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A combined cross-sectional and longitudinal design.To investigate relation between, on one hand, self-reported neck-shoulder symptoms and, on the other hand, low back symptoms and self-reported work-related physical load, psychosocial factors, and individual characteristics and to study the influence of physical capacity in adolescence on neck-shoulder and low back symptoms in adulthood.Heavy physical work and exposure to vibration constitute risk factors for low back problems, and repetitive and static work are risk factors for neck-shoulder symptoms in many jobs. The interplay between individual factors and work-related psychosocial and physical exposure, however, is not well documented. This study addresses effects of adolescent capacity on this interplay in a general population.A random sample of 425 Swedish students was investigated when the students were 16 years and 34 years of age. Sixty-five percent participated in both examinations; only those who worked ≥ 6 hours/week at the follow-up period, 148 men and 90 women, were included in these analyses. Data about musculoskeletal symptoms, work, and sociodemographic and individual characteristics were collected at the age of 34 years; physical performance data were collected at the ages of 16 years and 34 years.Among the men, self-employment and worry were associated with neck-shoulder symptoms; among the women, monotonous work and high decision latitude were associated with neck-shoulder symptoms. Low back problems were related to monotonous work among men and women and to exposure to vibration among men. Performance in certain fitness tests at the ages of 16 years and 34 years was negatively associated with musculoskeletal symptoms.The inverse relationships between performance at the age of 16 years and adult musculoskeletal symptoms may imply benefits of early fitness training.