- Poor workstation ergonomics, prolonged standing/sitting, repetitive tasks are to blame
- Training MOHs/PHIs on prevention, fostering partnerships with industry stakeholders important
Since there is a high prevalence of work-related musculoskeletal disorders among construction trade workers, with significant associations identified between age, work experience, the job category and rest breaks, early access to healthcare services for those reporting musculoskeletal symptoms is essential to prevent further complications, improve overall health outcomes, and reduce absenteeism in the construction sector.
These findings and recommendations were made in an original research article on the ‘Prevalence and correlates of work-related musculoskeletal disorders among construction workers at a building site in Colombo’ which was authored by K. Kalubowila (attached to the Colombo University's Postgraduate Institute of Medicine), R. Subash (attached to Scotland's Aberdeen University's School of Medicine, Medical Sciences and Nutrition), C. Jayasinghe (attached to the Colombo North Teaching Hospital [TH], Ragama), A. Mallawaarachchi (attached to the National Institute of Health Sciences) and S. Samanmali (attached to the Kalutara TH) , and published in the Journal of the College of Community Physicians of Sri Lanka's 31st Volume's First Issue, last month.
Work-related musculoskeletal disorders are a major global health concern affecting workers across various occupational sectors (Centres for Disease Control and Prevention's ‘Work-related musculoskeletal disorders and ergonomics’). The prevalence of work-related musculoskeletal disorders varies widely, with studies reporting rates of 35.1-88% in Asia (Chinese, Saudi Arabian and Iranian studies). Globally, work-related musculoskeletal disorders accounted for approximately 1.71 billion cases and 149 million years lived with disability in 2019, highlighting their substantial contribution to the disease burden (A. Cieza, K. Causey, K. Kamenov, S.W. Hanson, S. Chatterji and T. Vos's ‘Global estimates of the need for rehabilitation based on the Global Burden of Disease Study 2019: A systematic analysis for the Global Burden of Disease Study 2019’).
These disorders impair individual well-being and productivity, leading to absenteeism, early retirement and financial losses, especially in labour-intensive industries like construction (S. Eaves, D.E. Gyi and A.G. Gibb's ‘Building healthy construction workers: Their views on health, wellbeing and better workplace design’).
Work-related musculoskeletal disorders encompass conditions affecting the musculoskeletal system, including injuries to muscles, nerves, tendons, joints and spinal discs. They are primarily associated with occupational hazards such as repetitive movements, awkward postures, heavy lifting and insufficient rest. Unlike musculoskeletal conditions caused by aging, work-related musculoskeletal disorders are directly linked to workplace environments and tasks, often developing gradually and affecting the back, neck, shoulders, and upper limbs (a Chinese study). Effective management typically involves ergonomic interventions, job rotation, and training on safe work practices (B.R.D. Costa and E.R. Vieira's ‘Risk factors for work-related musculoskeletal disorders: A systematic review of recent longitudinal studies’, S. Anwer, H. Li, M.F. Antwi-Afari and A.Y. Wong's ‘Associations between physical or psychosocial risk factors and work-related musculoskeletal disorders in construction workers based on literature in the last 20 years: A systematic review’, and L.K. Jensen and L.B. Kofoed's ‘Musculoskeletal disorders among floor layers: Is prevention possible?’).
Construction is a high-risk sector in this regard. The construction industry plays a vital role in economic development in Sri Lanka but poses significant occupational health risks due to physically demanding tasks performed under challenging conditions (the World Bank's Sri Lanka Overview, 2018). Activities such as heavy lifting, prolonged standing and awkward postures elevate the risk of work-related musculoskeletal disorders among construction workers.
Methods
Kalubowila et al.'s descriptive, cross-sectional study was conducted among male construction workers aged 18 years and above, with at least six months of work experience, at a construction site in the Colombo District, Western Province. Foreign employees were included, while workers on leave for more than five consecutive working days or participating in off-site workshops during the data collection period were excluded.
The data were collected from 1 August 2020 to 31 October 2020. A stratified random sampling method with probability proportionate to size was used to ensure the proportional representation of four key job categories; structural workers (tasks include masonry, bricklaying, and concrete work, often involving heavy lifting and repetitive movements), finishing workers (responsible for tasks like plastering, painting, and tile laying, which require precision and repetitive hand movements), mechanical workers (roles include plumbing and electrical work, typically requiring awkward postures and working in confined spaces), and general labourers (performed tasks such as material transportation and site cleaning, often involving prolonged physical effort).
Work-related musculoskeletal disorders were defined as musculoskeletal complaints that developed after starting the current job and were aggravated by occupational tasks such as heavy lifting, repetitive movements or awkward postures. Data were collected using a pre-tested, interviewer-administered questionnaire.
Results
The study included 374 male construction workers (response rate of 96.5%). The majority of the participants were aged 26-40 years (mean age - 37.3 years; standard deviation – 11.5 years), of Sinhala ethnicity and had completed primary education. Nearly half drew a monthly family income of Rs. 30,001-40,000. Nearly half were employed as structural workers, with the majority having between six-15 years of work experience. On average, workers reported 6.1 days of work per week and 7.5 hours per day, with approximately one hour of rest during the workday.
The overall prevalence of work-related musculoskeletal disorders was 59.6%. The most affected body parts were the neck (27.1%), the shoulder (24.6%), the upper back (19.7%) and the lower back. Significant associations were revealed between work-related musculoskeletal disorders and several factors. Workers aged 26-40 were less likely to experience work-related musculoskeletal disorders in the shoulder, while those aged over 40 years were less likely to experience work-related musculoskeletal disorders in the lower back. Work experience was inversely related to work-related musculoskeletal disorders as workers with more than 15 years of experience were less likely to experience work-related musculoskeletal disorders in the neck and shoulder. In relation to the job category, mechanical workers and general labourers had significantly lower risk of experiencing work-related musculoskeletal disorders compared to structural workers, particularly in the neck and shoulder.
