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Work 54 (2016) 113–119
DOI:10.3233/WOR-162262
IOS Press
113
Association between postures
and work-related musculoskeletal
discomforts (WRMD) among beverage
bottling workers
U.O. Abaraogub,∗, D.O. Odebiyiaand O.A. Olawalea
aDepartment of Physiotherapy, Faculty of Clinical Sciences, College of Medicine of the University
of Lagos, Lagos, Nigeria
bDepartment of Medical Rehabilitation, College of Medicine, University of Nigeria, Enugu Campus,
Enugu, Nigeria
Received 22 July 2014
Accepted 26 June 2015
Abstract.
BACKGROUND: Bottling tasks postures may increase risk for developing work related musculoskeletal discomforts
(WRMDs). Postural evaluation with epidemiological investigation for possible association may be appropriate for planning
ergonomic programs.
OBJECTIVE: To evaluate working postures and investigate associations between postural risks and prevalence of WRMDs
among beverage bottling workers.
METHOD: 301 beverage bottling company workers (8 work-stations) participated in this survey. They were required to
complete a modified standard Nordic questionnaire, and their working postures examined utilizing Rapid Entire Body
Assessment (REBA).
RESULTS: Postural risks ratings were high (8–10) to very high (11–15). Shoulder was the most commonly reported body
part with WRMDs except at the carbonating workstations where Neck, Upper and Lower back discomforts were the most
common (60.0%). The compounding workstations recorded the highest prevalence of WRMDs in all body regions except
shoulder and wrist. There was a significant association between working posture and occurrence of WRMDs in at least one
body part. Similarly, working posture was significantly associated with WRMDs at Neck, Upper back and Wrist.
CONCLUSIONS: Working postures may be exposing beverage bottling workers to significant risk of developing WRMDs
in at least one body part, more specifically, Shoulder, Neck, Upper back and Wrist. Intervention aimed at reducing postural
risks is necessary.
Keywords: Ergonomics, working posture, REBA
∗Address for correspondence: Abaraogu Ukachukwu Oko-
roafor, Lecturer, Department of Medical Rehabilitation, College
of Medicine University of Nigeria, Enugu. E-mails: uabaraogu@
yahoo.com; ukachukwu.abaraogu@unn.edu.ng.
1051-9815/16/$35.00 © 2016 – IOS Press and the authors. All rights reserved
AUTHOR COPY
114 U.O. Abaraogu et al. / Association between postures and WRMDs
1. Introduction
Work related musculoskeletal disorders (WRMDs)
are a health problem of the loco-motor apparatus,
and a common problem in working populations in
western countries [1]. They also constitute significant
ergonomic problems encountered in the workplaces
[2]. There is some evidence to suggest that WRMDs
are associated with exposures to risk factors in the
work place [1–4], with complaints usually consisting
of a range of symptoms and disorders localized in the
neck, shoulder, elbow, wrist, hand, back as well as
the lower limb [1, 4, 5]. Work related musculoskele-
tal disorders are the leading causes of occupational
disability [2, 6].
According to the National Institute for Occupa-
tional Safety and Health (NIOSH), a high incidence
of WRMDs has been reported among workers of bot-
tling industry, compared to other manufacturing and
services industries [7]. This has been attributed to
the involvement of sustained awkward static pos-
tures, which is characteristics of the categories of
workers; as well as the repetitive manual handling
activities/motion associated with the majority of the
different stages of the beverage bottling industry job
tasks [8–10]. This trend of work situations poses
health risk both for individual workers and the bot-
tling company production line.
Studies have implicated WRMDs as a major
cause of work-related disabilities and lost-time ill-
ness injuries in both developed, and industrially
developing countries and this has been attributed to
the poor working conditions [4, 11–14]. The prob-
lem is extremely serious in the developing countries
owing to the absence of an effective work injury pre-
vention programme [12, 15]. The bottling industry
has become one of the most important food indus-
tries since the invention of carbonated water and
the discovery of the fermentation process. It is a
large employer of labour in Nigeria, ranging from
executive to casual job positions, as well as numer-
ous individual dealers and retailers whose business
revolves around products from the bottling industry.
