Low back pain (LBP) represents one of the most significant occupational health challenges globally, affecting an estimated 619 million people in 2020, with projections suggesting 843 million prevalent cases by 2050 [1]. Among healthcare workers, LBP is the most commonly reported musculoskeletal disorder, with a pooled lifetime prevalence of 54.8% [2]. The Global Burden of Disease Study 2021 identified LBP as the leading cause of years lived with disability worldwide, contributing substantially to reduced productivity and increased healthcare expenditure [3]. Healthcare workers are particularly vulnerable due to the physically demanding nature of their work, which frequently involves manual patient handling, prolonged standing, awkward postures, and repetitive movements [4].

In India, the burden of LBP is notably higher than global averages. A systematic review and meta-analysis by Shetty et al. reported pooled point, annual, and lifetime prevalence rates of 48%, 51%, and 66%, respectively, in the Indian population [5]. Healthcare workers in Indian tertiary care hospitals face unique challenges, including high patient-to-staff ratios, inadequate ergonomic infrastructure, and long duty hours [6]. These factors create a perfect storm for the development and exacerbation of LBP, yet occupational musculoskeletal disorders remain under-researched and under-reported in this population [7].

The prevalence of LBP among healthcare workers varies across professional categories. Nurses consistently demonstrate the highest prevalence rates, with studies reporting rates as high as 84.3% among nurses in Asian countries [8]. A systematic review of 154 studies found that the estimated lifetime prevalence of LBP among healthcare personnel was 54.8%, with body position at work (OR=2.55), stress (OR=1.67), and lack of physical activity (OR=1.56) emerging as the strongest risk factors [2]. Among Indian nurses specifically, studies have documented prevalence rates ranging from 52.1% to 82.7%, with female gender, high BMI, job dissatisfaction, and improper footwear identified as significant contributors [6,9].

The consequences of LBP extend beyond individual suffering to include substantial economic costs, reduced quality of life, and compromised patient care. Healthcare workers with LBP report increased sick leave, reduced work productivity, and in severe cases, premature retirement [10]. Despite this considerable burden, there is a paucity of research examining the specific prevalence and risk factors of LBP among healthcare workers in Indian tertiary care settings, particularly in the central Tamil Nadu region. Understanding the local epidemiology is essential for developing targeted interventions and informing occupational health policies. This study was therefore undertaken to determine the prevalence of LBP and identify its associated risk factors among healthcare workers at a tertiary care hospital in Tamil Nadu.

OBJECTIVE

The primary objective of this study was to determine the prevalence of low back pain among healthcare workers, including doctors, nurses, and paramedical staff, at the Department of Orthopaedics, Dhanalakshmi Srinivasan Institute of Medical Sciences and Hospital. The study aimed to quantify the burden of LBP across different professional categories and to establish baseline data for this tertiary care institution.

The secondary objective was to identify the demographic, occupational, and lifestyle-related risk factors associated with low back pain in this population. Specifically, the study sought to examine associations between LBP and variables such as age, gender, body mass index (BMI), work experience, daily working hours, prolonged standing, manual patient handling, ergonomic training, and psychosocial factors including job satisfaction and stress levels. Identifying these risk factors will inform the development of targeted preventive strategies and workplace interventions to reduce the occupational burden of LBP among healthcare workers.

Study Design and Setting

This cross-sectional observational study was conducted in the Department of Orthopaedics at Dhanalakshmi Srinivasan Institute of Medical Sciences and Hospital, a tertiary care teaching hospital in Tamil Nadu, India. The study period spanned from November 2025 to June 2026. The study protocol was approved by the Institutional Ethics Committee prior to commencement, and written informed consent was obtained from all participants. The study was conducted in accordance with the Declaration of Helsinki and adhered to the STROBE guidelines for reporting observational studies [11].

Study Population and Sampling

The study population comprised healthcare workers currently employed at the hospital, including doctors (faculty and residents), nurses, and paramedical staff (physiotherapists, laboratory technicians, and radiology technicians). A convenience sampling method was employed to recruit participants who were willing to participate and met the eligibility criteria. The sample size was calculated based on the anticipated prevalence of LBP of approximately 70% reported in similar Indian studies [9], with a 95% confidence level and 15% absolute precision, yielding a minimum sample of 36 participants. Accounting for potential non-response, a final sample of 40 healthcare workers was recruited.

Inclusion and Exclusion Criteria

Inclusion criteria: (a) Healthcare workers aged 18 years and above; (b) currently employed at the study hospital for at least six months; (c) directly involved in patient care or clinical duties; (d) willing to provide written informed consent.

