A cross-sectional study of self-reported back and neck pain among English schoolchildren and associated physical and psychological risk factors

This study set out to identify the associations between ergonomics and other factors with back and neck pain among schoolchildren. Self-reported questionnaires were used to record health outcomes and potential risk factors in state schools. Six hundred and seventy-nine schoolchildren from Surrey in the United Kingdom aged 11–14 years took part. Twenty-seven percent of children reported having neck pain, 18% reported having upper back pain, and 22% reported having low back pain. A forward stepwise logistic regression was performed with pain categories the dependent variables. Neck pain was significantly associated with school furniture features, emotional and conduct problems, family history of low back pain and previous treatment for musculoskeletal disorders. Upper back pain was associated with school bag weight (3.4–4.45 kg), school furniture features, emotional problems and previous treatment for musculoskeletal disorders. Low back pain was associated with school furniture features, emotional problems, family history and previous injury or accident. It is important to recognise the influence of physical, psychological and family factors in children's pain.     

Preparation of dynamic posture and occurrence of low back pain

Abstract

Improper posture is considered as one of the causes for low back pain. This study focused attention on low back pain that occurs when people adopt a dynamic posture. Low back pain in attendants was investigated as a typical example of low back pain in a dynamic posture. When multi-dimensional quantification III was applied to the results of the investigation, low back pain was found to occur in six postural patterns: bending knee posture, the posture of lifting and holding a light object, the posture of tilting the trunk, working posture to push a cart, the posture of turning or lifting a cart, and the posture of stretching. This survey found that low back pain frequently occurred when an unexpected load was imposed on the lumbar region and experiments were conducted to simulate the unexpected loading of this region. The experimental results showed that lumbar muscular activity was not fast enough to cope with the load and resulted in an increased swaying of the trunk. This swaying was considered to induce a load on the lumbar region. It is concluded that low back pain can be prevented if an appropriate preparatory set is taken.     

Preparation of dynamic posture and occurrence of low back pain.

Improper posture is considered as one of the causes for low back pain. This study focused attention on low back pain that occurs when people adopt a dynamic posture. Low back pain in attendants was investigated as a typical example of low back pain in a dynamic posture. When multi-dimensional quantification III was applied to the results of the investigation, low back pain was found to occur in six postural patterns: bending knee posture, the posture of lifting and holding a light object, the posture of tilting the trunk, working posture to push a cart, the posture of turning or lifting a cart, and the posture of stretching. This survey found that low back pain frequently occurred when an unexpected load was imposed on the lumbar region and experiments were conducted to simulate the unexpected loading of this region. The experimental results showed that lumbar muscular activity was not fast enough to cope with the load and resulted in an increased swaying of the trunk. This swaying was considered to induce a load on the lumbar region. It is concluded that low back pain can be prevented if an appropriate preparatory set is taken.     

Relationship between comfort and back posture and mobility in sitting-posture

The objective of this work is to analyze the causes of lumbar discomfort while sitting on a chair, by analyzing the relationship of lumbar curvature, pelvic inclination and their mobilities with discomfort. An experiment has been performed with healthy subjects, in which comfort, postural and mobility parameters have been measured. Their relationship has been analyzed with multivariate analysis. Factorial analysis has been used to represent all the correlated variables measured. Logistic regression and discriminant analyses have been used to classify discomfort/absence of discomfort. The results show that great changes of posture are a good indicator of discomfort, and that lordotic postures with forward leaned pelvis and low mobility are the principal causes of the increase of discomfort.     

Associations between individual and workplace risk factors for self-reported neck pain and disability among female office workers

A cross-sectional survey of female office workers (n=333) was undertaken to determine the level of neck pain and disability (Neck Disability Index-NDI) and to explore the relationship between individual and workplace risk factors with the NDI score and the presence of pain. Workers reported nil (32%), mild (53%), moderate (14%) and severe (1%) neck pain. There were more risk factors associated with the NDI score than the presence of neck pain. The presence of neck pain was associated with a history of neck trauma (OR: 4.8), using a graduated lens (OR: 4.6), and negative affectivity (OR: 2.7) in the multiple regression model. Factors associated with higher NDI score were using the computer mouse for more than 6h per day, higher negative affectivity, older age and an uncomfortable workstation. These results suggest that measuring the level of neck pain and disability rather than just the presence of neck pain provides more specific directives for the prevention and management of this disorder.     

