Combined ergonomic exposures and development of musculoskeletal pain in the general working population: A prospective cohort study

Objective:This study aimed to investigate the importance of combined ergonomic exposures at work for the development of musculoskeletal pain.Methods:Through four rounds (2012–2018) of the Work Environment and Health in Denmark Study, 18 905 employees of the general working population replied to a baseline and 2-year follow-up questionnaire. First, a k-means cluster analysis of seven ergonomic factors (back bending, arm above shoulders, lifting etc., from ‘never’ to ‘almost all the time’) identified nine naturally occurring clusters. Second, using a weighted survey regression model controlling for age, gender, survey year, education, lifestyle, influence at work, and pain intensity at baseline, we estimated development of pain intensity (0–10) in the neck-shoulder and low-back in these clusters. The largest cluster served as reference to the other clusters and was characterized by low ergonomic exposures.Results:Clusters characterized by multiple combined ergonomic exposures for a relatively high percentage of the working time showed the largest increase in neck-shoulder as well as low-back pain intensity from baseline to follow-up. However, clusters characterized by high exposure to a few specific ergonomic factors also increased pain significantly, eg, standing/walking combined with lifting/carrying or twisted/bent back for the majority of the working time increased low-back pain, whereas repetitive arm movements for the majority of the working time with or without standing/walking increased neck-shoulder pain.Conclusion:Combined occupational ergonomic exposures play an important role in the development of musculoskeletal pain. Workplace preventive approaches should consider this in risk assessments and organization of the work.     

Effects of Ambulant Myofeedback Training and Ergonomic Counselling in Female Computer Workers with Work-Related Neck-Shoulder Complaints: A Randomized Controlled Trial

Objective: To investigate the effects of ambulant myofeedback training including ergonomic counselling (Mfb) and ergonomic counselling alone (EC), on work-related neck-shoulder pain and disability. Methods: Seventy-nine female computer workers reporting neck-shoulder complaints were randomly assigned to Mfb or EC and received four weeks of intervention. Pain intensity in neck, shoulders, and upper back, and pain disability, were measured at baseline, immediately after intervention, and at three and six months follow-up. Results: Pain intensity and disability had significantly decreased immediately after four weeks Mfb or EC, and the effects remained at follow up. No differences were observed between the Mfb and EC group for outcome and subjects in both intervention groups showed comparable chances for improvement in pain intensity and disability. Conclusions: Pain intensity and disability significantly reduced after both interventions and this effect remained at follow-up. No differences were observed between the two intervention groups.     

The relationship between leisure time, physical activities and musculoskeletal symptoms and disability in worker populations

Objectives: To assess the association between leisure time physical activity and musculoskeletal morbidity, as well as possible interactions with physical activity at work. Methods: A literature search was performed to collect all studies on musculoskeletal disorders in which physical activity was involved as a variable. Next, an analysis was made of questionnaire data on a group of 2,030 workers in various occupations, on self-reported physical activity in leisure time and at work, musculoskeletal symptoms (from low back, neck-shoulder and lower extremity) and sick leave due to these symptoms. A logistic regression analysis was carried out to estimate the association between musculoskeletal morbidity and four physical-activity indices (participation in sports and sedentary activities, active life style, sedentary life style), adjusted for age, gender, education and work load. Interaction of leisure activities with age and work load was tested too. Results: Available literature data (39 studies) showed inconsistent results. Most studies did not show any effects. Some studies indicated favourable effects of physical activity, both on low back and neck pain. Participation in some vigorous sports seemed associated with unfavourable effects. The empirical data showed no association between participation in sports and/or other physical activities in leisure time and musculoskeletal symptoms. Sedentary activity in leisure time was associated with higher prevalence rates of low back symptoms and sick leave due to low back symptoms. Conclusions: Stimulation of leisure time physical activity may constitute one of the means of reducing musculoskeletal morbidity in the working population, in particular in sedentary workers. Received: 4 October 1999 / Accepted: 25 April 2000     

