The widespread adoption of mobile phones has resulted in significantly increased screen time and sedentary behaviors among adolescents (1, 2). This trend raises concerns about the potential burden on the musculoskeletal system. Globally, mobile phone usage is growing, with 5.44 billion users representing 68% of the world's population (1). Among adolescents, usage has dramatically increased, with a 17% rise observed between 2019 and 2021 (2), with approximately 70% of Latino youth owning a mobile phone. Adolescents frequently use these devices for social media, video streaming, and gaming, with a weekly average usage increasing from 8 to 10 h (2). In Colombia, the prevalence of mobile phone ownership among adolescents is approximately 61.7%, with 30.6% reporting daily use ranging from 30 min to 1 h (3).

While mobile phones offer adolescents numerous benefits, including increased autonomy, improved academic performance, and enhanced social interaction (4, 5), excessive use is associated with considerable risks to physical, mental, and psychosocial well-being (6, 7). Problematic mobile phone use is particularly prevalent among 15- to 16-year-olds, as it is considered the most common way of dependency disorder during adolescence (8–12). This is characterized by excessive and frequent use (13), academic disruption, and emotional distress (14).

Emerging evidence strongly suggests a link between problematic mobile phone use and musculoskeletal disorders (MSKDs) in adolescents (15–18). MSKDs include a range of conditions affecting bones, muscles, joints, and connective tissues. Representing a major contributor to the global disease burden in individuals aged 15–65, MSKDs affect an estimated 1.7 billion people worldwide (19). The prevalence of MSKDs in adolescents is estimated at 47.4%, with pain being the primary reported symptom (20). Studies indicate a higher incidence of MSKDs associated with excessive mobile phone use among females compared to males (18, 20), particularly among those aged 15–17 years (21).

The most reported pain sites include the neck, shoulders, wrists/hands, upper back, and lower back; some adolescents also report vision-related symptoms (7, 8, 15–17, 20–23). Prolonged mobile phone use (more than 10 h per week) significantly increases the risk of neck and lower back pain. Furthermore, lifestyle factors such as physical inactivity, poor sleep, inadequate fruit and vegetable consumption, and substance use have been identified as predictors of persistent MSKDs (24), in addition to the posture adopted during mobile phone use (25).

Given these concerns, this study investigated the association between MPD and MSKDs in adolescents residents of the Sabana Centro region of Colombia. It is the first to assess the prevalence of pain associated with problematic mobile phone use within the Colombian population. Its relevance is heightened by the substantial increase in screen time following the COVID-19 pandemic, impacting both educational and non-educational settings. A comprehensive understanding of problematic screen use, particularly concerning mobile phones, is crucial for developing effective interventions to improve adolescents' health and well-being.

Of the 1,183 students invited, 622 (52%) participated in the study, including pupils from grades 5–11th, of which 54.5% were females and 45.5% were males, with a median age of 14 years. Musculoskeletal pain (in at least one of five specified body regions) was reported by 56.3% (n = 350) participants within the past 6 months. The upper back was the most frequently affected region (30.4%, n = 193), followed by the neck (29.3%) and shoulders (21.1%). The median MPD score was 27 [interquartile range (IQR): 17–37] (Table 1).

Female adolescents reported significantly higher MPD scores than males in all dimensions except for Excessive Use (median difference in total MPD: 4 points; p < 0.001). MPD scores increased significantly with the grade level (p = 0.019). Participants reporting pain in any body region exhibited significantly higher MPD scores (median difference: 5 points; p < 0.001) compared to those without pain, except for those with low back pain (p = 0.055) (Table 2).

The analysis of MPD dimensions by gender revealed consistently higher female scores across all dimensions except “problems arising from use” (Table 3). Among participants with back pain, those experiencing pain in the neck, shoulders, or upper back had significantly higher scores on three of the four MPD dimensions; however, no significant difference was observed for low back pain (Table 4).

A weak positive correlation was found between age and total MPD scores (Rho = 0.19, p < 0.01). This association was particularly pronounced for the “withdrawal” (Rho = 0.15, p < 0.01), “abuse/difficulty” (Rho ρ = 0.16, p < 0.01), and “tolerance” (Rho = 0.25, p < 0.01) dimensions of the MPD scale. Females reported a significantly higher prevalence of pain (approximately 10% greater than males) across most body regions, except for the low back and shoulders (χ² test, p < 0.001). Furthermore, adolescents reporting pain were significantly older (mean difference of 1 year, p < 0.001) than those without pain (Table 5).