Interactive effects from self-reported physical and psychosocial factors in the workplace on neck pain and disability in female office workers

This study explored the interaction between physical and psychosocial factors in the workplace on neck pain and disability in female computer users. A self-report survey was used to collect data on physical risk factors (monitor location, duration of time spent using the keyboard and mouse) and psychosocial domains (as assessed by the Job Content Questionnaire). The neck disability index was the outcome measure. Interactions among the physical and psychosocial factors were examined in analysis of covariance. High supervisor support, decision authority and skill discretion protect against the negative impact of (1) time spent on computer-based tasks, (2) non-optimal placement of the computer monitor and (3) long duration of mouse use. Office workers with greater neck pain experience a combination of high physical and low psychosocial stressors at work. Prevention and intervention strategies that target both sets of risk factors are likely to be more successful than single intervention programmes.

Statement of Relevance: The results of this study demonstrate that the interaction of physical and psychosocial factors in the workplace has a stronger association with neck pain and disability than the presence of either factor alone. This finding has important implications for strategies aimed at the prevention of musculoskeletal problems in office workers.     

Trunk posture: reliability, accuracy, and risk estimates for low back pain from a video based assessment method

It has been recently reported that both dynamic movement characteristics, as well as the duration of postures adopted during work, are important in the development of low back pain (LBP). This paper presents a video-based posture assessment method capable of measuring trunk angles and angular velocities in industrial workplaces. The inter-observer reliability, system accuracy, and the relationship of the measured exposures to the reporting of low back pain are reported. The video analysis workstation consisted of a desktop computer equipped with digital video capture and playback technology, a VCR, and a computer game type joystick. The operator could then use a joystick to track trunk flexion and lateral bending during computer-controlled video playback. The joystick buttons were used for binary input of twisting. The inter-observer reliability for peak flexion and percentage of time spent in posture category variables were excellent (ICC>0.8). Lower reliability levels were observed for peak and average velocity and movement related variables. The video analysis system time series data showed very high correlation to the criterion optoelectronic imaging system (r=0.92). Root mean square errors averaged 5.8° for the amplitude probability distribution function data. Trunk flexion variables including peak level, peak velocity, average velocity indicators, and percent time in flexion category indicators all showed significant differences between cases and controls in the epidemiological study. A model consisting of the measures peak trunk flexion, percent time in lateral bend and average lateral bending velocity emerged after multivariable analysis for relationship to low back pain.

Relevance to industry

Risk of injury for the low back is multifactorial. The trunk position and movement velocity are emerging as important parameters. This analysis confirms the importance of these factors and demonstrates the utility of a video-based method to measure them in industrial settings.     

The role of whole body vibration, posture and manual materials handling as risk factors for low back pain in occupational drivers

It seems evident that occupational drivers have an increased risk of developing back pain. Not only are they exposed to whole body vibration (vibration), their work often includes exposure to several other risk factors for low back pain (LBP), particularly the seated posture (posture) and manual materials handling (MMH). Excessive demands on posture are likely to be aggravated by vibration and vice versa, and the risks may be further compounded when MMH is performed. This study investigated the relative role of vibration, posture and MMH as risk factors for LBP and the stated hypothesis was that the risks for LBP in drivers are the combined effect of vibration, posture and/or MMH. The findings showed that interaction effects due to posture and one or both of vibration and MMH, rather than the individual exposure effects, are the main contributors for precipitation of LBP.     

Neck,shoulder and low back pain in secondary schoolchildren in relation to schoolbag carriage: Should the recommended weight limits be gender-specific?

The occurrence of neck, shoulder and low back complaints in relation to schoolbag carriage and other potential risk factors were investigated in a cross-sectional study of 586 Iranian schoolchildren aged 12–14 years. The average load carried by schoolchildren was 2.8 kg. Neck, shoulder and low back complaints during the preceding month were reported by 35.3%, 26.1% and 33% of the students, respectively. Gender was an independent factor predicting musculoskeletal symptoms in schoolchildren. Girls were more likely than boys to suffer from neck, shoulder and low back complaints, although there was no significant difference between genders in terms of schoolbag carriage variables. The findings suggest that the recommended weight limit for schoolbag carriage may need to differ between boys and girls. The associations between schoolbag variables and reported symptoms are also discussed. The results provide evidence that the current weight limit should consider a broader combination of factors that influence the use of schoolbags.     

Effectiveness of an ergonomic intervention on work-related posture and low back pain in video display terminal operators: A 3 year cross-over trial

This study investigated the effectiveness of a workstation ergonomic intervention for work-related posture and low back pain (LBP) in Video Display Terminal (VDT) workers. 100 VDT workers were selected to receive the ergonomic intervention, whereas 100 were assigned to a control group. The two groups were then crossed-over after 30 months from baseline. Follow-ups were repeated at 5, 12, and 30 months from baseline and then at 6 months following crossover. Outcomes: Work-related posture and LBP point-prevalence using the Rapid Entire Body Assessment method and a Pain Drawing, respectively. The ergonomic intervention at the workstation improved work-related posture and was effective in reducing LBP point-prevalence both in the first study period and after crossover, and these effects persisted for at least 30 months. In conclusion, our findings contribute to the evidence that individualized ergonomic interventions may be able to improve work-related posture and reduce LBP for VDT workers.     

