Professional experience, work setting, work posture and workload influence the risk for musculoskeletal pain among physical therapists: a cross-sectional study

  • Yasmín Ezzatvar
  • Joaquín CalatayudEmail author
  • Lars L. Andersen
  • Ramón Aiguadé
  • Josep Benítez
  • José Casaña
Original Article



Physical therapists (PTs) have a high risk of developing musculoskeletal pain (MP) due to the physically demanding nature of their work tasks. Experience or the specialty area, have been associated with MP, however, previous studies are few and small. The aim of this study was to investigate the association between work-related factors and MP among PTs.


In this cross-sectional study, we collected information about MP and work-related factors of 1006 PTs using an online questionnaire. Associations between various work-related factors and MP were modelled using logistic regression controlled for various confounders.


Neck (57%) and low back pain (49%) were most common. Work-related factors associated with higher risk for having moderate-to-high MP (≥ 3 on a scale of 0–10) were “treating more patients at the same time” [OR 2.14 (95% CI 1.53–2.99)], “working ≥45 h per week” [OR 1.73 (95% CI 1.05–2.84)], and “work in a seated position” [OR 2.04 (95% CI 1.16–3.57)] for the low back. “More years of experience” showed a negative association for elbow pain [OR 0.41 (95% CI 0.21–0.78)] and low back pain [OR 0.48 (95% CI 0.29–0.79)] compared with their less experienced counterparts.


The lack of professional experience, working in private clinics, working in a seated position and high workload are associated with the higher risk for MP among PTs. These results add further insight about the relevance of such factors, which might be considered for developing effective interventions to prevent work-related MP and better working conditions among PTs.


Musculoskeletal Health care workers Physical work Workload 



No funding or grant from any commercial source was involved in this study. The authors thank the participants for their contribution to the study

Compliance with ethical standards

Conflict of interest

The authors of this study declare that they have any conflict of interest

Ethical approval

This study received ethical approval by the University of Valencia’s Ethical Committee (H1530736596718), and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.