Musculoskeletal disorders among female dental personnel – clinical examination and a 5-year follow-up study of symptoms

Objectives: To explore the natural course of musculoskeletal disorders during a 5-year period among dental personnel, to survey findings and diagnoses according to a standardized protocol, and to compare and evaluate different methods for the detection of musculoskeletal disorders in a population. Methods: In a 5-year follow-up study, dental personnel (n = 90) and referents (n = 30) were studied. The Nordic questionnaire (years 0 and 5), the present pain rating according to the Borg category ratio scale, and physical examination (year 5) were used. Results: In year 0 the prevalence of symptoms in the shoulders, the wrists/hands, and, unexpectedly, the hips was higher in the dental personnel as compared with the referents. Furthermore, those (16%) who had left the dental profession during the observation period showed a higher prevalence of and, often, combined symptoms from several body regions in year 0 than did those who stayed. Dental personnel who remained in the profession tended to have an increased risk of developing more symptoms in the shoulders and the elbows/wrists/hands in year 5 as compared with year 0 and at year 5 were in more pain and had received more diagnoses for the neck/shoulder region relative to the referents. Furthermore, there was a considerable variation in symptoms during the follow-up period. The sensitivity of the pain rating and of the Nordic questionnaire in detecting musculoskeletal disorders was high for the neck and shoulders but was not as high for the elbow, wrists/hands, or hips. The association was better for diagnoses than for findings. The opposite patterns were observed for specificity. Conclusions: Dental personnel had an increased risk of developing musculoskeletal disorders as verified by symptoms and diagnoses and more painful or persistent conditions. This led to a selection out of work. The questionnaire and the present pain rating gave a relatively good picture of the prevalence of musculoskeletal disorders arising from the neck, shoulders, and hips and would be useful as screening tools. Their sensitivity in detecting disorders was higher for diagnoses than for findings. However, these methods were not as sensitive for disorders involving the elbows/wrists/hands. Physical examinations gave more detailed information. Received: 20 October 1998 / Accepted: 6 March 1999     

Co-occurrence of musculoskeletal pain among female kitchen workers

Objectives: The co-occurrence of musculoskeletal pain symptoms in seven body sites and their combinations among women in kitchen work were studied. Methods: Data on musculoskeletal pain during the past 3 months in the neck, shoulders, forearms/hands, low back, hips, knees and ankles/feet were gathered by questionnaire from 495 female workers (mean age 45 years) in connection with an ergonomic intervention study in municipal kitchens of four cities in Finland. Altogether 122 kitchens (60% of those eligible) participated in the study. The response rate in the participating kitchens was 98%. Results: The 3-month prevalence of any musculoskeletal pain was 87%, the most common sites being the neck (71%), low back (50%) and forearms/hands (49%). About 73% of the subjects had pain in at least two, 36% in four or more, and 10% in 6–7 sites. In pair wise comparisons, e.g. neck pain was associated with pain in other sites with prevalence ratios (PR) varying from 1.3 to 1.6, and ankle or foot pain with ratios between 1.9 and 2.4. The seven pain symptoms occurred in more than 80 different combinations. When the co-occurrence of pain was studied in three larger anatomical areas, i.e. any pain in the axial (neck and low back), upper limb and lower limb areas, subjects reporting concurrent pain in all three were the largest category (36% of the respondents). Altogether 53% of the workers reported pain in at least the axial and upper limb areas, and 48% in at least the axial and lower limb areas. Conclusions: Widespread co-occurrence of musculoskeletal pain symptoms was common among female kitchen workers with slight predominance in the upper body.     

