2012 Southeast Asian Network of Ergonomics Societies Conference (SEANES)
Work Related Musculoskeletal Disorders among
Medical Laboratory Technicians
Shreya Maulik1, Amitabha De2, Rauf Iqbal3
Ergonomics. NITIE
Mumbai, India
{1shreya.maulik, 3deamitabha}@gmail.com, 2rauf_iq@yahoo.com
Abstract—Medical laboratory technicians are a unique group of
healthcare professionals who are at risk for developing work
related musculoskeletal symptoms. The study was conducted
using 49 laboratory technicians working in the department of
laboratory medicine in Mumbai hospitals. Several measures were
obtained: Quick Exposure Checklist (QEC), Nordic Musculo-
skeletal Questionnaire (NMQ), Visual Analogue Scale (VAS),
RULA and REBA. Results show that the most prevalent body
regions were lower back (30.61%), upper back, knees (20.40%)
and neck (18.36%). The QEC analysis showed that the neck
(93.4%) has the highest level of exertion followed by the wrist
(69.1%), back (62.7%) and shoulder (54.3%). The analysis of
Visual Analogue Scale (VAS) revealed significant differences in
the morning and evening scores for neck (p<0.005), low back
(p<0.012) and knees (p<0.023). A significant difference was also
found in hand grip measurements before and after the 8 hour
shift, similar as for pinch grip measurements. RULA and REBA
scores for various activities varied from 4 to 7 and 5 to 12
respectively. Scores of RULA and REBA indicated that risk was
very high and further investigations were required. The
subjective evaluation of workstations revealed that 22.4% felt the
workstation height was inappropriate and an objective
evaluation showed that the dimensions of the laboratory work
benches were not appropriate. Stress and pain were evident from
the findings of NMQ and QEC. Ergonomics intervention was
recommended to reduce WRMSDs for the medical laboratory
technicians.
Keywords-medical laboratory technicians; work related
musculoskeletal disorders; ergonomic risk factors
I. INTRODUCTION
Work related musculoskeletal disorders (WRMSDs) are
widespread with significant costs and impact on quality of life.
The etiology of WRMSDs is complex, controversial and
physical environmental factors, organizational factors, and
individual factors play a role. Chronic exposure may produce
cumulative trauma and tendonitis, and if there is not sufficient
time or capacity for tissues to heal, WRMSDs may result [31].
Musculoskeletal Disorder (MSD) is the most prevalent
occupational problem in manufacturing and heavy labour
industries [14]. Studies have reported MSD risk factors among
healthcare professionals including: nurses, doctors, surgeons,
physiotherapists and many others [34-35]. However there are
limited evidence medical laboratory technicians.
978-1-4673-1734-4/12/$31.00 ©2012 IEEE
Medical laboratory technicians are a unique group of
healthcare professionals who are at risk for developing work
related musculoskeletal symptoms. The activities carried out
in the laboratory impose various physical demands, and they
also work under great time pressure. Laboratory procedures
are highly repetitive and involve a variety of risk factors.
Various studies have shown that the key risk factors in
medical laboratories are awkward postures, repetition and
excessive force [1, 6, 17]. Laboratory technicians may be
exposed to variety of risk factors, such as: awkward and static
postures, high repetition, excessive force, contact stress,
vibration, overhead reach, manual material handling, pinch
force and many others. They perform multiple tasks including:
pipetting, microscopy, microtomy, working on cell counters,
biosafety cabinets and cryostats. It is known that laboratory
workers often suffer from upper-limb disorders [1, 6].
MSDs is an important occupational issue worldwide, but
surprisingly few studies have been conducted among medical
laboratory technicians in India. This study intended to evaluate
the pervasiveness of the MSD among the medical laboratory
technicians in India. It was conducted with an aim to: i)
Analyze the working pattern, work posture and the
workstation design of the medical laboratory and ii) Identify
ergonomic risk factors, characteristics and the prevalence of
work related musculoskeletal disorders among the medical
laboratory technicians in India.