The starting point of a bottling process begins at the
de-palletizing workstation where the factory workers
manually unload new cases of bottles from a pallet
onto a conveyor [8]. The process of unloading new
cases of bottles from a pallet onto a conveyor involves
excessive overhead reaching at the beginning of a
new pallet and forward bending toward the end of the
unloading process [16]. Other bottling tasks, such as
bottle screening, beverage bottling and crowning as
well as palletizing operation have been categorized
as high risk for developing WRMDs in at least one
part of the body [8]. It has been suggested that an
association exist between WRMDs and certain multi-
ple physical work task variations especially repetitive
machine paced tasks [17], various postural stresses [5,
8], forceful exertion – sustained static muscle action
[18], contact machine stress [17] as well as work
organizational and demographic confounders [8, 18].
The main focus of an ergonomics intervention is
to make tasks and environments compatible with the
abilities and limitations of people [19]. In most cases,
this usually begins with baseline risk identification
and epidemiological investigations [8]. Associa-
tion between WRMDs and the working-posture
assumed by beverage bottling factory workers has
remained grossly understudied. Although studies
have been done on work-related musculoskeletal dis-
order among beverage workers, none has reported the
condition among African or developing country set-
ting. Also a specific objective assessment has not been
attempted to delineate association between different
workstations postures of beverage workers and the
occurrence of musculoskeletal disorders. This is the
gap sought to be filled by the present study. Specifi-
cally, the study sought to investigate the association
between working postures of beverage bottling fac-
tory workers in a developing country setting and
reported musculoskeletal discomfort.
2. Methods
2.1. Participants
A total of 301 beverage industry workers (from
eight work-stations of palletizing, depalletizing,
bottle screening, compounding, carbonating, water
treatment and crowning) participated in the study.
They were recruited from three bottling companies
located in Eastern Nigeria. Only workers who have
worked for at least one year in the work-stations were
allowed to participate in the study. Workers were
recruited into the study if they could comprehend
written English and/or Igbo language and consented
to participate in the study. Supervisors or others who
are not involved in direct manual handling in these
work-stations were excluded from the study.
2.2. Research protocol
Prior to the commencement of this study, approval
was sought for and obtained from the Research
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U.O. Abaraogu et al. / Association between postures and WRMDs 115
and Ethic Committee of Lagos University Teaching
Hospital, Idi-Araba, Lagos, Nigeria. Cross-sectional
design was employed in this study. The participants’
posture was assessed while at their duty post using
Rapid Entire Body Assessment (REBA) [20] after
which they were requested to complete a modi-
fied Standard Nordic Musculoskeletal questionnaire
(NMQ) [21]. The detail descriptions of the NMQ
and REBA have been given in previous publication
[22]. As a recap, the REBA scores, risk levels and
the corresponding action levels needed are as fol-
lows: REBA score of 1 means no risk and no action
required; Scores 2–3 is a low risk and may require
change. With scores between 4 and 7, medium risk
is described and further investigation is needed with
change needed soon. Scores 8–10 signifies high risk,
and needing immediate investigation and change. A
REBA score of 11 and above is described as very high
risk and entails that immediate change is required
[20].