Review of the factors associated with musculoskeletal problems in epidemiological studies

Objectives: To review systematically all epidemiological studies of the past 15 years concerning the factors associated with musculoskeletal disorders (MSDs) or complaints of the neck and upper limbs. Methods: Fifty-seven cross-sectional and seven longitudinal studies were reviewed. A list was made of all personal, occupational, extra-occupational and psycho-organisational factors taken into consideration in each study, and of those that were found in association with MSDs. MSDs of the neck-shoulder region (NSs) and hand-wrist (HWs) were considered separately. About 70 different factors are listed. Results: This inventory identifies the factors or categories of factors that were generally taken into consideration. It makes it possible also to evaluate the strength of the association with a given factor, in considering the number of studies finding an association, and those that did not consider this factor. Based on this review, some factors taken into consideration (such as weight or hobbies) could be excluded in further studies, and replaced by more specific psycho-organisational factors. Received: 3 July 2000 / Accepted: 31 October 2000     

The Prevalence of and Risk Factors for Neck Pain and Upper Limb Pain among Secondary School Teachers in Hong Kong

Objective: To investigate the prevalence and occupational risk factors of neck and upper limb disorders among secondary school teachers. Methods: One hundred secondary schools in Hong Kong were randomly chosen. Every full-time teacher received a questionnaire and a letter describing the purpose of the study. Questionnaires were collected 1 to 3 weeks later. Results: Among 3,100 secondary school teachers, the lifelong prevalence of neck pain and upper limb pain was 69.3% (2091/3018) and 35.8% (1088/3042) respectively. The lifelong cumulative incidence of both neck and upper limb pain was 31.6% (938/2966). Multiple logistic regression analysis showed that gender, age and working in head down posture were identified as risk factors for neck and upper limb pain. High workload, low colleague support and high anxiety were found to be significant on affecting the neck pain and upper limb pain developed after becoming teachers. Conclusions: Neck pain and upper limb pain were highly prevalent in secondary school teachers in Hong Kong. Gender, age, head down posture and some psychological factors were found to be significant risk factors.     

Gender differences in upper extremity musculoskeletal complaints in the working population

Objectives: This study analysed the association between gender and upper extremity musculoskeletal complaints, among the general working population and in various occupational groups. The hypothesis was tested whether the higher risk for women in the general working population for these complaints could partly be explained by differences in the distribution of men and women in occupations with different risks for the onset of upper extremity musculoskeletal complaints. Methods: The data for this study came from cross-sectional questionnaire data from 16,874 employees categorised in 21 different occupational classes. Associations between gender and complaints of the upper extremities were analysed for the total study sample and for each occupational class separately. An adjustment was made for the variable `occupational class' in the final model in order to study the impact of occupational gender segregation on gender differences in upper extremity complaints in the working population. Results: In the total study sample, significantly higher risks of complaints of the neck, shoulder, elbow, and wrist among the women were observed. Within many occupational classes, women reported significantly higher risks than did men, in particular for complaints of the neck and shoulder. Adjustment for occupational class showed increased risks for female workers for complaints of the neck, shoulder, elbow, and wrist, hence, rejecting our hypothesis on occupational gender segregation as an explanation for the higher risks for upper extremity complaints among women in the general working population. Conclusions: This study confirmed the presence of gender differences in upper extremity musculoskeletal complaints among the working population and in many occupational classes, with female workers having the higher risk. The results, however, do not lend support to a differential occupational exposure theory as an explanation for the higher risks for these complaints among women in the general working population. Careful consideration of gender influence in ergonomic epidemiological studies is recommended. Received: 16 February 2000 / Accepted: 10 June 2000     

Active or passive treatment for neck-shoulder pain in occupational health care? A randomized controlled trial

AIMS: To compare the effectiveness of thoracic manipulations with instructions for physiotherapeutic exercises for the treatment of neck pain in occupational health care. METHODS: Seventy-five subjects aged 30-55 years from a random sample of 241 employees of the Finnish Broadcasting Company were randomly allocated to treatment in the form of four thoracic manipulations (n = 43), or instructions for physiotherapeutic exercises (n = 32). The subjects reported neck-shoulder pain on a structured pain questionnaire using a visual analogue scale (VAS, 0-10). Muscle tenderness and tender thoracic levels were evaluated by a blinded investigator (A.S.) at 6- and 12 month follow-ups. RESULTS: A statistically significant difference was found in self-reported worst pain by VAS at the 12 month follow-up in favour of the thoracic manipulation group. CONCLUSIONS: The natural course of the neck-shoulder pain in this study appears benign; pain was also reduced in the drop-out group. Both treatments were found effective at the 12 month follow-up. The effect of four manipulations was more favourable than the personal exercise program in treating the more intense phase of pain.     

