Association between objectively measured sitting time and neck–shoulder pain among blue-collar workers

  • David M. HallmanEmail author
  • Nidhi Gupta
  • Svend Erik Mathiassen
  • Andreas Holtermann
Original Article



Prolonged sitting has been suggested as a risk factor for neck–shoulder pain (NSP). Using a cross-sectional design, we investigated the extent to which objectively measured time sitting is associated with NSP among blue-collar workers.


Sitting time was measured during multiple working days on male (n = 118) and female (n = 84) blue-collar workers (n = 202) using triaxial accelerometers (Actigraph) placed on the thigh and trunk. Workers were categorized into having, on average, a low, moderate or high sitting time, with mean values (SD between subjects) of 4.9 (1.0), 7.3 (0.5) and 9.6 (1.1) h in total per day. Workers rated their largest NSP intensity during the previous month on a numerical scale (0–9) and were subsequently dichotomized into a low and high NSP intensity group (ratings 0–4 and >4, respectively). Logistic regression analyses adjusted for several individual, and work-related factors were used to investigate the association between average sitting time per day (work, leisure and total) and NSP intensity.


For total sitting time, workers in the high sitting category were more likely (adjusted OR 2.97, CI 1.25–7.03) to report high NSP intensity than those who sat moderately (reference category). Low sitting during work was associated with a reduced NSP intensity, but only for males (adjusted OR 0.26 CI 0.07–0.96). No significant association was found between sitting during leisure and NSP intensity.


These findings suggest an association between sitting time, in total per day and specifically during work, and NSP intensity among blue-collar workers. We encourage studying the structure and explanation of this association further in prospective studies on larger populations.


Daily sitting Accelerometer Occupational sitting Sitting during leisure 


Conflict of interest

The authors have no conflict of interest to declare.