There are three stages involved in this study. The
first stage involved meetings with the employees
of the selected beverage bottling companies, dur-
ing which the aims and objectives of the study and
procedures were discussed with the hope of getting
approval. The voluntary consent form applicable to
this study was also discussed to assure the partici-
pants of absolute confidentiality. The questionnaires,
each bearing a serial number, were handed out to
workers; the Igbo version was administered only
to participants who could not comprehend written
English Language. The second stage involves video-
taping of workers as they were on their duty post
carrying out their tasks; participants video clip was
crossed tagged against the serial number on his/her
questionnaire to enable easy references. The third
stage involved the REBA frame-by-frame analysis
of working posture by utilizing the memory card,
laptop computer, goniometer, and a water-based felt
tip marker. For each working posture, the video
recording was paused and a felt-tip marker was used
to draw lines on the computer screen. Then, body
postures and joint angles were measured with a
goniometer. Specifically, the most severe instances
of flexion/extension/twist of neck and ulnar/radial
deviations of the hands and wrists were sought as
well as the pronation/supination of the forearm and
elbows, shoulder abduction adduction, trunk twist-
ing, forward bending, and feet location and support.
Observations for the more severe posture and joint
angles were made while the workers were carrying
out their tasks.
Table 1
Physical characteristics of the respondents (N= 301)
Frequency (n) Percentage (%)
Gender:
Male 222 73.75
Female 79 26.25
Highest Educational Attainment:
No former education 30 10.00
Primary education 142 47.20
Secondary education 102 34.20
Post-secondary 26 8.60
Years of experience:
1 – 2 65 21.60
3 – 4 89 29.60
5 – 6 78 25.90
7 – 8 39 12.90
9 – 10 21 7.30
>10 18 2.70
Work station:
Depalletizing 113 37.50
Palletizing 84 27.90
Crowning 28 9.30
Bottle screening 35 10.60
Carbonating 10 3.30
Bottle Filling 16 5.30
Compounding 7 2.30
Water Treatment 8 2.70
2.3. Data analysis
The data collected were analyzed using SPSS (ver-
sion 15.0), and presented using descriptive statistics
of frequency and percentages. Inferential statistics
of chi-square was used to determine association
between variables. The level of significance was set
at p< 0.05.
3. Results
3.1. Physical characteristics
A total of 301 fully filled copies of the ques-
tionnaire were returned from 367 copies that were
distributed, giving 82.16% response rate. Also, 301
copies of REBA form were available for the final
analysis. Table 1 showed the physical characteristic
of the respondents; 222 (73.8%) and 79 (26.2%) of
the respondents were males and females respectively.
The highest educational attainment of the majority
of the respondents was either primary education 142
(47.2%) or secondary education 102 (34.2%). The
majority 89 (29.6%) of the respondents had spent
between 5–6 years on the job (Table 1). Depalletizing
unit had the highest 113 (37.5%) number of respon-
dents (Table 1).
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116 U.O. Abaraogu et al. / Association between postures and WRMDs
Pattern distribution of WRMDs in the different
workstations is represented in Table 2. At least half
of the workers in the all the workstations reported
WRMDs of the neck, shoulder, upper back and lower
back. WRMDs of the elbow were most prevalent
at the water filling and compounding workstations
with over half of the workers in these workstations
reporting elbow symptoms. The compounding and
water treatment workstations recorded workers with
the highest prevalence of knee. More than 50% of
workers these workstations reported WRMDs of the
knee. See details in Table 2.
3.2. REBA analysis of participants’ postures and
presentations at different workstations
At palletizing workstations, video analysis
revealed that the neck was recurrently bent forward
in excess of 20◦and many times twisted. At the
depalletizing workstation, the back was bending
forward greater than twenty degrees and being
twisting to the side while placing cases on the
conveyor. This was also done in extreme repetitions
per minute (more than 4x). Here also, subjects often
stood on one leg to reach the top or very bottom
layers of the pallets and lorries rendering the leg
posture unstable. Shoulders of the workers at both
the palletizing and depalletizing units were being
raised and abducted greater than 45 degrees while
reaching overhead to remove or put back cases onto
the upper layers of conveying lorries or pallets.
In both workstations, handgrips were less stable
and wrist flexion usually greater than 15 degrees.
Generally, poor quality of forward-bent postures
and over-reaching of the shoulder while twisting
the neck were common among the depalletizers and
palletizers.
