Background and Aims Neck and shoulder pain (NSP) is common in school age, but preventative factors have not been identified. The purpose was to study whether a fitness test could be used to predict the incidence of NSP and determine whether good physical fitness characters would be associated with lower NSP incidence in school-aged children at 2-year follow-up.

Methods After the invitation to nine schools, 970 children (10–15 years old) agreed to participate. Flexibility, fundamental movement skills, musculoskeletal fitness, and cardiorespiratory fitness measurements included in Finnish Schools on the Move! monitoring system for physical functional capacity were measured at baseline in 2013. The NSP incidence was assessed by an online survey during school hours after 1 and 2 years. Logistic regression was used to analyze associations between physical fitness characteristics and NSP incidence.

Results The mean prevalence of NSP was 26% at baseline. The NSP incidence was 15% in the first and 18% in the second follow-up year. Good physical fitness was not associated with lower NSP incidence in the 2-year follow-up. Successful lower back extension (odds ratio [OR] = 2.83) and good scores in curl-up (OR = 1.80) adjusted with age, gender, and body mass index, were associated with higher NSP incidence between T0 and T2. Throwing–catching combination (OR = 0.55) was associated with a lower NSP incidence in unadjusted analysis, but the association did not remain after adjustments.

Conclusion Good physical fitness characteristics were not consistently associated with a lower NSP incidence in school-aged children in a 2-year follow-up. The role of general field-based physical fitness test as a screening tool for NSP incidence remains unconfirmed. More longitudinal studies are needed to detect the factors underlying NSP incidence in school-aged children.