Work Related Musculoskeletal Disorders

(WRMSD) in Construction Workers

and Main Causes

Zenija Roja1(&), Henrijs Kalkis2, Inara Roja3, and Janis Zalkalns2

1
University of Latvia, Jelgavas 1, Riga, Latvia
zenija.roja@lu.lv
2
Riga Stradiņš University, Dzirciema 16, Riga, Latvia
henrijs.kalkis@gmail.com
3
Riga 1st Hospital, Bruninieku 5, Riga, Latvia
inara.roja@gmail.com

Abstract. Construction industry still is characterized with physically demand-

ing work duties despite the ongoing modernization of new technology. Con-
struction work requires physical and psychosocial effort, working in compulsory
and awkward postures. WRMSD are the most common health problems among
employees in construction. The aim of this study was to determine WRMSD
reasons caused by physical load and psychosocial risks at work for painters and
tilers in the construction enterprise. Results of the study shows that causes of
WRMSD in employed in construction, are not only physical risks at work, but
also psychosocial risks, as well as individual attitude towards one’s own health.

Keywords: WRMSD
Construction
Questionnaire
Painters
Tilers

1 Introduction

Construction is one of the biggest Latvian national economy sectors. Many jobs in the
construction industry are still physically demanding. The construction site is a tem-
porary workplace, meaning that material and tools may have to be carried and the
demands may vary (e.g., between renovation and the construction of new buildings).
Construction work also requires climbing ladders and sometimes working in awkward
postures. WRMSD and injuries are among the most frequently reported causes of lost
or restricted work time [1]. WRMSD are the most common health problems among
employees in Latvia, incl. construction. Research in other countries has also proved
that construction workers most of all suffer from WRMSD, especially older employees
[2]. Opposite to other occupational diseases, WRMSD are of multifactor origin [3],
where significant are not only physical risks [4], but also psychosocial and organiza-
tional [5, 6], as well as individual risk factors [7]. Cigarette smoking, obesity, diabetes,
hypertension, and high cholesterol level are major health risk factors for builders [8].
Research has proved that cigarette smoking 12 to 13 times increases risk of death from
chronic obstructive pulmonary disease (COPD) and accounts for nearly one of every
five deaths in the United States [9, 10]. Obesity has been linked with stroke, diabetes,

© Springer International Publishing AG 2018

R.S. Goonetilleke and W. Karwowski (eds.), Advances in Physical Ergonomics
and Human Factors, Advances in Intelligent Systems and Computing 602,
DOI 10.1007/978-3-319-60825-9_31
280 Z. Roja et al.

and several other chronic conditions. The prevalence of obesity among adults, mea-
sured by body mass index, has increased significantly since the 1980s in US [11].
Physical overload at work (lifting and moving heavy loads, repeated hand move-
ments, awkward postures, including long-term bending or sharp turning of the body,
work on knees, work with hands raised above shoulder level are considered to be the
main reasons in the origin of WRMSD [12, 13]. Construction workers, comparing to
office workers, suffer from arthritis, back health disturbances, chronic pulmonary dis-
eases, limitation of movements, and traumata much more often [14, 15]. Work envi-
ronment is an important predictor of disability pension among construction workers
with those in physically heavy jobs having the highest burden of disability [16].
Research in Finland, in its turn, has proved that disability in relation to health problems
due to strain at work occurs 1.5 to 2.4 times more than due to WRMSD [17]. Psy-
chosocial risks at work are also significant in the health of employees in relation to
WRMSD. A lot of researchers consider that work stressors have a negative effect on
employees’ health, which manifests as anxiety, depression, burn-out and cardiovascular
diseases [18, 19].
Therefore, in order to avoid health problems related to the effect of ergonomic risks
on construction workers, thorough analysis of WRMSD reasons and working out of
ergonomic interference plan are necessary [20].
The aim of this study was to determine WRMSD reasons caused by physical load
and psychosocial risks at work in painters and tilers in the construction enterprise.
24 painters and 31 tilers participated in this investigation. All of them were males and
complained about feeling discomfort (4 months or longer) in different body parts every
day after work. Exclusion criteria were: acute musculoskeletal and peripheral nervous
system diseases, as well as other diseases.
The study was approved by the Human Ethics and Institutional Review Board of
Riga Stradins University, Latvia in 2015.

