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“Postural defects and structural integration disorders” are few of the common physical anomalies that faced by physiotherapists. This study is entirely based on evaluation of cause and effects of lower back pain and other musculoskeletal disorders amongst physiotherapists. 

Chapter 1: This includes Introduction” which outlines scope and content of entire research. This section is further composite of “research background, rationale, aim and objectives, significance of study and entire dissertation structure”. The research aims at determining the issues and challenges of the physiotherapists as they struggle with neck and back pain.

  Chapter 2: This is based on systematic review of literature based on subject matter. This section has comprised itself with notable information on “LBP patient management, application of a multi-disciplinary approach, cause and effect of MSD” and other relevant topics. 

Chapter 3: This is based on “Research methodology” which deals with sections of “Research paradigm”. It shows that the entire research is based on “positivism, descriptive and systematic way with premium focus on “data collection method”. Furthermore, this section has further established ethical consideration undertaken by researcher for completion of this study. 

Chapter 4: This is based on a tabular form of “findings and analysis” based on collected literature.

Chapter 5: This section represents “Discussion” that underlines thematic analysis of entire findings of this research. Furthermore, it is comprehensive of “Research hypothesis” and its justification based on entire discussion. 

Lastly, Chapter 6: It has included a section on “Conclusion”, which is further constituted of “summary of review findings” along with justification of research’s objectives fulfillment. A list of recommendations and final statement of findings also have been included at this section. One of the most useful recommendations for instance is consideration of “behaviour therapy, pharmaceutical and non-pharmaceutical treatments.

All of the research chapters starts with a brief introduction to the chapter contents and ends with a short summary of inclusive elements of the chapter


I would like to express my gratitude to my professor at first, without whose consideration and support I would not have been able to complete this entire research. Furthermore, it was his teaching and moral support that enabled me to complete this research at its entirety. Secondly, I would like to thank my peers who have helped me immensely in solving temporary doubts in absence of my professor. Lastly, I would like to express my gratefulness towards the immeasurable support have attained from my parents both morally and ethically.

Table of Contents

Chapter 1: Introduction
1.1 Introduction
1.2 Research background
1.3 Research rationale
1.4 Research aim and objectives
1.5 Research questions
1.6 Importance of study
1.7 Significance of the research
1.8 Dissertation structure
1.9 Summary
Chapter 2
2.0 Introductions
2.1 Work-related musculoskeletal disorder
2.2 Physiotherapy and cause of lower back pain
2.3 LBP patient perception scale
2.4 Ways to approach problem of LBP
2.5 LBP patient management
2.6 Laboratory tests and imaging in LBP detection among physiotherapists
2.7 Multi-disciplinary approach to Lower back pain management
Chapter 3: Research Methodology
3.0 Introduction
3.1 Research Paradigm
3.1.1 Research Philosophy- Positivism
3.1.2 Research Design- Descriptive
3.1.3 Research Approach- Systematic
3.1.4 Data Collection method
3.2 Ethical consideration
3.3 Summary
Chapter 4
4.0 Introduction
4.1 Findings and analysis
4.2 Summary
Chapter 5: Discussion
5.0 Introduction
5.1 Research Hypothesis
5.2 Thematic analysis
5.3 Hypothesis justification
5.4 Summary
Chapter 6
6.0 Introduction
6.1 Summary of review findings
6.2 Linking with objectives
6.3 Recommendations and findings
6.4 Summary

List of Figures

Figure 1.1: Dissertation structure
Figure 2.1: Work-related musculoskeletal disorder in a different body part
Figure 2.2: Pain context in different body part
Figure 2.3: LBP patient management in post and pre-time
Figure 2.4: Foot arch examination in a laboratory test
Figure 3.1: Research paradigms
Figure 3.2: Flow chart of research methodology


Chapter 1: Introduction  

1.1 Introduction 

This section covers clear identification of scope of the research along with setting up a clear definition and significance of the topic. The following section is inclusive of aim and objectives of the research along with research questions, based on which entire study has been framed. Furthermore, this chapter is also inclusive of a research rationale that enlightens regarding context of this subject matter with current situation. Furthermore, a dissertation structure is also biopsychosocial inclusive of this introduction in order to understand framework of the entire study.  

1.2 Research background 

Work related musculoskeletal disorders and severity in lower back pain or LBP is one of the most common and widespread human health conditions. Approximately 23% of global population suffer from ‘Non-specific Chronic low back pain (NSCLBP)’ (Mansour et al. 2020). This is another cause for high levels of disability with tremendous imposition of ‘societal and individual cost’. Substantial economic losses are faced by physiotherapists owing to their growing LBP disorders. 

This is mainly caused due to their ‘job demands and positions maintained all day long’. Estimated ‘lifetime prevalence’ of such disorders in Physiotherapist’s account for more than 79.6% (Milhem et al. 2017). Primary risk factors that are associated with LBP

are ‘transferring of medical patients at 30%’, lifting and manual handling at 25% and responding towards patients’ sudden movements by 24% (Milhem et al. 2017). About 74% of overall physiotherapists are caused due to working at the same position for more than 2 hours. 

1.3 Research rationale  

An increased rate of risk regarding musculoskeletal disorders and lower back pain is witnessed among physiotherapists and healthcare professionals. A higher prevalence of LBP has been found in female therapists rather than their male counterparts. According to a study 31% of physiotherapists reported signs of LBP symptoms while working with ‘general musculoskeletal out-patients’, while almost 14% of physiotherapists faced LBP symptoms while working with patients of ‘neurological rehabilitation’ or elderly patients (Ardakani et al. 2020). 

Physiotherapists are witnessed to get more accustomed to musculoskeletal borders and severity in LBP, owing to their jobs that deal with patients of ‘cardiovascular rehabilitation, orthopaedic rehabilitation’ or other physical anomalies (AL Zoubi et al. 2018). Highest prevalence of this issue has been found within physiotherapists and healthcare assistance those who deal with specialties such as ‘orthopaedics’.   

Musculoskeletal disorders and lower back pain due to occupational setting and practices account for up to 22.3% of ‘global disability’ (Malayil Mangalath, Alias & Sajith, 2018). Despite available guidance on risks of LBP and potential physiological

stress on working with patients with disability a number of professional barriers add up to increased amount of LBP symptoms in physiotherapists. These are mainly ‘lack of awareness skills, self-capacity and motivation’ (O’Sullivan et al. 2020). Such situations have worsened physical conditions in context of LBP in physiotherapists along with 17.3% of prolonged ‘non-spinal MSK’, 10.5% of osteoarthritis and 2.3% of rheumatoid arthritis (Malayil Mangalath, Alias & Sajith, 2018). This has caused for a need to discuss potential barriers to such regressive health situations and present useful intervention in the way of human disability.

This research sheds light upon cause of LBP in physiotherapists along with extent of impact caused by such disorders. Furthermore, discussions have been presented in this study regarding factors leading to ‘long-term chronic pain’ and ways of countering such health conditions. Types of interventions and diagnostic measures that could be helpful in lowering term-life of such LBP has also been discussed in this study.     

