<b>Prevalence of Postural Deviations and Their Association with Shoulder Pain in Adolescent Handball Players</b>

Background: Shoulder pain is a common complaint in overhead athletes and has been increasingly linked to postural deviations affecting the cervical spine, trunk, and scapular complex. Adolescent handball players, exposed to repetitive throwing and high training loads, may be particularly vulnerable to such biomechanical imbalances, yet evidence addressing posture–pain associations in this population remains limited. Objective: This study aimed to determine the prevalence of postural deviations and assess their association with shoulder pain in adolescent handball players. Methods: A cross-sectional observational study was conducted among 109 male handball players aged 18–25 years in Faisalabad, Pakistan. Eligibility required regular training for ≥3 months, with exclusion of those with spinal, neurological, or surgical histories. Posture was evaluated using a standardized posture grid, while shoulder pain was quantified with the Numeric Pain Rating Scale. Associations were tested using chi-square analysis, and odds ratios with 95% confidence intervals were calculated. Results: Shoulder pain was reported by 66.1% of players, predominantly of moderate intensity. High prevalence of anterior pelvic tilt (65.1%), scapular abnormalities (58.7%), and forward head posture (32.1%) was observed. Significant associations with pain were found for scapular malalignment (OR 40.0, 95% CI 11.9–134.0, p<0.001), pelvic tilt (p=0.042), and head posture (p=0.041). Foot posture showed no association. Conclusion: Postural deviations, particularly scapular malalignment and pelvic tilt, are strongly associated with shoulder pain in adolescent handball players. Early screening and kinetic chain–based corrective strategies are warranted to reduce injury risk and support long-term musculoskeletal health.