Sustained posture was the most common observed
in the carbonation, compounding and water treat-
ment workstations. The most notable in the bottle
filling and crowning work stations were ranged from
repetitive motion to rapidly changing postures due to
machine paced operations in these workstations. The
details posture rating according to REBA is presented
in Table 3.
The value of REBA ground scores for the major-
ity of the respondents in all the workstations ranged
from 7 to 18 indicating medium postural risk level
for 7.0% (21), high postural risk level for 55.8%
(168), and very high postural risk level for 37.2%
(112) of the workers; None of the respondents in all
the workstations were in the low postural risk level
(Table 3). Chi-Square statistics showed that there
was an association between the reported WRMDs
in the workstations and postural risk level of the
respondents (Table 4). In all the body regions, higher
prevalence of WRMDs was reported among the
respondents with high or very high risks posture
scores compared to those with medium. Chi-Squared
test showed that there was a significant difference
between respondents with medium risk – those with
REBA score of 4 ≤7 and those with high or very
high risk levels - REBA scores > 7 for wrist (p= 0.03),
upper-back (p= 0.016) and neck (p= 0.02) respec-
tively (Table 4).
4. Discussion
To our knowledge this is the first study in Africa
or developing country setting that sought, with spe-
cific objective assessment, to delineate association
between different workstations postures of bever-
age workers and the occurrence of musculoskeletal
disorders. Specifically, the research study sought to
determine the patterns of work-related musculoskele-
tal discomforts (WRMDs) and also to evaluate the
association between postural risks and occurrence of
WRMDs among beverage bottling workers. A high
prevalence of WRMDs was reported in this study
for almost all body parts, with the shoulder symp-
toms being the most commonly affected in all the
workstations. This was followed by the neck, upper
back and low-back in all the workstations. The find-
ing shows that WRMDs was a common occurrence
among this category of workers. Studies have shown
that WRMD is extremely common among beverage
bottling workers [23, 24], with the bottling industry
ranked sixth among 470 industries in terms of preva-
lence of WRMDs [7]. However, these studies were
done in the developed countries and never sought
any specific factors associated with WRMDs in this
population. In our study, the observed higher preva-
lence of WRMDs in the shoulder may be due to
the fact that the tasks are performed above shoul-
der, repetitive in nature and required sustained static
used of the shoulder muscles. It has been reported
that increased activities of postural muscles are asso-
ciated with altered pattern of motor activity and may
eventually lead to musculoskeletal disorders [25, 26].
Ezeukwu and colleagues [17], in their study sug-
gested that there is an association between WRMDs
and certain multiple physical work task variations
especially repetitive machine paced tasks.
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U.O. Abaraogu et al. / Association between postures and WRMDs 117
Table 2
Frequency distribution of reported WMSDs by workstations (N= 301)
Job categories/work-stations
Body parts Depal Pal Cr Scr Carb Fill Comp H20Tr Total
n % n%n%n%n%n %n % n % n%
Neck 59 52.2 54 64.3 16 57.1 20 57.1 6 60.0 8 50.0 5 71.4 5 62.5 173 57.5
Shoulder 83 73.5 65 77.4 21 75.0 27 77.1 10 10.0 12 75.0 5 71.4 6 75.0 229 76.1
Elbow 30 26.5 31 36.9 11 39.3 10 28.6 3 30.0 9 56.3 4 57.1 1 12.5 99 32.9
Wrist 43 38.1 35 41.7 7 25.0 13 37.1 3 30.0 4 25.0 2 28.6 2 25.0 109 36.2
Upper-back 59 52.2 49 58.3 14 50.0 19 54.3 6 60.0 6 37.5 5 71.4 5 62.5 163 54.2
Lower-back 69 61.1 54 64.3 19 67.9 19 54.3 6 60.0 9 56.3 5 71.4 6 75.0 187 62.1
Thighs 17 15.0 17 20.2 1 3.6 4 11.4 2 20.0 2 12.5 2 28.6 2 25.0 47 15.6
Knee 32 28.3 23 27.4 12 42.9 10 28.6 2 20.0 5 31.3 4 57.1 5 62.0 93 30.9
Ank/foot 48 42.5 33 39.3 10 35.7 15 42.4 3 30.0 6 37.5 3 42.9 1 12.5 119 39.5
Key: Depal = Depalletizing, Pal= Palletizing, Cr = Crowning, Scr = Screening, Carb= Carbonating, Fill = Bottle Filling, Comp = Compoun-
ding, H20Tr=Water Treatment.