Effect of prescribed sleep surfaces on back pain and sleep quality in patients diagnosed with low back and shoulder pain

The purpose of this study was to assess sleep quality and comfort of participants diagnosed with low back pain and stiffness following sleep on individually prescribed mattresses based on dominant sleeping positions. Subjects consisted of 27 patients (females, n = 14; males, n = 13; age 44.8 yrs ± SD 14.6, weight 174 lb. ±SD 39.6, height 68.3 in. ± SD 3.7) referred by chiropractic physicians for the study. For the baseline (pretest) data subjects recorded back and shoulder discomfort, sleep quality and comfort by visual analog scales (VAS) for 21 days while sleeping in their own beds. Subsequently, participants’ beds were replaced by medium-firm mattresses specifically layered with foam and latex based on the participants’ reported prominent sleeping position and they again rated their sleep comfort and quality daily for the following 12 weeks. Analysis yielded significant differences between pre- and post means for all variables and for back pain, we found significant (p < 0.01) differences between the first posttest mean and weeks 4 and weeks 8-12, thus indicating progressive improvement in both back pain and stiffness while sleeping on the new mattresses. Additionally, the number of days per week of experiencing poor sleep and physical discomfort decreased significantly. It was concluded that sleep surfaces are related to sleep discomfort and that is indeed possible to reduce pain and discomfort and to increase sleep quality in those with chronic back pain by replacing mattresses based on sleeping position.     

Effect of prescribed sleep surfaces on back pain and sleep quality in patients diagnosed with low back and shoulder pain

The purpose of this study was to assess sleep quality and comfort of participants diagnosed with low back pain and stiffness following sleep on individually prescribed mattresses based on dominant sleeping positions. Subjects consisted of 27 patients (females, n = 14; males, n = 13; age 44.8 yrs ± SD 14.6, weight 174 lb. ±SD 39.6, height 68.3 in. ± SD 3.7) referred by chiropractic physicians for the study. For the baseline (pretest) data subjects recorded back and shoulder discomfort, sleep quality and comfort by visual analog scales (VAS) for 21 days while sleeping in their own beds. Subsequently, participants’ beds were replaced by medium-firm mattresses specifically layered with foam and latex based on the participants’ reported prominent sleeping position and they again rated their sleep comfort and quality daily for the following 12 weeks. Analysis yielded significant differences between pre- and post means for all variables and for back pain, we found significant (p < 0.01) differences between the first posttest mean and weeks 4 and weeks 8–12, thus indicating progressive improvement in both back pain and stiffness while sleeping on the new mattresses. Additionally, the number of days per week of experiencing poor sleep and physical discomfort decreased significantly. It was concluded that sleep surfaces are related to sleep discomfort and that is indeed possible to reduce pain and discomfort and to increase sleep quality in those with chronic back pain by replacing mattresses based on sleeping position.     

City bus driving and low back pain: a study of the exposures to posture demands, manual materials handling and whole-body vibration

A cross-sectional study was conducted to investigate worker exposure to posture demands, manual materials handling (MMH) and whole body vibration as risks for low back pain (LBP). Using validated questionnaire, information about driving experience, driving (sitting) posture MMH, and health history was obtained from 80 city bus drivers. Twelve drivers were observed during their service route driving (at least one complete round trip) and vibration measurements were obtained at the seat and according to the recommendations of ISO 2631 (1997), for three models of bus (a mini-bus, a single-decker bus, a double-decker bus). The results showed that city bus drivers spend about 60% of the daily work time actually driving, often with the torso straight or unsupported, perform occasional and light MMH, and experience discomforting shock/jerking vibration events. Transient and mild LBP (not likely to interfere with work or customary levels of activity) was found to be prevalent among the drivers and a need for ergonomic evaluation of the drivers' seat was suggested.     

Lumbar posture and individual flexibility influence back muscle flexion-relaxation phenomenon while sitting

Although numerous studies have documented back muscle flexion-relaxation phenomenon (FRP) in standing postures, few studies have examined the FRP in various seated lumbar postures and individual flexibilities. This study, therefore, recruited 18 male students and assigned to low- and high-flexibility groups (9 in each). Activation of thoracic and lumbar erector spinae (ES) and lumbosacral angles were examined while participants sat in two postures (lordosis and kyphosis) and flexed their trunks at 15°, 30°, 45°, 60°, and maximum flexion. Results showed that kyphotic lumbar posture caused relatively low and unchangeable thoracic and lumbar ES activations, whereas lordotic lumbar posture engendered more contractive and varying thoracic and lumbar ES activations. Flexible participants exhibited higher thoracic ES activation than less flexible participants during lordotic sitting. Thoracic ES seemed to play a compensative role to stabilize the spine in the lordotic sitting posture, especially when the trunk was flexed over 45°. In lordotic lumbar posture, FRP occurred only in the lumbar ES; however, the activation and lumbosacral angles were still higher than those in kyphotic posture. The increased back muscle activation associated with lumbar lordosis may partially share the load on passive interspinous tissues, which are close to the discs during these flexed trunk positions.Relevance to industryThis study suggests that various lumbar postures and individual flexibilities may cause different FRP patterns when sitting. While performing seated tasks, people should exercise caution about the lumbar posture.     