Work relatedness of chronic neck pain with physical findings--a systematic review

OBJECTIVES: This paper systematically reviews the work-relatedness of neck-shoulder disorders with associated physical findings. METHODS: Studies incorporating a physical examination were focused upon. Four detailed reviews were searched, and a systematic search of the MEDLINE, Embase BIDS, and Psychinfo databases was conducted until May 2006, the key words for the outcome and various occupational exposures being combined. The quality of each paper was rated by criteria related to study design, power, sampling methods, response rate, potential for bias, or confounding, and approaches to the assessment of exposure outcome. Weight was given to studies with objective exposure-response information. RESULTS: Twenty-one relevant reports (four prospective) were found. Most considered the outcome neck pain with palpation tenderness (tension neck syndrome) or mixed neck-shoulder disorder (predominantly tension neck syndrome). Most investigations shared common limitations--small sample size, potential for confounding, incomplete blinding, and crude exposure assessment. The overall quality of the information was rated as excellent for only two reports. Exposures included repetitive work (14 studies), static loading (12 studies), neck flexion (7 studies), force (5 studies), and occupational psychosocial factors (7 studies). Moderate evidence was found for a causal relation for repetition at the shoulder and for neck flexion allied with repetition. Limited evidence was found for hand-wrist repetition, neck flexion with respect to static loading and force in the absence of repetition, and high job demands, low control, low job support and job strain. CONCLUSION: There is some evidence that neck pain with palpation tenderness is causally related to workplace exposures. However, evidence is lacking on the validity, clinical course, and functional importance of this diagnostic entity.     

Risk factors for neck and upper limb disorders: results from 24 years of follow up [published erratum appears in Occup Environ Med 1999 May;56(5):358]

OBJECTIVES: To investigate associations between different potential risk factors, related and not related to work, and disorders of the neck and upper extremities occurring up to 24 years later. METHODS: The study comprised 252 women and 232 men, Swedish citizens, 42-59 years of age and in a broad range of occupations. Information about potential risk factors was available from a former study conducted in 1969. Data on disorders of the neck, shoulder, and hand-wrist disorders were obtained retrospectively for the period 1970-93. RESULTS: Risk factors were found to differ between the sexes. Among women over-time work, high mental workload, and unsatisfactory leisure time were associated with disorders in the neck-shoulder region. Interaction was found between high mental workload and unsatisfactory leisure time. Neck symptoms earlier in life were associated with recurrent disorders. Hand and wrist disorders were associated mainly with physical demands at work. Among men blue collar work and a simultaneous presence of high mental workload and additional domestic workload predicted disorders in the neck-shoulder region. CONCLUSIONS: Factors related and not related to work were associated with disorders of the neck, shoulders, and hands and wrist up to 24 years later in life. These included factors related to working hours which previously have not been noted in this context. Interactions between risk factors both related and not related to work were commonly found.

 

     

Work postures and neck-shoulder pain among orchestra musicians

BACKGROUND: The purpose of the present study was to identify associations between a work posture with elevated arm position, duration of active playing time, and neck-shoulder pain among orchestra musicians. METHODS: In this study, with a cross-sectional study design, a total of 235 subjects from 12 Swedish orchestras were categorized into four exposure groups according to arm position and duration of active playing time. Logistic regression analysis was used to calculate odds ratios (OR) for neck-shoulder pain in the four exposure groups. RESULTS: A higher prevalence of neck-shoulder pain were found in the groups "elevated arm position, <2 hr per workday" [OR 4.15 (1.30-13.22)], and "elevated arm position, >3 hr per workday" [OR 5.35 (1.96-14.62)] compared to the group "neutral arm position, <2 hr per workday". CONCLUSIONS: Musicians working in an elevated arm position (e.g., violinists, violists, flutists, and trumpet players) had a higher prevalence of neck-shoulder pain than those working in a more neutral position.     