2 Methods

2.1 Participants
Research group consisted of 24 painters and 31 tilers. Background factors of the
research group are shown in Table 1.

2.2 Extended Version of Nordic Musculoskeletal Questionnaire (NMQ-E)

The extended version of Standardized Nordic Musculoskeletal Questionnaire (NMQ-E)
was used to assess WRMSD reasons in painters and tilers [21]. The extended version of
NMQ-E in our study contains some additional questions regarding body postures, job
demands and social support.
 Work Related Musculoskeletal Disorders (WRMSD) 281

Table 1. Background factors of the subjects: length of service, age, height, weight, body mass
index (BMI).
Occupation n Mean Range Mean height, Mean weight, Mean BMI,
(length of service) age ± SD m ± SD kg ± SD kg/m2 ± SD
Painters 24 42.17 ± 17.75 18–71 1.71 ± 0.08 79.42 ± 7.10 27.16 ± 2.94
(0–5 years) 9 3.22 ± 1.39 18–39 1.71 ± 0.11 75.11 ± 8.85 25.94 ± 3.42
(6–10 years) 3 39.00 ± 5.57 33–44 1.73 ± 0.08 79.33 ± 1.15 26.50 ± 2.14
(11–20 years) 7 49.14 ± 7.13 38–60 1.70 ± 0.04 84.14 ± 3.53 29.23 ± 2.19
(>20 years) 5 66.60 ± 5.86 65–71 1.73 ± 0.05 80.60 ± 5.59 26.85 ± 2.32
Tilers 31 50.32 ± 16.17 19–72 1.73 ± 0.09 81.13 ± 7.03 27.11 ± 1.74
(0–5 years) 3 21.00 ± 1.73 19–22 1.69 ± 0.01 82.00 ± 3.46 28.60 ± 1.32
(6–10 years) 5 43.40 ± 10.67 36–56 1.76 ± 0.10 81.60 ± 5.86 26.39 ± 2.48
(11–20 years) 14 49.36 ± 12.48 34–72 1.72 ± 0.10 80.43 ± 7.73 27.30 ± 1.55
(>20 years) 9 65.44 ± 7.68 46–71 1.75 ± 0.08 81.67 ± 8.14 26.70 ± 1.60

2.3 Statistical Analysis

The acquired results were processed, using statistical data processing software SPSS.20
[22] according to popular descriptive statistical methods. Confidence interval (95% CI)
and prevalence proportion ratio (PPR) were used to indicate the reliability [23].

3 Results and Discussion

Analyzing the participants of the study it should be noted that the involved painters and
tilers were at the age of 18–72 with disposition to obesity. It is confirmed by BMI
calculation data (BMI > 25). Overweight people are more susceptible to heart and
blood circulation diseases, as well as to musculoskeletal health problems. Above
mentioned observations are also described in other studies related to construction
workers [24]. 75% of them had primary school education, 15% - secondary school
education, 10% - professional qualification. All of the involved males were heavy
smokers and willingly used alcohol in their spare time, which suggests unhealthy life
style and free time activities.
Observing the work process of the participants it was concluded that painters move
and lift heavy loads manually, they are subjected to chemical risks, noise and fluctu-
ations of microclimate parameters in the work environment. Work is performed in
standing, sometimes in squatting position and kneeling down. Specifics of tilers’ work
is: work with sharp manual instruments cutting or leveling out tiles, work in awkward
position, standing or kneeling down, as well as in squatting or crawling position. Apart
from that tilers are more subjected to dust and fluctuations of microclimate parameters
in the work environment.
The distribution of persistent complaints in each part of the body and psychosocial
conditions, for painters and tilers separately, according to the extended version of
Nordic musculoskeletal questionnaire NMQ-E, was shown in the Tables 2 and 3.
282 Z. Roja et al.