1.4 Research aim and objectives

The research aims at determining the issues and challenges of the physiotherapists as they struggle with neck and back pain. It shall explore into the long working hours of the profession and the resulting challenges of health issues while trying to resolve the same. 

Research objectives 

  • To understand the health issues among physiotherapists 
  • To explore the causes and effects of neck and back pain in the physiotherapy profession 
  • To come up with recommendations to resolve the issues 

1.5 Research questions 

  1. What are the health issues physiotherapists face because of long working hours?
  2. How are they dealing with neck and back pain issues?
  3. What are the recommendations for resolving the issues?

1.6 Importance of study 

One of the major importance of this study would be towards description of ways in which lower back pain and other relevant musculoskeletal disorders could be prevented. Benefits of this study would be towards helping and assessing importance of diagnosing LBP or other MSD related disorders in healthcare professionals. This would be further beneficial for assessment of ways in which occupational settings within hospital or healthcare institutions’ arena could be improved. 

1.7 Significance of the research   

According to several studies physiotherapy students and professionals are 2.61 times more likely to undergo LBP and other severe arthritic symptoms, owing to their prolonged and consistent manual operations (AL Zoubi et al. 2018). Out of such cases almost 43% of the cases can be chronic and cause movement barriers. About 54% of nurses working with patients with some levels of disability are witnessed to demonstrate symptoms of ‘nonfatal occupational MSK risks’ (Malayil Mangalath, Alias & Sajith, 2018). This is mainly due to human physical incapability to absorb stress from ‘high level of force, hazardous postures and biomechanical loads.   

Certain clinical practices are extremely stressful both in mental and physical context. Concerning this, it is essential that health practitioners take ample amount of notice and directive measures that would prevent a life-time of disabilities. This study has presented a significant number of interventions and measures that can act as preventive barriers to LBP causing factors. Based on this research, one would be able to identify roots of the actual problem and identify factors that can be re-modified for sufficing appropriate health conditions for health workers. Through discussions of analytical and a wide range of literature from academic sources, this research has presented significant intervention of LBP causing symptoms.  

1.8 Dissertation structure

1.9 Summary            

This chapter has thereby produced detailed structure based upon which entire study is built. This chapter has presented an elaborative rationale for the subject matter enlightening upon relevance of LBP in physiotherapists in current context. Furthermore, framing of research questions would be of great help while discussing entire literature review and review findings in the discussion section. Significance of this research has further made evident mention of ways in which this research could be presented usefully to healthcare professionals and interested individuals in this field. Hypotheses have been developed in this section which would be proved in later segments of this research.

Chapter 2: Literature Review

2.0 Introductions

In this chapter of literature review, a different concept of low back pain management in the UK is summarised. Moreover, approaches to physiotherapy and causes of lower back pain are discussed in chapter. This section emphasises on multi-disciplinary way to cure low back pain management in UK. In this section, a multi-disciplinary and multi-variant way has been discussed to cure this disease. In a laboratory set up, tools and imaging process is identified to diagnosis low back pain management. 

2.1 Work-related musculoskeletal disorder

In UK, there are different types of work-related low back pain and musculoskeletal disorder which are “carpal tunnel syndrome, tendonitis, tendon and nerves” related disease and many others. As per the view of Tesfaye et al. (2020), it is a major threat to public and the disability of UK. It used to reduce effect and productivity of work quality. Moreover, in UK, the effect of the skeletal disease is identified through a major survey which is known as the “Nordic Musculoskeletal survey“. The musculoskeletal disease has a major effect on morbidity. It has been analysed that people with disability have been enhanced due to skeletal disease which is 61.6%. This effect of disease is also known as “disability-adjusted life years (DALYs)”. As per the survey result, it is diagnosed that, 469,000 numbers of employees used to experience musculoskeletal disease due to heavy work pressure (Tesfaye et al. 2020). This reason has different types of reasoning which are long time standing, repetitive motion, forceful activity and extortion. This disease has three different aspects which are low back, shoulder and neck.

In addition to this, this disease has different types of body zones which are knees, wrist, elbow, lower back and upper back. On the other contrary, Ngai Leung et al. (2021) argued that, In UK, it has been analysed that 50.5% of the persons are affected by low back pain. A disease of the elbow is a major factor in this skeletal disease. It is evident that in this disease, a demographic factor is a major issue among the citizen of UK. In a clinic, the rheumatic disease of patients is enhanced by 95% due to this musculoskeletal disease (Simula et al. 2020). In a workplace, 3.55% of the persons used to face these skeletal and rheumatic diseases due to heavy workload.

2.2 Physiotherapy and cause of lower back pain

Lower back pain is considered under rheumatic and foot care problem in body orthopedically context. According to Savia et al. (2017), there are different types of symptom which are chronic foot symptoms, lack of step during work and aching kind of pain. In addition to this, a radiograph used to track signs and symptoms of the disease. Physiotherapy has a major benefit in this disease and it is considered as a primary care and prognosis care in the World. It is identified that lower back pain is considered a global physical burden. Moreover, 40% of patients used to prefer physiotherapy for improving health and lower back pain situation. It is identified that women have a higher chance to be affected by lower back pain. 

On the other contrary Lochting et al. (2017) argued that in a primary care setting, physiotherapy used to improve health and lower back pain situation from 2% to 48%. This lower back pain can be acute, sub-acute and chronic disease also. Common causes of lower back are spinal pain, compression of root of nerve in the human body. In this case, physiotherapy is considered as a manual therapy to improve situation through exercise. In UK, the “Ethics Committee of Regional Health Administration of Lisbon and Tagus Valley (ARSLVT)” is important for statement of any LBP disease. In addition to this health-related quality of life needs to be improved to reduce effect of this disease. In this disease, there are two types of patient who needs care and who has mild symptoms. It has been identified that 585 patients need physiotherapy care and treatment. 


2.3 LBP patient perception scale

Lower back pain and skeletal patients have different types of perception of these diseases such as it has different types of pain and symptom. It is evident that in the natal and pre-natal period, a pregnant woman has higher chances of being affected by this disease. It can be said that 28.1% of pregnant women used to face low back pain due to pregnancy period. As per view of Borys et al. (2015), there are different types of pain such as “lumbar pain (LP), posterior pelvic pain (PPP), and combined pain (CP)”. Moreover, in human body, effect of lumbar pain is highly impassive. In UK healthcare system, 58% of patients used to face this lumbar pain. As a surveillance pain, it can be said that work pressure, activity and movement need to reduce in lower back pain patients in UK. As per view of Wang et al. (2020), this lower back pain disease is known as a complex disease and multi-factorial disease. Due to lower back pain issue, pelvic pain among women has been enhanced. Moreover, perception of this disease also has a connection with depression and psychological diseases in the prenatal stage. 