II. MATERIALS AND METHODS
A. Study Population
The study was conducted in departments of laboratory
medicine in Mumbai hospitals. Forty-nine laboratory
technicians from different departments of laboratory medicine
participated: clinical pathology, histology, clinical micro-
biology, hematology, biochemistry and serology. Medical
laboratory technicians were selected based on work experience
(one year plus) and no current illness or disorder.
Demographic and employment information were collected.
All participants agreed to participate in the study.
B. Methodology
The study was carried out using the following techniques.
 2012 Southeast Asian Network of Ergonomics Societies Conference (SEANES)
• Tools: used to identify ergonomic risk factors, analyze
working posture and occupational stress. Identify
symptoms of musculoskeletal disorders by using:
Nordic Musculoskeletal Questionnaire (NMQ) [20],
Quick Exposure Checklist (QEC) [23], Visual
Analogue Scale [25], Rapid Upper Limb Assessment
(RULA) [26] and Rapid Entire Body Assessment
(REBA) [13]. Several studies have used these
techniques to identify occupational musculoskeletal
problems [1, 6, 9, 14, 16, 24]. The present study is
also focusing on the working posture and the
prevalence of musculoskeletal disorders and hence the
same tools have been used.
• Instruments: The instruments used to measure hand
grip strength and pinch grip strength is Jamar
(Sammon Preston Rolyan, USA) Hand grip
dynamometer and a Jamar Pinch grip dynamometer
respectively.
• Workstation analysis: Techniques used for
workstation analysis were: observation technique,
photography, video recording and a Laboratory
Ergonomics Checklist from National Institute of
Environmental Health Sciences, University of
Cincinnati, USA [21].
Average years worked as lab technician was 6.12 ± 7.7
years. Majority of the technicians had educational level of
diploma (50%), followed by master degree (30.61%) and
graduates (18.36%). Mostly they used to work in shifts and
their daily work shift hours were 8 hours. Though their
working hours were fixed but due to heavy workload many of
them had to do overtime (65.31%).
B. MSD Prevalence
The overall prevalence of musculoskeletal symptoms
among the medical laboratory technicians was 79.6%. Results
from NMQ revealed that in the last 12 months, the MSD
prevalence was 73.5% and in the last 7 days, it was 53.1%.
The prevalence of musculoskeletal disorders in 9 body parts
during the last 12 months and last 7 days are shown in “Fig.
1”.
The above figure shows that medical laboratory
technicians had highest reported of MSD on lower back (30.6
% and 22.4%), upper back (20.4% and 16.3%), knees (20.4%
and 16.3%) and neck ( 18.4% and 8.2%) in the last 12 months
and last 7 days. A majority of the respondents reported work
(84%) as the cause for their musculoskeletal symptoms. More
than half of respondents reported their pain intensity as mild
(51.02%), severe (20.4%) and very severe (8.16%).

Statistical Analyses were conducted using Statistical Package C. Physical Exertion Among Laboratory Technicians
for the Social Sciences (SPSS 16) with five percent Medical laboratory technicians perform different types of
significance level. tasks including: pipetting, microscopic work, test tube
handling, automated analyzers, microtomy, micromanipulation
III. RESULTS etc. All the tasks were analyzed using QEC. The analysis in
“Fig. 2” showed that risk factors at the neck (93.4%) were
A. Demographic Characteristics highest followed by wrist/hand (69.1%), back (62.7%) and
A majority of the subjects were females (77.6%) and shoulder/arm (54.3%).
(22.5%) males. The results of demographic characteristics of From the analysis of QEC “Fig.2”, it was found that
are shown in Table I. laboratory technicians experience quite a high level of
exertion (63.1%) and also resultant physical stress (62.3%)
TABLE I. DEMOGRAPHIC CHARACTERISTICS
during their work.
