The aim of this study was to examine posture positions and associated joint and muscle pain among school-aged students during the COVID-19 pandemic. The overall results showed significant differences between kinds of body posture, different sitting positions, place of sitting, different lying positions, place of lying, feeling joint or muscle pain, and joint or muscle pain in various parts of the body while taking virtual classes during the COVID-19 pandemic. To our knowledge, this is the first study to assess the impact of the COVID-19 pandemic and associated public health restrictions on posture behaviors and joint and muscle pain among school-aged students in Iran.
Over the previous decade, postural abnormalities linked to changes in young people's habits have increased (3). Bad posture is a modern-day health issue that affects large amounts of people and has implications for ill health (10). People's behavior has changed as a result of lifestyles, which has resulted in individuals becoming more sedentary and developing bad physical habits, including bad posture during work and leisure activities (10). Technological development has provided individuals with increased comfort and luxury, but has also led to a physical activity decline that includes increased sedentary behavior and related postural issues (12). Since the COVID-19 pandemic was declared by the WHO, the disease's rapid global spread has forced almost 2.6 billion individuals into quarantine to minimize the spread and consequences of COVID (15). As a result of segregation and isolation, about 60 million students have been deprived of traditional educational and health services and were forced to stay in their homes during the quarantine period. This has disturbed their daily routines and minimized their engagement in physical activities (6). Our results illustrate that the majority of participants (77%) reported sitting postures while taking virtual classes during the COVID-19 pandemic, with some reporting lying (22%) or standing (1%) postures. In the sitting posture, 57% of the students reported incorrect posture while taking virtual classes during the COVID-19 pandemic. They reported leaning forward (28%), leaning backward (11%) or curving (18%) during virtual classes. The majority of places where students sit during virtual classes were on the floor (58%) and the majority of places where students lie were also on the floor. Students who reported lying positions during virtual classes, half reported lying on their stomach while 31% and 20% reported lying on their back and side respectively. Posture acts as a reference frame for the generation of accurate movement patterns because it ensures that balance is maintained during the start, continuation, and completion of any action (1). There is a link between poor posture and musculoskeletal disorders in people of all ages, and various variables can contribute to these changes, such as adjustments and adaptations to body changes, psychosocial pressures, and ergonomic issues, among others (12). As a result, school-aged students must be screened by the school when starting in-person classes and those who have postural abnormalities must receive medical or corrective exercise interventions and information. More research is needed to assess and compare the postural deviation of school-aged children before and after the pandemic.
Individuals who maintain long postures or execute repetitive actions develop tissue adaptations (tissue impairments) (4). Short, stiff, lengthy, overworked, or weak muscles cause imprecise movement patterns, which can lead to tissue injury (2). Long periods of sitting, for example, have been linked to the development of back pain. According to the findings of this study, the majority of respondents (54%) reported feeling some joint or muscle pain while taking virtual classes during the COVID-19 pandemic. The most pain was reported in the neck (28%), upper back (14%) and lower back (13%) (Fig. 2). According to research on the effects of sustained stress, posture positions should not be maintained for longer than one hour. McGill and colleagues observed that 20 minutes in a sustained flexion position might cause creep in the soft tissues, requiring more than 40 minutes to fully recover (4). The study also demonstrated how bad posture affects muscles, joints, and connective tissue over time. Sitting with the head forward for an extended period of time while reading a book will elongate the ligaments and muscles in the posterior neck and upper back, making it more difficult to regain appropriate posture.
Poor posture can also weaken the scapular muscles and put persistent stress on the rotator cuff, leading to glenohumeral impingement, particularly when using overhead motions. Future research should focus on interventions to inform people about the effect of postural habits on their health. Individuals also need to be reminded of the necessity of engaging in regular physical activity, and there is strong evidence that physical activity improves a variety of health outcomes, including posture (16, 17). The term "COFIT-19" was developed to underline the importance of being physically active during the COVID-19 pandemic (18). Because of the changes in the structure and delivery of education and employment during the COVID-19 pandemic, these changes may become more permanent following the pandemic. As a result, more research into the health benefits of home-based exercise and the effects of daily routines on posture needs to be conducted. Interventions to improve participation in home-based activities and reduce associated health risks need consideration.
This study has some limitations. These include no assessment of postural deviations in-person, and the inability to assess the amount of time spent in different postural positions. The current study used an online self-report methodology, which may have included biases (e.g., social desirability and memory recall). Furthermore, because the study was cross-sectional, we could not establish causality between any of the variables evaluated. Finally, we used specific general questions designed by the researchers rather than a standard questionnaire to assess participants' physical activity behaviors.