Table 2.

Epidemiologic studies of awkward posture and musculoskeletal disorders of the neck and shoulder

Author	Study design	Industry or occupation	Sample	Exposure(s)	Outcome(s)	Results and comments
Abd Rahman et al, 2010	Cross-sectional	Malaysia: workers in a car tire service center	12 (possibly all men)	Poor body posture, prolonged standing, squatting and kneeling, bending the back and neck, highly repetitive motions, lifting heavy objects, use of hand tools, and poor workstation design	Pain/discomfort in hand/wrists, shoulder, back, elbow/forearm, and other locations	The main sources of injury/discomfort were poor body posture, bending the back, highly repetitive motions, lifting heavy objects, long-term standing, long-term squatting, bending the neck, and high hand force.
Alipour et al, 2008	Cross-sectional	Iran: workers in an automobile-manufacturing industry	14,384 men and women (79.8% response rate)	Awkward working position, repetitive work, sitting for long hours, monotonous work, and psychosocial factors	Neck/shoulder pain	Men: awkward working positions & repetitive work were physical risk factors. Women: repetitive work & sitting were physical risk factors.
Arcury et al, 2014	Cross-sectional	USA: women in poultry processing and other manual work	234 women	Awkward posture, heavy load, and psychological factors	Epicondylitis, rotator cuff syndrome, etc.	Awkward posture, decision latitude, and work organization characteristics were associated with epicondylitis, and rotator cuff syndrome among women.
Boschman et al, 2015	Longitudinal	Netherlands: construction workers (bricklayers and supervisors)	750 bricklayers and 750 supervisors (gender not stated)	Working above height, repetitive arm–hand movements, and vibrating tools	MSDs of the shoulder, and upper extremities	Working above height, repetitive arm–hand movements associated with MSDs of the shoulder and upper extremities.
Carnide et al, 2006	Cross-sectional	Portugal: paint area production workers in an automobile plant	29 (mostly men)	Awkward posture and physical workload	MSDs of the neck and upper limbs	Physical workload and awkward posture associated with MSDs of the shoulder, neck & upper limbs.
Cassou et al, 2002	Prospective cohort	France: workers in various occupations (from executive to blue-collar workers)	21,378 men and women (response rate 88.2%)	Awkward posture, carrying heavy loads, vibrations, repetitive work, and psychosocial factors	Neck and shoulder pain.	In addition to several ergonomic factors, the aging of the workforce appeared to have contributed to the MSD symptoms. Psychosocial factors also played a role.
Chandrasakaran et al, 2003	Cross-sectional	Malaysia: female workers in the wafer fabrication & semiconductor industry	529 women	Prolonged bending and sitting	Neck and shoulder MSDs	Pain in the shoulder and neck was among the most common MSDs. Neck/shoulder pain significantly associated with sitting and bent forward positions.
Chee et al, 2004	Cross-sectional	Malaysia: female workers in semiconductor industries	906 women	Awkward posture, sitting without back support, lifting weights, prolonged standing, and repetition	Neck/shoulder MSDs and upper and lower extremity pain	Frequent lifting, awkward posture & prolonged sitting significantly associated with neck/shoulder pain.
Chowdhury et al, 2012	Cross-sectional	India: male workers in liquid petroleum gas industries	100 men	Awkward posture and repetitive motions	Severe injury to back, neck, shoulder, knees, and toes	Awkward posture associated with MSD injuries.
Engholm and Holmstrom, 2005	Cross-sectional	Sweden: construction workers	85,191 men	Awkward posture, working with hands above shoulders, heavy lifting, kneeling, and psychosocial factors	Neck and shoulder disorders	Neck and shoulder disorders were significantly associated with vibration exposure, heavy lifting, and working with hands above the shoulder.
Feveile et al, 2002	Longitudinal	Denmark: workers in various industries	Baseline: 5,001 men and women, follow-up: 3,990	Physical hard work, heavy lifting, twisting/bending, working with hands at/above shoulders, and psychological factors	MSDs of the neck/shoulder and wrist/hand	Among men and women, twisting or bending and psychosocial issues predicted neck/shoulder MSD symptoms.
Gangopadhyay et al, 2010	Cross-sectional	India: male workers in carbon dioxide and chemical sand core–making operations	50 men	Awkward posture	MSDs of the shoulder, neck, and other regions	Awkward posture was significantly associated with MSDs of the shoulder, neck, and other regions.