Female 27.4 ± 8.8
Age in years – M ± SD
Male 25.1 ± 2.9
Female 153 ± 11
Height (cms) – M ± SD
Male 167 ± 6.7
Female 50.0 ± 9.3
Weight (kg) – M ± SD
Male 56.8 ± 8.3
Length of employment as Lab
6.1 ± 7.7
Technician
Female 77.5 %
Gender
Male 22.4%
Graduate 18.4%
Educational Level Diploma Holder 51.2%
Post Graduate 30.6%
8hr 95%
Daily Work Shift
5hr 5%
Yes 71.4%
Shift System
No 28.6%
Yes 65.3%
Overtime Work
No 34.7%
Figure 1. Prevalence of symptoms in last 12 months and last 7 days
 2012 Southeast Asian Network of Ergonomics Societies Conference (SEANES)
exposure. When the study group was evaluated for hand grip
measurements, there was a significant difference in their pre
and post shift measurements for both the hands (t=5.813,
p=0.000 and t= 5.859, p=0.000). In case of pinch grip
measurements, a significant difference was found for all the
fingers in right hand (Index finger: t=6.319, p=0.000; middle
finger: t=4.916, p=0.000; ring finger: t=8.485, p=0.000; little
finger: t=5.908, p=0.000) and left hand (Index finger: t=6.899,
p=0.000; middle finger: t=5.767, p=0.000; ring finger:
t=5.435, p=0.000; little finger: t=5.879, p=0.000).

E. Postural Analysis
Laboratory technicians perform various kinds of activities
like pipetting, microscopy, cell counter, test tube handling,
micromanipulation, video display terminals, centrifuging,
automated equipment, microtomy and biosafety cabinets.
Among these tasks, important tasks, thought to be a major risk
factor for the workers were taken into consideration and for
Figure 2. Level of exertion among technicians
the following activities postural analysis is being done with
the help of RULA and REBA technique as illustrated in Table
III.
D. Magnitude of Musculoskeletal Discomfort
The Visual Analogue Scale (VAS) was used to analyze TABLE III. TASK SPECIFIC RULA-REBA SCORE IN LABORATORY
musculoskeletal discomfort in different body parts. The RULA Score REBA Score
musculoskeletal discomfort was rated before and after work. Activity
(Range) (Range)
The perceived discomfort is shown Table II.
Pipetting 5.4 ± 1.2 (4-7) 6.7 ± 1.7 (5-10)
TABLE II. PRE-POST PERCEIVED MUSCULOSKELETAL Microscopy 5.5 ± 1.2 (4-7) 7.6 ± 1.8 (8-11)
DISCOMFORT AMONG TECHNICIANS
Automated Analyzer 6.4 ± 1.1 (4-7) 9 ± 2.67 (5-12)
Pre-shift
Post-shift
Body VAS score T test score Biosafety Cabinets 6.8 ± 0.5 (6-7) 10
VAS score p value
Regions Mean ±SD
Mean ±SD Centrifuge 5.8 ± 0.5 (5-6) 8.3 ± 2.8 (4-10)
Neck 0.18±0.49 0.88±2.10 -2.881 0.006 sign
Microtomy 7 11
Shoulder 0.02±0.14 0.12±0.86 -1.000 0.322 n.s.
Video Display
4.9 ± 0.9 (4-6) 7.8 ± 1.2 (7-10)
Upper Terminals (VDT)
0.73±1.75 1.18±2.43 -1.429 0.159 n.s.
back
Underreporting
6.6 ± 0.5 (5-6) 10.6 ± 1.1 (7-10)
Low back 0.65±1.64 1.51±2.45 -2.598 0.012 sign Results

Wrist 0.06±0.43 0.12±0.86 -1.000 0.322 n.s.