  1. Andersen JH, Haahr JP, Frost P (2007) Risk factors for more severe regional musculoskeletal symptoms: a two-year prospective study of a general working population. Arthritis Rheum 56(4):1355–1364. doi: 10.1002/art.22513 CrossRefGoogle Scholar
  2. Andersen LL, Clausen T, Burr H, Holtermann A (2012) Threshold of musculoskeletal pain intensity for increased risk of long-term sickness absence among female healthcare workers in eldercare. PLoS One 7(7):e41287. doi: 10.1371/journal.pone.0041287 CrossRefGoogle Scholar
  3. Ariëns G, van Mechelen W, Bongers P, Bouter L, van der Wal G (2000) Physical risk factors for neck pain. Scand J Work Environ Health 26(1):7–19CrossRefGoogle Scholar
  4. Ariëns GAM, Bongers PM, Douwes M, Miedema MC et al (2001) Are neck flexion, neck rotation, and sitting at work risk factors for neck pain? Results of a prospective cohort study. Occup Environ Med 58(3):200–207. doi: 10.1136/oem.58.3.200 CrossRefGoogle Scholar
  5. Ariëns GA, Bongers PM, Hoogendoorn WE, van der Wal G, van Mechelen W (2002) High physical and psychosocial load at work and sickness absence due to neck pain. Scand J Work Environ Health 28(4):222–231CrossRefGoogle Scholar
  6. Balogh I, Ørbæk P, Ohlsson K, Nordander C et al (2004) Self-assessed and directly measured occupational physical activities—influence of musculoskeletal complaints, age and gender. Appl Ergon 35(1):49–56. doi: 10.1016/j.apergo.2003.06.001 CrossRefGoogle Scholar
  7. Bennie JA, Chau JY, van der Ploeg HP, Stamatakis E, Do A, Bauman A (2013) The prevalence and correlates of sitting in European adults—a comparison of 32 Eurobarometer-participating countries. Int J Behav Nutr Phys Act 10:107. doi: 10.1186/1479-5868-10-107 CrossRefGoogle Scholar
  8. Bongers P, Ijmker S, van den Heuvel S, Blatter B (2006) Epidemiology of work related neck and upper limb problems: psychosocial and personal risk factors (Part I) and effective interventions from a bio behavioural perspective (Part II). J Occup Rehabil 16(3):272–295. doi: 10.1007/s10926-006-9044-1 CrossRefGoogle Scholar
  9. Cagnie B, Danneels L, Van Tiggelen D, De Loose V, Cambier D (2007) Individual and work related risk factors for neck pain among office workers: a cross sectional study. Eur Spine J 16(5):679–686. doi: 10.1007/s00586-006-0269-7 CrossRefGoogle Scholar
  10. Celis-Morales CA, Perez-Bravo F, Ibañez L, Salas C, Bailey MES, Gill JMR (2012) Objective vs. self-reported physical activity and sedentary time: effects of measurement method on relationships with risk biomarkers. PLoS One 7(5):e36345. doi: 10.1371/journal.pone.0036345 CrossRefGoogle Scholar
  11. Chau JY, van der Ploeg HP, Merom D, Chey T, Bauman AE (2012) Cross-sectional associations between occupational and leisure-time sitting, physical activity and obesity in working adults. Prev Med 54(3–4):195–200. doi: 10.1016/j.ypmed.2011.12.020 CrossRefGoogle Scholar
  12. Cheung J, Kajaks T, Macdermid JC (2013) The relationship between neck pain and physical activity. Open Orthop J 7:521–529CrossRefGoogle Scholar
  13. Christensen JO, Knardahl S (2014) Time-course of occupational psychological and social factors as predictors of new-onset and persistent neck pain: a three-wave prospective study over 4 years. PAIN® 155(7):1262–1271. doi: 10.1016/j.pain.2014.03.021 CrossRefGoogle Scholar
  14. Côté P, van der Velde G, Cassidy JD, Carroll LJ et al (2009) The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. J Manip Physiol Ther 32(2, Supplement 1):S70–S86CrossRefGoogle Scholar
  15. da Costa BR, Vieira ER (2010) Risk factors for work-related musculoskeletal disorders: a systematic review of recent longitudinal studies. Am J Ind Med 53(3):285–323. doi: 10.1002/ajim.20750 Google Scholar
  16. Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA et al (2005) Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain 113(1–2):9–19. doi: 10.1016/j.pain.2004.09.012 CrossRefGoogle Scholar
  17. Ellingson LD, Shields MR, Stegner AJ, Cook DB (2012) Physical activity, sustained sedentary behavior, and pain modulation in women with fibromyalgia. J Pain 13(2):195–206. doi: 10.1016/j.jpain.2011.11.001 CrossRefGoogle Scholar
  18. Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP (2011) Validity of four pain intensity rating scales. Pain 152(10):2399–2404. doi: 10.1016/j.pain.2011.07.005 CrossRefGoogle Scholar