Ghasemkhani et al, 2008	Cross-sectional	Iran: workers manufacturing hygienic products	75 workers	Repetitive movements and awkward posture	MSDs of the neck and shoulders	Repetitive movements with awkward posture were significantly associated with MSDs.
Ghosh et al, 2010	Cross-sectional	India: male goldsmiths	120 men	Awkward posture and repetitiveness	MSDs of the neck, shoulder, lower back, and wrists.	Awkward posture associated with MSDs especially those of the neck and low back.
Grzywacz et al, 2012	Cross-sectional	US: Latino immigrant workers in the poultry industry	138 men and 138 women each in poultry and nonpoultry work groups	Awkward posture and repeated movements, heavy load, psychological demands, and abusive supervision	Epicondylitis, rotator cuff syndrome, and back pain	Awkward posture and repeated movements were associated with epicondylitis, rotator cuff syndrome, and back pain.
Hanklang et al, 2014	Cross-sectional	Thailand: female workers using hand-operated rebar benders	272 women	Awkward posture, repetitive movements, prolonged working hours, bending of neck or trunk, stooping, and psychosocial factors	MSDs of the neck and shoulders	Workers with prolonged working hours and awkward posture were more likely (43.8 times) to develop MSDs.
Herin et al, 2012	Longitudinal	France: workers in various industries	1990: 21,378 and 1995: 18,695, men and women	Physical factors: forceful effort, effort with tools, heavy loads, movements, posture, and vibration and psychological factors	Shoulder pain	Forceful effort and awkward posture were predictive of chronic shoulder pain at 5 years; the most robust predictor was awkward posture. Decision control was also a predictor.
Kaminskas and Antanaitis, 2010	Cross-sectional	Lithuania: construction workers	276 (62.7% response rate)	Awkward work posture, and high use of physical force	Pain and discomfort in the neck, shoulders, and other regions.	Awkward work posture and high use of physical force were significantly associated with pain and discomfort in the neck, shoulder, and other regions.
Lemasters et al, 1998	Cross-sectional	USA: carpenters (e.g., drywall, ceiling, framing, building concrete forms, etc.)	522 (97.8% men) (83% response rate)	Repetitiveness, awkward posture, exhaustion, and psychosocial issues	MSDs of shoulders, and upper and lower extremities.	Psychosocial issues associated with MSDs of the shoulder, etc. MSDs of upper extremities are most prevalent among all carpenters, particularly drywall and ceiling installers.
Miranda et al, 2001	Longitudinal	Finland: workers in the forestry industry	2094 women and men	Working with trunk forward flexed, with hand above shoulders, and physical work with a heavy load	Shoulder pain	Working with trunk forward flexed, with hand above shoulders, physical work with a heavy load increased the risk of incident shoulder pain.
Miranda et al, 2008	Longitudinal	Finland: workers in various industries	883 women and men	Repetitive movements, vibration, awkward posture, lifting heavy loads, and psychosocial factors	Shoulder MSDs	63 incident cases of shoulder MSDs. Men: vibration and repetitive movements. Women: lifting heavy loads and awkward posture significantly associated with MSDs.
Nag et al, 2012	Cross-sectional	India: workers in fish-processing industry	450 women	High levels of physical activity, cold environment, poor task clarity, and manual material handling	Pain and discomfort in neck and shoulders.	High levels of physical activity, cold environment, poor task clarity, and manual material handling were associated with pain and discomfort in the neck and shoulder.
Roquelaure et al, 2009	Cross-sectional	France: salaried workers in various industries	3,710 men and women	Working with arms at or above shoulders, vibrating hand tools, extreme wrist bending, and psychosocial factors	MSDs of upper extremities	13% had ≥1 upper extremity MSD. Men: MSDs associated with repetitiveness, arms at or above shoulders, full elbow flexion, and psychological demands. Women: MSDs associated with extreme wrist bending, and vibrating hand tools.
Sim et al, 2006	Cross-sectional	UK: workers in various manual occupations (e.g., pottery)	10,000 men and women (53.5% response rate)	Lifting heavy objects, prolonged bending of neck, working with arms above shoulder, and psychosocial factors	Neck and upper limb pain.	Significant association between neck & upper limb pain and several physical & psychosocial factors.
Sterud et al, 2014	Longitudinal	Norway: workers in various industries	12,550 men and women (67% response rate)	Lifting in awkward posture, neck flexion, repetitive motions, and psychosocial factors	Neck and shoulder pain	Highly demanding jobs, neck flexion, awkward lifting, hand/arm repetition, and working with hands above the shoulder were important predictors of neck/shoulder pain.