Hips 0.00±0.00 0.16±0.83 -1.385 0.173 n.s. Table III shows that for pipetting activity, average RULA and
REBA score were 5.4 and 6.7 respectively. This depicts that
Thighs 0.14±0.71 0.18±1.23 -0.275 0.785 the activity was at medium risk, further action was considered
Buttocks 0.00±0.00 0.10±0.71 -1.000 0.322 necessary whereas working with microscopes, automated
analyzers, biosafety cabinets, centrifuging machine and video
Knees 0.43±1.21 1.16±2.56 -2.331 0.024 display terminals (VDT) involves high risk and further action
Calf 0.04±0.29 0.12±0.86 -1.000 0.322 is considered to be necessary soon as their RULA and REBA
scores were quite high. However average RULA and REBA
Ankles 0.18±1.01 0.41±1.59 -1.055 0.297 score for microtomy activity (7 and 11) and under reporting
Feet 0.16±0.9 0.33±1.61 -1.385 0.173
results (6.6 and 10.6) indicated that these activities were at
very high risk and thereby action needed to be taken as early
The analysis of above table shows that there is a as possible.
significant difference between the means of pre and post work
exposure scores of neck (t = -2.881; p = 0.006); low back (t = - F. Workstation Analysis
2.598; p = 0.012) and knee (t = -2.331; p = 0.024). The The subjective evaluation of workstation analysis revealed
maximum value of VAS for neck, low back and knees that 22.4% of the technicians felt that the workstation height
reported were 8, 8 and 9 respectively. The negative T-value was inappropriate and the work tools and supplies were not
indicates that the musculoskeletal discomfort has increased for located within arm’s reach. As a result they had to walk
neck, low back and knee from pre work exposure to post work
 2012 Southeast Asian Network of Ergonomics Societies Conference (SEANES)
through different workplaces. Table IV shows the workstation musculoskeletal symptom was reported as 79% among the
analysis for the personnel working in the medical laboratories. laboratory technicians [17].

TABLE IV. WORKSTATION DIMENSIONS A majority of the technicians reported work as the cause of
their musculoskeletal discomfort. The laboratory task was
Work- Work Horizont Functional Reach found to increase the prevalence of MSD among technicians.
station piece -al When their perceived musculoskeletal strain was analyzed
Height Height Reach (Min) (Max) before and after their work exposure, it was found that there is
Varia- (WSH) (WPH) (HR) a significant difference between the means of pre and post
(cm) (cm)
bles (cm) (cm) work exposure scores of neck, low back and knee (Table II).
(cm)
M±SD M±SD When the study group was evaluated for hand grip strength,
M±SD M±SD M±SD there was a significant difference in their pre and post work
(Range) (Range)
(Range) (Range) shift scores for both the hands and similarly in case of pinch
(Range)
grip strength, a significant difference was found for all the
86.7 ± 27.6 ± 75.0 ± 40.3 ± 90.0 ± 15.2 fingers in both the hands. Previous researches had found
Dimens 6.3 25.3 5.7 5.5 relationship of work posture to MSD [3, 27]. For example,
ions
(76-92) (2-88) (61-90) prolonged standing position was related to musculoskeletal
(23-52) (38-117)
symptoms of low back, knees, neck and shoulder [7, 28]. This
Indian 87.5 24 72.9 35.8 90.9 might be the reason that workers have prolonged static posture
data [5] to perform manual tasks with arms elevated and involving
Standing Standing excessive hand movements [11]. Majority of the technicians
Name waist elbow Olecran Standing reported their pain intensity as mild, this might be due to the
of height height Standing on to forward fact that they are at an initial stage of their musculoskeletal
anthrop (5th (95th %ile) forward Dactylio arm reach hazard but as their experience in this field increases, the
ometric %ile) – Standing arm reach n (leaning) intensity of pain might get severe.
dimens for waist (5th %ile) (5th
ion precisio height (5th %ile) (5th %ile) Postural analysis from RULA and REBA technique
n work %ile) revealed that pipetting activity is at medium risk whereas
microscopy, working with automated analyzers, biosafety
cabinets, centrifuging machine and VDT work involves high
Workstation analysis showed that there was a mismatch in risk. Lastly microtomy and underreporting results are at very
the dimensions of the laboratory benches and the dimensions high risk. Postural analysis reveals that most of the activities
of the technicians. The results revealed that workstation height carried out in the laboratory are at high risk, where it was
of the medical laboratory was less i.e. 86.7(±6.3) cm when observed that the technicians work in awkward and
compared to Indian data i.e. 87.5 cm whereas work piece constrained postures which ultimately lead to MSDs.