Taking rest breaks was found to be protective against work-related musculoskeletal disorders, with workers who took breaks more frequently having significantly lower odds of work-related musculoskeletal disorders in the neck, shoulder, and lower back. However, the effect of rest breaks on the upper back was not statistically significant. Additionally, mechanical workers were significantly less likely to experience work-related musculoskeletal disorders in the upper back, and the general labourers in the shoulder, compared to structural workers. Workers aged 26-40 years had a lower risk of work-related musculoskeletal disorders related to the shoulder.
Discussion
The overall prevalence of work-related musculoskeletal disorders was 59.6%. Discrepancies in the prevalence rates may be attributed to variations in sample characteristics, data collection methods, and work environments, highlighting the importance of considering contextual factors when interpreting work-related musculoskeletal disorders prevalence across different settings. Further, this high prevalence is likely due to factors such as poor workstation ergonomics, prolonged standing or sitting, repetitive tasks and the limited awareness of proper posture among workers. In Sri Lanka, where many workplaces lack formal ergonomic assessments and interventions, these findings emphasise the urgent need for targeted measures. Incorporating ergonomic training programmes, promoting the use of adjustable workstations, and implementing regular workplace assessments can help reduce the burden of work-related musculoskeletal disorders and improve occupational health outcomes in the country.
The body regions most affected in this study were the neck (27.1%), the shoulder (24.6%), the upper back (19.7%) and the lower back (12.6%). However, lower back pain was reported less frequently in this study, which could be due to the adoption of mechanical equipment that has reduced the reliance on manual lifting. This finding suggests that technological advancements in construction-related work such as cranes, lifts, and other mechanical tools may play a significant role in alleviating the physical strain on workers and could be a key component in future workplace interventions aimed at reducing work-related musculoskeletal disorders.
The study found no significant association between age and the occurrence of lower back work-related musculoskeletal disorders. Experiencing lower back work-related musculoskeletal disorders was similar for workers aged over 40 and those aged 26-40 years, which suggests that factors other than age may play a more prominent role in the development of lower back work-related musculoskeletal disorders. The use of mechanical lifting devices and job rotation could be mitigating the strain that is typically associated with older workers. Additionally, the frequency of rest breaks was significantly associated with work-related musculoskeletal disorders prevalence, with workers who rarely took breaks experiencing higher rates of musculoskeletal pain. These findings reinforce the importance of implementing structured rest periods to mitigate the risk of work-related musculoskeletal disorders in construction.
Shoulder-based disorders in the 26-40 age group indicated a lower reported risk compared to the below 25 age group. This difference might not solely reflect a true variation in the prevalence but could also be influenced by underreporting among younger workers. Individuals below 25 years may avoid reporting shoulder-based discomfort due to stigma, the fear of being perceived as weak or incapable, or concerns about job security. Additionally, younger workers may lack awareness of the importance of addressing musculoskeletal symptoms and may dismiss discomfort as trivial. To address this, organisations should promote a culture that encourages the open reporting of health issues, implement anonymous reporting systems, provide education on the importance of early symptom management, and conduct regular health check-ups to identify problems proactively, especially among younger employees.
Further, with the construction industry increasingly relying on advanced machinery and tools, there is a unique opportunity to embed ergonomic principles into the design and use of new technologies. Policies should support training programmes focused on the safe and efficient use of equipment to prevent musculoskeletal strain, particularly for older workers who are more vulnerable to these conditions. Additionally, age-specific interventions, including targeted preventive strategies, should be considered to help mitigate the risks of musculoskeletal degeneration in older workers.
The risk factors for work-related musculoskeletal disorders may differ across regions, depending on various environmental, cultural, and occupational practices.
A limitation of the study is that certain key work-related characteristics, such as detailed postural assessments and physical loading, were not accounted for. These factors are crucial for understanding the full scope of ergonomic risks in construction work. Hence, future research could incorporate more granular assessments of the posture, lifting techniques, and work environments. Workers who are healthier or have fewer musculoskeletal issues may be more likely to remain in physically demanding jobs. Future studies should explore additional factors that could impact the development of work-related musculoskeletal disorders, such as lifestyle factors and preexisting health conditions.
This study highlights the critical need for enhanced occupational health policies and interventions in Sri Lanka's construction sector. By integrating ergonomic principles, ensuring adequate rest breaks, and addressing the specific needs of older workers, the construction industry can reduce the burden of work-related musculoskeletal disorders and improve the long-term health and productivity of workers.
Conclusions and recommendations
The findings underscore the need for targeted strategies to reduce risks related to work-related musculoskeletal disorders. Based on the identified risk factors, it is recommended that construction companies implement measures such as regular workplace assessments, proper training, and encouraging rest breaks to mitigate the prevalence of work-related musculoskeletal disorders.
To address the physical demands placed on workers, recommendations include improving the workplace design, promoting task rotations, and using advanced tools and machinery to reduce repetitive strain. Training workers on the proper posture, lifting techniques, and ergonomics is also crucial.
This research emphasises the need for a proactive approach, including training medical officers of health (MOHs) and public health inspectors (PHIs) on the prevention of work-related musculoskeletal disorders, fostering partnerships with industry stakeholders, and integrating ergonomic interventions into occupational health practices. Strengthening the public health capacity and enforcing regulations are essential to safeguard workers' musculoskeletal health.