Table 3
Posture Evaluation by REBA and distribution of scores by workstations (301)
REBA Grand Scores
4–7 8–10 11–18
Medium risk High risk Very high risk
Workstations n % n % n % X2p-value
All workstations 21 7.00 168 55.80 112 37.20
Palletizing 2 1.70 66 58.50 45 39.80
Depalletizing 2 2.30 35 41.70 47 56.00
Crowning 1 2.50 18 64.30 3 10.70
Screening 1 2.80 26 74.30 8 22.90 79.220 0.000∗
Carbonating 1 10.00 5 50.00 4 40.00
Filling 7 43.80 7 43.80 2 12.00
Compounding 0 0.00 5 71.40 2 2.80
H2O Treatment 1 12.50 6 75.00 1 12.50
∗Significant at p< 0.05. Key: X2= Chi-Square; REBA =Rapid Entire Body Assessment.
Table 4
Association between WMSDS by Body regions and REBA score (N= 301)
Ground REBA Score/ Risk level df= 1
4≤7>7
Medium risk High or very high risk
Body parts n % n % X2p-value
Overall 16 76.20 256 91.40 5.210 0.022∗
Neck 7 33.30 166 59.30 5.383 0.020∗
Shoulder 13 61.90 216 77.10 2.493 0.114
Elbow 6 28.60 93 33.20 0.191 0.662
Wrist 3 14.30 106 37.90 4.699 0.030∗
Upper back 6 28.60 156 55.70 5.791 0.016∗
Lowe back 11 52.40 176 62.90 0.911 0.340
Hip/thigh 2 9.50 45 16.10 0.636 0.425
Knee 6 28.60 87 31.10 0.057 0.811
Ankle/foot 7 33.30 112 40.00 0.363 0.547
∗Significant at p< 0.05. Key: X2= Chi-Square; REBA =Rapid Entire Body Assessment.
Participants from the Depalletizing, Palletizing,
Crowning and Screening workstations reported
more WRMDs when compared with their counter-
part from Carbonating, Bottle-Filling, Compounding
and Water Treatment workstations. The reported
WRMDs follow similar trend in some categories of
workstations, and probably described these workers’
workstations peculiarity, vis-`
a-vis the demand of the
tasks of these workstations. Workers from the Car-
bonating, Bottle-Filling, Compounding and Water
Treatment workstations are more exposed to less
manual tasks. At the compounding stations, WRMDs
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118 U.O. Abaraogu et al. / Association between postures and WRMDs
were mostly reported in the neck, shoulder, low-back
and upper back; for the carbonating stations WRMDs
were mostly reported in the lower back and knee; the
low-back and knee were the mostly reported sites of
WRMDs at the water treatment workstations.
Regarding workers from Depalletizing, Palletiz-
ing, Crowning and Screening workstations WRMDs
were mostly reported in the shoulder followed by the
neck, upper back and low-back. This observation has
been attributed to the high manual task involved in
the workstations. For instance, de-palletizing work-
station is the starting point of a bottling process and it
requires the workers to manually unload new cases of
bottles from a pallet onto a conveyor [8]. The process
of unloading new cases of bottles from a pallet onto
a conveyor involves excessive overhead reaching at
the beginning of a new pallet and forward bending
toward the end of the unloading process [16, 27].