  19. Ferretti G, Iellamo F, Pizzinelli P, Kenfack MA et al (2009) Prolonged head down bed rest-induced inactivity impairs tonic autonomic regulation while sparing oscillatory cardiovascular rhythms in healthy humans. J Hypertens 27(3):551–561. doi: 10.1097/HJH.0b013e328322ca2f CrossRefGoogle Scholar
  20. Grooten W, Mulder M, Josephson M, Alfredsson L, Wiktorin C (2007) The influence of work-related exposures on the prognosis of neck/shoulder pain. Eur Spine J 16(12):2083–2091. doi: 10.1007/s00586-007-0481-0 CrossRefGoogle Scholar
  21. Hagberg M, Vilhemsson R, Tornqvist EW, Toomingas A (2007) Incidence of self-reported reduced productivity owing to musculoskeletal symptoms: association with workplace and individual factors among computer users. Ergonomics 50(11):1820–1834. doi: 10.1080/00140130701674539 CrossRefGoogle Scholar
  22. Hallman DM, Lyskov E (2012) Autonomic regulation, physical activity and perceived stress in subjects with musculoskeletal pain: 24-hour ambulatory monitoring. Int J Psychophysiol 86:276–282. doi: 10.1016/j.ijpsycho.2012.09.017 CrossRefGoogle Scholar
  23. Hallman DM, Hed Ekman A, Lyskov E (2014) Changes in physical activity and heart rate variability in chronic neck–shoulder pain—monitoring during work and leisure time. Int Arch Occup Environ Health 87(7):735–744. doi: 10.1007/s00420-013-0917-2 CrossRefGoogle Scholar
  24. Hansson EK, Hansson TH (2005) The costs for persons sick-listed more than one month because of low back or neck problems. A two-year prospective study of Swedish patients. Eur Spine J 14(4):337–345. doi: 10.1007/s00586-004-0731-3 CrossRefGoogle Scholar
  25. Healy GN, Owen N (2010) Sedentary behaviour and biomarkers of cardiometabolic health risk in adolescents: an emerging scientific and public health issue. Revista Española de Cardiología (English Version) 63(03):261–264Google Scholar
  26. Healy GN, Dunstan DW, Salmon J, Cerin E et al (2008) Breaks in sedentary time: beneficial associations with metabolic risk. Diabetes Care 31(4):661–666. doi: 10.2337/dc07-2046 CrossRefGoogle Scholar
  27. Hildebrandt VH, Bongers PM, Dul J, van Dijk FJH, Kemper HCG (2000) The relationship between leisure time, physical activities and musculoskeletal symptoms and disability in worker populations. Int Arch Occup Environ Health 73(8):507–518CrossRefGoogle Scholar
  28. Jans MP, Proper KI, Hildebrandt VH (2007) Sedentary behavior in Dutch workers: differences between occupations and business sectors. Am J Prev Med 33(6):450–454. doi: 10.1016/j.amepre.2007.07.033 CrossRefGoogle Scholar
  29. Kuorinka I, Jonsson B, Kilbom A, Vinterberg H et al (1987) Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon 18(3):233–237. doi: 10.1016/0003-6870(87)90010-X CrossRefGoogle Scholar
  30. Lagersted-Olsen J, Korshoj M, Skotte J, Carneiro IG, Sogaard K, Holtermann A (2013) Comparison of objectively measured and self-reported time spent sitting. Int J Sports Med. doi: 10.1055/s-0033-1358467 Google Scholar
  31. Larsson B, Søgaard K, Rosendal L (2007) Work related neck–shoulder pain: a review on magnitude, risk factors, biochemical characteristics, clinical picture and preventive interventions. Best Pract Res Clin Rheumatol 21(3):447–463CrossRefGoogle Scholar
  32. Linton SJ (1990) Risk factors for neck and back pain in a working population in Sweden. Work Stress 4(1):41–49. doi: 10.1080/02678379008256963 CrossRefGoogle Scholar
  33. Mathiassen SE (2006) Diversity and variation in biomechanical exposure: what is it, and why would we like to know? Appl Ergon 37(4):419–427. doi: 10.1016/j.apergo.2006.04.006 CrossRefGoogle Scholar
  34. Mayer J, Kraus T, Ochsmann E (2012) Longitudinal evidence for the association between work-related physical exposures and neck and/or shoulder complaints: a systematic review. Int Arch Occup Environ Health 85(6):587–603. doi: 10.1007/s00420-011-0701-0 CrossRefGoogle Scholar
  35. Miller R, Brown W (2004) Steps and sitting in a working population. Int J Behav Med 11(4):219–224. doi: 10.1207/s15327558ijbm1104_5 CrossRefGoogle Scholar
  36. Overgaard K, Grøntved A, Nielsen K, Dahl-Petersen I, Aadahl M (eds) (2012) Stillesiddende adfærd - En helbredsrisiko?. Vidensråd for forebyggelse, CopenhagenGoogle Scholar
  37. Owen N, Healy GN, Matthews CE, Dunstan DW (2010) Too much sitting: the population health science of sedentary behavior. Exerc Sport Sci Rev 38(3):105–113. doi: 10.1097/JES.0b013e3181e373a2 CrossRefGoogle Scholar
