivariate and multivariable analyses were conducted using SPSS v24. A p -value <0.05 was considered statistically significant. Results The 1-month prevalence of activity-limiting MSK pain was 28.36%, with the back (39.74%), shoulders (30.77%), and knees (28.21%) being the most affected regions. Pain was more common in older children (12–15 years: 33.81%) and females (33.09%). Mean pain intensity was 5.93 ± 1.82. Children with pain had significantly higher screen time, backpack loads, Beighton scores, FPI-6, BMI, and lower-limb strength deficits ( p < 0.05 for all). Logistic regression identified screen time > two h/day (AOR: 1.84), backpack load >10% (AOR: 2.12), hypermobility (AOR: 1.95), and reduced strength and balance as significant predictors. The interaction between high backpack load and hypermobility showed the strongest association (AOR: 2.87). Conclusion Activity-limiting MSK pain affects nearly one-third of school-aged children and is strongly associated with modifiable lifestyle and biomechanical risk factors. Targeted screening and early interventions are warranted in pediatric settings.