On the other contrary, Vitoula et al. (2018) argued that among male, perception of lower back pain is 10% high. Thus, it has been analysed that this lower back pain needs to be recovered through a different process such as “acupuncture, spinal manipulation, and psychotherapy”.  As per view of Williams et al. (2017), all these processes are known and non-pharmaceutical treatment among patients in UK. In this lower back pain, impact of biofeedback and cognitive therapy is also important. Under this context, UK has two different types of treatment as pharmaceutical and non-pharmaceutical treatment. It is evident that most of the patients used to prefer the pathological section of low back pain disease.

2.4 Ways to approach problem of LBP

There are different ways to approach problem of Lower back pain which are There are different types of approaches to solving this case lower back pain which is behaviour therapy, pharmaceutical and non-pharmaceutical. In addition to this, there is a major approach which is a pharmacological approach. It is evident that physiotherapy is a major approach to cure this disease. In addition to this, there are different types of approaches to cure this treatment which are spinal manipulation, acupuncture and lateral care. It has been analysed that in UK, usefulness of pharmacological approach is important. In UK, 1 out of 2 people used to prefer treatment of pharmacological statement (Vitoula et al. 2018). Dialectical behavioural is also an important approach to solve this disease. It is evident that in UK, full-body vibration therapy is also important to cure therapy. It is estimated that this approach is also known as Medline and Medicare therapy among women (Ngai Leung et al. 2021). Through this vibration therapy, functional ability of a patient is increased and full-body movement is improved. 

It has been identified that full-body vibration process has a major opportunity to cure for lifetime prevalence for this disease. It is evident that 33% of patients used to prefer full-body vibration for skeletal disease. Lifetime prevalence rate is increased by 11% to 84% (Vitoula et al. 2018). In addition to this, impact of this global burden has been reduced due to this therapy. It is evident that usage of acupuncture is enhanced in this skeletal issue. This vibration process has a major effect to foster a movement of vertical and sinusoidal and side altering paining in body. It can be said that spinal manipulation has a major effect on the human body to cure this disease. Through this spinal therapy, 10% of lower back pain can be reduced. It is estimated that, before all these approaches to low back pain, anatomical diagnosis is important because the bone structure and fluid consistency in the human body vary from body to body.

As per view of De Sola et al. (2020), there is another major approach to treat this disease which is spinal segment ability. Moreover, it is also known as multi-factorial treatment globally. It is evident that 85% of the patient who has suffered from this disease used to prefer spinal segment care. As per view of Bitenc-Jasiejko, Konior & Lietz-Kijak (2020), Due to this care, lumber flexibility in body is increased.  In addition to this, there is a major approach which is known as Opioids. Treatment of opioids is known as a clinical tool for treatment. It is estimated it can cure the long-term issue of spinal and low back pain management. Moreover, patients need to be taken a long-term treatment of this care for nearly 3 months (De Sola et al. 2020). These Opioids care used to prevent chronic pain of body also. It is evident that opioids care used to prevent chronic pain by 27% in UK and other European countries. 

According to Chou et al. “National American Survey on Drug Use and Health (NSDUH)” has perceived are reported that one third of American population used to prefer this care as a prevalence plan. Opioid therapy is associated with alleviation of pain due to a long-term period. It can be said that 83.59% of persons of America used to report that they have suffered from spinal pain and this opioid are has prevented this issue. 

2.5 LBP patient management

Lower body pain management focuses on a multimodal approach to cure this skeletal and rheumatic disease. As per view of Borys et al. (2015), the Multimodal approach emphasises on a process to reduce mental issue as well as physical issue. It is evident that this process used to resolve pain intensity as well as related stress and anxiety. Moreover, this is known as the gate keeping system in LBP patient management. It is also known as an interdisciplinary way to treat a patient. It is estimated that multimodal therapy used to cure disease by 42.9% of the Patient. As an outcome, it can be said that this needs to be used to utilise healthcare of UK. In addition to this, this therapy has a total structure of three to twelve month of follow up for patients.  

On the other contrary, Bitenc-Jasiejko, Konior & Lietz-Kijak (2020), argued that integrated therapy is another important approach to cure rheumatic disease. It is known as Low back pain rehabilitation system. In addition to this, a different type of diseases such as inflammation, tumours and nerve pain is identified. It can be estimated that there are different global factors due to this integrated method which are “postural defects, structural integration disorders, lifestyle, and type of activity”. In this article, it has been analysed that lower back pain may cause due to injury and accident. Nearby 20% of the global population are affected by this back pain. This back pain has different types of chronic form in human body. In this treatment management of first year, 24% to 80% of the patient used to face relapse of pain. Moreover, due to treatment of this integrative method, 335 of the patients felt that they are better in 6 months’ time period.

On the other contrary, Ngai Leung et al. (2021) argued that there is a major disease in LBP management which is non-specifying and non-identifying back pain and it has been increased among young people. “Magnetic resonance imaging (MRI)” needs to be applied in order to identify the reason for tissue pain. This integrative method used to reduce motor activity and body movement among patients. 

 In the LBP care management of a patient, there is a major process which is known as “Benchmarking Controlled Trial (BCT) design”. Moreover, in this design, there are three major health care regions, which need to be identified. On the other hand, it has different multidisciplinary factors such as lifestyle and prolonged disability (Tanashyan et al. 2017). It is considered as a primary care management in the health care system of LBP patients. In pain management, there are two types of pain, which are specific pain and nonspecific pain. Nearly 90% of the pain is non-specific (Simula et al. 2020). In this pain management, there are different important factors which are intensity of pain and term period of pain (Chou et al. 2018). It has been identified that in care management. 70% of the people used to confirm that their disease has a specific reason for “dysfunction of my-fascial structures and disease of tissue”.  

2.6 Laboratory tests and imaging in LBP detection among physiotherapists

In a laboratory set up, there are two important elements which are MRI (Magnetic resonance imaging) and X-ray. It is evident that this is known as the manual process in a laboratory set up. As per view of Bitenc-Jasiejko, Konior & Lietz-Kijak (2020), in a laboratory set up; there is a major process to cure this disease which is the “Arthrokinematic Approach Hakata“. This process of manual therapy used to control joint movements of a human body. On the other side, in a laboratory set up, there is a major process which is “High-velocity low amplitude” (Cruz et al. 2020). Due to this process cause of lower back pain can be mitigated. In addition to this, it has another approach in a laboratory set up which is “manipulative and osteopathic techniques” (Long et al. 2020). It has been analysed that through the imaging process, anatomical and fluid structure in human body can be identified. Moreover, as a detecting process, there is a major approach is known as Kinesio Taping. Through this process, blood circulation and lymph and microcirculation can be improved. It has been identified that this is known as the self-healing process in physiology. As per view of Simula et al. (2020), in an orthopaedic context, imaging has immense benefit to detect diseases in preterm and post-term. It has been analysed that imaging and X-ray processes used to detect changes of disease by 18% to 62% (Tanashyan et al. 2017). In this electronic guideline of imaging, there is a crucial factor which is the “electronic patient registry”. It is estimated that this care is important to manage evidence-based care. In a clinical practice, imaging is used to diagnosis 90% of the non-specifiable disease. It is evident that in MRI Report, bio-physiological model of a patient has been shown.

