Perceived physical exertion during healthcare work and risk of chronic pain in different body regions: prospective cohort study

  • Lars L. AndersenEmail author
  • Thomas Clausen
  • Roger Persson
  • Andreas Holtermann
Original Article



To estimate the risk of developing chronic musculoskeletal pain in different body regions from varying degrees of perceived physical exertion during healthcare work.


Prospective cohort study among 4,977 Danish female healthcare workers responding to a baseline and follow-up questionnaire in 2005 and 2006, respectively. Using multi-adjusted logistic regression analysis, the risk of developing chronic pain (>30 days last year) at follow-up in the low back, neck/shoulder, and knees—among those without pain (0 days last year) in these respective body regions at baseline—from moderate and strenuous (reference: light) perceived physical exertion during healthcare work was modeled.


Adjusted for age, BMI, tenure, smoking status, and leisure physical activity, strenuous perceived physical exertion during healthcare work increased the risk of chronic low back pain (OR 3.16, 95 % CI 1.79–5.57) and chronic knee pain (OR 1.87, 95 % CI 1.19–2.94) at follow-up among those without pain in these respective body regions at baseline. With additional adjustment for psychosocial work conditions, only the risk of developing chronic low back pain from strenuous physical exertion remained significant (OR 1.99, 95 % CI 1.02–3.88). Strenuous physical exertion was not a risk factor for chronic neck pain, and moderate physical exertion was not a risk factor for chronic pain in any of the body regions.


Strenuous perceived physical exertion during healthcare work is a risk factor especially for developing chronic pain in the low back. The possible preventive effect of reducing strenuous physical exertion should be tested in randomized controlled trials.


Chronic pain Musculoskeletal disorders Neck pain Shoulder pain Back pain Knee pain Risk factor Longitudinal Eldercare Nurses 



The study was supported by a grant from the Danish Parliament (SATS 2004).

Conflict of interest

The authors declare that they have no conflict of interest.