  38. Palmer KT, Smedley J (2007) Work relatedness of chronic neck pain with physical findings—a systematic review. Scand J Work Environ Health 33(3):165–191CrossRefGoogle Scholar
  39. Palmlöf L, Skillgate E, Alfredsson L, Vingård E et al (2012) Does income matter for troublesome neck pain? A population-based study on risk and prognosis. J Epidemiol Community Health 66(11):1063–1070. doi: 10.1136/jech-2011-200783 CrossRefGoogle Scholar
  40. Pejtersen JH, Kristensen TS, Borg V, Bjorner JB (2010) The second version of the Copenhagen Psychosocial Questionnaire. Scand J Public Health 38(3 suppl):8–24. doi: 10.1177/1403494809349858 CrossRefGoogle Scholar
  41. Pincus T, Santos R, Breen A, Burton AK, Underwood M (2008) A review and proposal for a core set of factors for prospective cohorts in low back pain: a consensus statement. Arthritis Care Res 59(1):14–24. doi: 10.1002/art.23251 CrossRefGoogle Scholar
  42. Royston P, Altman DG, Sauerbrei W (2006) Dichotomizing continuous predictors in multiple regression: a bad idea. Stat Med 25(1):127–141. doi: 10.1002/sim.2331 CrossRefGoogle Scholar
  43. Saidj M, Jørgensen T, Jacobsen RK, Linneberg A, Aadahl M (2014) Differential cross-sectional associations of work- and leisure-time sitting, with cardiorespiratory and muscular fitness among working adults. Scand J Work Environ Health 40(5):531–538Google Scholar
  44. Skotte J, Korshøj M, Kristiansen J, Hanisch C, Holtermann A (2014) Detection of physical activity types using triaxial accelerometers. J Phys Act Health 11(1):76–84CrossRefGoogle Scholar
  45. Skov T, Borg V, Orhede E (1996) Psychosocial and physical risk factors for musculoskeletal disorders of the neck, shoulders, and lower back in salespeople. Occup Environ Med 53(5):351–356. doi: 10.1136/oem.53.5.351 CrossRefGoogle Scholar
  46. Sluka KA, O’Donnell JM, Danielson J, Rasmussen LA (2013) Regular physical activity prevents development of chronic pain and activation of central neurons. J Appl Physiol 114(6):725–733. doi: 10.1152/japplphysiol.01317.2012 CrossRefGoogle Scholar
  47. Sterud T, Johannessen H, Tynes T (2014) Work-related psychosocial and biomechanical risk factors for neck/shoulder pain: a 3-year follow-up study of the general working population in Norway. Int Arch Occup Environ Health 87(5):471–481. doi: 10.1007/s00420-013-0886-5 CrossRefGoogle Scholar
  48. Thorp A, Healy G, Winkler E, Clark B et al (2012) Prolonged sedentary time and physical activity in workplace and non-work contexts: a cross-sectional study of office, customer service and call centre employees. Int J Behav Nutr Phys Act 9(1):128CrossRefGoogle Scholar
  49. Toomingas A, Forsman M, Mathiassen S, Heiden M, Nilsson T (2012) Variation between seated and standing/walking postures among male and female call centre operators. BMC Public Health 12(1):154CrossRefGoogle Scholar
  50. Tüchsen F, Hannerz H, Burr H (2006) A 12 year prospective study of circulatory disease among Danish shift workers. Occup Environ Med 63(7):451–455. doi: 10.1136/oem.2006.026716 CrossRefGoogle Scholar
  51. Tudor-Locke C, Leonardi C, Johnson WD, Katzmarzyk PT (2011) Time spent in physical activity and sedentary behaviors on the working day: the American time use survey. J Occup Environ Med 53(12):1382–1387CrossRefGoogle Scholar
  52. van Weering M, Vollenbroek-Hutten M, Hermens H (2011) The relationship between objectively and subjectively measured activity levels in people with chronic low back pain. Clin Rehabil 25(3):256–263. doi: 10.1177/0269215510380828 CrossRefGoogle Scholar
  53. Visser B, van Dieën JH (2006) Pathophysiology of upper extremity muscle disorders. J Electromyogr Kinesiol 16(1):1–16CrossRefGoogle Scholar
  54. Yue P, Liu F, Li L (2012) Neck/shoulder pain and low back pain among school teachers in China, prevalence and risk factors. BMC Public Health 12(1):789CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • David M. Hallman
    • 1
    Email author
  • Nidhi Gupta
    • 2
  • Svend Erik Mathiassen
    • 1
  • Andreas Holtermann
    • 2
  1. 1.Department of Occupational and Public Health Sciences, Centre for Musculoskeletal ResearchUniversity of GävleGävleSweden
  2. 2.National Research Centre for the Working EnvironmentCopenhagenDenmark

Personalised recommendations