On the other contrary, Wang et al. (2020), argued that Imaging has different types of a process such as a computer tomography and X-ray. Through this process, medication needs to be introduced in the human body. In this laboratory set up, there is a major model which is a bio-medicalisation framework. Through this bio-medicalisation framework, pain management and cure processes can be improved (Williams et al. 2017). Thus, it can be concluded that health and imagining guidelines need to be followed in order to avoid any chances of an accident. Thus, data minority of the anatomy process used to reduce pain through diagnosis process.

2.7 Multi-disciplinary approach to Lower back pain management

The multidisciplinary approach used to reduce disease of patients who have chronic and acute pain in lower back of the body. As per view of Ngai Leung et al. (2021), multi-disciplinary is a beneficial approach that is used by “physiotherapists, occupational therapists and clinical psychologists”. This process emphasises the disability index of a person. Due to this approach, movement, motor activity and sitting and standing processes can be controlled. It has been identified that 7.7 million people globally used to bear a huge cost of low back pain disability. In this process, time is an important factor to treat a patient. Moreover, there is another important model which is known as the “Multivariate logistic regression model”. Through this model, the disability index can be identified. 

It is estimated that 74.1% of people used to vail this benefit of multi-disclaimer services to reduce their cost of burden (Bitenc-Jasiejko, Konior & Lietz-Kijak, 2020). This study has also revealed that this multi-disciplinary statement also focuses on reduction of smoking, drug addiction and any other addicting habit of a patient. Physiotherapy and pharmacological programs are used prior to this program. It is evident that multi-variation process focuses on an approach to opioid care to give relief from pain. It has been identified that through this approach, an improvement from chronic and acute disease is unlimited. Due to this multivariate process, skeletal and rheumatic injury processes can be solved. 43.5% of workplace persons used to apply these approaches for detecting and predicting their back pain in the UK (Savia et al. 2017). Nearby 88% of the UK population has availed major benefit from this multidisciplinary and multivariate approach. In this pain management, there is an important factor which is known as the “worst pain imaginable”. Due to this pain, a patient may feel depression, anxiety, diabetes and back pain, it is identified that this process emphasises a broader range of disease from mental; to physical.

It can be said that this multidisciplinary approach of pain management used to improve spine care and rheumatic care of a patient. Moreover, multi-side factors of medicalisation, biomedicine and multi-directional processes need to be applied to take care of a patient. It can be concluded that repetitive motion and motor captivity, sitting and standing for a long time needs to be reduced for male and female patients. In the prenatal and post-natal period, the application of multi-disciplinary care and multi-variation care needs to be improved among female. 

Chapter 3: Research Methodology 

3.0 Introduction 

A research is a significant collocation of “scientific and inductive” way of thought processing within a particular field of study. Through carrying out a research meeting, a particular researcher is able to develop a specific set of logical ideas and habits within areas of “thinking or a set of procedures” (Pidgeon, 2019). Undermining the exact type of research methodology that would suit a particular subject field and carry out detailed analysis and evaluation of research aim and objectives, is one of the main responsibilities of a researcher (Kaushik & Walsh, 2019). This section would include description of factors that have been considered while framing the entire literature of this review.

3.1 Research Paradigm

Given the idea of a systematic review, a particular research design should be comprehensive of a neatly “structured and specific” number of steps within a “specified number of sequences” along with a number of “well-defined set of rules”. Through identification of a particular research paradigm, researchers of this study have been able to clearly define scope and number of “common concepts” to be used within this research (Durdella, 2017). Thus, the research paradigm refers to a set of “generalised frameworks” or viewpoints that could be used in understanding of a research topic and its constituents. The main research paradigm could be of three types that are “positivists, constructivists and pragmatists”.

3.1.1 Research Philosophy- Positivism

Issuing positivism theory into completion of this study includes consideration of a set of “factual knowledge” that could be used through “observation” and trustworthy form of measurements (Park, Konge & Artino, 2020). Role of the researcher for completion of this study has been considered to acknowledge information through “data collection and interpretation”. Interpretation of data in this research has been primarily done through thematic analysis. 

Through consideration of a positivism philosophy this research has been completed through “quantifiable observation” of LBP disorders and symptoms in physiotherapists. It was further created for a way of incubating an “atomistic and ontological view” of subject matter and “discrete and observable elements” (Panhwar, Ansari & Shah, 2017). Factual information regarding the field of physiotherapy and leading causes of “musculoskeletal problems” in physiotherapists have been considered through application of this philosophy at large. Through application of this philosophical idea, researchers of this study were able to conduct research methodology based u0n purely objective collection of facts and data.  

3.1.2 Research Design- Descriptive 

Through application of a “descriptive research” this research has aimed towards accurate and purely systematic description of facts and “situation or a specific phenomenon” (Doyle et al. 2020). Through application of an appropriate choice this research has carried out mass identification of “characteristics, frequencies, trends and categories” that would take consideration of various aspects of LBP in physiotherapists. Thus, identification of a diverse range of information in a descriptive way has made this research to be extremely successful (Panhwar, Ansari & Shah, 2017)

Application of a descriptive research design has enabled validity for the study to undertake results that are highly “reliable and valid”. Thus, through undertaking descriptive research reliance of entire study has been satisfied. Development of a
“testable hypothesis” through application of a number of theoretical underpinning, “model and concepts” (Woiceshyn & Daellenbach, 2018). Thus, observation regarding LBP in physiotherapists and cause of such physical ailments were able to be included with proper theoretical validity.   

3.1.3 Research Approach- Systematic 

It is essential for a research to be conducted within a systematic way while taking consideration of “searching, selection, and managing” best available forms of evidence and literature while carrying out research work. Explicit methods have been used in order to gain a better insight of ways in which bias in gathering data about LBP in physiotherapists have been described (Azungah, 2018). Through carrying out a “planned and highly consistent” method, researchers of this study have aimed in elaboration and collocation of a number of “empirical evidences” regarding the concerned subject field (Chen, 2017).  An informed decision-making choice has been conducted thereafter to focus upon well development of overall conclusion and form the basis of study’s discussion over the subject matter. 

This has further enabled for this research to include a number of research questions that would later be resolved in the discussion section. It is an integral way of optimising informed process of decision making to achieve unbiased analysis and result of entire research (Park, Konge & Artino, 2020). Such a systematic research has aimed at evaluation and identification of separate individual studies based upon issue of lower back pain amongst physiotherapists. Alongside to that, systematic review conducted within this research have enabled researchers to undertake final summarisation of findings with proper clinical findings of subject matter (Park, Konge & Artino, 2020). This could formulate an authentic basis for entire research in conduction of ways in which professionals in health-related fields would be able to identify relevant knowledge in combating issues of lower back pain in healthcare professionals especially in physiotherapists.  

