Musculoskeletal pain (MSP) refers to discomfort or pain that occurs in the muscles, bones, tendons, ligaments, and other structures that support the body’s movement [1]. It is one of the most common conditions that imposes burdens on health systems globally [2, 3]. Postpartum women frequently experience MSP [4]. Physical and hormonal changes during pregnancy and childbirth can lead to various musculoskeletal problems, affecting the overall well-being and quality of life of new mothers [5]. Physical and mental disorders associated with the postpartum period can have effects for up to 12 months after the delivery of a child [6]. This pain can lead to various degrees of disability, as it impairs normal physical or mental functions, resulting in limitations of an individual’s activities and participation in their environment [2, 3].

Several studies have shown that MSP is a prevalent issue among postpartum women; a significant number of women experience neck and upper limb pain during the postpartum period, with a prevalence ranging between 22% and 61% [4, 7, 8, 9, 10, 11]. Risk factors have been identified for the prediction of neck and upper extremity pain, including an individual’s socio-demographic characteristics (e.g., older women and women with a high body mass index [BMI] experience more pain) and maternal characteristics (e.g., women who undergo Cesarian sections [C-sections] experience more pain than women who undergo vaginal deliveries) [9]. Darwish and Al-Zuhair attributed the higher prevalence of MSP among females in Saudi Arabia to the higher number of children per mother compared to mothers in many other countries [12]. In addition, factors such as the sustained posture imposed by the neck and upper extremities while taking care of the newborn may increase the prevalence and impact of MSP [13].

MSP is associated with disabilities, which may interfere with mothers’ overall well-being and ability to care for themselves and their newborns. Despite the high prevalence of postpartum pain among women, it is unclear how much disability is actually caused by this condition. However, MSP may interfere with a mother’s ability to care for herself and her baby. Understanding the factors that impact MSP is crucial in providing appropriate support and care during this period. Healthcare providers should be aware of postpartum MSP and disability to prevent and/or reduce its consequences. Therefore, the aims of this study were as follows: (1) to assess the prevalence of neck and upper limb pain and disability and (2) to investigate the factors associated with disability among postpartum women.

A total of 400 questionnaires were received from participants; all the questionnaires were complete, and all the participants met the inclusion criteria. There was no normal distribution for any continuous variable. The participants’ ages ranged from 20 to 50 years (210; 52.5% were aged between 31 and 40 years). The medians and first/third quartiles (in parentheses) of the characteristics of the sample were as follows: height was 160 cm (156 cm, 165 cm), weight was 70 kg (60 kg, 78 kg), and BMI was 26.57 kg/m² (23.94 kg/m², 29.67 kg/m²). The number of children each participant had ranged from one to six. The participant characteristics are reported in Table 1.

In this study, the postpartum mothers reported pain in at least one area of their upper body, with neck pain being the most common location, followed by pain in the shoulder, arm, and wrist/hand. It was found that 45% of those with pain had mild disabilities as measured by the NDI-Ar, and 58.2% had mild disabilities as measured by Arabic Q-DASH. Pain intensity appeared to be a predictor of disability development. Women who had a C-section delivery and experienced moderate to severe neck pain were more likely to develop mild disabilities. Being part of the 31–50 age group was a significant risk factor for mild disabilities among postpartum women with upper limb pain.

Consistent with the findings of the current study, in 2022, Asif et al. [11] reported that 52% of mothers within 12 months of childbirth experienced neck pain. Satoh et al. [25] reported that 46.8% and 40.0% of mothers reported hand/wrist pain at two and six months after birth, respectively. In addition, as reported in 2015 by Koyasu et al. [10], approximately 71.5% of two-month postpartum mothers experienced neck or shoulder pain. In 2019, Jothi Prasanna and Tamizhmani [7] found that MSP prevalence among mothers was distributed as follows: neck (61%), shoulders (59%), elbow (41%), and wrists/hands (22%). They also found that six-month postnatal mothers experienced greater neck, shoulder, and elbow discomfort than mothers in earlier months. In previous studies, a slight variation among postpartum mothers in neck and upper extremity pain rates and pain severity in relation to the duration following childbirth was noticed. However, all that former research supports the current study in its finding that a significant number of new mothers experience neck and/or upper limb pain.