Subjective complaints in orthopedists and general surgeons

The aim of this study was to investigate the prevalence of subjective complaints among two groups of health care personnel. Using a mail questionnaire, 63 male orthopedists and 78 male general surgeons were asked to respond to questions on their subjective musculoskeletal complaints as well as their age, occupational career, and daily working time. In the final analysis, 54 orthopedists and 63 general surgeons who were aged 59 years and had worked for at least 5 years in clinical practice were considered. The mean age was 43.3 (SD 7.6) years for the orthopedists and 41.8 (SD 9.5) years for the general surgeons. Their mean employment time was 18.1 (SD 8.9) years and 16.6 (SD 9.5) years, respectively. The average working time per day was 9.5 h. In general, the orthopedists had a higher prevalence of subjective complaints than the general surgeons. Problems in the shoulders and lower back were the most frequently reported complaints, followed by neck problems. There were significant differences (P < 0.05) between the two groups regarding stiffness in the shoulders, stiffness in the lower back, pain in the neck, and numbness in the fingers. When subjective complaints were compared between the junior (employment time: < 20 years) and senior (employment time: 20 years) staff, the junior orthopedists had significantly higher prevalence rates for stiffness in the shoulders, pain in the neck, and stiffness in the lower back. This subgroup had significantly higher odds ratios (ORs) for some subjective complaints as compared to the junior surgeons, e.g., pain in the neck [OR = 6.19, 95% confidence interval (95% Cl) 1.91–20.04], shoulder stiffness (OR = 3.75, 95% Cl 1.36–10.31), pain in the shoulders (OR = 4.41, 95% Cl 3.64–4.70), and stiffness in the lower back (OR = 4.93, 95% Cl 1.74–13.94). It was concluded that ergonomic intervention to improve the working environment is imperative. In addition to ergonomic factors, consideration might also be given to psychological factors with a view to reducing the risk of subjective complaints among these subjects.     

深圳市中学生日常行为习惯与其肩颈腰背健康状况的关系

目的 探讨深圳市中学生日常行为习惯与其肩颈、腰背健康的相关性,为更好地预防中学生肩颈、腰背症状提供理论依据。方法 采取分层整群抽样方法,抽取深圳市10个区10所中学的3 952名学生进行脊柱健康状况及日常行为习惯的问卷调查,调查数据采用SPSS 23.0软件进行分析。结果 深圳市中学生中有肩颈症状和腰背症状的分别为20.3%和15.2%;有肩颈症状的女生（25.3%）多于男生（16.2%）,高中生（24.5%）多于初中生（15.5%）,住校生（24.4%）多于非住校生（17.6%）;有腰背症状的女生（17.9%）多于男生（13.0%）,差异均有统计学意义（P<0.05）。多因素logistic结果分析显示,性别、学校类型、午休趴在桌子上睡觉、因学习或玩电脑熬夜、自评学习压力、持续长时间做作业、玩手机、看电视和使用电脑与学生肩颈症状相关（P<0.05）;性别、午休趴在桌子上睡觉、因学习或玩电脑熬夜、自评学习压力、持续长时间做作业、玩手机、看电视与学生腰背症状相关（P<0.05）。结论 深圳市中学生肩颈、腰背症状不容忽视,学习压力、长时间静坐行为和不良的睡眠习惯均对脊柱健康有影响。     

Musculoskeletal disorders of the neck and shoulders in female sewing machine operators: prevalence, incidence, and prognosis

