Risk Factor Analysis in Sedentary Office Workers with Low Back Pain

Abstract

ABSTRACT
Background and Objectives: Low back pain is one of the common musculoskeletal
disorders in the office workers and it is the leading cause for long term sick leave. The life
time prevalence of low back pain is estimated 60—85% and is the most common cause for work related disability in people under age of 45 years. Various studies have found that office workers are more prone to have low back pain symptoms. There was no study focus on the risk factor evaluation on the low back pain. The objectives of the study were to determine the prevalence and risk factors of low back pain among sedentary office workers. Materials and Methods: A cross-sectional study was designed with 120 Participants. Study was conducted on various locales like Schools, colleges, bank and office where the working was in an office environment, people included were working for more than 6 hours in a day or 30 hours in a week. A self-developed structured questionnaire was given to all participants with low back pain. Risk factors including personal factors, working factors, job stress, healthy behavior, and work environment were analyzed using descriptive analysis.Results: Results finds that 62% of man and 80% of women complains of low back pain, where as 47% of male are obese and 43% of female are overweight. Conclusion: Study concludes that back pain is strongly associated with various risk factors like obesity, poor posture and other factors.

Full text

Journal of Chalmeda Anand Rao Institute of Medical Sciences Vol 13 Issue 1 January - June 2017 ISSN (Print) : 2278-5310 15
INTRODUCTION
The world wide impact of musculoskeletal injuries is
about 4th in global health population. 75%-85% of the
global population experience low back pain at some point
during their lifetime. Approximately 50% of people have
recurrence of the symptoms.[1]
Low back pain is one of the commonest musculoskeletal
injuries in the sedentary individuals, usually associated
with high medical cost.[2] Chronic back pain result in
severe disability, this makes the individuals to find
difficult even a minimal task.[3]
Low back pain is the most common reason for sickness
absenteeism and it is one of the important causes for
disability in industrialized countries.[4]
Office workers are the professionals who sit in front of
the computer for longer working hours. Individuals who
occupy the static positioning for the longer duration will
end up with several musculoskeletal injuries. Obtaining
static posture like sitting, standing, bending and awkward
lifting causes strain to the muscles and other structures.
The injuries relate to the occupation occur because of
various reasons like static postures, awkward posture,
repetition of activity, monotonous job tasks, extended
work durations and job stress. Lengthened sitting or poor
sitting produce imbalance between the muscle strength
Risk Factor Analysis in Sedentary
Office Workers with Low Back Pain
Subramanian S1, Arun B2
1 Lecturer
MAHSA University
Kuala Lumpur
Malaysia
2 Professor
K.G. College of Physiotherapy
Coimbatore
Tamilnadu, India.
CORRESPONDENCE:
1 S.Subramanian, MPT
Lecturer
MAHSA University
Kuala Lumpur
Malaysia.
E-mail: kavisubbu06@gmail.com
Original Article
ABSTRACT
Background and Objectives: Low back pain is one of the common musculoskeletal
disorders in the office workers and it is the leading cause for long term sick leave. The life
time prevalence of low back pain is estimated 60—85% and is the most common cause for
work related disability in people under age of 45 years. Various studies have found that
office workers are more prone to have low back pain symptoms. There was no study focus
on the risk factor evaluation on the low back pain. The objectives of the study were to
determine the prevalence and risk factors of low back pain among sedentary office workers.
Materials and Methods: A cross-sectional study was designed with 120 participants.
Study was conducted on various locales like Schools, colleges, bank and office where the
working was in an office environment, people included were working for more than 6
hours in a day or 30 hours in a week. A self-developed structured questionnaire was given
to all participants with low back pain. Risk factors including personal factors, working
factors, job stress, healthy behavior, and work environment were analyzed using descriptive
analysis.
Results: Results finds that 62% of man and 80% of women complains of low back pain,
where as 47% of male are obese and 43% of female are overweight.
Conclusion: Study concludes that back pain is strongly associated with various risk
factors like obesity, poor posture and other factors.
Keywords: Low back pain, sedentary workers, obesity, BMI, risk factors

