Physical Activity, Spinal Pain, and Postural Disorders in Children and Adolescents: A Narrative Review

Background Spinal pain and postural disorders in children and adolescents are clinically relevant concerns. Physical activity may influence spinal health, but preventive benefits, therapeutic effects, and risks associated with excessive training require separate consideration. Aim To synthesize evidence on associations between physical activity, spinal development, spinal pain, and postural disorders in children and adolescents, including potential preventive and therapeutic effects and risks related to excessive training. Materials and Methods A narrative review of English-language literature available up to August 2026 was conducted using PubMed, Scopus, Web of Science, and Google Scholar. Pediatric clinical evidence was considered alongside supporting biomechanical literature, including indirect evidence from adult populations and experimental models. Results Observational evidence associates physical activity with lower odds of backache and, in some populations, lower likelihood of scoliosis diagnosis or progression. Exercise interventions may reduce nonspecific low back pain and improve selected outcomes in idiopathic scoliosis and postural hyperkyphosis, while effects on hyperlordosis remain uncertain. Higher training volumes and sports specialization are associated with overuse injuries, but universal training thresholds have not been established. School-based programs may improve activity levels, postural knowledge, and selected postural outcomes. Digital tools may support screening and monitoring. Interpretation is limited by heterogeneous study designs, indirect mechanistic evidence, and limited long-term follow-up. Conclusions Physical activity and targeted exercise may support pediatric spinal health, while excessive training requires attention to overuse risks. Current evidence does not establish whether childhood physical activity prevents spinal pain or postural disorders in adulthood.