3.1.4 Data Collection method

Data collected for systematic review is supposedly to withstand a number of studies having a “collaborative unit of interest”. For instance, data collected on finding out data based upon physiotherapists health status have been collected from secondary sources having similar background of study. Identification of studies has been done along with synthesising data regarding “design, risk of bias and results” (Park, Konge & Artino, 2020). All of the data collected for systematic review are based upon “accurate and complete as well as accessible” forms of secondary data from a reliable source. Data has been collected through costly peer reviewed articles while considering inclusion of theoretical underpinning into the literature section. All of the theories, models and concepts into this study have been added with proper citations of academic literature, thus contributing to research’s authenticity and extent of reliability on research literature. Data collected from such reliable sources have further made a basis for discussion and detailed thematic analysis of all articles chosen (Panhwar, Ansari & Shah, 2017).    

Data has been selected from two different forms of databases namely, Google Scholar and ProQuest with application of search strategies and key terms. 

Inclusion Criterion 

Exclusion Criterion 

  1. Publications having publication year within 5 years from present date of collection 
  2. Publications in English language 
  3. Publications including academic literatures such as scholarly journals and books 
  4. Full text publications 
  1. Publications having more than 5 years of publication date from present date of collection 
  2. Publications in any other language apart from English 
  3. Non-academic literatures 
  4. No full-text publications 

Table 3.1: Inclusion and exclusion criterion

(Source: Researcher)

Key terminologies used for gathering data are: Lower back pain, musculoskeletal disorders, physiotherapies, occupational MSD and LBL symptoms. 

3.2 Ethical consideration 

Maintenance of ethical concerns is a significant one while considering basic fulfillment of research questions and objectives. Through consideration of an ethical standard, researchers are able to consider gathering of facts based upon reliable and authenticated sources of data. Ethical considerations that have been taken into account for this research is mainly relevant to information provided within this research to be of appropriate and authentic type (Woiceshyn & Daellenbach, 2018). In doing so this research has avoided use of any “overexertion, deception or any sort of over exaggeration” of research data. While considering systematic review of a set of secondary data this research has made sure that all sorts of data and factual representations of LBP in physiotherapists are taken from either peer reviewed or well-cited published sources (Panhwar, Ansari & Shah, 2017). This has prevented the inclusion of any “misleading information” based upon subject matter. Furthermore, ethical consideration of this research has predominantly taken preventive measures for non-inclusion of “offensive, discriminatory or unacceptable language” within research literature. 

Use of proper referencing guidelines have been used with maintenance of a “high level of objectivity” in research’s “discussion and analysis” part. Ethics standards have been followed with proper adherence to UK’s “Data Protection Act 2018” (Chen, 2017). Most importantly, expansion of any further discussion into the matter has been done with special care and proper consideration of systematic reviewing format. This would be efficient in undermining useful components of the study in a progressive and authentic manner. All of the information included in the literature review section has been incorporated through proper identification of justified theories, models and concepts relevant to subject matter.    

3.3 Summary  

This section has thereby included number of elements that would help in assessment of ways in which research work has been considered. Research methodology has contributed relevant discussion about research design, approach, philosophy and ways of data collection.

Chapter 4

4.0 Introduction

This section includes a systematic way of presenting key findings as gathered from overall study from academic literature collected for completion of this research.

4.1 Findings and analysis 

Author and year

Key words 

Study design



Bitenc-Jasiejko, Konior & Lietz-Kijak (2020) 

Lower back pain, Postural defects and “structural integration disorders”


About 25 to 83% of overall physiotherapists at a global scale have demonstrated a relapse of pain with 33% of overall cases inhibiting moderate pain index

This study has dealt with meta-analysis of diagnosis and treatment of LBP and other relevant back pains amongst physiotherapists. Furthermore. This studies comprehensive of a functional assessment of human “musculoskeletal system” along with proper discussion of “initial, systematic and cross-sectional control”

Borys et al. (2015)

Pain intensity, MSD, Depression and “healthcare utilisation”


Pain intensity of physiotherapists and other patients of musculoskeletal disorders were found to be at “ES -0.48” in general and “ES -0.22” due to anxiety

Use of a multimodal therapy has been proven successful in this study for treating LBP and MSD

Chou et al. (2018)

LBP, pain management, “chiropractic therapy” 

Mixed method 

Economic burden caused due to prevalence of occupational LBP was estimated at 110 billion Euros 

There is a need of measuring proper intervention for successful use of CAM and Chiropractic therapies 

Cruz et al. (2020)

Chymotrypsin, pain management, protease inhibitors  


Almost 3.3 billion occupational injuries across world 

Application of a “polyphasic approach” could be essential for coping up with this situation 

De Sola et al. (2020)

Pain clinic, opioids, “non-malignant low back pain”

Mixed methods 

Average “chronic pain or CP index” is at 28.9% in Europe 

Limited information received by health-care professional is one of the major barriers to proper treatment of CP

Lochting et al. (2017)

PRO, LBP research, psychological distress and “pain catastrophizing”


Mean age for physiotherapists undergoing LBP was 38.3 years with 57.6% of female 

Use of “Hopkins Symptoms Checklist (HSCL-25” could be useful”

Ngai Leung et al. (2021)

LBP, physiotherapy and RTW 


Improvement through ODI was at 47.6 p

Use of a multidisciplinary program could increase patient muscular functions

Savia et al. (2017)

Healthcare costs, LBP treatment and PPI 


3% of patients with LBP can afford self-management of pain

Launch of mobile application for determining “outpatient waiting”  

Simula et al. (2020)

LBP framework, imaging, biopsychosocial factors


Over 90% of occupational pain are classified to be “non-specific” in nature 

“Patient-Reported Outcomes measurements” is a widely used tool 

Tanashyan et al. (2017)

RCT, rehabilitation, LBP 


MRI scan of LBP physiotherapists show herniation of “L4-L5 5mm”

Physiotherapist working for more than 2 years have shown “Palpation of the metatarsophalangeal joints”

Vitola et al. (2018)

LBP management, behavioural therapy 


More than 78.9% of physiotherapists face LBP after age of 45

Non-pharmaceutical treatments such as “acupuncture and spinal manipulation” along with psychotherapy is helpful 

Wang et al. (2020)

Vibration therapy, LBP, WBV


Point prevalence ranged from 12 to 34%

A PICO system could be efficient in application of vibration therapy 

Williams et al. (2017)

Musculoskeletal injuries, occupational actions, IPAT tool  


Detection of anxiety and stress was accounted as a major reason at 82% 

LBP and MSD are lesser among therapists having critical awareness and occupational ethics 

Table 4.1: Findings and analysis 

(Source: Researcher) 

4.2 Summary 

The above table thereby justifies collocation of a range of academic and authentic sources with qualitative and mixed study design. These sources have contributed significantly towards determination of overall findings in context of physiotherapists’ LBP and occupational pain related issues. 

Chapter 5: Discussion 

5.0 Introduction 

The discussion chapter of this research study identifies a basic and significant element of entire literature that would further dictate framing of the conclusion chapter of this study. Furthermore, this chapter is highly based upon formation of themes based on objectives and research questions. Moreover, a thematic analysis within scope of a research have signified importance of research questions and objective fulfillment of study’s outcome in a systematic way. 