Bottling tasks, such as bottle screening operation,
beverage bottling and crowning as well as palletiz-
ing have been categorized as high risk for developing
WRMDs in at least one part of the body [8]. Accord-
ing to the observation from the videotaping, workers
from the Carbonating, Bottle-Filling, Compound-
ing and Water Treatment workstations were more
involved in less manually involving activities while
arrangement of bottles into the bottle washer (depal-
letizing) and palletizing tasks in beverage bottling has
been identified as the most ergonomically unsound
[8].
The reported high prevalence WRMDs in this
study may also be attributed to other jobs’ psychoso-
cial co-founding variables. A recent study found
an association between prevalence of WRMDs and
job psychosocial risks among the bottling workers
[20]. According to the study, workers whose scores
were rated as high organizational risk reported higher
prevalence of prevalence of WRMDs in at least one
body part compared to those with low or medium
organizational risk ratings. The finding of the present
study that about 60% and 37% of the workers work
with high and very high risk postures respectively
implies that the working posture is very conductive
for the occurrence of WRMDs requiring an immedi-
ate corrective action - action level 4 or 5 [20] The final
REBA score of 9 and above indicating high to very
high risk calls for further investigation and immediate
engineering and/or work method changes to reduce
or eliminate musculoskeletal disorder risk. The find-
ing of this study revealed that the shoulder is the most
affected body part in bottling tasks; although symp-
toms may not be associated with working postures;
reflecting that factors outside working posture may be
acting in a complex manner to provoke symptoms.
The observed REBA scores and risk levels among
the workers were significantly associated with over-
all prevalence of WRMDs as well as WRMD at neck,
wrist and upper back. This suggests that by adopt-
ing awkward, sustained and/or repetitive postures at
work, bottling workers most often suffer WRMD in
at least one body part particularly the neck, wrist
and upper back. This lends credence that altered pat-
terns of postural muscle activity are associated with
WRMD, a finding that has important implications for
the assessment and treatment of WRMDs among this
occupational group with emphasis on education of
good working posture. It can therefore be inferred
that habitual use of abnormal postures may result
in increased mechanical muscle load and possibly
precipitate WRMDs.
Given that job psychosocial co-founding variables
have been implicated for WRMDs among beverage
workers [22], future studies looking at effectiveness
of interventions to reduce MSDs should also target
interventions on job psychosocial factors. The high
postural risk factors for WRMDs seen among the
workers have implications for the ergonomichealth of
the beverage workers and invariably the companies’
production line. Certainly, efforts to reduce WRMDs
should include ergonomic postural education, as well
as worksite restructuring to eliminate or reduce awk-
ward postures with ergonomic modifications to keep
vulnerable joints within the optimal range of motion
and positions during work tasks. Additionally, man-
agement may consider rotating workers from one task
to another as a way to reduce repeated and sustained
awkward postures that can lead to WRMDs. Lastly,
further workstation specific investigation for other
possible co-founding variables may be necessary. All
workplace parties should be encouraged to mean-
ingfully participate in problem identification, risk
assessment, implementation, and evaluation stages of
any control measures taken.
5. Limitations
The major limitation of our study is the design. The
cross sectional design implored in our present study
does not infer causality but only provided insight
into the association between posture and WRMDs in
beverage bottling workers. Also, the relatively fewer
individuals with medium risk exposure compared to
the number with high and very high risk category
AUTHOR COPY
U.O. Abaraogu et al. / Association between postures and WRMDs 119
may have reduced the power of the sample to be
able to draw credible comparison between posture
risk ratings. However the sample size was adequately
powered to compensate for the possible type 1 error.
6. Conclusion
In conclusion, this study has been able to show
that WRMDs is of common occurrence among bev-
erage bottling workers. The body parts commonly
affected were shoulder, neck and low-back and upper
back in that order. The observed higher prevalence
of WRMDs in this category of workers has been
attributed to the fact that tasks are performed above
shoulder, and are repetitive in nature and required
sustained static used of the shoulder muscles.
Conflict of interest
None to declare.
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