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Original Articles

Low Back Pain among Textile Workers


RAJNARAYAN R TIWARI*, MRINALINI C. PATHAK**, SANJAY P ZODPEY***

ABSTRACT The present cross sectional study was carried out among 514 cotton textile workers of Sri Bapurao Deshmukh Sut Girni, Wardha. Data collection was done by using interview technique as a tool. Self reported back pain since last six months in or near the lumbosacral spine was considered to be low back pain. Of the six study factors, except family history of musculoskeletal disorders, other five factors viz. age 35 years, obesity, smoking, duration of exposure 10 years and working position requiring prolonged sitting were found to be significantly associated with development of low back pain among cotton textile workers. Key Words: Low back pain, risk factors, cotton textile workers.

INTRODUCTION Low back pain is one of the most common health problems in industrialized societies. It is defined as a non specific condition that refers to complaints of acute or chronic pain and discomfort in or near the lumbosacral spine, which can be caused by inflammatory, degenerative, neoplastic, gynecological, traumatic, metabolic and other type of disorders1. Many of episodes of low back pain are disabling, thus making it one of the costly occupational health problem1 . However, in workplace occupational risk factors such as forceful exertions during manual materials handling, awkward trunk postures and whole body vibration are often associated with development of back pain1. The relative contribution of these occupational risk factors is determined by some non occupational factors such as obesity, smoking, family history of musculoskeletal disorders, duration of exposure to occupational risk factors, past history of trauma to spine, etc.2-7. Textile
* Research Officer, National Institute of Occupational Health, Ahmedabad. ** Professor, Department of Community Medicine, Jawaharlal Nehru College, Wardha. *** Associate Professor, Department of Preventive and social Medicine, & Faculty, Clinical Epidemiology Unit, Government Medicine College, Nagpur.

industry, which provides livelihood to a considerable section of population and also exposes workers to the occupational risk factors of back pain8 is often confronted to this occupational health problem. Moreover, the role of non-occupational factors increasing the risk for development of low back pain is scarcely reported particularly from developing countries. Thus, the present study was carried out to assess the risk associated with non-occupational risk factors in development of low back pain. MATERIAL AND METHODS The present cross sectional study was carried out at Sri Bapurao Deshmukh Sut Girni, Wardha. Of the total 730 cotton textile workers employed in the Sut Girni, 514 participated in the current study. Information regarding age, family history of musculoskeletal disorders, body weight, obese status of the subject, smoking status and duration since in occupation was recorded on a pre-designed proforma. Interview technique was used as a tool of data collection. Self reported back pain since last 6 months in or near the lumbosacral spine was considered to be low back pain. Further those complaining of pain referred to legs were labeled as having sciatica9. Statistical

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analysis included calculation of percentages and use of tests of significance for means. Univariate analysis for risk calculation was done by odds ratios and their 95% confidence intervals. RESULTS Table 1 shows the distribution of study subjects according to personal and occupational characteristics. 350 (68%) subjects belonged to 25-35 years age group, while only 0.8% of the subjects were <20 years. 141 (27.4%) subjects were obese while 373 (72.6%) were non-obese. Majority (65.1%) of the subjects were employed since 5-10 years. 117 (22.8%) subjects were smokers while in only 3.3% of subjects there was a positive family history of musculoskeletal disorders. 202(39.3%) subjects were working in those sections which involved prolonged hours of standing. Prevalence of low back pain is
Table 1: Distribution of study subjects according to personal and occupational characteristics. Characteristics Number of subjects (N=514) 4 69 176 174 73 11 7 %

Table 2: Distribution of study subjects according to prevalence of low back pain Characteristics Low back pain Present Absent Sciatica Present Absent 12 45 21.1 78.9 57 457 11.1 88.9 Number of subjects %

depicted in Table 2. 57 (11.1%) subjects self reported low back pain out of which 12 (21.1%) complained of pain being referred to legs thereby diagnosed clinically as sciatica. Distribution of cases of low back pain according to various risk factors and risk associated with it is shown in Table 3. Except positive family history of musculoskeletal all other study factors viz. age 35 years, obesity, smoking, duration of exposure 10 years and work involving prolonged hours of sitting were found to be significantly associated with development of low back pain.
Table 3: Distribution of cases of low back pain (LBP) to various risk factors and risk associated with it. Risk factors Study subjects No. of cases of LBP OR (95%Cl)

Age (in years) <20 20-25 25-30 30-35 35-40 40-45 45 Obesity Obese (BMI30) Non-obese (BMI<30) Duration of exposure <5 years 5-10 years 10 years Smoking habit Smoker Non smoker Working position Sitting Standing Family history of musculoskeletal disorders Present Absent 17 497 3.3 96.7 312 202 60.7 39.3 117 397 22.8 77.2 107 335 72 20.8 65.1 14.2 141 373 27.4 72.6 0.8 13.4 34.2 33.8 14.2 2.1 1.4

Age (in years) <35 35 Obesity Obese Non-obese Family history of musculoskeletal disorders Present Absent Smoking habit Smokers Non smokers Duration of exposure <10 years 10 years Working position Sitting Standing * Significant 312 202 42 15 1.93 (1.05-3.56)* 442 72 39 18 3.44 (1.85-6.39)* 117 397 21 36 2.19 (1.23-3.89)* 17 497 2 55 1.07 (0.23-4.79) 141 373 41 16 9.14 (4.95-16.87)* 423 91 24 33 9.45 (5.24-17.01)*

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LOW BACK PAIN AMONG TEXTILE WORKERS

DISCUSSION In the present cross sectional study the prevalence of low back pain was found to be 11.1%. Of the six study factors except for family history of musculoskeletal disorders, other five factors viz. age 35 years, obesity, smoking duration of exposure 10 years and working position requiring prolonged sitting were found to be significant risk factors for the development of low back pain. Age 35 years was found to have 9 times more risk as compared to <35 years (OR = 9.45; 95% Cl = 5.24-17.01). This may be due to decrease in the elasticity of ligaments with advancing age thereby decreased the flexibility of vertebral column10. Similarly obese subjects were found to be at risk of developing low back pain (OR = 9.14; 95% Cl = 4.95-16.87). Increased lordosis in obese persons in order to maintain the centre of gravity due to excess weight may be responsible for the complaint of low back pain2,5. Non-significance of familial history of musculoskeletal disorders can be attributed to small sample size. Smokers were found to have significant higher risk for development of low back pain than non-smokers (OR = 2.19; 95% Cl = 1.23-3.89). Possible mechanisms for the association between low back pain and smoking include increased pressure on the low back from frequent coughing and decreased diffusion of nutrients into the intervertebral disc among smokers10. Significance of increased duration of exposure for the development of low back pain can be attributed to cumulative effects of working in adverse conditions such as sedentary work. Working position involving prolonged hours of sitting was found to be significantly associated with low back pain. This is attributed to the twisting and bending of vertebral column subjecting it to undue stress while working in sitting position1,6,10.

Thus, it can be concluded that along with occupational risk factors, some non-occupational risk factors also play role in the development of low back pain. Hence, while ergonomic principles should be used for controlling occupational risk factors1 , interventions should also be done to control non-occupational risk factors.

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