Table 1 Summary of study characteristics of included studies

Cudre-Mauroux et al., 2006 [22]

Relationship between impaired functional stability and back pain in children: an exploratory cross-sectional study

Upper and lower back

Week prevalence

Cross-sectional

N = 125 (57/68) Median age = 10 years

Functional stability (Matthiass Test using a new scoring system)

No association between Matthiass test and upper back pain in the last week.

Dolphens et al., 2012 [23]

Sagittal standing posture and its association with spinal pain.

Neck, thoracic spine, low back

Lifetime and one-month prevalence, concomitant doctor visit

Cross-sectional

N = 1196 (639/557) Boys: 12.6 ± 0.5 years Girls: 10.6 ± 0.5 years

Global sagittal alignment (pelvic displacement, trunk lean angle, body lean angle) and local spinopelvic parameters (e.g. number of vertebrae in the lumbar lordosis, vertebral level of apex, pelvic orientation in the sagittal plane) in habitual standing using digital images, inclinometry and accelerometry.

Neck pain:

Boys: Positive association between lifetime prevalence of neck pain and anteroposition of the head (smaller craniovertebral angle) and increased trunk lean angle (R² = 0.03).

Positive association between month prevalence of neck pain and increased trunk lean angle (R² = 0.06).

Girls: Positive association between lifetime prevalence of doctor visit and anteroposition of the head (R² = 0.04).

Mid back pain:

Boys: Positive association between doctor visits and increased trunk lean angle (R² = 0.05).

Girls: No significant association.

Dolphens et al., 2013 [24]

Classification system of the normal variation in sagittal standing plane alignment.

A study among adolescent boys.

Neck, thoracic spine, low back

Lifetime and one-month prevalence, concomitant doctor visit

Cross-sectional

N = 639 (639/0) 12.6 ± 0.5 years

Global sagittal alignment (pelvic displacement, trunk lean angle, body lean angle) and local spinopelvic parameters (e.g. number of vertebrae in the lumbar lordosis, vertebral level of apex, pelvic orientation in the sagittal plane) in habitual standing using digital images, inclinometry and accelerometry.

Cluster analysis: 3 clusters of global alignment: neutral, sway-back, leaning-forward.

Sway-back (large trunk lean angle and large body lean angle) significantly associated with lifetime prevalence of neck pain. Global posture category accounts for 2% in lifetime prevalence of neck pain and for 4% in month prevalence of neck pain.

No association of spinal pain measures and local spinopelvic parameters.

Dolphens et al., 2014 [25]

Classification system of the sagittal standing alignment in young adolescent girls

Neck, thoracic spine, low back

Lifetime and one-month prevalence, concomitant doctor visit

Cross-sectional

N = 557 (0/557) 10.6 ± 0.5 years

Global sagittal alignment (pelvic displacement, trunk lean angle, body lean angle) and local spinopelvic parameters (e.g. number of vertebrae in the lumbar lordosis, vertebral level of apex, pelvic orientation in the sagittal plane) in habitual standing using digital images, inclinometry and accelerometry.

3 postural subtypes

No association between posture clusters and spinal pain measures.

Perry et al., 2008 [26]

Fitness, motor competence and body composition as correlates of adolescent neck/shoulder pain: an exploratory cross-sectional study.

Neck/shoulder (posterior neck and upper trapezius)

Lifetime and one-month prevalence, pain duration more than 3 months

Cross-sectional

1608 (825/783) 14.1 ± 0.2

Upper and lower limb power (seated basketball throw, standing long jump)

Trunk endurance (sustained back extension test, abdominal curls)

Grip strength

Shoulder flexibility (shoulder stretch)

Motor competence (neurodevelopmental index)

Boys:

Higher odds of neck pain when upper and lower limb power increased. Lower odds for neck pain when back muscle endurance reduced. R² of models between 0.02 and 0.09.

Girls:

Higher odds for diagnosed neck pain when back endurance decreased or increased (U-shape) and abdominal endurance increased. Lower odds for neck pain when upper limb power increased and lower limb power and shoulder flexibility decreased. R² of models between 0.001 and 0.06.

Straker et al., 2008 [28]

Sitting spinal posture in adolescents differs between genders, but is not clearly related to neck/shoulder pain: an observational study.

Neck/shoulder

Lifetime, one-month and point prevalence

Cross-sectional

1470 (713/757) 14.1 ± 0.2

Sitting spinal posture (photographs, 7 sagittal angles

Questionnaire (lifetime, month, point prevalence of neck pain)

Adolescents with neck/shoulder pain: 2 degrees less trunk angle and 1 degree less cervicothoracic angle. After controlling for gender, no differences between the groups with and without neck pain.

Straker et al., 2009 [27]

Relationships between prolonged neck/shoulder pain and sitting spinal posture in male and female adolescents.

Neck/shoulder

Month prevalence, pain duration more than 3 months

Cross-sectional

1593 (814/779) 14.1

Sitting spinal posture (photographs, 7 sagittal angles

Questionnaire (month prevalence of neck pain, duration of neck pain)

Adolescents with prolonged NSP:

More flexed (decreased) cervicothoracic angle, more extended (decreased) trunk angle, more lordotic (decreased) lumbar angle, more anterior pelvic tilt.

After controlling for gender: Association between prolonged NSP and increased lordosis/decreased lumbar angle (R² = 0.02) and increased anterior pelvic tilt (R² = 0.02).

Wirth et al., 2013 [29]

Spine Day 2012: spinal pain in Swiss school children - epidemiology and risk factors

Neck, thoracic spine, low back

Lifetime prevalence, recurrence, pain intensity, consequences (leisure activities, school absence, doctor visit, medication)

Cross-sectional

434 (211/223) 10.4 ± 2.8

Trunk functional stability (Matthiass test)

Trunk asymmetry (forward bending test)

Spinal mobility (fingertip-floor distance)

Coordination (single leg stance)

No association of the outcome parameters with neck pain or mid back pain.