OBJECTIVES—To assess the occurrence and persistence of two restrictively defined neck-shoulder disorders among sewing machine operators. To assess factors associated with the development of neck-shoulder disorder and prognostic factors for remaining a case, when disorders were already present.
METHODS—In an initial group of 243 sewing machine operators, 178 were followed up for 2 years. At baseline and at 1 and 2 years follow up the participants underwent a clinical examination of the neck and arms and filled in a questionnaire about current musculoskeletal complaints. Clinical criteria for two main neck-shoulder disorders were defined: rotator cuff tendinitis and myofascial pain syndrome. A baseline control group consisted of 357 women with varied non-repetitive work.
RESULTS—At baseline the overall prevalence of myofascial pain syndrome and rotator cuff tendinitis was 15.2% and 5.8% among sewing machine operators compared with 9.0% and 2.2%, respectively, among controls. The presence of the disorders was strongly associated with a self perception of poor general health. Although myofascial pain syndrome showed a U shaped association with years as a sewing machine operator, rotator cuff tendinitis was absent among the newest recruits and present among 15% of the women with more than 20 years as a sewing machine operator. Besides years as a sewing machine operator, the risk of having a neck-shoulder disorder at baseline was significantly associated with high stress (prevalence ratio (PR)=2.54; 95% confidence interval (95% CI) 1.28 to 5.05) when adjusted for age, body mass index, smoking, living alone with children, job strain, and social support from colleagues and supervisors. Only one of 13 participants with rotator cuff tendinitis at baseline recovered during follow up. Myofascial pain syndrome showed a much more fluctuating tendency. Low social support (RR 3.72; 95% CI 1.22 to 11.30) and smoking (RR 3.93; 95% CI 1.33 to 11.58) were associated with the development of neck-shoulder disorders, which was also associated with neck-shoulder pain score and living alone with children.
CONCLUSION—Rotator cuff tendinitis showed a higher degree of persistence than myofascial pain syndrome. Both disorders highly influenced the perception of general health. Women who lived alone with children, were smokers, or experienced low support from colleagues and supervisors had a higher risk of contracting a neck-shoulder disorder.


Keywords: rotator cuff syndrome; myofascial pain syndrome; follow up study; prognostic risk factors     

Occupational musculoskeletal stress and disorders of the neck and shoulder: a review of possible pathophysiology

Summary Disorders and complaints in the neck and shoulder regions are common among industrial workers and are often attributed to occupational musculoskeletal stress. The possible pathophysiological mechanism of occupational stress on the neck and shoulders is reviewed. A mechanical origin for cervical disc degeneration and osteoarthrosis is reported for a few occupational groups. However, a mechanical origin for osteoarthrosis is debatable. A work posture involving elevated arms may accelerate degeneration of shoulder tendons through impairment of circulation due to static tension and humeral compression against the coracoacromial arch. Furthermore, work tasks with repetitive arm movements may evoke shoulder tendinitis or tendovaginitis, probably due to friction. Three possible routes to neck-shoulder muscular pain are discussed; mechanical failure, local ischemia and energy metabolism disturbance.     

Randomized Controlled Trial of Physiotherapy and Feldenkrais Interventions in Female Workers with Neck-Shoulder Complaints

The present study aimed to investigate whether physiotherapy or Feldenkrais interventions resulted in a reduction of complaints from the neck and shoulders (prevalence, pain intensity, sick leave, and disability in leisure and work roles) in 97 female industrial workers (not on long-term sick leave). Range of motion of neck and shoulders, VO₂, endurance score (i.e., summation of pain intensity ratings during a static shoulder flexion), cortical control according to the Feldenkrais methodology, and physiological capacity according to a dynamic endurance test of the shoulder flexors with simultaneous surface EMG were also recorded. The workers were randomized to: (1) physiotherapy group (PT-group; treatment according to the ergonomic program of the PTs of the occupational health care service), (2) Feldenkrais group (F-group; education according to the Feldenkrais methodology), or (3) control group (C-group; no intervention). Pre- and post-tests were made at one-year intervals. The two interventions lasted 16 weeks during paid working time. The F-group showed significant decreases in complaints from neck and shoulders and in disability during leisure time. The two other groups showed no change (PT-group) or worsening of complaints (C-group). The present study showed significant positive changes in complaints after the Feldenkrais intervention but not after the physiotherapy intervention. Possible mechanisms behind the effects in the F-group are discussed.     

