Journal of Back and Musculoskeletal Rehabilitation 32 (2019) 555–560 555

DOI 10.3233/BMR-181218
IOS Press

Low back pain among nursing professionals

in Jeddah, Saudi Arabia: Prevalence and risk
factors
Riziq Allah Mustafa Gaowgzeh
Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah
21589, Saudi Arabia
Tel.: +96 6592110513, +96 2779819262; E-mail: rizikjoresearch@gmail.com

Abstract.
BACKGROUND: Lower back pain (LBP) is often work-related and is commonly observed among nurses. LBP occurs below
the 12th rib and above the gluteal fold. In nurses, back disorders are mainly associated with heavy physical activity, such as lifting
and moving patients.
OBJECTIVE: The aim of the presented work is to evaluate the prevalence, risk factors, and associations of personal character-
istics, general health status, and physical load with complaints of LBP.
METHODS: In this study, sixty nurses were randomly chosen to answer self-administered questionnaires. The results were
analyzed using the SPSS system.
RESULTS: An incidence rate of 61.7% for LBP among nurses was noticed. Among the sites of injury, LBP predominated with
a rate of 51.2%. Severity of injury mostly ranged between mild to moderate levels of severity, and 20% of the nurses with LBP
were working in obstetrics and gynecology units. Our study also showed that 66.7% of the participating nurses had experienced
LBP only after taking on nursing jobs.
CONCLUSIONS: The present study demonstrated that nurses working in Jeddah exhibit a high prevalence of lower back pain.
In order to reduce the risk of work-related musculoskeletal disorders among nurses, the physical therapist’s role is vital and
nurses’ practice of relaxation and stretching exercises in between work schedules is mandatory.

Keywords: Lower back pain, risk factors, nurses, physical work load

1. Introduction
Pain is an unpleasant emotional state felt in the mind
but identified as arising in a part of the body. Pain is a
designed defense mechanism to make the subject pro-
tect an injured body part from further damage. Lower
back pain (LBP), perhaps more accurately named lum-
bago or lumbo-sacral pain, occurs below the 12th rib
and above the gluteal folds [1,2].
Lower back pain (LBP) is common among the gen-
eral population and is considered one of the occupa-
tional causes of morbidity in the industrialized world.
LBP is a common cause of morbidity among health
care workers. Nurses are considered one of the occu-
pational groups within the health service that are vul-
nerable to LBP [2,3]. A study performed by Sikiru and
Hanifa [4] showed that whilst LBP is a widespread dis-
ease among nurses, it is not a major cause of sickness
absence in the workplace. Poor knowledge of back care
ergonomics and the unavailability of lifting equipment
are major predisposing factors of LBP among nurses.
Back disorders among nurses are highly associated
with heavy physical work tasks, particularly lifting and
moving patients [5]. Also, nursing jobs in intensive
care units are characterized as having excessive work-
loads and requiring repetition of frequent body move-
ments, such as reaching up or forward, holding, clasp-
ing, hugging, lifting, and turning, all of which prepare

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556 R.A.M. Gaowgzeh / Low back pain among nursing professionals in Jeddah, Saudi Arabia

the ground for the emergence of back disorders in gen-

eral and LBP in particular. Every year, thousands of
nurses in the received medical reports retire early; con-
sequently, the replacement of these injured employees
by temporary staff affects the continuity and quality of
patient care [6].
Nurses are often required to lift and move pa-
tients and equipment, especially in developing coun-
tries, where aiding facilities are often unavailable. The
present work was performed to evaluate the associa-
tion of heavy physical work tasks, work stress, and
personal characteristics with the occurrence of LBP Fig. 1. Distribution and the incidence of low back pain.
among nurses in Jeddah, Saudi Arabia. The yielded
data is expected to provide necessary information for
taking preventive measures against back pain and mod-
ifying the risk factors of LBP.

1.1. Subjects and methods

This study is a cross-sectional study performed on

60 nurses at King Abdulaziz University, Abdullatif
Jameel Hospital, Jeddah East Hospital, and the Inter-
national Medical Center. Nurses were randomly se-
lected from different units. Data was collected using a
structured, pre-coded questionnaire. The questionnaire Fig. 2. Gender distribution.
comprised data on socio-demographic data (including
age, body index, work hours, and specialty), experi-
ence with LBP, and possible risk factors of LBP. Inten-
sity of the pain was assessed using a 10-point horizon-
tal visual analogue scale (VAS) in which point number
one indicated absence of LBP while point number 10
indicated the highest level of pain. Similarly, horizon-
tal 10-point VASs were used to assess work satisfac-
tion and stress levels at work. The height and weight of
each participating nurse were recorded. The data was
entered and analyzed using the Statistical Package for
Social Sciences (SPSS) version. Details on work ac-
tivity focused on the nurses’ handling of materials and
patients. Body Mass Index (BMI) was calculated by
weight (kg)/height (m).