Exclusion criteria: (a) Healthcare workers with a history of spinal surgery, spinal fractures, or known inflammatory arthropathies; (b) pregnant women; (c) those with a history of trauma or accident within the past three months; (d) workers on long-term leave or those with less than six months of employment; (e) individuals with cognitive impairment or inability to understand the questionnaire.

Data Collection Procedure

Data were collected using a structured, self-administered questionnaire that was developed based on previously validated instruments. The questionnaire consisted of four sections: (1) demographic information (age, gender, BMI, marital status, education level); (2) occupational characteristics (professional category, years of experience, average working hours per day, shift pattern, prolonged standing duration, frequency of manual patient handling); (3) lifestyle factors (physical exercise, smoking, alcohol consumption, sleep duration); and (4) LBP characteristics assessed using the Standardised Nordic Musculoskeletal Questionnaire (NMQ) [12]. The NMQ is a widely validated tool for assessing musculoskeletal symptoms, with demonstrated reliability and validity across diverse populations. The questionnaire was administered in English and Tamil to accommodate linguistic preferences. Participants who reported LBP were further asked about pain intensity using the Numeric Pain Rating Scale (NPRS, 0–10), duration of symptoms, and impact on daily activities.

Statistical Data Analysis

Data were entered into Microsoft Excel and analyzed using SPSS version 25.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were expressed as frequencies, percentages, means, and standard deviations. The prevalence of LBP was calculated as the proportion of participants reporting LBP in the past 12 months. Chi-square tests or Fisher's exact tests were used to examine associations between categorical variables and LBP. Independent samples t-tests were used for continuous variables. Multivariate logistic regression analysis was performed to identify independent risk factors, with odds ratios (OR) and 95% confidence intervals (CI) calculated. A p-value < 0.05 was considered statistically significant.

Prevalence of Low Back Pain

Among the 40 healthcare workers who participated in the study, 29 (72.5%) reported experiencing low back pain in the past 12 months. The prevalence was highest among nurses (84.6%, n=11/13), followed by paramedical staff (71.4%, n=10/14) and doctors (58.3%, n=7/12). Among those with LBP, the mean pain intensity on the Numeric Pain Rating Scale was 4.8 ± 1.6, with 13 participants (44.8%) reporting moderate pain (NPRS 4–6) and 5 participants (17.2%) reporting severe pain (NPRS ≥7). The mean duration of LBP symptoms was 3.2 ± 2.1 years, with 16 participants (55.2%) reporting chronic symptoms lasting more than three months. Work absenteeism due to LBP was reported by 12 participants (41.4%), with a mean of 3.6 ± 2.3 days lost per year.

Table 1: Demographic and Occupational Characteristics of Participants (n=40)

Table 2: Prevalence of Low Back Pain by Professional Category

Table 3: Association Between Risk Factors and Low Back Pain

*Statistically significant (p<0.05)

Table 4: Multivariate Logistic Regression Analysis of Risk Factors for Low Back Pain

*Statistically significant (p<0.05)

Risk Factors Associated with Low Back Pain

Bivariate analysis revealed several significant associations with LBP. Prolonged standing for more than four hours per day was strongly associated with LBP (p=0.003), with 20 of 23 participants (87.0%) who stood for >4 hours reporting LBP compared to 9 of 17 (52.9%) who stood for shorter durations. Frequent manual patient handling was also significantly associated with LBP (p=0.008), with 19 of 22 participants (86.4%) who frequently handled patients reporting LBP versus 10 of 18 (55.6%) who did not. Lack of ergonomic training showed a strong association (p=0.012), with 24 of 29 participants (82.8%) without training reporting LBP compared to 5 of 11 (45.5%) with training. Work experience ≥5 years (p=0.021) and lack of regular physical exercise (p=0.038) were also significantly associated with LBP. Multivariate logistic regression identified prolonged standing (AOR=4.82; 95% CI: 1.52–15.28), lack of ergonomic training (AOR=5.14; 95% CI: 1.63–16.21), and frequent manual patient handling (AOR=3.67; 95% CI: 1.18–11.41) as independent predictors of LBP.

(72.5%) among healthcare workers in a tertiary care hospital in Tamil Nadu, India. This finding is consistent with the growing body of evidence documenting a substantial burden of LBP among healthcare personnel. A systematic review and meta-analysis by Al Amer reported a pooled career prevalence of 81.4% among healthcare workers in Saudi Arabia [13], while a comprehensive meta-analysis of 154 studies estimated the lifetime prevalence at 54.8% [2]. The prevalence observed in our study falls within this range and mirrors findings from other Indian studies, including a study of nurses in Kerala that reported an 82.7% prevalence of LBP [9] and a study of healthcare workers in Eastern India that documented significant LBP-related morbidity [6]. The high prevalence in our setting may be attributed to the demanding nature of healthcare work in Indian tertiary care hospitals, characterized by high patient volumes, inadequate staffing, and limited ergonomic infrastructure [7].

