Musculoskeletal symptoms and pain-response behaviors among university students in Palestine: a cross-sectional study

Musculoskeletal (MSK) symptoms are a major contributor to disability worldwide, and university students may be increasingly affected because of prolonged sedentary behavior, intensive digital-device use, and sustained academic workloads. In Palestine, these risks may be compounded by psychosocial stressors and constrained healthcare access. This study assessed the prevalence of MSK symptoms and hand discomfort and examined associated behavioral, ergonomic, and device-use factors among Palestinian university students. A cross-sectional study was conducted among 1,052 university students in the West Bank, Palestine, between February and April 2026. MSK symptoms were assessed using the Nordic Musculoskeletal Questionnaire, and hand discomfort was evaluated using the Cornell Hand Discomfort Questionnaire. Multivariable logistic and ordinal regression analyses were performed. Additional model diagnostics, false-discovery-rate correction, sparse-cell checks, and sex-weighted sensitivity analyses were conducted to assess model stability and the influence of the female-predominant sample. Twelve-month prevalence was highest for neck (82.4%), shoulders (75.0%), lower back (73.4%), and upper back (65.8%) symptoms. Wrist/hand symptoms affected 49.7% of participants. Moderate pain was the most commonly reported severity level (56.3%). Female participants reported higher MSK symptom prevalence across most body regions. In ordinal regression, younger age, male sex, and shorter uninterrupted study sessions were associated with lower odds of higher pain severity. Continuing study activity without behavioral modification after pain onset was associated with higher odds of several regional symptoms, including upper back symptoms (aOR 9.21, 95% CI 2.91–29.22), although estimates involving pain-response categories were interpreted cautiously because of sparse cells and wide confidence intervals. In hand-pain models, preventive hand/neck stretching was associated with higher odds of hand pain, likely reflecting symptom-driven behavior rather than a harmful effect of stretching. Sex-weighted sensitivity analyses showed that the direction of the main adjusted associations was generally unchanged, although several marginal associations were attenuated after weighting. MSK symptoms were highly prevalent in this convenience sample of Palestinian university students and were associated with behavioral, ergonomic, and device-use factors. Because of the cross-sectional design and non-probability sampling, causal inference and population-level generalizability are limited. These findings may help inform university-based ergonomic education and behavioral strategies, while prospective and more representative studies are needed to clarify temporality and generalizability.