Postural angles, musculoskeletal pain, and body awareness in school-aged adolescents: An exploratory cross-sectional study

Background Adolescence is a critical developmental period during which habitual postural patterns and musculoskeletal behaviors are established. Altered sagittal alignment in this stage has been linked to discomfort, reduced body awareness, and later functional limitations. Understanding these relationships may support early musculoskeletal risk identification. Objective To examine the associations between sagittal postural angles, multisite musculoskeletal pain, and body awareness in school-aged adolescents. Methods This cross-sectional study included 325 adolescents (210 girls, 115 boys; mean age 15.4 ± 0.9 years). Posture was assessed photogrammetrically using five sagittal angles. Musculoskeletal pain was evaluated with the Cornell Musculoskeletal Discomfort Questionnaire, and body awareness with the Body Awareness Questionnaire. Sex differences were examined using Mann–Whitney U tests, and associations were analyzed with linear regression adjusted for age, sex, and Body Mass Index. Results Girls demonstrated greater Trunk Angle (p = 0.005), lower body awareness (p = 0.011), and higher prevalence of neck (p = 0.001) and right shoulder pain (p = 0.012). Lower Extremity Angle was negatively associated with neck and low back pain, whereas Trunk Angle was positively associated with wrist pain. Higher body awareness showed a protective relationship with pain. These associations were small and should be interpreted as exploratory. Conclusion Postural alignment, body awareness, and musculoskeletal pain appear interrelated in adolescents. Findings offer clinically relevant insights for pediatric physiotherapists, highlighting the value of early school-based postural screening and awareness-focused education to support healthier alignment and potentially reduce discomfort.