In addition to the prevalence of MSP, it is also important to consider the intensity of the pain experienced by postpartum mothers. In this study, the majority of mothers described their pain as mild (42.5%), and only a few described it as moderate or severe (8% and 14%, respectively). This is contrary to the findings regarding Nigerian mothers, as reported in a recent study [26]. In that study, approximately 55% of Nigerian mothers reported neck pain, with around 35% describing the pain as moderate in intensity, and 35% describing it as mild. These findings suggest some variability in the prevalence and perceived intensity of neck pain among postpartum women across different populations [26]. However, in the previous study, only lactating mothers were included, and they used different pain assessment methods than in the current study, which may explain the contradictory results.

In this study, pain intensity was found to be significantly correlated with disability. Similarly, a previous study concluded that pain in the hand and wrist (after 2 or 6 months of delivery) was significantly associated with upper extremity-related disability [25]. Moreover, Asif and colleagues [11] concluded that neck pain was a primary contributor to disability among women during the postpartum period. According to previous literature, this is because pain can have a profound impact on musculoskeletal functional abilities [27].

A previous study of lactating women found that persistent pain can have a significant impact on daily activities and well-being, affecting mobility, functionality, and mental and physical health [28]. However, the prevalence of disabilities and their associated factors among postpartum women has not been extensively studied.

According to a 2023 study conducted by Shafeeq et al. [28], significantly higher rates of disability among lactating mothers due to neck pain were found that are comparable to the findings of the present study. Shafeeq et al. [28] also found that 19.9% of lactating mothers were completely disabled, 35.5% were severely disabled, 33.3% were moderately disabled, and 10.6% were mildly disabled. These results indicate a higher degree of disability compared to the findings in our study. However, in their study, they included postpartum mothers with pre-existing spinal deformities, which could explain the differences in the studies in disability degree. It is important to note that the presence of spinal deformities can greatly impact the severity and functional limitations associated with neck pain, potentially leading to higher levels of disability.

Based on the Arabic Q-DASH scores, in the current study, we found that older women had higher disability scores. This is consistent with the recognition that musculoskeletal pain and disabilities increase with age because musculoskeletal systems undergo natural physiological changes over time [29]. We found that younger postpartum mothers were less likely to have neck disabilities than older mothers, which is inconsistent with Shafeeq et al.’s [28] finding that younger lactating mothers can develop severe disabilities while older lactating mothers do not, illustrating a relationship between age and pain-related disability. One possible explanation could be that younger postpartum mothers in the brevious study may have less experience and potentially less support, which can lead to difficulties in managing the demands of a newborn, such as breastfeeding and caring activities.

A previous study showed a positive correlation between BMI and the prevalence of musculoskeletal pain among postpartum women [30]. In contrast, in the current study, BMI had a negative correlation with the scores of the NDI-Ar and no correlation with Arabic Q-DASH scores. Postpartum mothers with higher BMI scores were less likely to develop disabilities according to the NDI-Ar scores. BMI is associated with changes in body composition and increased muscle mass, which can have an impact on neck muscle strength.

In the current study, disability measured using the NDI-Ar showed a positive correlation with higher educational levels. This may be attributed to the fact that mothers with higher educational attainment often hold professional or physically demanding jobs, which can exacerbate musculoskeletal issues. Additionally, women in high-demanding occupations are more susceptible to gender-specific influences on musculoskeletal pain, with ergonomics and occupational factors playing significant roles, as highlighted by Bento (2020) et al. [31]. While higher educational levels have previously been linked to better outcomes for shoulder disability [32], persistent musculoskeletal pain can still result in considerable functional impairments. For instance, Bergström et al. [33] reported a high incidence of sick leave due to persistent musculoskeletal pain, lasting up to 14 months postpartum [33].

