Musculoskeletal Health of Hairdressers - Protection of Occupational Health and Safety at Workplace - ErgoHair
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Musculoskeletal Health of Hairdressers –
Protection of Occupational Health and Safety
at Workplace
Medical Reference Document
Imprint Contents
Abstract Scoping Review........................................................................................................4
Introduction................................................................................................................................5
1.
The hairdressing sector in Europe..................................................................................6
1.1. European efforts to strengthen occupational health and safety
Authors: protection............................................................................................................8
Agnessa Kozak1 1.2. Social dialogue efforts within the hairdressing sector....................................8
Claudia Wohlert1
Tanja Wirth1 2.The musculoskeletal system.......................................................................................10
Olaf Kleinmüller1 2.1. Structure and function.....................................................................................10
Miet Verhamme2 2.2. Musculoskeletal disorders (MSD)....................................................................11
Rainer Röhr 3 2.2.1. Work-related MSD.................................................................................11
Albert Nienhaus1,4 2.2.2. Risk factors for MSD..............................................................................13
2.2.3. Economic relevance..............................................................................19
1
University Medical Centre Hamburg-Eppendorf, Competence Centre for Epidemiology 2.2.4. The economic benefit of MSD prevention within companies...........21
and Health Services Research for Healthcare Professionals (CVcare), Hamburg, Germany
3.Scoping review on musculoskeletal health of hairdressers....................................22
2
Unie van Belgische Kappers vzw, Gent, Belgium 3.1. Background......................................................................................................22
3.2. Methods............................................................................................................24
3
The German Confederation of Skilled Crafts, Germany (former CEO (2004-2014) and 3.3. Results..............................................................................................................25
former secretary of Coiffure EU) 3.3.1. Prevalence of musculoskeletal disorders...........................................26
3.3.2. Reasons for leaving the trade...............................................................26
4
Department of Occupational Medicine, Hazardous Substances and Public Health, Ins- 3.3.3. Comparative findings............................................................................27
titution for Statutory Accident Insurance and Prevention in the Health and Welfare Servi- 3.3.4. Work-related risk factors......................................................................27
ces (BGW), Hamburg, Germany 3.3.5. Preventive and rehabilitative approaches to prevent or reduce
MSD.......................................................................................................29
Design and implementation: 3.3.6. Strategies and barriers to reduce or prevent MSD.............................31
in.signo GmbH, Hamburg, Germany 3.4. Discussion........................................................................................................32
3.5. Conclusions......................................................................................................33
Picture credits:
Fotolia/LIGHTFIELD STUDIOS (Cover), iStock/Nastasic (p. 5), freepik.com (p. 6-7), 4. Outcomes of the workshops in Hamburg and Paris – ergoHair project................34
Fotolia/Leonid (p. 9), Fotolia/DenisProduction.com (p. 14), iStock/robertprzybysz (p. 17),
Fotolia/Jacob Lund (p. 20), iStock/dimid_86 (p. 22-23), Fotolia/JackF (p. 30, 39), Fotolia/ 5.Ergonomic and organizational approaches to prevention......................................40
Maksim Shebeko (p. 34-35), Fotolia/phpetrunina14 (p. 40-41), Fotolia/pololia (p. 49), 5.1. Outcomes of the ergoHair project workshops..............................................42
iStock/DjelicS (p. 78-79) 5.1.1. Prevention in training and continuing professional
development..........................................................................................42
Funding: 5.1.2. Ergonomic design and equipment......................................................43
This project was funded by the European Union (Reference VS/2017/0077) 5.1.3. Ergonomic working...............................................................................45
5.1.4. General organizational conditions in the workplace..........................46
Publication date: 5.1.5. Risk assessment...................................................................................47
4. April 2019 5.2. Musculoskeletal complaints during pregnancy.............................................49
6. Annex............................................................................................................................50
7. References....................................................................................................................66
3
Abstract Scoping Review ween European committees for social dia- Section 2 is dedicated to the anatomical
logue within the sector. By doing so, it con- structure and functions of the musculoske-
tributes to the harmonization of occu- letal system and work-related MSD. The
pational health and safety with a particular prevalence of work-related MSD, multifac-
Objective Hairdressers are exposed to regions or exhibited a greater risk of leaving focus on ergonomic workplace design and torial risk factors and the cost of this health
conditions that can cause or exacerbate the profession for health reasons. Common equipment. Furthermore, it aims to help problem are presented in detail. Further-
musculoskeletal disorders (MSD). The pur- risk factors include working with arms promote effective, ergonomic work proces- more, there is a discussion of the economic
pose of this scoping review is to gain above shoulder level, repetitive movements, ses. The overarching goal is to raise awa- benefits of preventive measures to counter
insight into the current state of research on forceful exertion of upper extremities, awk- reness of the stresses and strains faced by MSD at work.