  1. Alexopoulos EC, Tanagra D, Detorakis I, Gatsi P, Goroyia A, Michalopoulou M, Jelastopulu E (2011) Knee and low back complaints in professional hospital nurses: occurrence, chronicity, care seeking and absenteeism. Work 38:329–335Google Scholar
  2. Andersen LL, Andersen CH, Mortensen OS, Poulsen OM, Bjornlund IB, Zebis MK (2010) Muscle activation and perceived loading during rehabilitation exercises: comparison of dumbbells and elastic resistance. Phys Ther 90:538–549CrossRefGoogle Scholar
  3. Andersen LL, Clausen T, Mortensen OS, Burr H, Holtermann A (2011a) A prospective cohort study on musculoskeletal risk factors for long-term sickness absence among healthcare workers in eldercare. Int Arch Occup Environ Health Oct 11 [Epub ahead of print]Google Scholar
  4. Andersen LL, Mortensen OS, Hansen JV, Burr H (2011b) A prospective cohort study on severe pain as a risk factor for long-term sickness absence in blue- and white-collar workers. Occup Environ Med 68:590–592CrossRefGoogle Scholar
  5. Bergstrom G, Bodin L, Bertilsson H, Jensen IB (2007) Risk factors for new episodes of sick leave due to neck or back pain in a working population. A prospective study with an 18-month and a 3-year follow-up. Occup Environ Med 64:279–287CrossRefGoogle Scholar
  6. Bevan S, Quadrello T, McGee R, Mahdon M, Vovrovsky A, Barham L (2009) Fit For Work—Musculoskeletal disorders in the European workforce. 1-143. The work foundation. Ref Type: ReportGoogle Scholar
  7. Borg G (1990) Psychophysical scaling with applications in physical work and the perception of exertion. Scand J Work Environ Health 16(Suppl 1):55–58CrossRefGoogle Scholar
  8. Borg G (1998) Borg’s perceived exertion and pain scales. HK, Champaign, ILGoogle Scholar
  9. Borg G, Lindenholm H (1967) Perceived exertion and pulse rate during graded exercise in various age groups. Acta Med Scand Suppl 472:194–206Google Scholar
  10. Borg GAV (1982) Psychophysical bases of perceived exertion. Med Sci Sports Exerc 14:377–381Google Scholar
  11. Capodaglio P, Bazzini G (1997) Tolerability to prolonged lifting tasks. A validation of the recommended limits. G Ital Med Lav Ergon 19:72–75Google Scholar
  12. Clausen T, Nielsen K, Carneiro IG, Borg V (2011) Job demands, job resources and long-term sickness absence in the Danish eldercare services: a prospective analysis of register-based outcomes. J Adv Nurs 68:127–136CrossRefGoogle Scholar
  13. Elders LA, Burdorf A (2001) Interrelations of risk factors and low back pain in scaffolders. Occup Environ Med 58:597–603CrossRefGoogle Scholar
  14. Eriksen W, Bruusgaard D, Knardahl S (2004) Work factors as predictors of intense or disabling low back pain; a prospective study of nurses’ aides. Occup Environ Med 61:398–404CrossRefGoogle Scholar
  15. Feng CK, Chen ML, Mao IF (2007) Prevalence of and risk factors for different measures of low back pain among female nursing aides in Taiwanese nursing homes. BMC Musculoskelet Disord 8:52CrossRefGoogle Scholar
  16. Gamberale F (1990) Perception of effort in manual materials handling. Scand J Work Environ Health 16(Suppl 1):59–66CrossRefGoogle Scholar
  17. Holmberg SA, Thelin AG (2006) Primary care consultation, hospital admission, sick leave and disability pension owing to neck and low back pain: a 12-year prospective cohort study in a rural population. BMC Musculoskelet Disord 7:66CrossRefGoogle Scholar
  18. Holtermann A, Jorgensen MB, Gram B, Christensen JR, Faber A, Overgaard K, Ektor-Andersen J, Mortensen OS, Sjogaard G, Sogaard K (2010) Worksite interventions for preventing physical deterioration among employees in job-groups with high physical work demands: background, design and conceptual model of FINALE. BMC Public Health 10:120CrossRefGoogle Scholar
  19. Kamaleri Y, Natvig B, Ihlebaek CM, Bruusgaard D (2008) Does the number of musculoskeletal pain sites predict work disability? A 14-year prospective study. Eur J Pain 13:426–430CrossRefGoogle Scholar
  20. Kuorinka I, Jonsson B, Kilbom Å, Vinterberg H, Biering-Sørensen F, Andersson G, Jørgensen K (1987) Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergo 18:233–237CrossRefGoogle Scholar
  21. Larsson B, Søgaard K, Rosendal L (2007) Work related neck-shoulder pain; a review on magnitude, risk factors, biochemical characteristics, clinical picture and preventive interventions. Invited review. Best Practice in Clinical Rheumatology. Ref Type: In PressGoogle Scholar
  22. Morken T, Riise T, Moen B, Hauge SH, Holien S, Langedrag A, Pedersen S, Saue IL, Seljebo GM, Thoppil V (2003) Low back pain and widespread pain predict sickness absence among industrial workers. BMC Musculoskelet Disord 4:21CrossRefGoogle Scholar
  23. Natvig B, Eriksen W, Bruusgaard D (2002) Low back pain as a predictor of long-term work disability. Scand J Public Health 30:288–292CrossRefGoogle Scholar
  24. Nyman T, Grooten WJ, Wiktorin C, Liwing J, Norrman L (2007) Sickness absence and concurrent low back and neck-shoulder pain: results from the MUSIC-Norrtalje study. Eur Spine J 16:631–638CrossRefGoogle Scholar
  25. Pejtersen JH, Kristensen TS, Borg V, Bjorner JB (2010) The second version of the Copenhagen psychosocial questionnaire. Scand J Public Health 38:8–24CrossRefGoogle Scholar
  26. Podsakoff PM, Mackenzie SB, Podsakoff NP (2012) Sources of method bias in social science research and recommendations on how to control it. Annu Rev Psychol 63:539–569CrossRefGoogle Scholar
  27. Roffey DM, Wai EK, Bishop P, Kwon BK, Dagenais S (2010) Causal assessment of workplace manual handling or assisting patients and low back pain: results of a systematic review. Spine J 10:639–651CrossRefGoogle Scholar
  28. Saltin B, Grimby G (1968) Physiological analysis of middle-aged and old former athletes. Circulation 38:1104–1115CrossRefGoogle Scholar
  29. Simoens S, Villeneuve M, Hurst J (2005) Tackling nurse shortages in OECD countries. OECD health working papers, no.19. OECD Publications Services, ParisCrossRefGoogle Scholar
  30. Sjogaard G, Rosendal L, Kristiansen J, Blangsted AK, Skotte J, Larsson B, Gerdle B, Saltin B, Sogaard K (2010) Muscle oxygenation and glycolysis in females with trapezius myalgia during stress and repetitive work using microdialysis and NIRS. Eur J Appl Physiol 108:657–669CrossRefGoogle Scholar
  31. Skotte JH, Essendrop M, Hansen AF, Schibye B (2002) A dynamic 3-D biomechanical evaluation of the load on the low back during different patient-handling tasks. J Biomech 35:1357–1366CrossRefGoogle Scholar
  32. Torgen M, Nygard CH, Kilbom A (1995) Physical work load, physical capacity and strain among elderly female aides in home-care service. Eur J Appl Physiol Occup Physiol 71:444–452CrossRefGoogle Scholar
  33. Twisk JWR (2006) Applied multilevel analysis. Cambridge University Press, CambridgeCrossRefGoogle Scholar
  34. Waters T, Collins J, Galinsky T, Caruso C (2006) NIOSH research efforts to prevent musculoskeletal disorders in the healthcare industry. Orthop Nurs 25:380–389CrossRefGoogle Scholar
  35. Wikman A (2006) Reliability, validity and true values in surveys. Social Indicators Research 78Google Scholar
  36. Zywiak W (2010) U.S. Healthcare workforce shortages: Caregivers. Ref Type: Online SourceGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Lars L. Andersen
    • 1
    Email author
  • Thomas Clausen
    • 1
  • Roger Persson
    • 1
  • Andreas Holtermann
    • 1
  1. 1.National Research Centre for the Working EnvironmentCopenhagen ØDenmark

Personalised recommendations