Introduction <p>The rapid growth in the food delivery industry, driven by changing consumer habits and technology, has created job opportunities for gig riders, including food delivery riders. However, concerns about their working conditions, which impact their health, safety, and labour rights, have emerged.</p> Objectives <p>The main objectives of this study were to estimate the prevalence of pain, discomfort, and injuries among app-based food delivery riders in Tamil Nadu and identify its associated factors.</p> Methods <p>A cross-sectional study was conducted among 425 app-based male food delivery riders among the four major cities in Tamil Nadu, namely; Chennai, Coimbatore, Villupuram, and Cuddalore. The data was collected from June to July 2023 using the Nordic Musculoskeletal Questionnaire to assess physical pain, discomfort, and injuries.</p> Results <p>Among 425 food delivery riders chronic pain persisting over 12&#xa0;months is prevalent among food delivery riders, notably affecting the lower back (49.18%), upper back (39.53%), neck (28.71%), and shoulders (26.12%). Short-term pain was reported by 56% of the respondents in the lower back in the last week. Substance use, dehydration, and work location are significantly associated with long- and short-term pains. The knees, Ankles and wrists are the most common body sites of injuries and skipping meals during duty hours is significantly associated with injuries.</p> Conclusions <p>Research in assessing the pain and injuries among food delivery riders is minimal. The present study, notably, extends the understanding of the health impact of full-time food delivery work by revealing a high prevalence of physical pain, particularly in the lower back.</p>