The finding that nurses had the highest prevalence of LBP (84.6%) aligns with existing literature identifying nursing as a high-risk occupation for musculoskeletal disorders. A systematic review of work-related musculoskeletal disorders among nurses in Asia reported a pooled lower back pain prevalence of 58.4% [8], while a meta-analysis of nurses' work-related LBP found an overall prevalence of 67.1% [14]. The elevated risk among nurses is attributable to the physical demands of their role, which frequently involves manual patient handling, transferring, and repositioning—tasks that impose significant compressive and shear forces on the lumbar spine [15]. Paramedical staff in our study also demonstrated a high prevalence (73.3%), reflecting the ergonomic challenges faced by physiotherapists, laboratory technicians, and radiology staff who perform repetitive tasks and maintain static postures for extended periods [16]. Doctors, while having the lowest prevalence (58.3%), still experienced a substantial burden, consistent with studies reporting LBP prevalence rates of 36–68% among physicians [17].

The identification of prolonged standing, manual patient handling, and lack of ergonomic training as independent risk factors in multivariate analysis provides important insights for intervention. Prolonged standing (>4 hours/day) emerged as the strongest predictor (AOR=4.82), consistent with a meta-analysis by Rezaei et al. that identified body position at work as the most significant occupational risk factor (OR=2.55) [2]. Manual patient handling was significantly associated with LBP (AOR=3.67), corroborating the findings of a meta-analysis demonstrating that healthcare workers with frequent heavy lifting have a 2.01-fold increased risk of back pain [18]. The protective effect of ergonomic training observed in our study (AOR=5.14 for lack of training) is particularly noteworthy and suggests that structured educational interventions could substantially reduce LBP prevalence. A study by Rajarethinam et al. similarly reported that lack of ergonomic training was independently associated with musculoskeletal disorders (AOR=3.12; 95% CI: 1.48–6.58) [7]. These findings underscore the need for comprehensive workplace ergonomic programs that include training on safe patient handling techniques, proper posture, and the use of assistive devices [19]. The near-significant associations observed for BMI ≥25 kg/m² and female gender align with the broader literature identifying these as important individual risk factors [6,13]. The high proportion of participants reporting chronic LBP (55.2%) and work absenteeism (41.4%) highlights the substantial personal and professional impact of this condition, emphasising the urgent need for preventive and therapeutic interventions.

Limitations of the Study

This study has several limitations that warrant consideration. First, the cross-sectional design precludes establishment of causal relationships between identified risk factors and LBP; longitudinal studies are needed to determine temporality. Second, the relatively small sample size (n=40) limits the statistical power to detect small but potentially important associations and restricts the generalisability of findings to other healthcare settings. Third, the use of convenience sampling may introduce selection bias, as participants with LBP may have been more motivated to participate. Fourth, data on LBP and risk factors were collected through self-reported questionnaires, which are subject to recall bias and social desirability bias. Fifth, the study was conducted in a single tertiary care hospital in Tamil Nadu, and the findings may not be generalisable to primary or secondary care settings or to other geographic regions with different working conditions. Sixth, important variables such as psychosocial work environment, job strain, and specific ergonomic exposures were not comprehensively assessed. Finally, the study did not include a control group of non-healthcare workers, limiting the ability to compare occupational risk. Despite these limitations, the study provides valuable preliminary data on the burden of LBP in this setting and identifies actionable targets for intervention.

Acknowledgement

The authors express their sincere gratitude to the Department of Orthopaedics at Dhanalakshmi Srinivasan Institute of Medical Sciences and Hospital for providing the necessary infrastructure and support for this study. We extend our heartfelt thanks to all the healthcare workers who generously participated in this research and shared their experiences. We are grateful to the Institutional Ethics Committee for their guidance and approval. We also acknowledge the contributions of the nursing and paramedical staff who facilitated data collection. Finally, we thank our colleagues and mentors for their valuable feedback and encouragement throughout the study period.

