Work-related psychosocial and mechanical risk factors for neck/shoulder pain: a 3-year follow-up study of the general working population in Norway

  • Tom SterudEmail author
  • Håkon A. Johannessen
  • Tore Tynes
Original Article



This study examines the impact of work-related psychosocial and mechanical exposure on the development of neck/shoulder pain in the general working population.


A randomly drawn cohort from the general population in Norway aged 18–66 was followed up for 3 years (n = 12,550, response rate = 67 %). Eligible respondents were in paid work during the reference week in 2006 and 2009, or temporarily absent from such work (n = 6,745). Four work-related psychosocial factors and six mechanical exposures were measured. Outcomes of interest were moderate or severe neck/shoulder pain at follow-up adjusted for baseline neck/shoulder pain.


In total, 16.9 % (1,138 individuals) reported neck/shoulder pain during the last month at follow-up. Work related psychosocial predictors of neck/shoulder pain were high job demands (highest OR 1.41, 95 % CI 1.11–1.78) and low levels of supportive leadership (highest OR 1.66, 95 % CI 1.08–2.54). Mechanical factors were neck flexion (highest OR 1.77, 95 % CI 1.31–2.39) and lifting in awkward postures (highest OR 1.81, 95 % CI 1.21–2.71). The estimated population risk attributable to these factors was about 23 %. The relative risk for neck/shoulder pain associated with psychosocial exposure was slightly influenced by adjustment for physical risk factors, and vice versa. There was no substantial confounding related to age, gender, education, occupation or psychological distress.


Highly demanding jobs, neck flexion and awkward lifting appear as the most important predictors of neck/shoulder pain.


Psychosocial factors Mechanical factors Occupational exposure Neck pain Prospective study 


Conflict of interest


Ethical standards

The survey was carried out by Statistics Norway according to statutory rules. Statistics Norway has appointed its own privacy ombudsman, approved by the Norwegian Data Inspectorate. All persons gave their informed consent prior to their inclusion in the study.