height in the present laboratory conditions varied and the Furthermore, working in sustained or constrained postures,
average work piece height was 27.6(±25.3) cm which was such as task requires movement of upper extremity that
quite high compared to Indian data i.e. 24 cm. Anthropometric eventually force neck and shoulders aligned awkwardly can
dimensions of the laboratory technicians revealed that average contribute to the development of MSDs of neck and shoulder
horizontal reach was 75.0(±5.7) cm which exceeded the Indian [4, 29-30]. Analysis of literature shows the association of
data. Regarding functional reaches, the average minimum musculoskeletal complaints with pipettes [1, 6, 9, 22],
functional reach was 40.3 (±5.5) cm which is more when microscopes [8, 10, 15, 19] and microtomy work [12, 16].
compared to Indian data and average maximum functional
reach was 89.5(±15.2) cm which is very near to the Indian Workstation analysis showed that there is a mismatch in
data i.e. 90.9cm. the dimensions of the laboratory benches and the dimensions
of the technicians. It was found in the present study that the
workstation height of the laboratory technicians was less but
IV. DISCUSSION the work piece height when compared with Indian data found
In the present study, results from NMQ “Fig. 1” to be high (Table 4) which led the technicians to work in an
demonstrate that prevalence of MSD is most common at low unnatural working posture and ultimately caused body
back. Other body regions include upper back, knees, neck, discomfort. Analysis of anthropometric dimensions shows
shoulder and ankles or feet. Whereas QEC analysis “Fig. 2” that, horizontal reach exceeded the range when compared with
shows that neck has the highest level of exertion followed by Indian data which led the technicians to work in a forward
wrist/hand, back and shoulder/arm. The findings show bending posture while working in the laboratory. Whereas in
resemblance with the findings made by other researchers case of functional reaches, the minimum value observed in the
which shows that the low back pain, knees, upper back and present study exceeded the Indian data which led the
neck as the highest reported cases for healthcare professionals technicians to work with an elevated arm and shoulder while
[2, 32-33, 37-38]. In this study the overall prevalence of working but the maximum functional reach was within the
musculoskeletal symptoms among the medical laboratory range. This mismatch between the workstation dimension and
technicians was 79.6% which is similar to the studies done by the anthropometric dimensions caused unnatural working
other researchers where the overall prevalence of posture, stress and the resultant pain. Since the postural
problems have been found to be largely caused by improperly
 2012 Southeast Asian Network of Ergonomics Societies Conference (SEANES)
designed and ill-arranged workstation furniture [18], reducing
the RULA and REBA Grand Score via redesigning
workstations was strongly recommended. Some of the
corrective measures could be taken into consideration to
reduce the exposure level: a) increasing the height of the work
benches accordance to the anthropometric dimensions of the
technicians or providing a sit-sand workstation to avoid
posture fixation. b) Since their current work-rest cycle shows
only one rest break in the 8 hour shift, redesign of their work-
rest cycle should be considered c) Reducing the height of
racks and shelves on which the chemicals and other materials
are stored to reduce their functional reaches d) Providing
sufficient leg space under the work benches for facilitating
postural changes during their work. It is recommended that
any ergonomics intervention programme in the workplace
should focus on eliminating awkward postures of back, knees,
neck, shoulder and hands among the laboratory technicians in
order to reduce the rate of WMSDs among them and to
promote efficiency in patient care.
V. CONCLUSION
The results from the present study indicate that the medical
laboratory technicians are exposed to MSD risks particularly
on low back, knees, upper back, neck, ankles or feet and
shoulders. It was found that the work is an aggravating factor
for musculoskeletal disorders. Taking corrective measures to
reduce the risk level seemed essential. Adopting adequate
postures in clinical practice and having a favorable work
environment could reduce the muscular skeletal system
problem. Since the majority of ergonomic factors for
developing musculoskeletal symptoms among laboratory
technicians were attributable to poorly-designed laboratory
workstation, it can be concluded that for any ergonomics
interventional program, there is a need to design user oriented
workstation.
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