Prevalence and associated factors of musculoskeletal pain among university students in Saudi Arabia: an analytical cross-sectional study

BACKGROUND: Musculoskeletal pain is common among university students and may be influenced by prolonged sitting, digital-device use, suboptimal ergonomic practices, and low physical activity. However, evidence from Saudi university settings remains limited. This study aimed to estimate the 12-month prevalence and anatomical distribution of musculoskeletal pain among university students at Al-Baha University and to examine its associations with ergonomic behaviours and physical activity levels. METHODS: This analytical cross-sectional study was conducted among university students aged ≥ 18 years at Al-Baha University. Data were collected using self-administered questionnaires capturing demographics, 12-month musculoskeletal pain and affected body regions assessed using the Nordic Musculoskeletal Questionnaire (NMQ), and ergonomic practices. Participants reported physical-activity summaries from their smartphone health applications (Google Fit and Apple Health). Descriptive statistics, chi-square tests, Mann-Whitney U tests, and multivariable logistic regression were used to analyse the data and identify factors independently associated with musculoskeletal pain. Results are presented as odds ratios (ORs) with 95% confidence intervals (CIs), and model discrimination was assessed using the area under the receiver operating characteristic curve (AUC). RESULTS: Among 675 students, the mean age was 22.26 ± 3.36 years; most participants were male (74.4%) and enrolled in health-sciences programs (85.2%). Overall, 85.0% reported musculoskeletal pain in the previous 12 months. The neck (47.6%), lower back (46.8%), and shoulders (34.2%) were the most affected regions. In multivariable analysis, internship-level students had higher odds of pain (OR = 15.05, 95% CI: 2.91-77.78, p = 0.001), and sitting 6-8 h/day was associated with higher odds of pain (OR = 13.95, 95% CI: 4.13-47.19, p < 0.001). Low daily physical activity time (< 15 min/day) was also associated with higher odds of pain (OR = 5.70, 95% CI: 2.14-15.16, p < 0.001). The model showed acceptable discrimination (AUC = 0.793, 95% CI: 0.742-0.843, p < 0.001), although specificity and calibration were limited. CONCLUSIONS: Musculoskeletal pain was common among university students at Al-Baha University, particularly in the neck, lower back, and shoulders. The findings suggest that prolonged sitting and selected physical-activity indicators are important associated factors. These findings may inform campus-based strategies promoting regular movement breaks, ergonomic study practices, and physical activity.