Subramanian S et. al
Journal of Chalmeda Anand Rao Institute of Medical Sciences Vol 13 Issue 1 January - June 2017 16
and flexibility will eventually lead to low back pain with
no movement loss or abnormal signs.[5] Various studies
focuses on prolong sitting and confirmed that it could be
one of the risk factor for low back pain.[6, 7]
Risk factors are many in the magnitude of low back pain.
Many epidemiological studies have identified several risk
factors for the prevalence of low back pain in various
occupational pursuits.[8] Literatures find common risk
factors and these were analyzed quantitatively and
qualitatively, like gender, age and BMI.[9,10] Few literatures
also suggest that individuals with high body mass index
have strongly associated with poor health and poor
musculoskeletal function.
Researches also added that obese people are more
frequent in seeking medical care for the joint pain and
muscle complains.[11] Evidences show that there is strong
relation between the overweight and low back pain12.
Body fat distribution also showed associations with low
back pain.[13,14]
There are lack of evidences for the prevalence and risk
factors of low back pain in sedentary individuals, as well
as in office workers. This study is designed to find out
the list of risk factors for the low back pain in sedentary
office workers especially working in computers.
MATERIALS AND METHODS
A Cross sectional study was conducted over a period of
12 months. Samples were selected from various
occupational perspectives based on convenient sampling
method. No single occupation was selected in this study.
Study was conducted on various locales like Schools,
colleges, bank and office where the working was in an
office environment.
A total of 120 samples were selected and self-developed
structured questionnaire on back pain was given to all
participants.
The selection criteria includes office workers working at
least 6 hours in a day or 30 hours in a week, office workers
working in computers, participants with no active
exercises, subjects who excluded from the study are the
individuals with pre existing arthritis or any other
physiological problems like diabetes or hypertension, any
history of trauma, history of cancer, and patients who
use corticosteroids for longer period for other
physiological problems.
Interview was conducted with self administered
questionnaire along with it weight and height was
measured. The interviewer explained about the study
clearly, and the consent form was filled by all the
participants.
The questionnaire consists of two parts, the first part
includes demographic data and the second part includes
the low back pain questionnaire. The components
includedwerefood habits, Duration of work, years of
experience, stress, Body mass index, personal habits and
foot wear types.
Data were analyzed using the SPSS. Difference in
categorical variables was examined using descriptive
analysis. The desired precision of confidence interval was
set as 95% which was statistically significant.
RESULTS AND DISCUSSION
The data were analyzed using the descriptive statistics,
the analysis was done using SPSS. 19.1. Various risk
factors analysis was done based on Gender, Age, Year of
experience, Stress, BMI, Smoking, Alcoholism, food
habits, and type of foot wear. The analysis was shown in
Table I & Table II.
Out of 120 individuals were included in the study 82
subjects complain of pain within a year. The number of
male participants was assessed are 76 and the number of
female are 44, out of which 47 males and 35 females
complains of low back pain at least felt once in the 12
months. About 62% and 80% of population in male and
female are affected respectively.
Table 1 : Demographic profile
Male Female
1 Subjects with pain 62% 80%
2 Body Mass Index
Normal 17% 17%
Over weight 36% 43%
Obese 47% 40%
3 Duration of work
6—8 hours 4% 6%
8—9 hours 24% 31%
9—10 hours 38% 34%
>10 hours 34% 29%
4 Year of experience
7 years 7% 17%
8—10 year 19% 14%
11—13 years 21% 40%
>14 years 53% 29%
5 Foot wear
Shoe 51% 23%
Sandals 38% 57%
Flip tops 11% 20%
6 Work Stress
Yes 83% 80%
No 17% 20%
Characteristics Gender Percentage (%)
Sl.
No.