1.2. Inclusion criteria

Postgraduate nursing students and professionals (60
subjects) aged 20–60 years.
1.3. Exclusion criteria
Hyper mobile joints; cervical joint diseases; cen-
tral and peripheral nervous diseases; trauma and frac-
ture Sprains and other musculoskeletal injuries and dis-
eases; subjects undergoing regular flexibility exercises
or any other physical work.
Fig. 3. Distribution of severity of injury.
2. Results
Sixty subjects, of whom 18 were male and 42 were
female nurses with an average age of 35.4, were in-
cluded in the study. The descriptive data are listed in
Tables 1–6 and Figs 1–6. The incidence rate of lower
back pain among the nurses was 61.7%; with regards
to the specific area of injury, lower back pain predom-
 R.A.M. Gaowgzeh / Low back pain among nursing professionals in Jeddah, Saudi Arabia 557

Table 1
Distribution and the incidence of low back pain
Frequency Percent Valid percent Cumulative percent
Valid Yes 37 61.7 61.7 61.7
No 23 38.3 38.3 100.0
Total 60 100.0 100.0

Table 2
Gender distribution
Gender
Frequency Percent Valid percent Cumulative percent
Valid Male 18 30.0 30.0 30.0
Female 42 70.0 70.0 100.0
Total 60 100.0 100.0

Table 3
Distribution of severity of injury
Severity of injury
Number %
Severe 4 9.5%
Moderate 18 42.9%
Mild 20 47.6%
Total 42 100%

inated with a rate of 51.2%. The severity of injury

ranged between mild to moderate levels of severity for
93.4% of nurses, whilst only 6.7% of nurses experi-
enced severe lower back pain. 11% of the nurses had
spinal cord injuries. Nurses’ work experience ranged
equally from 1 to more than ten years of experience.
20% of the nurses complaining from LBP worked in
obstetrics and gynecology units, while 15% worked
in general and emergency units. 4.33% were adminis-
trators and nurse tutors and 8% were nurse-midwives.
66.7% of the nurses had experienced LBP only after
taking on a nursing job, while 33.3% had already expe-
rienced LBP prior to working as a nurse, which showed
that there is a correlation between nursing jobs and in-
creased incidence of back pain. 60.3% of the nurses
with LBP worked for long hours. Though 49% of the
nurses had experienced an increase in lower back pain,
it was determined that 65% of the total nurses who ex-
perienced lower back pain did not make any attempts
to relieve the pain. 13.3% of the nurses reported de-
pressive symptomswhile the remaining nurses saw no
correlation between the incidence of back pain and
psychological problems. LBP was also determined in
nurses who sometimes complied with body mechanics
When working with patients, about 66.7% of the
nurses who did not use any aiding equipment during in-
terventions experienced an increase in lower back pain.
With lower back pain being the outcome, exposure-
response trends were observed for manually transfer-
ring patients between bed and chair; transferring pa-
Fig. 4. Distribution of using of assistive tools.
tients between bed and chair with a hoist; manually
moving patients around and repositioning themon the
bed; and lifting patients into the bath with a hoist.
3. Discussion
The highest incidence rates of work-related lower
back problems have been demonstrated among nurses,
and lower back pain ranked third amongst muscu-
loskeletal occupational health problems among nurses.
This problem was associated with nurses’ physical
activity in the workplace and ergonomic risk fac-
tors [7,8]. In comparison to other musculoskeletal dis-
orders LBP, was shown to have the highest incidence
rate among nurses. The same has beenshownin an-
other previously conducted study [9–11], whose au-
thors reported high annual prevalence varying from
73% to 76% among nurses employed by a large uni-
versity hospital in Switzerland. Though the nature and
specific causes of LBP remain unclear, many studies
have found a strong link between LBP and several
work-related factors [12], similar to the findings of this
present study [13]. Heavy physical activity by nurses
such as lifting patients manually makes nurses more
558 R.A.M. Gaowgzeh / Low back pain among nursing professionals in Jeddah, Saudi Arabia

Fig. 5. Distribution of nurse specialization in relation to LBP.