The Prevalence of Musculoskeletal Complaints among Women in Tijuana,Mexico: Sociodemographic and Occupational Risk Factors

Abstract

The authors interviewed an age- and occupation-stratified sample of 466 women, aged 18–40, from 12 Tijuana neighborhoods, about sociodemographic characteristics, work and reproductive history, and musculoskeletal complaints. A total of 29.8% reported experiencing aches or pain in the low back, 38.3% in the upper back, 26.4% in the neck/shoulders, 18.2% in the hand/wrist, and 28.3% in the legs in the preceding year. Both sociodemographic and occupational factors were associated with these complaints. Very low educational attainment, having substandard housing, being the head of household, and being a migrant were each associated with an increased prevalence of one or more musculoskeletal complaints. In general, working outside the home increased the risk of musculoskeletal complaints. Compared with women who had not worked in the preceding 30-month period, those working in the maquiladora had 40–90% higher risks of upper back, neck/shoulder, and hand/wrist pain. Compared with women working outside the maquiladora, maquiladora women workers had 20% higher risks of low back, upper back, and neck/shoulder complaints. More detailed studies of the incidences of musculoskeletal disorders and of specific etiologic risk factors within the maquiladora industry are warranted. Future studies should concurrently evaluate sociodemographic risk factors.     

The epidemiology of chronic pain in a Swedish rural area

In order to establish basic epidemiological data on chronic pain (duration > 3 months) in a rural population, a survey of pain symptoms was conducted by means of a postal questionnaire. The questionnaire was sent to a random sample (from the population register) of 15% of the population aged 25–74 (n=1806) in two Swedish primary health care districts. The response rate was 90%. In a follow-up study individuals selected among the responders (neck-shoulder pain, widespread pain and controls without pain; n=213) were examined and interviewed. They were requestioned about pain symptoms 24 months after the initial survey.Without sex differences 55% of the population had perceived persistent pain for 3 months and 49% for 6 months. Women experienced more multiple localizations of pain and had pain in neck, shoulder, arm and thigh to a greater extent than men. Prevalence of pain increased by age up to 50–59 years for both genders and then slowly decreased. The neck-shoulder area was the most common site of pain (women 32.9%, men 27.5%). Blue-collar workers and employers (including farmers) reported chronic pain to a greater extent than other groups. In 13% of the population, manifest pain problems were associated with reduced functional capacity.     

Physical exercise, body mass index, and risk of chronic pain in the low back and neck/shoulders: longitudinal data from the Nord-Trondelag Health Study

Chronic musculoskeletal pain constitutes a large socioeconomic challenge, and preventive measures with documented effects are warranted. The authors' aim in this study was to prospectively investigate the association between physical exercise, body mass index (BMI), and risk of chronic pain in the low back and neck/shoulders. The study comprised data on approximately 30,000 women and men in the Nord-Tr?ndelag Health Study (Norway) who reported no pain or physical impairment at baseline in 1984-1986. Occurrence of chronic musculoskeletal pain was assessed at follow-up in 1995-1997. A generalized linear model was used to calculate adjusted risk ratios. For both females and males, hours of physical exercise per week were linearly and inversely associated with risk of chronic pain in the low back (women: P-trend = 0.02; men: P-trend < 0.001) and neck/shoulders (women: P-trend = 0.002; men: P-trend < 0.001). Obese women and men had an approximately 20% increased risk of chronic pain in both the low back and the neck/shoulders. Exercising for 1 or more hours per week compensated, to some extent, for the adverse effect of high BMI on risk of chronic pain. The authors conclude that physical inactivity and high BMI are associated with an increased risk of chronic pain in the low back and neck/shoulders in the general adult population.