Risk Factor Analysis in Sedentary Office Workers with Low Back Pain
Journal of Chalmeda Anand Rao Institute of Medical Sciences Vol 13 Issue 1 January - June 2017 17
Table 2 : Various risk factors and percentage
1 Personal Habits
Smoking
Yes 49%
No 51%
Alcoholism
Yes 3 7%
No 63%
2 Food habit
Veg 46%
Non Veg 39%
Only Egg 15%
Characteristics Percentage (%)
Sl.
No.
Year of work experience were analyzed in table 1, which
shows that 53% of male participants who work more than
14 years complains of more pain, followed by 21%, 19%
and 7% for 11-13 year, 8-10 years and 7 years, whereas
the female participants who work more than 11-13 years
complain more pain at 40%, which was followed by 29%
in more than 14 years, 17 % in 7 years and 14% in 8-10
years.
Duration of the work (hours of work) per day were
assessed and analyzed in table 1, which shows that 38%
of males and 34% of female work 9-10 hours per day,
34% of male complain back pain who work more than 10
hours where as 31% of female complains pain who works
for 8-9 hours. 24% of males complain pain when they
work for 8-9 hrs where as 29% of female complains of
pain when they work for more than 10 hrs, and 4% of
males and 6% of females complain pain when they work
for 6-8 hrs in a day.
Body mass index were assessed in the participants using
weighing scale and the height in centimeters. Around 47
male participants 39 participants were not normal
(Overweight or Obese), only 8 were normal. Overall 83%
of the participants are overweight or obese individual, 47%
of participants were obese and 36% were overweight. Out
of 35 female participants 29 were obese or overweight, that
is 83% of participant’s falls in overweight or obese criteria.
Whereas 43% of participants were in overweight category
and 40% of them belong to obese category.
Obesity has moderately associated with low back pain,
studies shows that there was increase risk of obesity in
there is a persistent increase of body weight.[15,16] Few
studies have stated that the relationship is not well
understood; whereas the back pain in obese individual
may be because of accumulation of adipose tissues that
cause over load in the spine17. Still there are unclear
evidences of relationship between obesity and low back
pain. A recent Meta analysis found that obesity and
overweight has strong association with low back pain.[18]
Personal habits were analyzed in table II, two of the habits
were analyzed, Smoking and Alcoholism. Out of 82
participants around 40 participants were smokers which
average 51% and 49% are non smokers. 30 participants
were alcoholic which ranges about 37% of overall
participants, and 52% are non alcoholic. Out of 82
participants 38 person who is 46% are non vegetarians
and39% are vegetarians and 15% of participants
consumes only egg. Smoking and alcoholism is the weak
indicator for the low back pain.[16]
Stress is one of the risk factor for musculoskeletal
problem. Out of 82 participants 67 of them had complains
of stress in job and 15 did not complain of stress in job.
Further analyses were done in which 39 males and 28
females were complaining of stress. About 82% of
participants complain of stress.
Psychological factors like stress has significant relation
with the musculoskeletal disorders, Stress produce
increase tension in the muscle, which may predispose to
injury. [19] Studies showed that stress at work has relation
on consequences of low back pain.[20, 21] Studies also found
that occupational stressors like environment, poor
ergonomics are the important predictors of the
musculoskeletal pain.[22]
Foot wear was not much concerned with back pain history
and incidence where as upon analysis the study found
that out of 82 participants 38 were wearing sandals which
means 46% of participants wore shoes, 32 with shoes and
12 with flip top, which states 39% in shoes and 15% with
flip top. Similar type of study done by Marius in 2010
showed that 41% of individuals having symptoms at least
one in past 12 months. Life time prevalence of the low
back pain incidence is 58.3% and 62% in United
Kingdom.[23] Other countries also show prevalence of low
back pain includes 19.7 in Nigeria, 34% in Netherland
and 19% in Finland. [24, 25]
Many occupational analyses show that low back pain is
the most common musculoskeletal complains followed
by neck and shoulder.[26] Absenteeism, reduced turnover,
increased costs and reduced morale are reasons to the
pain and disability that occurred due to long term use of
computer and acquiring static posture at work.
Use of questionnaire in evaluating the persons with low
back pain, no particular occupations were selected in this
study, the quantity of work is not measured,non-inclusion
of recreational activities are some of the limitations of
this study. The same study can be replicated as
experimental study by using interventions and can also
done in other occupational disorders to identify the
relationship of risk factors of occupations.