MSD in hairdressing. ward back postures and movements, high hairdressers and consequently reduce the
mechanical workload and standing. The number of work-related musculoskeletal Section 3 presents the systematic litera-
Methods Studies published up to May effect of these risk factors can be enhanced disorders (MSD) and conditions (MSC) in ture appraisal (scoping review) completed
2017 (Update Nov, 2018) were identified by by the lack of adequate breaks, high wor- this sector throughout Europe by develo- as part of the ergoHair project. In line with
a systematic search using electronic data- kload, and general distress. Six rehabilita- ping and disseminating preventative ergo- the aims of the project, the collated studies
bases (MEDLINE, PUBMED, CINAHL, Web tive and preventive intervention studies nomic measures and standards in a target provided the scientific basis for the initia-
of Science, LIVIVO), Google Scholar and were found. Only the rehabilitative studies group-specific fashion. tive. The epidemiological insights delivered
reference lists of articles. Studies were showed positive effects on the manage- by these studies allow conclusions to be
screened by two researchers and synthe- ment of physical and mental strain and The project builds on the European frame- drawn about the occupational and health-
sized in a narrative and quantitative man- resulted in significant pain reduction, incre- work agreement on the protection of occu- related stresses and strains encountered
ner. Pooled effect estimates for 12-month ased physical capacity and knowledge of pational health and safety in the hairdres- by hairdressers and clearly indicate that
and point prevalence of MSD were calcu- potential risk factors for MSD. sing sector, signed in 2016. The objectives there should be a stronger focus on steps
lated, using random effects models. identified in this agreement are to contri- to protect occupational health and safety
Conclusion These data provide some evi- bute to the development of a collective, both at work and in educational settings.
Results Overall 44 studies were included. dence for work-related risk factors for MSD research-based European standard for
Nineteen studies reported MSD prevalence: in hairdressers and indicate that there protecting health and safety in the work- Section 4 compiles further research results
the highest 12-month prevalence was found should be an intense focus on preventive place. One of the five focal issues is the that were presented in the workshops in
for the lower back 48% (95% CI 35.5-59.5), technical, organizational and individual prevention of MSD. The parties who make Hamburg and Paris.
neck 43% (95% CI 31.0-55.1), shoulders measures for health and safety at work. up the signatories to the agreement are
42% (95% CI 30.1-53.2) and hand/wrists High quality and long-term intervention particularly concerned with communica- Section 5 then collates suggestions and
32% (95% CI 22.2-40.8). In comparison to studies are needed to clarify the effective- ting at the earliest possible opportunity the recommendations for promoting healthy
other occupational groups, hairdressers ness of complex preventive concepts in need for preventative and health-promo- and safe working conditions for hairdres-
reported more frequent MSD in all body hairdressing. ting behaviour in the workplace. This sers by designing ergonomic workplaces
encompasses issues such as product and work processes.
acquisition, workflow organization and the
treatment of employees. The aim of this
medical reference document is to provide
professionals in the hairdressing sector
Introduction with a guideline listing the criteria which
should be taken into account when deve-
loping a healthy work environment.
The objective of the project “Development proposals contained in the social partners’ Section 1 contains a description of the
and promotion of a healthy and safe wor- agreement regarding the development of a hairdressing sector in Europe and the gene-
king environment through the design of healthy and safe work environment in the ral approaches taken by both the European
ergonomic workplaces and work proces- hairdressing sector [1, 2]. To accomplish Union and the social partners from within
ses in the hairdressing sector” (ergoHair) this, it aims to strengthen synergies and the industry to strengthen the protection of
is the uniform implementation of the core promote the exchange of information bet- occupational health and safety.