  1. Andersen JH, Kaergaard A, Mikkelsen S, Jensen UF, Frost P, Bonde JP, Fallentin N, Thomsen JF (2003) Risk factors in the onset of neck/shoulder pain in a prospective study of workers in industrial and service companies. Occup Environ Med 60(9):649–654CrossRefGoogle Scholar
  2. Andersen JH, Haahr JP, Frost P (2007) Risk factors for more severe regional musculoskeletal symptoms: a 2-year prospective study of a general working population. Arthritis Rheum 56(4):1355–1364. doi: 10.1002/art.22513 CrossRefGoogle Scholar
  3. Ariens GA, Bongers PM, Douwes M, Miedema MC, Hoogendoorn WE, van der Wal G, Bouter LM, van Mechelen W (2001a) Are neck flexion, neck rotation, and sitting at work risk factors for neck pain? Results of a prospective cohort study. Occup Environ Med 58(3):200–207CrossRefGoogle Scholar
  4. Ariens GA, Bongers PM, Hoogendoorn WE, Houtman IL, van der Wal G, van Mechelen W (2001b) High quantitative job demands and low coworker support as risk factors for neck pain: results of a prospective cohort study. Spine (Phila Pa 1976) 26(17):1896–1901 discussion 1902–1893CrossRefGoogle Scholar
  5. Ariens GA, Bongers PM, Hoogendoorn WE, van der Wal G, van Mechelen W (2002) High physical and psychosocial load at work and sickness absence due to neck pain. Scand J Work Environ Health 28(4):222–231CrossRefGoogle Scholar
  6. Binder AI (2008) Neck pain. Clin Evid (Online) 2008:1103Google Scholar
  7. Bongers PM, de Winter CR, Kompier MA, Hildebrandt VH (1993) Psychosocial factors at work and musculoskeletal disease. Scand J Work Environ Health 19(5):297–312CrossRefGoogle Scholar
  8. Bovim G, Schrader H, Sand T (1994) Neck pain in the general population. Spine 19(12):1307–1309 (Phila Pa 1976)CrossRefGoogle Scholar
  9. Carroll LJ, Hogg-Johnson S, Cote P, van der Velde G, Holm LW, Carragee EJ, Hurwitz EL, Peloso PM, Cassidy JD, Guzman J, Nordin M, Haldeman S (2008) Course and prognostic factors for neck pain in workers: results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders. Spine (Phila Pa 1976) 33(4 Suppl):S93–100. doi: 10.1097/BRS.0b013e31816445d4 CrossRefGoogle Scholar
  10. Christensen JO, Knardahl S (2010) Work and neck pain: a prospective study of psychological, social, and mechanical risk factors. Pain 151(1):162–173. doi: 10.1016/j.pain.2010.07.001 CrossRefGoogle Scholar
  11. Cote P, van der Velde G, Cassidy JD, Carroll LJ, Hogg-Johnson S, Holm LW, Carragee EJ, Haldeman S, Nordin M, Hurwitz EL, Guzman J, Peloso PM (2008) The burden and determinants of neck pain in workers: results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders. Spine (Phila Pa 1976) 33(4 Suppl):S60–S74. doi: 10.1097/BRS.0b013e3181643ee4 CrossRefGoogle Scholar
  12. da Costa BR, Vieira ER (2010) Risk factors for work-related musculoskeletal disorders: a systematic review of recent longitudinal studies. Am J Ind Med 53(3):285–323. doi: 10.1002/ajim.20750 Google Scholar
  13. Dallner M (2000) Validation of the General Nordic Questionnaire (QPSNordic) for psychological and social factors at work. Nordic Council of Ministers, Copenhagen. Nord 2000:12Google Scholar
  14. Fejer R, Kyvik KO, Hartvigsen J (2006) The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J 15(6):834–848. doi: 10.1007/s00586-004-0864-4 CrossRefGoogle Scholar
  15. Feveile H, Jensen C, Burr H (2002) Risk factors for neck-shoulder and wrist-hand symptoms in a 5-year follow-up study of 3,990 employees in Denmark. Int Arch Occup Environ Health 75(4):243–251. doi: 10.1007/s00420-001-0298-9 CrossRefGoogle Scholar
  16. Harkness EF, Macfarlane GJ, Nahit ES, Silman AJ, McBeth J (2003) Mechanical and psychosocial factors predict new onset shoulder pain: a prospective cohort study of newly employed workers. Occup Environ Med 60(11):850–857CrossRefGoogle Scholar
  17. Hauke A, Flintrop J, Brun E, Rugulies R (2011) The impact of work-related psychosocial stressors on the onset of musculoskeletal disorders in specific body regions: a review and meta-analysis of 54 longitudinal studies. Work Stress 25(3):243–256. doi: 10.1080/02678373.2011.614069 CrossRefGoogle Scholar
  18. Hooftman WE, van der Beek AJ, Bongers PM, van Mechelen W (2009) Is there a gender difference in the effect of work-related physical and psychosocial risk factors on musculoskeletal symptoms and related sickness absence? Scand J Work Environ Health 35(2):85–95CrossRefGoogle Scholar
  19. Hoogendoorn WE, van Poppel MN, Bongers PM, Koes BW, Bouter LM (2000) Systematic review of psychosocial factors at work and private life as risk factors for back pain. Spine (Phila Pa 1976) 25(16):2114–2125CrossRefGoogle Scholar
  20. Leclerc A, Chastang JF, Niedhammer I, Landre MF, Roquelaure Y (2004) Incidence of shoulder pain in repetitive work. Occup Environ Med 61(1):39–44Google Scholar
  21. Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS, Verhaar JA (2004) Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol 33(2):73–81CrossRefGoogle Scholar
  22. MacDonald LA, Karasek RA, Punnett L, Scharf T (2001) Covariation between workplace physical and psychosocial stressors: evidence and implications for occupational health research and prevention. Ergonomics 44(7):696–718. doi: 10.1080/00140130119943 CrossRefGoogle Scholar
  23. McLean SM, May S, Klaber-Moffett J, Sharp DM, Gardiner E (2010) Risk factors for the onset of non-specific neck pain: a systematic review. J Epidemiol Community Health 64(7):565–572. doi: 10.1136/jech.2009.090720 CrossRefGoogle Scholar
  24. Natarajan S, Lipsitz SR, Rimm E (2007) A simple method of determining confidence intervals for population attributable risk from complex surveys. Stat Med 26(17):3229–3239. doi: 10.1002/sim.2779 CrossRefGoogle Scholar
  25. Orhede E (1994) Nordic cooperation in research on the work environment. Scand J Work Environ Health 20(1):65–66CrossRefGoogle Scholar
  26. Ostergren PO, Hanson BS, Balogh I, Ektor-Andersen J, Isacsson A, Orbaek P, Winkel J, Isacsson SO (2005) Incidence of shoulder and neck pain in a working population: effect modification between mechanical and psychosocial exposures at work? Results from a 1 year follow up of the Malmo shoulder and neck study cohort. J Epidemiol Community Health 59(9):721–728. doi: 10.1136/jech.2005.034801 CrossRefGoogle Scholar
  27. Palmer KT, Smedley J (2007) Work relatedness of chronic neck pain with physical findings—a systematic review. Scand J Work Environ Health 33(3):165–191CrossRefGoogle Scholar
  28. Rothman KJ, Greenland S, Lash TL (2008) Modern epidemiology. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  29. Statistics Norway (2010) Samordnet levekårsundersøkelse 2009—Tverrsnitt. Tema: Arbeidsmiljø. [Coordinated Living Conditions Survey 2009 - Cross Sectional. Focus: Work environment]. [Report in Norwegian]. Statistics Norway, OsloGoogle Scholar
  30. Sterud T, Tynes T (2013) Work-related psychosocial and mechanical risk factors for low back pain: a 3-year follow-up study of the general working population in Norway. Occup Environ Med. doi: 10.1136/oemed-2012-101116 Google Scholar
  31. van den Heuvel SG, van der Beek AJ, Blatter BM, Hoogendoorn WE, Bongers PM (2005) Psychosocial work characteristics in relation to neck and upper limb symptoms. Pain 114(1–2):47–53. doi: 10.1016/j.pain.2004.12.008 CrossRefGoogle Scholar
  32. Van Loon AJ, Tijhuis M, Picavet HS, Surtees PG, Ormel J (2003) Survey non-response in the Netherlands: effects on prevalence estimates and associations. Ann Epidemiol 13(2):105–110CrossRefGoogle Scholar
  33. Viikari-Juntura E, Martikainen R, Luukkonen R, Mutanen P, Takala EP, Riihimaki H (2001) Longitudinal study on work related and individual risk factors affecting radiating neck pain. Occup Environ Med 58(5):345–352CrossRefGoogle Scholar
  34. Wahlstrom J, Hagberg M, Toomingas A, Wigaeus Tornqvist E (2004) Perceived muscular tension, job strain, physical exposure, and associations with neck pain among VDU users; a prospective cohort study. Occup Environ Med 61(6):523–528CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Tom Sterud
    • 1
    Email author
  • Håkon A. Johannessen
    • 1
  • Tore Tynes
    • 1
  1. 1.Department of Occupational Health Surveillance, National Institute of Occupational HealthOsloNorway

Personalised recommendations