CONCLUSION
The findings of this study clearly states that low back pain
was influenced by variety of factors. One of the important
risk factor noted is the obesity and overweight, the
participants who are overweight has strong positive
influence on the back pain related symptoms. Other
factors like stress also plays a role in back injury.
CONFLICT OF INTEREST :
The authors declared no conflict of interest
FUNDING : None
REFERENCES
1. Marius AW. Low Back Pain In The Corporate Workplace; A South
African Review, 2003, available: http:Low Back Pain in the Corporate
Workplace.html.
2. Woolf A, Pfleger B. Burden of major musculoskeletal conditions.
Bull World Health Organ. 2011; 81:646-656.
3. Katz R. Impairment and disability rating in low back pain. Clin
Occupational Environmental Med. 2006; 5: 719-740.
4. Barbara A, Niland J, Patricia J. Fundamentals of Industrial Hygiene.
National safety council. Saunders, Washington, USA, 2003.
5. Mckenzie RA, May S. Lumbar Spine mechanical diagnosis and
therapy. 2nd edition. Walkane: Spinal publication, NZ, 2003.
6. Corlett EN. Background to sitting at work: research requirements
for the design of work seats. Ergonomics. 2006 ; 49: 1538-1546.
7. Pope,MH, Goh, KL, Magnusson, ML. Spine ergonomics.Annual
Review Biomed Eng. 2002; 4: 49-68.
8. Mortimer M, Wiktorin C, Pernold G, Svensson H, Vingard E.
Sport’s activities, body weight and smoking in relation to low
back pain: a population based case referent study. Result
from the MUSIC-Norrtalje study. Scand JMed Sci Sports. 2001;
11:178-192.
9. Kerr MS, Frank JW, Shannon HS, Norman W R, Wells R P,
Neumann W P, Bombardier C, and Ontario Universities Back
Pain Study Group Ontario Universities Back Pain Study Group.
Biomechanical and psychosocial risk factors for low back pain
at work. Am J Public Health. 2001; 91:1069-1075
10. IJzelenberg W, Molenaar D, Burdorf A. Different risk factors for
musculoskeletal complaints and musculoskeletal sickness
absence. Scand J Work Environ Health. 2004; 30:56-63.
11. Seidell JC, De Groot LCPGM, Van Sonsbeek JLA, Deurenberg P,
Hautvast JGAJ. Associations of moderate and severe overweight
with self-reported illness and medical care in Dutch adults. Am J
Public Health. 1986; 76: 264-269.
12. Popkess-Vawter S, Patzel B. Compounded problem: low back
pain and overweight in adult females. Orthop Nurs. 1992; 11:31-
35.
13. Wright D, Barrow S, Fisher AD, Horsley SD, Jayson MI. Influence
of physical, psychological and behavioral factors on consultation
for back pain. Br J Rheumatol. 1995; 34:156-161.
14. HelioÈvaara M. Body height, obesity, and risk of herniated
lumbar intervertebral disc. Spine. 1987; 12:469-472.
15. Bener A, Alwash R, Gaber T, Lovasz G. Obesity and low back
pain. CollAntropol. 2003; 27:95-104.
16. Leboeuf-Yde C Smoking and low back pain. A systematic
literature review of 41 journal articles reporting 47
epidemiologic studies. Spine. 1999; 24:1463-70.
17. Adams MA, Roughley PJ. What is intervertebral disc
degeneration, and what causes it. Spine. 2006; 3:2151–61.
18. Shiri R, Karppinen J, Leino-Arjas P, et al. The association between
obesity and low back pain: A meta-analysis. Am J Epidemiol. 2010;
2:135–54.
19. Rick J, Thomson L, Briner RB, O’Regan S, Daniels K. Review of
existing supporting scientific knowledge to underpin standards of good
practice for key work-related stressors-Phase I. Contract Research
Report 427, Health and Safety Executive Books, Sudbury, UK,
2002.
20. Elfering A, Grebner S, Semmer NK, et al. Time control,
catecholamines and back pain among young nurses. Scand J Work
Environ Health. 2002; 28:386–93.
21. Wickstrom GJ, Pentti J. Occupational factors affecting sick leave
attributed to low-back pain. Scand J Work Environ Health. 1998;
24:145–52.
22. Wu Chen, I Yu, T Wong. Impact of occupational stress and other
psychosocial factors on musculoskeletal pain among Chinese
offshore oil installation workers. Occup Environ Med. 2005; 62:
251–256.
23. McKinnon ME, Vickers MR. Community studies of the health
service implication of low back pain. Spine. 1997; 22:2161-2166.
24. Omokhodion FO, Sanya AO. Risk factors for low back pain
among office workers in Ibadan, Southwest Nigeria. Occup Med
(Lond). 2003; 53:287-289
25. Burdorf A, Naaktgeboren B, de Groot HC. Occupational risk
factors for low back pain among sedentary workers. J Occup Med.
1993; 35:1213-20.
26. Smith DR, Kondo N, Tanaka E, et al. Musculoskeletal disorders
among hospital nurses in rural Japan. Rural Remote Health. 2003;
3: 241.
Subramanian S et. al
Journal of Chalmeda Anand Rao Institute of Medical Sciences Vol 13 Issue 1 January - June 2017 18