5.1 Research Hypothesis     

Ha0 (Null Hypothesis): Occupational practices of physiotherapists do not lead to LBP and other musculoskeletal disorder

Ha1 (Alternative Hypothesis): Occupational practices of physiotherapists leads to LBP and other musculoskeletal disorder

Hb0 (Null Hypothesis): Occupational setting are the only cause for LBP in physiotherapists

Hb1 (Alternative Hypothesis): Occupational setting are not the only cause for LBP in physiotherapists 

5.2 Thematic analysis

Theme 1: Health issues faced by physiotherapists due to long working hours

Physical therapies as provided by a range of therapists is a collocation of a number of “rehabilitative health services” that often involve extensive pressure handling. Association with such consistent and highly physical strain involved job has made possible ways for physiotherapists to get accustomed to a number of musculoskeletal disorders. Through application of a number of “bivariate and multivariate analyses” differences between cause and symptoms of lower back pain and other associated musculoskeletal disorders have been considered (Çınar-Medeni, Elbasan & Duzgun, 2017). About 66.7% of overall LBP and neck pain events amongst physiotherapists occur from work related injuries while serving a range of patients with movement related disabilities (Tahir et al. 2020). 

Given the statistical dimensions as collected by a group of study, total number of estimated disabilities involved physiotherapists were are 355 within a single institute with about 51% male physiotherapists suffering from LBP and other relevant musculoskeletal disorders. This has been generally caused due to “manual medical lifts and patient lifting” of patients. This further accounted for an overall percentage of 56.8% (Lunde et al. 2019). Furthermore, it can be said that More than 88% of overall injuries have occurred due to prolonged working hours of physiotherapists in an awkward position in order to suffice through patient’s movement generation. More than 45% of women physiotherapists have been made accustomed to witness symptoms of medium to severe symptoms of LBP and other musculoskeletal disorders within 6 to 7 months or at most 1 year of their joining into the working sphere (Taulaniemi et al. 2020).

Furthermore, it has been noticed that physiotherapists who are accustomed to working premises within a “clinical setup” are 13% more at risk to get accustomed to LBP symptoms due to job demand. Other factors that have accompanied with working premieres and environment of healthcare conditions, factors such as “lifestyle and social living experiences’ ‘ also add up as a provocation element for persistent conditions of MSD disorders in physiotherapists (Vinstrup, 2019). Through an ultimate estimation of a number of causes, major ones were due to “massive weight lifting”, “repetition of similar tasks for a prolonged period”, “personal mental stress”, lack of employee diagnosis within physiotherapists. 

Factors such as “old age morbidity ratios” and “socio-demographic conditions” play a major role in determining severity of musculoskeletal disorders in physiotherapists. Due to working conditions of such therapists might cause “lack of spinal motion” that could be an entirely devastating role with “increased stress on back muscles” (Ekechukwu et al. 2020). Improper ways of handling patients with movement disabilities have also led to “muscle tension” at a specific area along with representative “fatigue, joint pain and strain as well as joint compression”. Furthermore, over 56.5% of physiotherapists have reported psychological stress to be a determinant factor of “lower back pain and other lumbar pains” (Maakip et al. 2020). Furthermore, it is important to mention that stress related symptoms of MSD and LBP are quite common in countries such as “South Africa, South Asian countries as well as Australia” (Bornhöft et al. 2019). This has further resulted in justification of “theory of stress” for relevant back pain which has been named as “Tension myositis syndrome or TMS”.

It is however, significant to mention that a number of “health care professionals” are similarly victims of such lower back and neck pain, owing to their job requirements. Furthermore, the job of physiotherapists to provide a number of “rehabilitative care” within a diverse range of highly disabling conditions is supposed to be the main reason for regressive health status of therapists. Other skills that require within job premises of “hands on” techniques are also reasons for such health severities. Techniques involving a number of “repetitive movements and prolonged standing and difficult postures” have caused further severities (Khan & Fasih, 2017)Over 4 million physiotherapists globally have gotten accustomed to such problems since their occupational practice sessions. Maintenance of a severe and consistent “static and dynamic posture” could also lead towards regression of overall physical conditions of physiotherapists. 

Moreover, it has been found that factors relevant to “age, height and weight” have contributed towards accentuation of severities regarding LBP and MSD diseases. More than 73% of LBP and MSD have been witnessed to occur among physiotherapists having heights of more than 5 feet 6 inches. This is mainly relevant to greater stress amplified over the spinal cord due greater need of bending down to patients’ level (Roy et al. 2018). Furthermore, it is essential to mention that people with greater amounts of obesity and higher BMI weight are supposed to be more affected by the working conditions of physiotherapy than others. Similar cause of such conditions is due to inability of moving with lesser amount of flexibility. In addition, the overweight and lifestyle of obese people would be affecting physical conditions of a particular physiotherapists to a much larger extent few to exertion of excess body weight over the spine and other vertebrates.    

Theme 2: Ways to deal with LBP and other musculoskeletal disorders amongst physiotherapists

“Work related musculoskeletal disorder” or WRMD are one of the most significant conditions that are often faced by physiotherapists. Furthermore, it is important to know that WMSDs and injuries relevant to it are mostly concerned with development and “exacerbation of painful symptoms” that would allow for contributing to more severe health outcomes in therapists. This could be added up through consistent repetition of activities that lead towards “strain to the nervous system of the human body” along with “ligaments, muscles, tendons, joints and spinal discs’ ‘ (Maakip et al. 2020).  It is essential for the hospital and therapeutic institutions to look after physical stains caused upon their staff and practitioners with ample amount of focus upon “cumulative trauma disorders’ ‘ and development of a “overuse syndrome”. Furthermore, it is essential to consider that overexertion of just the upper limbs of the human body used for this profession could significantly add up to extremities caused in musculoskeletal situations. Maintenance of a standard within hospital and therapeutic institutions would thus be necessary and assertive of hospital’s recognising capacity of staff and healthcare professionals current state of being. 

Through formulation of a set of guidelines based upon “European Agency for Safety and Health at Work (EU-OSHA)” healthcare services could be amplified with an accentuated focus on health and wellbeing of physiotherapists. Increasing rates of MSD and LBP as well as other traces of lumbar pain have resulted in a rise of 12 million more hospitalisation cases of severe and chronic LBP in countries such as the UK and Australia. This has further added up to expenditure and the rise of economic costs up to 44.6 billion Euros to about 56.7 billion Euros (Khan & Fasih, 2017). Thus, identifying some basic and general number of risk factors are quite necessary in assuming a successful positive healthcare environment in countries such as the UK, Australia and South Africa. 

So, in order to focus upon reduction of statistics that would give rise to a number of ways in accommodating for a healthy lifestyle and postural ability of physiotherapists within working premises is a significant necessity. Furthermore, it is necessary that employers take consideration of a number of factors in avoiding greater risks of work-related hazards. Encouragement of an open discussion forum could be one of the greatest factors that would help in reduction of LBP causing factors in healthcare institutions would be through inclusion of a “minimal lifting approach” and accommodation of proper knowledge and training on accurate use of equipment facilities (Maakip et al. 2020). Adequate staffing would also be a major factor for identification of whether a number of physiotherapists would comply in companies with a good way of managing working hours along with appropriate detection and early diagnosis of MSD related symptoms. 