Table 2. Distribution of persistent complaints in different parts of the body, psychosocial

conditions of painters, prevalence proportion ratio (PPR) and 95% confidence interval (CI),
compared with joint group (n = 24).
Painters* Reference groups (length of service, years)
(n = 24) I (0–5) (n = 9) II (6–10) (n = 5) I (0–5) (n = 9) III (>20) (n = 8)
Number % Number % Number % Number % Number %
PPR (95% CI) PPR (95% CI) PPR (95% CI) PPR (95% CI)
Neck 20 83 7 78 3 100 5 71 5 100
0.93 (0.88–0.97) 1.2 (1.09–1.27) 0.86 (0.74–0.97) 1.2 (1.03–1.36)
Shoulder 21 88 9 100 3 100 4 57 5 100
1.14 (1.02–1.26) 1.14 (1.02–1.25) 0.65 (0.57–0.69) 1.14 (1.03–1.22)
Elbow 5 21 1 11 0 0 4 80
0.53 (0.47–0.59) 3.84 (3.26–4.98)
Wrist/hands 20 83 7 78 3 100 5 71 5 100
0.93 (0.84–1.04) 1.2 (1.13–1.29) 0.86 (0.67–0.98) 1.2 (1.12–1.24)
Upper back 17 71 8 89 1 33 7 100 1 20
1.25 (1.11–1.29) 0.47 (0.45–0.51) 1.41 (1.33–1.47) 0.28 (0.26–0.31)
Low back 5 21 2 22 0 0 3 60
1.07 (1.02–1.18) 2.88 (2.71–3.04)
Hip/thigh 0 0 0 0 0 0

Knee 15 63 4 44 0 6 86 5 100
0.71 (0.67–0.75) 1.37 (1.23–1.45) 1.6 (1.35–1.92)
Ankle/shank/feet 3 13 0 0 2 29 1 20
2.29 (2.14–2.65) 1.6 (1.43–1.76)
Awkward 24 100 9 100 3 100 7 100 5 100
posture 1 (0.96–1.05) 1 (0.96–1.04) 1.00 (0.98–1.04) 1.00 (0.98–1.05)
Physical 10 42 3 33 1 33 6 86 0
exhausting 0.8 (0.68–0.93) 0.8 (0.73–1.02) 2.06 (1.94–2.21)
Extensive work 5 21 0 1 33 2 29 2 40
1.6 (1.42–1.74) 1.37 (1.22–1.45) 1.92 (1.71–1.98)
High work speed 4 17 0 0 2 29 2 40
0 1.71 (1.59–1.88) 2.4 (2.17–1.56)
Too many job 0 0 0 0 0
tasks
Colleagues’ 12 50 7 78 1 33 2 29 2 40
support 1.56 (1.36–1.72) 0.67 (0.46–0.73) 0.57 (0.396–0.79) 0.8 (0.68–1.02)
Supervisors’ 4 17 1 11 1 33 1 14 1 20
support 0.67 (0.63–0.72) 2 (1.88–2.16) 0.86 (0.72–1.03) 1.2 (1.14–1.32)
* Multiple answers were possible

Results displayed in Table 2 show that painters mostly complain of discomfort in

the neck (83%), shoulders (88%), at the base of the hand (83%) and upper back (71%).
After work, 63% note pain and discomfort in knees as well. These problems occur
more in younger painters (24.22 ± 7.84), whose length of service in the related pro-
fession is from 0 to 5 years (PPR 0.93–1.25; CI 0.88–1.26). In our study it could be
related with physical and psychological unpreparedness for work load. It is also proved
by information obtained in interviews with painters. Similar complaints appear also
among older painters (66.60 ± 5.86), whose length of service in the profession is >20
years (PPR 2.8–1.2; CI 2.78–1.24). Older employees (100%) complain of discomfort in
knees as well (PPR 1.6–1.37; CI 1.35–1.92). The employees whose length of service in
 Work Related Musculoskeletal Disorders (WRMSD) 283