Table 4
Distribution of using of assistive tools
Using of assistive tools
Number %
Yes 24 40%
No 36 60%
Total 60 100%

prone to LBP [14], thus increasing nurses’ absence

from work and early retirement due to ill health [3].
The effectiveness of a training program on the reduc-
tion of stressful trunk postures in geriatric nursing pro-
fessions was evaluated by Kozak et al. [15]. Stressful
trunk postures can be significantly reduced by raising
awareness of the physical strains that frequently occur
during a shift, by changes in work practices, and by
redesigning the work environment. Work place inter-
ventions aimed at preventing or reducing lower back
pain in nursing personnel would probably benefit from
sensitizing employees to their postures during work.
Nurses who do not maintain a normal posture at
work are more vulnerable to developing back pain. It
was reported that lower back pain increased in parallel
with the increase in working hours and this result was
Fig. 6. Distribution of experiencing LBP before the job or after.
associated with the decrease in resting time [16–18].
Therefore, it is important to define the risk factors that
may lead to lower back pain in nurses and to take
the necessary protective measures. Nurses, who play
an important role in protecting, maintaining, and im-
proving other individuals’ health, should be encour-
aged to take care of their own physical competence and
apply the necessary protective measures to maintain
their health. Such necessary measures include main-
taining a healthy posture when working with patients,
 R.A.M. Gaowgzeh / Low back pain among nursing professionals in Jeddah, Saudi Arabia 559

Table 5
Distribution of nurse specialization in relation to LBP
Specialization
Frequency Percent Valid percent Cumulative percent
Valid
Emergency 9 15.0 15.0 15.0
outpatient department 9 15.0 15.0 30.0
General nursing 7 11.7 11.7 41.7
Midwife 10 16.7 16.7 58.3
Spinal cord injury 7 11.7 11.7 70.0
Ward assistant 3 5.0 5.0 75.0
Extended care 4 6.7 6.7 81.7
Rehab 2 3.3 3.3 85.0
Pain management 5 8.3 8.3 93.3
Newalogy 2 3.3 3.3 96.7
Internal medicine 2 3.3 3.3 100.0
Total 60 100.0 100.0

Table 6
Distribution of experiencing LBP before the job or after
After or before
Frequency Percent Valid percent Cumulative percent
Valid
After 40 66.7 66.7 66.7
Before 20 33.3 33.3 100.0
Total 60 100.0 100.0

and nurses should be made aware of the importance of
such measures [19,20].
Poor working habits and incorrect lifting postures
have been identified as causative factors of LBP. In
the present study, all nurses without LBP (38.3%) had
previous knowledge of postural hygiene, while the re-
maining (61.7%) with LBP did not significant associ-
ation (p < 0.05) was found between posture hygiene
and the incidence of LBP among nurses. It is necessary
to integrate occupational health policies in company
strategies and widely disseminated to workers and em-
ployees responsible for managing their own occupa-
tional health [21].
The nature of nursing work subjects nurses to long
hours of standing and other physical activities such as
bending forward and lifting and repositioning patients.
It was found that nurses who did not use any aiding
equipment during physical interventions with patients,
often due to lack of time, had higher average lower
back pain scores. These results may be explained by
the lack of sufficient education given to nurses about
the causing factors of lower back pain and the impor-
tance of maintaining a healthy posture [22,23].
Our results revealed that nurses fromobstetrics and
gynecology (O&G) units, including nurses from la-
bor wards, reported the highest incidence of LBP 80
(20%), while nursing administrators and tutors re-
ported the lowest incidence of 13 (4.33%) each. This
is possibly related to the fact that prevalence is high
among females and only female nurses (midwives)
work in O&G departments. It might also be related to
the amount of work pressure in O&G departments, in-
cluding labor wards [18].
Management of LBP with physiotherapy and surgery
has already been well established [24]. Sex did not play
a role in the consultation and management of LBP, but
there was a significant association between severity of
LBP and the type of management adopted by nurses.
4. Conclusions and recommendations
Our study concludes that nurses working in the hos-
pitals of Jeddah have a high prevalence of lower back
pain. In order to reduce the risk of work related mus-
culoskeletal disorders among nurses, the physical ther-
apist’s role is vital and nurses’ practice of relaxation
and stretching exercises in between work schedules is
mandatory.
Acknowledgments
This work was supported and funded by the Dean-
ship of Scientific Research (DSR) of King Abdulaziz
University, Jeddah, Saudi Arabia (grant no. 141-42-
560 R.A.M. Gaowgzeh / Low back pain among nursing professionals in Jeddah, Saudi Arabia
D1436). The authors gratefully acknowledge and thank
the technical and financial support of the DSR.
Conflict of interest
None to report.
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