Technical school students exposed to neck and shoulder pain

A recent study sought to determine the prevalence of neck, shoulder and upper back pain among technical school students in their transition from school to working life. The study involved 173 participants and was conducted over a six-year period. A high prevalence of pain in the neck, shoulder and upper back was found among these students, with a significantly higher proportion of women than men reporting this problem, despite men’s higher levels of mechanical exposure.

Musculoskeletal disorders

In 2004, some 46% of people on sick leave and 36% of persons receiving disability pensions for the first time had a musculoskeletal disorder as their primary diagnosis. These numbers are increasing, particularly among younger workers. The causes of musculoskeletal disorders are believed to be multi-factorial. Some of the causes are work related, while others are linked more to social and individual factors. A recent study (Hanvold et al, 2010) was conducted to identify and quantify the relationships between workload and the development of health problems, in order to provide better advice on preventive measures.

About the study

The study aimed to relate the prevalence of neck, shoulder and upper back pain to occupational and individual risk factors among technical school students in their transition from school to working life. The students were recruited from 13 technical schools and represented student hairdressers, student electricians, and art, media and design students. Data for the study were collected every three months over a six-year period – that is, at the baseline year (2002) and at one-year and three-year follow-up stages.

A total of 173 participants – comprising 59 male and 114 female students – answered the questionnaires. In 2002, all of the students had just started their second year of technical school. Follow-up contact was made with the students through their first years of apprenticeship and working life. In all three questionnaires, the participants were asked to recall if they had experienced neck, shoulder and upper back pain during the previous four weeks. Modified questions from the Statistics Norway (Statistisk Sentralbyrå, SSB) Survey of Living (2000) were used, and participants were asked to report on both the pain intensity and the pain duration. Self-reported work-related mechanical exposure was assessed using a 12-item index (Balogh et al, 2001) through a questionnaire that was collected at the same time as the outcome measurement.

The participants were asked whether their work involved or required repetitive movements, precision movements, manual material handling, vibration, and body postures such as working with their arms elevated, their neck bent backward, or their back twisted or bent forward. The participants were also asked about their perceived stress level at school and work, how often they performed activities that led to increased heart rate or shortness of breath, their socioeconomic background and whether they worked elsewhere in addition to their full-time work or study.

Main findings of study

Prevalence of neck, shoulder and upper back pain

A high initial prevalence of pain in the neck, shoulder and upper back was found among the technical school students: a baseline of 78% of female students and 47.5% of male students reported that they had experienced pain in the past four weeks. Although the neck, shoulder and upper back pain decreased at the one-year and three-year follow-up stages, the significant gender difference remained. The figure below illustrates the movement of participants from the ‘no pain’ group to the ‘pain’ group over the three-year period. Of the participants, 18% (representing 37% of male and 9% of female participants) reported no pain on all three occasions. On the other hand, 28% of the participants (constituting 14% of male and 35% of female participants) reported pain on all three occasions.

Influential factors

The analysis was further adjusted for factors pertaining to perceived stress, gender, additional part-time work and physical activity. Subjects reporting that they were physically active two to three times a week or more had a significantly lower risk of reporting pain at the three-year follow-up stage, compared with those reporting a lower physical activity level. Surprisingly, high and moderate levels of self-reported mechanical exposure and high stress levels were not found to be risk factors for pain after entering working life. Although this contradicts other previous research (see, for example, Bernard, 1997), it is important to note that previous studies concerning neck/shoulder pain and mechanical exposure mainly focused on older subjects who had a longer exposure time.

When examining the participants reporting pain in all of the questionnaires (‘continuous pain’), the results showed a link between increasing self-reported mechanical exposure and a higher risk of reporting ‘continuous pain’. When adjusted for perceived stress, gender, physical activity, additional part-time work and smoking, the odds ratio for the ‘continuous pain’ group was also found to be higher for women than men. More women than men also reported severe pain, with 14% of the male and 32% of the female participants reporting such pain at the baseline year, and 7% of men and 18% of women citing severe pain at the three-year follow-up stage.

Commentary

Neck, shoulder and upper back pain are common among adolescents and may persist into their working life. The study results show that a considerably higher number of female than male adolescents report neck, shoulder and upper back pain. At the same time, men tend to report higher levels of mechanical exposure than women. These gender differences may, to some extent, be explained by social and individual expectations, and the fact that women generally tend to be more sensitive to their body’s responses and to consider it more acceptable to report complaints.

References

Hanvold, T.N., Veiersted, K.B. and Wærsted, M., ‘A prospective study of neck, shoulder and upper back pain among technical school students entering working life’, Journal of Adolescent Health, 2010, pp. 1–7.

Balogh, I., Ørbæk, P., Winkel, J. et al, ‘Questionnaire-based mechanical exposure indices for large population studies – reliability, internal consistency and predictive validity’, in Scand, J., Work Environ Health, No. 27, 2001, pp. 41–48.

Bernard, B.P., Musculoskeletal disorders and workplace factors, Washington DC, National Institute for Occupational Safety and Health (NIOSH), 1997.

Bjørn Tore Langeland, National Institute of Occupational Health