Work organization and Low back pain in nursing personnel

Nursing personnel are at a high risk from occupational low back injury. Work organization has been suggested as one factor playing a part in the aetiology of occupational low back pain. Baseline data for a prospective epidemiology study were gathered by means of a questionnaire. One part of the questionnaire elicited characteristics of work organization, perceived autonomy, the relationship with head nurse and satisfaction in the relationship with co-workers. Information on history of musculoskeletal problems, reported frequency of lifting and personal characteristics was also gathered. Of 787 nursing staff at two acute care hospitals, 154 (19-6%) reported troublesome low back pain occurring within the previous 6 months. From univariate analyses, such characteristics of work organization as shift, type of schedule and primary versus functional nursing were not associated with low back pain. The relationship with head nurse and perceived autonomy of the job also were not related to recent back pain. Recent low back pain was significantly associated with younger age, the job category ‘registered nurse’ and greater satisfaction in relationships with co-workers. These associations were confirmed in multivariate analysis. None of the work organization factors examined, with the exception of satisfaction with co-workers, were associated with back pain in this study. Moreover, the positive association of satisfaction with coworkers suggests that interventions to improve working relationships may not be helpful in prevention programmes. To some extent, these results are susceptible to biases resulting from selective attrition from nursing and selective participation in the study.     

Back pain arising from schoolbag usage among primary schoolchildren

This study employed multifactorial variables to determine the effect of schoolbag weight on the occurrence of back pain among primary schoolchildren and also determined the reliability and factorability of their survey responses. A total of 615 prepubescent children aged between 7 and 12 years with a boy to girl ratio of 2:3 participated in the study. Of these children, 205 were also selected for a test–retest to determine the reliability of the questionnaire. The kappa coefficient was used to analyze dichotomous and nominal variables, and the intraclass correlation coefficient (ICC) was used for the categorical variables. Correlation techniques were also used to investigate backpack-induced back pain problems. The test–retest revealed that dichotomous and demographic (k = 0.7–1.0), psychosocial perception of pain (ICC = 0.6–0.72) and backpack culture (ICC = 0.6–0.78) variables all demonstrated good and high reliability. Variables associated with multiple responses, however, recorded low reliability value. The exploratory factor analysis also reveals six factors, of which only psychosocial perception of pain, individual rating ability and backpack culture accounted for more than 70% of the variance explained during the analysis. Both the subjective and objective variables revealed the significant effect of the children's heavy bag on their degree of feeling back pain (F(2,612) = 3.72, p = 0.02), neck inclination (F(2,166.15) = 54.8, p < 0.0001), back inclination (F(2,183.9) = 60.92, p < 0.0001), pulse rate (F(2,155.31) = 4.07, p = 0.019) and saturated oxygen (F(2,152.83) = 5.95, p = 0.003) were significantly associated with the weight of their schoolbags. The significant effect of age was also identified as the measuring variables were all negatively correlated with the children's age. Backpack–back pain intervention and awareness are still needed especially among the younger primary schoolchildren who are at greater risk of back pain from backpack usage.     

Changes in neck muscle electromyography and forward head posture of children when carrying schoolbags

This study tested the effects of three alternative types of backpack on head posture and neck muscle electromyography (EMG) in children. Four loading conditions were tested: no pack; a backpack; a double pack; a modified double pack (designed with a backpack and a front pack weighing 10% and 5% of body weight, respectively). Dependent variables were neck muscle activity, forward head angle and forward head distance (the perpendicular distance from C7 to a vertical line through the tragus of the ear). Fifteen children were asked to walk at a speed of 0.8 m/s on a treadmill. The EMG activity of upper trapezius, sternocleidomastoid and midcervical paraspinals muscles and the forward head angle and forward head distance were all significantly higher when carrying a backpack than for the other conditions. When carrying a double pack, there was a backward head posture characterised by an increased negative forward head angle, decreased forward head distance, increased sternocleidomastoid EMG signal and decreased midcervical paraspinals EMG signal, compared to carrying no pack. When carrying a modified double pack, the forward head angle and forward head distance decreased when compared to carrying a backpack. These findings indicate that the modified double pack minimises postural deviation.