Regular re-evaluation on employers’ part would be exceptionally effective in measuring “content and frequency” of training courses. Especially through the constitution of a group of newly hired and young personnel for PT’s need to be strongly administered through feedback of training exercises (Maakip et al. 2020). Application of an “aggressive ergonomic evaluation” could be of high benefit for a particular healthcare firm in amplifying working conditions of its constituent physiotherapists. Based on guidelines of “NIOSH or National Institute for Occupational Safety and Health” application of spinal compression needs to be regulated within working activities of physiotherapists (Khan & Fasih, 2017). Furthermore, it is essential for a health institution to take care of ways in which high lifting techniques can be accommodated through proper training and setting up of lifting weight limits for staff working with alignment of their physical variability and conditions. 

It is important to mention that at present human society has not come up with any “targeted therapies for MSD” with a “supportive and symptoms based” treatment formula. However, in order to care for physiotherapists that have shown symptoms of MSD, a multidisciplinary setting of team could be highly efficient in considering prolonged effect of MSD over physiotherapists (Maakip et al. 2020). Consideration of a “broad spectrum” constituting a comprehensive approach could result in accentuation of high levels of neurological actions and improved metabolism in patients suffering from acute MSD and back pain (Khan & Fasih, 2017). Application of MRI could be highly beneficial for acknowledging the rate of “MSD variables and nonspecific symptoms’ ‘ within physiotherapists“. Alongside to this, hospitals might take consideration of withstanding early evaluation of MSD symptoms through “physical occupational interventions, speech therapy and maximising amount of mobility and communication”. 

Theme 3: Recommendations for resolving these issues 

Prolonged symptoms of MSD could cause heavy impact upon conditions of physiotherapists regarding their “muscles, bones, and joints”. MSDs have been noted to be of various kinds including “tendinitis, carpal tunnel syndrome, Osteoarthritis, rheumatoid arthritis RA and fibromyalgia or even bone fracture” (Vinstrup, 2019). It is confident damage to physical and bone structures of specific action related diseases that could deteriorate basic lumbar spinal conditions of a human being. Early diagnosis is one of the most significantly effective ways of taking care of easy symptoms and facilitating improvement of “long term outlook” on MSD conditions. Diagnostic signs of MSD could be accumulated through provision of regular and timely check-ups and provision of a “physical examination system” (Maakip et al. 2020). Symptoms such as “muscle weakness and atrophy” could be diagnosed with imaging tests. Provision of such imaging tests such as “X rays and MRI scans” with proper examination of “bones and soft tissue structures” (Vinstrup, 2019).

Awareness system within working premises of physiotherapists would be another important factor that needs to be taken care of, by parent institutions under which physiotherapists function. Furthermore, it is important to know that through application of moderate exercises, one would be able to encapsulate improvements within initial conditions of physiotherapists (Maakip et al. 2020). Furthermore, the healthcare firm could also provide for “over-the-counter medication provision” to its therapists such as “ibuprofen and acetaminophen” in order to avoid occasional existence of pain. Both “physical and occupational therapy” would be highly recommended” in this section (Vinstrup, 2019). Through application of such therapies within hospital premises, other staff would also be able to identify common causes and problems of MSDs. Such therapies could in turn help in reduction of “pain or discomfort along with maintenance of strength or particular range of motion”.

Maintenance of a healthy and effective lifestyle would be another necessary component that needed to be taken care of by hospitals and intrinsic members. Furthermore, several therapeutic conditions have been administered in recent years in order to manage issues relevant to musculoskeletal and other vertebral conditions. Use of regenerative medicines could be yet another significant step at countering scope of modifying acute MSDs onto a chronic one (Khan & Fasih, 2017). Furthermore, through regenerative medicines growth factors could be stopped along with alignment of “mesenchymal cell therapy” used for augmented healing of MSD and lower back pains. Hospital staff should be well acquainted with physiotherapeutic medications and testing facilities that could be amplified for determination of pain index in physiotherapists. (Vinstrup, 2019). Identification of “weight bearing cause” could suffice for accentuation of better healthcare premises for physiotherapists to work within. All of such findings could be later amplified and used for generation of historical indicators for a patient’s physical state.

Through use of a “computerised gait analysis system” a particular hospital would be able to quantify the number of ways in which localisation of pain could be administered. Furthermore, severity of “soft tissue structures and bones” could be administered through application of “radiography, MRI or CT scans and even nuclear imaging techniques” (Maakip et al. 2020). Furthermore, being a part of the hospital arena, it would be useful for physiotherapists to get a check-up done immediately through either conventional scans and imaging techniques and in severe cases even “synovial fluid analysis” could also be accommodated for development of a “prognosis based on earlier diagnosis”. This would in turn help physiotherapists to help in administration of “restricted or modified activities’‘ with immobilisation of “acute and chronic injured structures” (Khan & Fasih, 2017). Apart from these kinds of therapeutic and detection-based disorders of MSD and lower back pain in physiotherapists would be through application of NSAIDs and even “corticosteroid administration” for severe cases. Furthermore, hospitals might provide for a chance of ‘physical therapies, or extracorporeal shock wave therapy” and in certain cases even surgical repairs for curing staffs moderate to severe MSD por other kinds of WRMD within hospital premises.               

Theme 4: Responsibilities of healthcare institutions in coping up with such health anomalies 

Hospitals need to be well aware of working conditions that lead towards decreasing efficiency of physiotherapists because of a musculoskeletal syndrome. Repetitive labour could be effectively reduced by the hospital authority to take care of a “less labour-intensive working condition”. Application of robots could be an essential step in undermining efficiency in jobs that involve higher manual handling of weights at large scale therapeutic institutions. Individual risk factors need to be identified with proper care of physiotherapists’ health conditions such as “individual BMIs and presence of co-morbidities” (Taulaniemi et al. 2020). 

Based on guidelines of OSHA and NIOSH working regulations should be compliant with corporate social responsibility in taking utmost significance to workers’ occupational health and safety. Inadequacy on “injury prevention” training needs to take into considerations by administrative officials within a therapeutic institution.  Furthermore, such health care centres need to be assertive of systems that would take a judgemental step of reducing psychological stress factors leading to severity of MSD based working conditions (Taulaniemi et al. 2020). Factors such as “low working content, time pressure and high perceived working load, perceived amount of stress and psychological stresses” are certain indicators of causing severity in lower back pain and other lumbar spine pains.     

In order to avoid more than 5.5 billion Euros of total economic cost spent behind provision of financial concession to staff suffering from MSD and lower back pain could be avoided through initial adoption of intervention measures. Through utilisation of “administrative time dealing” and training of injury prevention as well as early rehabilitation, hospitals and therapeutic institutions could avoid scope of future anomalies in physiotherapists. Application of a risk assessment in this regard would be able to retain at least 65% of overall normalcy into physiotherapists physical health status (Taulaniemi et al. 2020).  