To the best of our knowledge, no prior research has established a relationship between the number of children a woman has and her risk of developing a disability following childbirth. While the score of disability based on Arabic Q-DASH was not found to be associated with the number of children, the NDI-Ar scores were higher for mothers who had fewer children. A potential explanation is that mothers with fewer children may have less experience caring for newborns and infants, which often involves repetitive movements and postures that can place additional strain on the neck. Thus, the new mothers have not developed strength and flexibility in their neck muscles over time. As a result, they may experience more neck problems during and after childbirth.

Although no studies have linked C-section deliveries with disability (to the best of our knowledge), it has been reported that postpartum mothers are more likely to experience musculoskeletal pain [34, 35]. C-section deliveries can cause women to adopt postures to cope with surgical wound pain while holding and caring for their newborns for extended periods of time. These posture changes can cause increased stress on the neck and shoulders, resulting in pain.

By gaining insights into the prevalence and risk factors associated with these disabilities, healthcare professionals can implement effective prevention strategies and early interventions to reduce their impact. This study provides a better understanding of these disabilities, enabling healthcare professionals to provide appropriate care and improve the quality of life for postpartum women. In addition, this knowledge can be used for the development of targeted interventions and rehabilitative programs to support postpartum women in managing their musculoskeletal disabilities.

This study has some limitations that should be considered when interpreting the results. The sample was limited to postpartum women in Riyad City, which may not be representative of the entire population of postpartum women in Saudi Arabia. As a result, the generalizability of the findings is limited, and the results cannot be applied to other regions without caution. Further research is needed to confirm whether similar patterns are found in those other regions. The use of convenience sampling is another limitation of the study, which involves selecting participants based on their availability and accessibility rather than through systematic random sampling.

Future research should focus on longitudinal studies to explore the long-term impact of musculoskeletal pain and disability on postpartum women’s health and functioning. Additionally, investigating the effectiveness of different interventions and preventive strategies in reducing the prevalence and severity of musculoskeletal pain in this population is warranted. More research is needed to examine other factors that can affect postpartum women’s musculoskeletal pain and disabilities, including lifestyle habits and newborn feeding methods. Furthermore, it would likely be informative to compare postpartum women with women of the same age who have never given birth to gain a deeper understanding of how pain and disability affect the prior group.

The findings of this study highlight the high prevalence of neck and upper limb pain among postpartum mothers, as well as the disability associated with the pain. In addition, these results emphasize the importance of considering factors such as the severity of neck pain, C-section births, and maternal age, as these can be linked to disabilities that may have lasting health consequences. Identifying factors that contribute to disabilities provides valuable insights into the specific challenges faced by postpartum mothers and how they can be addressed. To identify mothers at risk of developing musculoskeletal pain and disability after childbirth, healthcare professionals should implement early screening and assessment protocols. By doing so, targeted physical therapy, pain management, and ergonomic modifications can be delivered promptly.

The data that support the findings of this study are available upon request from the corresponding author. The data are not publicly available, as they contain information that could compromise the privacy of the research participants.

MFA and AAA contributed to the design. MFA and AAMS supervised the work. AAA and LAA were responsible for data collection. MFA, SA, AAMS, SMIA and AfA handled the data analysis. MFA and AAA drafted the manuscript. SAA, MMA, AsA, LAA, SMIA and MA worked on the methodology. AsA, LAA, SMIA, AAMS, and SA reviewed and edited the writing. All the authors contributed to editorial changes in the manuscript. All authors read and approved the final manuscript. All authors have participated sufficiently in the work and agreed to be accountable for all aspects of the work.

In accordance with the Declaration of Helsinki of 1964, King Fahad Medical City’s Institutional Review Board provided ethical approval (IRB Log Number: 22-427E), and all participants provided signed informed consent for inclusion before they engaged in any study activities.

This research received no external funding.

The authors declare no conflict of interest.