A systematic review of the relationship between sitting and upper quadrant musculoskeletal pain in children and adolescents

Abstract

Background

Upper quadrant musculoskeletal pain (UQMP) is a common health problem in children and adolescents. The upper quadrant refers to the occiput, cervical and upper thoracic spine including the clavicles and scapulae. The current literature, which indicates that sitting, in terms of sedentary activities and sitting spinal posture, is a possible risk factor of UQMP, is controversial. This systematic review is aimed at ascertaining whether there is evidence for sitting as a risk factor for UQMP, and determining the different elements of sitting that are related to UQMP experienced by children and adolescents.

Methods

Six electronic databases, BioMed Central (2007–2011), CINAHL (2007–2011), Proquest (2007–2011), Pubmed (2007–2011), Science Direct (2007–2011) and SCOPUS (1960–2011) were searched. The eligible papers were appraised using a standardised critical appraisal tool, the Critical Appraisal Tool for Quantitative Studies (Law et al., 1998).

Results

Ten papers were eligible for the review. Four papers reported significant positive associations between sitting and UQMP in children and adolescents. Five elements of sitting were identified as relating to UQMP. Those were sitting duration; activities while sitting; activities while sitting and sitting duration; dynamism; and postural angles.

Conclusion

There is unequivocal evidence that sitting and UQMP are related in children and adolescents. End of range postural angles should be considered as possible risk factors and these elements of sitting should be explored in future research.

Introduction

Upper quadrant musculoskeletal pain (UQMP) in children and adolescents is a common health problem that has been widely researched in recent years. Both acute and chronic conditions have been reported and investigated (Brattberg, 2004; El-Metwally et al., 2004; Perry et al., 2008; Briggs et al., 2009a; Paananen et al., 2010; Trevelyan and Legg, 2010; Rees et al., 2011). It is evident that, as the prevalence of musculoskeletal pain increases with age (Siivola et al., 2004; Sjolie, 2004; Stahl et al., 2004; Mikkelsson et al., 2008), so does the impact of the health problem on the individual's social interaction, peer relationships, mental health, school absenteeism, scholastic competence and participation in physical activities (Guite et al., 2007; Sunblad et al., 2008; Forgeron et al., 2010; Rees et al., 2011).

Research has shown that associative factors for non-specific UQMP are multifactorial in nature. They include factors related to psychosocial elements, life style, physical activeness, postural elements, joint hypermobility, environmental elements, motor competence and gender (Mikkelsson et al., 2008; Briggs et al., 2009a; O'Sullivan et al., 2011a). A review by Prins et al. (2008) found clear evidence that psychosocial factors such as depression, mental distress and psychosomatic complaints are risk factors for UQMP. This review also reported prolonged sitting to be a risk factor, although due to the limited research available at the time, this finding was less evident and the review was inconclusive whether sitting posture should be considered a risk factor.

The impact of sitting or sitting posture on musculoskeletal pain seems to be controversial, since some research has reported no significant associations between UQMP and sitting or sitting posture among adults, adolescents and children (Cardon et al., 2004; Szeto et al., 2005; Edmonston et al., 2007; Briggs et al., 2009a; Waerstad et al., 2010) whereas other research has reported positive associations (Ariens et al., 2001; Murphy et al., 2004; Kelly et al., 2009; Lau et al., 2010; O'Sullivan et al., 2011a; Hakala et al., 2012). Children and adolescents are increasingly exposed to sedentary lifestyles, mainly due to the growing use of screen-based activities (Saarni et al., 2007; Torsheim et al., 2010). Caneiro et al. (2010) reported that different sitting postures can significantly influence the head/neck posture and the muscle activity of the cervicothoracic erector spinae. Thus, sitting posture or the duration thereof might not contribute only to low back pain, but could also be the cause of UQMP. Therefore it was considered necessary to conduct a review to determine whether the latest published research can clarify this controversy.

Furthermore, it could be very likely that sitting duration or poor sitting postures of patients with musculoskeletal symptoms have been addressed by health professionals without sitting or sitting posture being the source of the pain (Bullock-Saxton, 1993). Consequently, it is imperative that the outcome of this review guides health professionals in implementing preventative and treatment strategies aimed at the appropriate risk factors in order to effectively address this health problem among children and adolescents.

The aim of the review was to ascertain whether there is evidence for sitting to be an associative or causative factor for UQMP experienced by children and adolescents. A secondary aim was to determine the different elements of sitting that are related to UQMP. The review questions can be formulated as follows:

• Is there evidence to support that sitting is related to UQMP experienced by children and adolescents?

• What are the different elements of sitting that are related to UQMP?