the profession is 17.29 ± 3.64 complain mainly about discomfort or pain in knees
(PPR 1.37; CI 1.23–1.45), upper back (PPR 1.41; CI 1.33–1.47), in the area of the hand
(PPR 0.86–0.93; CI 0.67–0.98), neck and shoulders (PPR 0.86–0.65; CI 0.74–0.69).
It may be explained by great length of service in the profession, amount of work
affecting hands and upper back, work in bent position, rather often on knees, and
fluctuations of microclimate parameters in work premises. It also conforms to the
results of other authors’ studies which claim that WRMSD are affected not only by
physical load, but also by other risks of work environment [25]. Analyzing painters’
complaints about work postures, it should be noted that 100% of the participants
complained about work in awkward posture. About physical exhaustion at work
complained 42% of painters, mainly those with length of service 17.29 ± 3.64 (PPR
2.06; CI 1.98–1.04). Support from colleagues is received by 50% of painters, mainly
younger ones from the age group 24.22 ± 7.84 with length of service 0–5 years
(3.22 ± 1.39). Supervisor`s support is received by 17% only from different age groups.
As to high work speed and too many job tasks, there are practically no complaints.
Acquired results allow us to conclude that essential significance in WRMSD origin
belongs to interaction between physical load at work and psychosocial risks, and that
employees’ age and length of service are also significant. Similar conclusions have
been made also by other authors [26].
Statistical data presented in Table 3 show that 65% of tilers complain about pain in
their neck, 55% - shoulders, 68% - wrist/hands, 48% - low back and 42% - knee. All
(100%) of younger employees (21.00 ± 1.73) with length of service in the profession
0–5 years complain about pain in the neck and shoulders, the same refers to employees
of age group 49.36 ± 12.48 having length of service 11–20 years (PPR 1.03–1.22; CI
1.01–1.25). About pain in knees and legs more complain older employees (PPR 1.19–
2.58; CI 1.13–1.63) with length of service more than 20 years, and 50% of employees
whose length of service is 11–20 years (PPR 1.11–0.69; CI 1.10–0.75). Comparing
with painters’ complaints, it should be noted that 48% of tilers, mainly older ones,
acknowledge pain in the lower back (PPR 1.38–0.78; CI 1.35–0.82), but they practi-
cally do not have complaints about pain in the upper back. It may be explained by
specifics of tilers’ work, frequent load on legs and knees, work in crawling position,
irregular load on these parts of the body. Statistical data reveals that 100% of tilers in
all age groups admit work in awkward postures, 77% complain about physical
exhaustion, 55% about work at high speed. This category of employees receives bigger
support from colleagues and supervisors than painters: support from colleagues is
received by 68% and supervisor`s support by 39% of tilers. About physical exhaustion
more have complained tilers whose length of service in the profession is 11 to 20 years
(PPR 1.03; CI 0.98–1.03), and above 20 years-older employees (PPR 1.29; CI 1.23–
1.35). The employees whose length of service is 11–20 years have admitted work at
high speed (PPR 1.03; CI 1.397–1.49), and this group of tilers has also received the
greatest support from colleagues and supervisors in their direct work (PPR 0.98–1.02;
CI 1.11–1.78). It shows that work load is not divided evenly, and in order to satisfy
client’s needs, rather often, direct supervisors join the work process. Together with this,
rest pauses are not taken, tilers work with physical and mental overload, which sig-
nificantly affects development of WRMSD.
284 Z. Roja et al.
Table 3. Distribution of persistent complaints in different parts of the body, psychosocial
conditions of tilers, prevalence proportion ratio (PPR) and 95% confidence interval (CI),
compared with joint group (n = 31).
Tilers* Reference groups (length of service, years)
(n = 31) I (0–5) (n = 3) II (6–10) (n = 5) III (11–20) (n = 15) III (>20) (n = 8)
Number % Number % Number % Number % Number %
PPR (95% CI) PPR (95% CI) PPR (95% CI) PPR (95% CI)
Neck 20 65 3 100 3 60 10 66 4 50
1.55 (1.48–1.61) 0.93 (0.88–0.95) 1.03 (1.01–1.06) 0.78 (0.69–0.82)
Shoulder 17 55 3 100 4 80 10 66 0
1.82 (1.73–1.87) 1.46 (1.42–1.51) 1.22 (1.17–1.25)
Elbow 5 16 0 1 20 3 20 1 13
1.24 (1.21–1.25) 1.24 (1.22–1.28) 0.78 (0.71–0.83)
Wrist/hands 21 68 0 4 80 12 80 2 25
1.18 (1.14–1.20) 1.18 (1.15–1.23) 0.37 (0.28–0.45)
Upper back 8 26 0 0 0 7 47 1 13
1.81 (1.75–1.83) 0.48 (0.46–0.54)
Low back 15 48 0 2 40 10 67 3 38
0.83 (0.81–0.88) 1.38 (1.35–1.42) 0.78 (0.72–0.81)
Hip/thigh 0 0 0 0 0 0