Three logistic regression models were developed to examine the association between general pain, neck pain, and upper back pain, as these were the most prevalent pain areas reported among the participants. These models included sex, age, and the four dimensions of the MPD scale (withdrawal, abuse/difficulty, problems arising from use, and tolerance/interference) as independent variables. Significant associations were found between the “abuse/difficulty” dimension of the MPD and general and neck pain. Furthermore, female sex was identified as associated variable for neck and upper back pain (Appendix 1).

This study revealed a high prevalence of musculoskeletal pain among adolescents, particularly affecting the upper back and neck. Higher MPD scores were significantly associated with pain and were more prevalent among female and older adolescents. A positive correlation was found between age and MPD scores and between sex and pain prevalence.

The observed prevalence of musculoskeletal pain aligns with previous research. Martins et al. (20) reported a 47.4% prevalence in a similar adolescent population, consistent with our findings of 56.3%. Straker et al. (18) found neck and shoulder pain in 50% of participants, with lower back pain in 34% and upper limb pain in 30%, supporting the high prevalence of upper body pain found in our study. Mustafaoğlu et al. (22) also reported high prevalence rates of upper back, neck, and wrist/hand pain, and similar observations regarding neck, shoulder, and eye discomfort have been reported by Ahmed et al. (17) and Mokhtarinia et al. (8).

Previous studies on mobile phone dependency have shown varying prevalence rates. Mokhtarinia et al. (8) reported a 53.3% prevalence in Iran, with slightly higher rates among males (54.5%) than females (52.7%), although no significant difference in average dependency scores was found. Gangadharan et al. (7) reported a lower prevalence (33%) in India, with slightly higher rates among males (33.6%) than females (32.3%). Alsalameh et al. (15) also observed higher rates in males. In contrast, our findings are consistent with Straker et al. (18), who reported higher mobile phone use among older adolescents and females.

The observed discrepancies regarding sex and MPD between our study and prior research might be attributable to several factors. Our study included a wider age range, which may have influenced the results. Furthermore, our larger sample size allowed for greater statistical power to detect significant differences. The observed higher mobile phone dependency among females supports further investigation into potential gender-specific patterns of mobile phone usage.

Our findings showed a significant association between higher MPD scores and musculoskeletal pain, primarily in the neck, shoulders, and upper back, but not in the lower back. This is consistent with Alsalameh et al. (15), who also found higher MPD scores among participants with pain (except those with elbow or lower back pain). However, our study only revealed a significant correlation between MPD and age. The gender differences in pain prevalence align with Sirajudeen et al. (28) who observed an association between sex and shoulder pain, although Walankar et al. (29) did not report a similar relationship. These variations may reflect differences in study populations, cultural contexts, or methodological approaches.

This cross-sectional study has several limitations. Its design does not allow for establishing causality between MPD and musculoskeletal pain. Additionally, other forms of screen time potentially associated with pain, such as the use of computers and tablets, were not assessed. Self-reported pain data are subject to bias, which could lead to underreporting or overreporting of results. Finally, selection bias should be considered, as the study included only pupils who returned signed informed assents and whose parents or legal guardians provided signed consent.

Extensive literature links risk mobile phone use to various negative health outcomes, affecting both physical and mental health. The rising prevalence of musculoskeletal pain in adolescents is likely multifactorial, involving excessive mobile device use, sedentary behavior, poor posture (e.g., forward head posture), and sleep disturbances. Muscular fatigue, chronic pain, and reduced quality of life are common consequences (30). Based on this evidence, interventions promoting increased physical activity, sports participation, and limiting screen time (to no more than 2 h daily) are strongly recommended (30).

The prevalence of musculoskeletal pain is a significant contributor to the global burden of disease, which is increasing among children and adolescents. Lifestyle habits are a risk factor for these conditions in this population. This study found not only a prevalence of 58% for pain but also an association with mobile dependency, particularly among females, with the incidence increasing with age. These findings emphasize the need for public health interventions aimed at adolescents to promote healthier mobile phone use, encourage physical activity, and improve posture, particularly among females. Future research should assess the effectiveness of these interventions, with a specific focus on addressing the “abuse” and “difficulty regulating use” dimensions of MPD.