Patterns of Biomechanical Demands Are Associated with Musculoskeletal Pain in the Beginning of Professional Life: A Population-Based Study

By Lourenço, Sara; Araújo, Fábio et al. | Scandinavian Journal of Work, Environment & Health, May 1, 2015 | Go to article overview

Patterns of Biomechanical Demands Are Associated with Musculoskeletal Pain in the Beginning of Professional Life: A Population-Based Study


Lourenço, Sara, Araújo, Fábio, Severo, Milton, Miranda, Luís Cunha, Carnide, Filomena, Lucas, Raquel, Scandinavian Journal of Work, Environment & Health


Musculoskeletal conditions are the most common cause of severe long-term pain and physical incapacity, representing 17% of the total years lived with disability among the young adult population worldwide (1, 2). Even though these diseases are multifactorial, work-related factors account for 30-40% of musculoskeletal complaints among active workers (3). In turn, musculoskeletal pain has been pointed as the main cause of work disability, and it is the most frequent reason for long-term sick leave and early retirement (4, 5).

Occupational exposures such as external loads, organizational factors and psychosocial work environment are strong determinants of musculoskeletal pain (6). Among those, physical factors such as heavy loads, bending or twisting, vibrations and awkward postures are the strongest predictors of multisite musculoskeletal pain, probably due to the direct mechanical tissue overload induced on joints (7-9).

Most research on the biomechanical etiology of work-related musculoskeletal conditions has focused on adults of heterogeneous age ranges (10). In such context, the well-documented healthy worker bias is expected to arise since workers with musculoskeletal complaints are more likely to have retired early or to be moving towards less demanding mechanical tasks. In addition, changes throughout life in the individual's work-related biomechanical demands lead to increasing misclassification of cumulative exposure with advancing stages of professional life.

Recent studies among newly-employed workers have shown that even short-term exposures to mechanical loads contribute significantly to the etiology of musculo-skeletal pain, which suggests that investigating occupational health since the beginning of professional life may guide the timing of preventive strategies (11-14). However, research in early stages of employment remains fairly scarce, as well as restricted to a limited number of anatomical regions and specific occupational groups.

Work activities are commonly characterized by a narrow spectrum of co-occurring biomechanical demands (15) that cluster within workers and create different patterns of physical exposures in the occupational setting (16). Most previous evidence has emerged from independent analysis of isolated mechanical tasks, disregarding the potential synergistic effects of multiple combinations of distinct biomechanical factors in determining regional musculoskeletal pain (17). Such synergistic effect on low-back pain was indeed suggested in a 2011 study of students with traineeship-related occupations (18). Currently, still little is known about the association between the effective beginning of professional life - with the diversity of exposures as they occur in the current labor market - and the occurrence of pain in the musculoskeletal system as a whole.

Therefore, using data collected in a population-based sample of 21-year-old adults, we aimed to: (i) describe patterns of occupational biomechanical demands; and (ii) assess whether exposure to different patterns of work-related biomechanical demands have an effect on the presence and intensity of regional musculoskeletal pain in the beginning of professional life.

Study population and methods

Participants

In this study, we use cross-sectional data collected in 2011-2013 from young adults as part of the Epidemiological Health Investigation of Teenagers in Porto (EPI-Teen). The EPITeen study was designed as a prospective cohort first assembled during the 2003/2004 school year, when we approached all public and private schools in Porto (Portugal) providing teaching to adolescents born in 1990. In the first wave, we identified 2787 eligible adolescents, of whom 2159 agreed to participate (77.5% baseline participation). In 2007/2008 (second wave), the initially recruited sample was re-evaluated and 783 students born in the same year but who moved to Porto after 2003/2004 were additionally recruited to the cohort. …

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