Knee 13 42 0 2 40 7 47 4 50
0.95 (0.89–0.98) 1.11 (1.10–1.15) 1.19 (1.13–1.24)
Ankle/shank/feet 3 1 0 0 1 7 2 25
0.69 (0.68–0.75) 2.58 (1.56–1.63)
Awkward 31 100 3 100 5 100 15 100 8 100
posture 1.00 (0.98–1.05) 1.00 (0.96–1.03) 1.00 (0.95–1.06) 1.00 (0.96–1.05)
Physical 24 77 0 3 60 12 80 8 100
exhausting 0.78 (0.74–0.85) 1.03 (0.98–1.03) 1.29 (1.23–1.35)
Extensive work 7 23 1 33 1 20 3 20 2 25
1.48 (1.42–1.54) 0.89 (0.85–0.92) 0.89 (0.86–0.92) 1.11 (1.08–1.14)
High work speed 17 55 1 33 2 40 12 80 2 25
0.61 (0.58–0.64) 0.73 (0.70–0.79) 1.46 (1.37–1.49) 0.46 (0.42–0.51)
Too many job 10 32 2 67 2 40 3 20 3 38
tasks 2.07 (2.02–2.14) 1.24 (1.19–1.26) 0.62 (0.60–0.63) 1.16 (1.14–1.19)
Colleagues’ 21 68 0 1 20 12 80 5 63
support 0.30 (0.25–0.37) 1.18 (1.11–1.31) 0.92 (0.90–1.01)
Supervisors’ 12 39 0 1 20 10 67 1 13
support 0.52 (0.48–0.55) 1.72 (1.65–1.78) 0.32 (0.28–0.36)
* Multiple answers were possible

In our study on WRMSD reasons the acquired results conform to studies of other
authors showing that construction employees, actually, perform heavy manual work
and are employed in awkward postures, they lift and move heavy weight. Health
condition of painters and tilers is also affected by other risks of work environment, for
example, work in unsuitable microclimate, noise, as well as work at high speed, which
in long-term period can cause WRMSD [24–27]. The health and well-being of workers
are greatly influenced by exposures not only to occupational hazards in organizational
context, but also by risks associated with individual health behaviours [28]. It corre-
sponds with data acquired in our study revealing that painters and tilers spend their
leisure time using alcohol and smoking.
 Work Related Musculoskeletal Disorders (WRMSD) 285

4 Conclusion

Results of our study allow us to conclude that causes of WRMSD in painters and tilers,
employed in construction, are not only physical risks at work (awkward postures,
heavy manual work, load on the back, etc.), but also psychosocial risks (work at high
speed, lack of support from colleagues and supervisors), as well as individual attitude
towards one’s own health. This study reveals that there is no relationship between the
increased level of pain or discomfort in body parts with age or length of service. The
study will be continued in order to analyze interaction of physical load and psy-
chosocial risks in tillers and painters.

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