ORIGINAL ARTICLE

Pushing and pulling in association with low back and shoulder complaints

M J M Hoozemans¹, A J van der Beek¹, M H W Frings-Dresen¹, L H V van der Woude² and F J H van Dijk¹

¹ Coronel Institute for Occupational and Environmental Health, AmCOGG Amsterdam Centre for Research into Health and Health Care, Academic Medical Centre/University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, Netherlands
² Institute for Fundamental and Clinical Human Movement Sciences, Faculty of Human Movement Sciences, "Vrije Universiteit", Van der Boechorststraat 9, 1081 BT Amsterdam, Netherlands

Correspondence to:
Correspondence to:
Dr M H W Frings-Dresen, Coronel Institute for Occupational and Environmental Health, Academic Medical Centre/University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, Netherlands;
m.frings{at}amc.uva.nl

Aims: To examine the association between exposure to pushing/pulling at work and low back and shoulder complaints.

Methods: A cross sectional questionnaire survey was carried out among 434 workers from several companies with mainly pushing/pulling tasks. From the same companies 188 workers without physically demanding tasks served as reference. The questionnaire was used to assess the exposure to pushing/pulling and other physical risk factors for low back and shoulder complaints. Mean scores at company level were used to classify groups into medium and high exposed to pushing/pulling and a reference group. Psychosocial factors at work were also assessed. Several pain related questionnaires were used to assess the 12 month prevalence of low back and shoulder complaints in three dimensions: trouble (ache, pain, discomfort), pain intensity, and disability. Prevalence rate ratios (PRs) were calculated using Cox’s proportional hazards regression analysis.

Results: The 12 month prevalence of low back complaints was almost equal for all three groups. The prevalence of shoulder complaints increased with an increase in exposure level. Adjusted PRs showed that the high exposed group had an increased risk for low back complaints compared to the reference group. For all dimensions of shoulder complaints a clear tendency towards a dose–response relation was observed. The high exposed group had significant PRs for shoulder complaints, ranging from 2.09 to 6.37. Generally, psychosocial factors had a confounding effect for pain intensity and disability, but not for trouble.

Conclusions: For shoulder complaints a dose–response relation was observed for exposure to pushing/pulling. Low back complaints were less consistently associated with pushing/pulling. Stronger associations were observed for more severe cases of low back and shoulder complaints. It is hypothesised that work related psychosocial factors affect these associations.

Keywords: epidemiology; musculoskeletal complaint; physical work load

Abbreviations: CI, confidence interval; HWE, healthy worker effect; PR, prevalence rate ratio

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