This study demonstrates a high prevalence of low back pain (72.5%) among healthcare workers in a tertiary care hospital in Tamil Nadu, with nurses bearing the greatest burden (84.6%). The findings identify prolonged standing, frequent manual patient handling, and lack of ergonomic training as significant independent risk factors for LBP. The high rates of chronic symptoms and work absenteeism observed underscore the substantial occupational health impact of this condition. These results highlight the urgent need for targeted ergonomic interventions, including the implementation of patient lifting equipment, redesign of workstations, and provision of structured ergonomic training programs for all healthcare workers. Healthcare institutions should prioritise the development of occupational health policies that address musculoskeletal disorders, including regular screening, early intervention, and workplace modifications. The implementation of such measures has the potential to reduce LBP prevalence, improve healthcare worker well-being, decrease absenteeism, and ultimately enhance the quality of patient care.

Future research should employ longitudinal designs with larger, multi-centre samples to establish causal relationships and evaluate the effectiveness of specific ergonomic interventions. Qualitative studies exploring the barriers and facilitators to ergonomic practice among healthcare workers would provide valuable insights for implementation. Additionally, cost-effectiveness analyses of ergonomic interventions would help inform resource allocation decisions. The present findings serve as a baseline for future studies and provide evidence to advocate for policy-level changes to protect the musculoskeletal health of frontline healthcare workers in India.

1. GBD 2021 Low Back Pain Collaborators. Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023;5(6):e316–e329.
2. Rezaei B, Mousavi E, Heshmati B, Asadi S. Low back pain and its related risk factors in health care providers at hospitals: A systematic review. Ann Med Surg. 2021;70:102903.
3. Ferreira ML, de Luca K, Haile LM, et al. Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023;5(6):e316–e329.
4. Al Amer HS. Low back pain prevalence and risk factors among health workers in Saudi Arabia: A systematic review and meta-analysis. J Occup Health. 2020;62(1):e12155.
5. Shetty GM, Jain S, Thakur H, Khanna K. Prevalence of low back pain in India: A systematic review and meta-analysis. Work. 2022;73(2):429–452.
6. Biswas A, Kumar N, Ghosh S, et al. Socio-demographic profile of low back pain in health care workers of a tertiary care center of Eastern India - A cross-sectional study. Indian J Occup Environ Med. 2025;29(2):110–117.
7. Rajarethinam R, Venkatachalam K, Perumal V. Prevalence and risk factors of work-related musculoskeletal disorders in healthcare workers: An observational study. Indian J Occup Environ Med. 2025;29(4):269–276.
8. Jacquier-Bret J, Gorce P. Work-related musculoskeletal disorder prevalence by body area among nurses in Asia: Systematic review and meta-analysis. Int J Environ Res Public Health. 2025;22(4):512.
9. Kanakkarthodi R, et al. Low back pain among nurses in a tertiary care teaching hospital at Malappuram Kerala. Cureus. 2022;14(11):e31622.
10. Sikiru L, Shmaila H. Prevalence and risk factors of low back pain among nurses in Africa: Nigerian and Ethiopian specialized hospitals survey study. East Afr J Public Health. 2009;6(1):22–25.
11. von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147(8):573–577.
12. Kuorinka I, Jonsson B, Kilbom A, et al. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon. 1987;18(3):233–237.
13. Al Shammari M, et al. Low back pain prevalence and risk factors among health workers in Saudi Arabia: A systematic review and meta-analysis. J Occup Health. 2020;62(1):e12155.
14. Zhang Y, et al. The impact of physical and psychological job demands on nurses' work-related low back pain: A systematic review and meta-analysis. J Adv Nurs. 2024;80(11):4567–4582.
15. Richarz HU, et al. The impact of mechanical devices for lifting and transferring of patients on low back pain and musculoskeletal injuries in health care personnel—A systematic review and meta-analysis. J Occup Health. 2023;65(1):e12423.
16. Situmeang IF, Ilmidin I, Sarasnita N. The prevalence and risk factors of low back pain among healthcare workers in Asia: A systematic review. Indones J Occup Saf Health. 2023;12(3):345–356.
17. Sanjoy SS, Ahsan GU, Nabi H, Joy ZF, Hossain A. Occupational factors and low back pain: a cross-sectional study of Bangladeshi female nurses. BMC Res Notes. 2017;10(1):173.
18. Effects of occupational stress and frequency of lifting heavy loads on low back pain in health workers: A meta analysis. J Epidemiol Public Health. 2022;7(4):324–335.
19. Cunningham C, Flynn T, Blake C. Low back pain and occupation among Irish health service workers. Occup Med (Lond). 2006;56(7):447–454.
20. Tosunoz IK, Oztunc G. Low back pain in nurses. Int J Caring Sci. 2017;10(3):1728–1731.