Through undermining employer’s responsibilities about ways in which employee communication could be enhanced, prevention measures could be applicable. Application of an “adequate staffing measure” would be equally suitable for taking control of a “re-evaluation of staff’s physical and historical records” along with their ergonomic evaluation. Training of “body mechanics” accompanied with “back care training” would be necessary for implementation of a highly saturated and structured prevention program (Taulaniemi et al. 2020). Consideration of a number of feasible measures along with provision of an integral training system within physiotherapists about ways to handle excess weight and asking for help would in turn reduce scope of such physical trauma.  

Application of a “custom training system” with safe use of proper equipment, training for sustained posture management and controlling “caseload variations” need to be considered. Activities that could be made an integral part of such training would be application of a “cognitive behavioural theory” along with training regarding “patient centred goal setting, graded exposure and gradual systematic progression” (Taulaniemi et al. 2020). Application of “promoted micro breaks” would also be an essential element of increasing entire operational productivity.  

5.3 Hypothesis justification 

Based on the above discussion hence it can be said that various occupational factors have been witnessed to be primary cause of degrading MSD conditions. Thus, hypothesis Ha1 (Alternative Hypothesis) is justified. On the other hand, it has been said that not just occupational settings however other factors such as mental health and stress could also lead up to regressive state of lower back pain and other MSD diseases. Thus, Hb1 (Alternative Hypothesis) has been proven right through this discussion.

5.4 Summary 

Hence, based upon the above discussion major issues of musculoskeletal disorders have been notified along with identification of processes that could help in successful countering of such conditions among physiotherapists. This section has thereby significantly contributed towards identification of major themes of the entire study based upon research questions and provide ultimate justification for two research hypotheses.  

Chapter 6

6.0 Introduction 

This section is based primarily upon factual information collocated within the systematic literature and accompanies a number of conclusive statements that would help in further research in concerned subject matter. The conclusion section is a summation of major study outcomes that has shaped the entire basis of study’s validity and contextuality. Through studying this chapter, one would be able to justify key objectives that have been drafted at the preliminary section of this study. Verification of aim and objectives of the entire study has been carried out in this section significantly.  

6.1 Summary of review findings 

Through systematic review of this study and entirety of entire subject matter could be significantly established. Based on the amount of literature this study has dealt with, it can be found that musculoskeletal disorders among physiotherapists could be due to the major amount of “physical efforts” that physiotherapists constantly put through their occupational jobs. This has made physiotherapists to be more susceptible to a wide number of lumbar spinal defects and chronic disability in certain cases. Prevalence rates as obtained from studying a number of academic literatures has portrayed that more than 66% of cases belong from the UK and 61% from USA, while the rest 98% cases are from Australia and 91.3% of cases are from Nigeria. Another significant reason that has been associated for degradation of such physical ailments among therapists round world is due to increasing prevalence of job pressure and need for administering maximum number of “manual effort” for treating their patients. Risk factors that have been studied are majorly witnessed to be due to continuous exertion of force, “continuous bending, patient transfer, sudden unanticipated movements and lack of physiotherapeutic assistance for themselves”.

Based upon the table of findings it can be clearly noticeable that a number of intervention measures could be adopted by healthcare industries in order to take care of occupational hazards relevant to LBP and WRMD. These could range from a number of separate multi-disciplinary programs such as “patient outcome recorded measurements” and “chiropractic therapy” and many more. However, it is important to note that in order to gain an intervention measure functional within a particular occupational environment, objectifying key measures and infrastructures required for painting out deliberate provision of satisfactory healthcare support to therapists. 

More than 84.4% of UK’s therapists are subjected to denial of proper healthcare acknowledgements that further lead towards getting subjected to severe and chronic LBP syndromes. About 44.4% of therapists do not get proper provision of work-related training in Nigeria that accounts for more than 3 million physiotherapists suffering from a lifetime spinal anomalies and constant pain. One of the air concerns that has been identified in this context is that 48% of physiotherapists undergoing such ailments belonged from the age group 26 to 31 years. 

Concerns over MSDs due to occupational setting is as valid as concerns for implementation of adequate health care policies. For instance, application of “Quality, innovation, productivity and Prevention” or QIPP has been one of the major initiatives taken by British healthcare system for endorsing   

6.2 Linking with objectives 

Objective 1: To understand the health issues among physiotherapists

 Based on the above discussion and a number of analyses it has been clearly evident that prolongation of a career as a physiotherapist, deeply affects the health conditions of these health professionals. Furthermore, it has been found that factors relevant to Lower Back Pain and other musculoskeletal disorders amongst physiotherapists have also been caused due to riding mental stress and occupational pressure and strict working conditions. 60% of overall physiotherapists in their entire lifetime have one way or other faced grave anomalies regarding back related injuries. 

Objective 2: To explore the causes and effects of neck and back pain in the physiotherapy profession 

Furthermore, in this study, a number of primary literatures have shown evidential proof on relevance of age and working conditions in worsening MSD related conditions of physiotherapists. Through application of such literature, this study has significantly fulfilled its second objective and has confounded factors associated with “neck and back pain”. It has been found that factors such as “age, phase course, BMI and even psychometric elements” add up to regression of such physical ailment related conditions.  

Objective 3:  To come up with recommendations to resolve the issues 

Through study of a vast number of literatures, this study has come up with a number of intervention measures on both employee and employer’s part. This has enabled the fulfillment of study’s third objective. This study has significantly added on notifying benefits of following “OSHA guidelines”, ““Benchmarking Controlled Trial (BCT) design”, physiotherapists training and various sorts of activity promotion techniques in order to acknowledge graveness of the situation and allow for a better occupational standard for physiotherapists at hospital. 

6.3 Recommendations and findings 

The work-related musculoskeletal disease can vary through different factors such as age, sex, timer pressure and marital status. As a mitigation plan, it can be said that time of workplace spending needs to be reduced in a workplace. In UK, 83.3% of the employees used to face low back pain. Thus, it is identified that healthy activities such as physiotherapy, exercise need to be increased in order to manage this disease. Maintenance of following recommendations would thereby be necessary in this context.

  • Carrying out occupational “Nordic Musculoskeletal survey” for physiotherapists in hospitals  
  • Following of OSHA guidelines 
  • Provision of treatment through “acupuncture, spinal manipulation, and psychotherapy”
  • Provide long-leave on case of severities in situation  
  • Consideration of “behaviour therapy, pharmaceutical and non-pharmaceutical treatments” 

6.4 Summary 

This entire section sums up key contents of entire research and adds relevance to set objectives of the study. Furthermore, through inclusion of a number of recommendations this section serves as a conclusive one for the entire research work. from the analysis it is understood that more than 57.4% of overall hospital and therapeutic training centres have lagged such infrastructural requirements along with improper and inadequate requirements for trained staff and appropriate knowledge of working conditions. Thus, this study has significantly contributed towards satisfying above objectives to its fullest. In doing so this study has significantly dealt with a number of literatures informing about health issues of physiotherapists. 


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