  1. Adegoke BO, Akodu AK, Oyeyemi AL (2008) Work-related musculoskeletal disorders among Nigerian Physiotherapists. BMC Musculoskelet Disord 9:112CrossRefGoogle Scholar
  2. Alrowayeh HN, Alshatti TA, Aljadi SH et al (2010) Prevalence, characteristics, and impacts of work-related musculoskeletal disorders: a survey among physical therapists in the State of Kuwait. BMC Musculoskelet Disord 11:116CrossRefGoogle Scholar
  3. Andersen JH, Haahr JP, Frost P (2007) Risk factors for more severe regional musculoskeletal symptoms: a two-year prospective study of a general working population. Arthritis Rheum 56:1355–1364CrossRefGoogle Scholar
  4. Bhattacharya A (2014) Costs of occupational musculoskeletal disorders (MSDs) in the United States. Int J Ind Ergon 3:448–454CrossRefGoogle Scholar
  5. Bork BE, Cook TM, Rosecrance JC et al (1996) Work-related musculoskeletal disorders among physical therapists. Phys Ther 76:827–835CrossRefGoogle Scholar
  6. Brodal P (2017) A neurobiologist’s attempt to understand persistent pain. Scand J Pain 15:140–147. CrossRefGoogle Scholar
  7. Buckle PW, Devereux JJ (2002) The nature of work-related neck and upper limb musculoskeletal disorders. Appl Ergon 33:207–217CrossRefGoogle Scholar
  8. Calatayud J, Jakobsen MD, Sundstrup E et al (2015) Dose-response association between leisure time physical activity and work ability: cross-sectional study among 3000 workers. Scand J Public Health 43:819–824CrossRefGoogle Scholar
  9. Caragianis S (2002) The prevalence of occupational injuries among hand therapists in Australia and New Zealand. J Hand Ther Off J Am Soc Hand Ther 15:234–241CrossRefGoogle Scholar
  10. Chen H, Cohen P, Chen S (2010) How big is a big odds ratio? Interpreting the magnitudes of odds ratios in epidemiological studies. Commun Stat Simul Comput 39:860–864CrossRefGoogle Scholar
  11. Cromie JE, Robertson VJ, Best MO (2000) Work-related musculoskeletal disorders in physical therapists: prevalence, severity, risks, and responses. Phys Ther 80:336–351CrossRefGoogle Scholar
  12. Darragh AR, Huddleston W, King P (2009) Work-related musculoskeletal injuries and disorders among occupational and physical therapists. Am J Occup Ther 63:351–362CrossRefGoogle Scholar
  13. Devreux IC, Al-Awa B, Mamdouh K, Elsayed E (2012) Relation of work-related musculoskeletal disorders and over-commitment of rehabilitation staff in Saudi Arabia. Life Sci J 9:781Google Scholar
  14. Grooten WJ, Wernstedt P, Campo M (2011) Work-related musculoskeletal disorders in female Swedish physical therapists with more than 15 years of job experience: prevalence and associations with work exposures. Physiother Theory Pract 27:213–222CrossRefGoogle Scholar
  15. Ji R-R, Nackley A, Huh Y et al (2018) Neuroinflammation and central sensitization in chronic and widespread pain. Anesthesiol J Am Soc Anesthesiol 129:343–366Google Scholar
  16. Kuorinka I, Jonsson B, Kilbom A et al (1987) Standardised nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon 18:233–237CrossRefGoogle Scholar
  17. Liao J-C, Ho C-H, Chiu H-Y et al (2016) Physiotherapists working in clinics have increased risk for new-onset spine disorders: a 12-year population-based study. Medicine (Baltimore) 95:e4405CrossRefGoogle Scholar
  18. Luger T, Maher CG, Rieger MA, Steinhilber B (2017) Work‐break schedules for preventing musculoskeletal disorders in workers. The Cochrane library. Wiley, HobokenGoogle Scholar
  19. Luttmann A, Jäger M, Griefahn B et al (2003) Work-related musculoskeletal disorders—a definition. Preventing Musculoskeletal Disorders in the Workplace. World Health Organization, GenevaGoogle Scholar
  20. Mansfield M, Thacker M, Smith T (2018) Physical activity participation and the association with work-related upper quadrant disorders (WRUQDs): a systematic review. Musculoskeletal Care 16:178–187. CrossRefGoogle Scholar
  21. McMahon M, Stiller K, Trott P (2006) The prevalence of thumb problems in Australian physiotherapists is high: an observational study. Aust J Physiother 52:287–292CrossRefGoogle Scholar
  22. McPhail SM, Waite MC (2014) Physical activity and health-related quality of life among physiotherapists: a cross sectional survey in an Australian hospital and health service. J Occup Med Toxicol Lond 9:1CrossRefGoogle Scholar
  23. Nordin NAM, Leonard JH, Thye NC (2011) Work-related injuries among physiotherapists in public hospitals-a Southeast Asian picture. Clinics 66:373–378Google Scholar
  24. Nyland LJ, Anne K (2003) Is undergraduate physiotherapy study a risk factor for low back pain? A prevalence study of LBP in physiotherapy students. BMC Musculoskelet Disord 4:22CrossRefGoogle Scholar
  25. Ohlsson K, Attewell R, Johnsson B et al (1994) An assessment of neck and upper extremity disorders by questionnaire and clinical examination. Ergonomics 37:891–897CrossRefGoogle Scholar
  26. Power H, Fleming H (2007) Work-related thumb pain in manipulative physiotherapists-an Irish survey. Physiother Irel 28:51Google Scholar
  27. Rozenfeld V, Ribak J, Danziger J et al (2010) Prevalence, risk factors and preventive strategies in work-related musculoskeletal disorders among Israeli physical therapists. Physiother Res Int 15:176–184CrossRefGoogle Scholar
  28. Salik Y, Özcan A (2004) Work-related musculoskeletal disorders: a survey of physical therapists in Izmir-Turkey. BMC Musculoskelet Disord 5:27. CrossRefGoogle Scholar
  29. Trinkoff AM, Lipscomb JA, Geiger-Brown J et al (2003) Perceived physical demands and reported musculoskeletal problems in registered nurses. Am J Prev Med 24:270–275CrossRefGoogle Scholar
  30. Vieira ER, Schneider P, Guidera C et al (2016) Work-related musculoskeletal disorders among physical therapists: a systematic review. J Back Musculoskelet Rehabil 29:417–428. CrossRefGoogle Scholar
  31. von Elm E, Altman DG, Egger M et al (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 4:e296CrossRefGoogle Scholar
  32. Yassi A (1997) Repetitive strain injuries. Lancet Lond Engl 349:943–947CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Exercise Intervention for Health Research Group (EXINH-RG), Department of PhysiotherapyUniversity of ValenciaValenciaSpain
  2. 2.National Research Centre for the Working EnvironmentCopenhagenDenmark
  3. 3.Sport Sciences, Department of Health Science and TechnologyAalborg UniversityAalborgDenmark
  4. 4.Department of Nursing and PhysiotherapyUniversity of LleidaLleidaSpain

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