Journal of Isfahan Medical School

Journal of Isfahan Medical School

Investigation of changes in pelvic and lower limb alignment during prolonged static sitting: A cross-sectional study on video game users

Document Type : Original Article (s)

Authors
Farhad Rezazadadeh 1
Amirali Jafarnejadgro 2
Parinaz Fahimi 3
Shirin Aali 4
Marjan Zareyan 5
1 Assistant Professor, Department of Sports Biomechanics, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
2 Professor, Department of Sports Biomechanics, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
3 MSc, Department of Sports Biomechanics, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
4 Assistant Professor, Department of Physical Education, Farhangian University, Tehran, Iran
5 PhD in Information Science and Epistemology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
10.48305/jims.v44.i863.0795
Abstract
Introduction: The sedentary lifestyle resulting from long-term video game playing has presented the musculoskeletal system of the young generation with serious biomechanical challenges and injuries. Despite the predominant focus of previous studies on upper limb and cervical-dorsal spine abnormalities, the present study was designed and implemented with the aim of comparing the frequency and severity of lower limb postural and musculoskeletal abnormalities between adolescent gamers and non-gamers.

Methods: This observational and cross-sectional comparative study was conducted on 40 participants (12 to 20 years old) in two independent groups of 20 including gamers and non-gamers. Assessments included measurement of lumbar lordosis, assessment of pelvic tilt, severity of crossed knee, navicular bone loss, and functional tests to measure lower limb muscle shortening (Thomas test, active knee extension, and lunge). Data were analyzed using two-way analysis of variance.

Results: Compared to the non-gamers, the gamer group showed significantly higher values in lumbar lordosis, anterior pelvic tilt, iliopsoas muscle shortening, and knee clubbing(P<0.001). However, no significant differences were found in more distal variables such as navicular depression, ankle dorsiflexion range, rectus femoris shortening, and hamstring flexibility between the two groups. The studies showed that gender had no significant main or interaction effect on these abnormalities.

Discussion: The results showed that prolonged sitting in gamers is associated with postural changes in the flexors, while it is less associated with more distal structures in the short term. Specialists can use these findings to design ergonomic programs and pelvic stabilization exercises for the rehabilitation of this group.

Highlights

Farhad Rezazadeh: Google Scholar , PubMed

Parinaz Fahimi: Google Scholar

Shirin Aali: Google Scholar , PubMed

Keywords
Lower extremity
Lordosis
Genu valgum
Adolescent
Pelvic tilt
Subjects
1.     Riatti P, Thiel A. The societal impact of electronic sport: a scoping review. Ger J Exerc Sport Res 2022; 52(3): 433–46.
2.     Tholl C, Bickmann P, Wechsler K, Froboese I, et al. Musculoskeletal disorders in video gamers–a systematic review. BMC Musculoskelet Disord 2022; 23(1): 678.
3.     Leis O, Sharpe BT, Pelikan V, Fritsch J, Grieben C. Stressors and coping strategies in esports: A systematic review. International review of sport and exercise psychology. 2026;19(1):1–31.
4.     Sakata J, Nakamura E, Suzukawa M, Akaike A, Shimizu K. Physical risk factors for a medial elbow injury in junior baseball players: a prospective cohort study of 353 players. Am J Sports Med 2017; 45(1): 135–43.
5.     Ashok K, Purushothaman VK, Muniandy Y. Prevalence of forward head posture in electronic gamers and associated factors. International Journal of Aging Health and Movement 2020; 2(2): 19–27.
6.     Soffner M, Schmidt A, Tomschi F, Hilberg T. Do Esports Players Experience Pain? Pain Prevalence of Esports Players: a Systematic Review and Meta-analysis. Sports Med Open 2026; 12(1): 1.
7.     Arippa F, Nguyen A, Pau M, Harris-Adamson C. Postural strategies among office workers during a prolonged sitting bout. Appl Ergon 2022; 102: 103723.
8.     Kett AR, Sichting F, Milani TL. The effect of sitting posture and postural activity on low back muscle stiffness. Biomechanics 2021; 1(2): 214–24.
9.     Alqabbani S, Alhussaini RF, Alsaedan SA, Alfaqi MK, Almudaifer RI, Zain Aldeen NM, et al. A cross-sectional survey on musculoskeletal pain among professional and non-professional gamers in Saudi Arabia: associations with gaming genre, duration, and ergonomic factors. J Pain Res 2026; 19: 557124.
10.  Massey SM, Rai A. Musculoskeletal Disorder in Esports Players: A Scoping Review of Prevalence, Risk Factors and Interventions. Journal of Clinical & Diagnostic Research 2026; 20: 16.
11.  Nguyen A-D, Shultz SJ, Schmitz RJ, Luecht RM, et al. A preliminary multifactorial approach describing the relationships among lower extremity alignment, hip muscle activation, and lower extremity joint excursion. J Athl Train 2011; 46(3): 246–56.
12.  Ayushi DJ, Kaur H. Biomechanical and musculoskeletal disorders in e-sports player: An integrative review of literature. Int J Innov Sci Res Technol 2026; 11(1): 257-68.
13.  von Elm E, Altman DG, Egger M, Pocock SJ, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 2007; 335(7624): 806–8.
14.  Reshma, Sirajudeen MS, Chinnakalai T, Suhail M, et al. Reliability of the Flexible Ruler in Measuring Lumbar Lordosis among Children. Journal of Clinical and Diagnostic Research 2020; 14(11).
15.  Harvey D. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998; 32(1): 68–70.
16.  Hamid MS, Ali MR, Yusof A. Interrater and Intrarater Reliability of the Active Knee Extension (AKE) Test among Healthy Adults. J Phys Ther Sci 2013; 25(8): 957–61.
17.  Bennell KL, Talbot RC, Wajswelner H, Techovanich W, Kelly DH, Hall AJ. Intra-rater and inter-rater reliability of a weight-bearing lunge measure of ankle dorsiflexion. Aust J Physiother 1998; 44(3): 175–80.
18.  Chang JS, Kwon YH, Kim CS, Ahn SH, et al. Differences of ground reaction forces and kinematics of lower extremity according to landing height between flat and normal feet. J Back Musculoskelet Rehabil 2012; 25(1): 21–6.
19.  Lahoz C, Pérez-Rey J, González D, Gallart J, Park SH. The relationship between lower limb alignment and physical fitness in children aged 10-12: A sex-specific analysis using the ALPHA-fitness test battery. Braz J Phys Ther 2025; 29(5): 101242.
20.  Vicente-Pina L, Sánchez-Rodríguez R, Ferrández-Laliena L, Heredia-Jimenez J, et al. Validity and Reliability of Kinovea® for Pelvic Kinematic Measurement in Standing Position and in Sitting Position with 45° of Hip Flexion. Sensors 2025; 25(1): 250.
21.  Straker LM, O'Sullivan PB, Smith A, Perry M. Computer use and habitual spinal posture in Australian adolescents. Public Health Rep 2007; 122(5): 634–43.
22.  In T-s, Jung J-h, Jung K-s, Cho H-y. Spinal and pelvic alignment of sitting posture associated with smartphone use in adolescents with low back pain. Int J Environ Res Public Health 2021; 18(16): 8369.
 
Journal of Isfahan Medical School
Volume 44, Issue 863
3rd Week, July
July and August 2026
Pages 795-804

  • Receive Date 10 July 2026
  • Accept Date 21 July 2026