4 5
1 1
The hairdressing sector in Europe
The hairdressing sector in Europe consists primarily of small and micro busines-
ses. There are an estimated 400,000 hair salons with approximately one million
hairdressers. That is equivalent to around 0.4–0.8% of a country’s employees [3,
4]. Self-employment is widespread in the hairdressing sector. According to a study
of eight EU Member States1, around 50–60% of all hair salons are run by self-
employed stylists without any employees. The growth rate for hairdressing busi-
nesses is between 12% and 149% in EU countries. Italy, Germany and France have
the largest number of businesses. Alongside one-person salons, the number of
companies that run hairdressing chains or offer franchises is also on the rise [4].
In Germany, these are believed to account for a 15% share of all hairdressing busi-
nesses [5]. The majority of employees are women: in most countries, 9 out of 10
hairdressers are female. Compared with other sectors, young people are over-
represented in hairdressing; more than half of employees are below the age of 34
[4]. This industry is also hallmarked by a large proportion of part-time workers
(approximately 40%) [3]. However, there are considerable differences between
countries in this respect. In the Netherlands, for instance, 70% of hairdressers are
part-time, compared with just 9% in Hungary. The sector is also characterized by
high staff turnover. In the Netherlands and the United Kingdom, around 16% and
14% of employees respectively leave their job within a year [4]. In Denmark, hair-
dressers spend an average of 8.4 years in the profession (including time spent in
training) [6].
Denmark, France, Germany, Hungary, Italy, the Netherlands, Slovenia, United Kingdom
1
6 7
1.1. European efforts to
1 strengthen occupational health
Health protection became a key issue for
the hairdressing industry back in the 90s.
various target groups – such as instructors,
teachers, workers and salon managers –
ped protection measures and require a
knowledge of them as part of hairdressing
1
and safety protection This was triggered by a rise in work-related could implement the social partners’ training and in professional tests and final
skin conditions since the late 80s (e.g. in agreements at national level. In response examinations [10]. According to the social
Preventing or minimizing physical hazards Germany), which forced many hairdressers to this call, Osnabrück University comple- dialogue participants, the number of skin
in the workplace is a fixed part of the EU to leave the profession. As long ago as ted the projects Safehair 1.0 and 2.0 bet- disorders reported in the hairdressing
Member States’ occupational health and 2001, CIC Europa – the predecessor of ween 2009 and 2012 on behalf of the social industry has fallen sharply as a conse-
safety policy. Article 153 of the Treaty on Coiffure EU – and UNI Europa Hair & partners and the European Commission. quence of the joint efforts. Furthermore, in
the Functioning of the European Union (EU) Beauty agreed on a set of guidelines for The key outcome of the projects was a 2014, EU-OSHA and the social partners
authorizes the European Council to impose working conditions. The corresponding list voluntary commitment on the part of the developed an online risk assessment tool,
minimum requirements by means of direc- of demands included key elements of the social partners – agreed in the Declaration OiRA, for the hairdressing sector [11].
tives to ensure that steps are taken to better European agreement on the protection of of Dresden – to uphold the jointly develo-
protect workers’ health and safety. The health in the hairdressing sector which was
legal requirements differ between EU Mem- subsequently signed in 2012. In 2011, the
ber States. Each state has leeway and can social partners began discussing a more
establish stricter regulations for the protec- concrete health protection agreement
tion of workers and their interests when it covering a wider range of issues. This
incorporates directives into national legis- agreement was signed in April 2012 in the
lation [7]. Directive 89/391/EEC explicitly presence of the then Commissioner for
makes employers responsible for individu- Employment, Social Af-fairs and Inclusion,
ally adapting the working environment with László Andor. It covers the following areas:
regard to workplace design, the choice of • Use of substances, products and tools
equipment/materials and the choice of pro- • Protection of the skin and respiratory
duction methods [8]. In its priorities for tracts
occupational safety and health research for • Prevention of musculoskeletal disorders
the period 2013–2020, the European • Working environment and work organi-
Agency for Safety and Health at Work (EU- zation
OSHA) recommends developing and imple- • Maternity protection
menting multidimensional ergonomic mea- • Mental health
sures which take individual, technical and
organizational aspects into account [9]. The European Commission was asked to
transpose this agreement into a European
directive, making it mandatory for all hair-
1.2. Social dialogue efforts dressing businesses. This request has not
within the hairdressing sector yet been fulfilled because a number of
Member States objected to parts of the
Social dialogue is a fundamental part of the agreement. Following renewed negotia-
European social model whose legal basis tions, a revised framework agreement on
is set down in Articles 151–156 of the Treaty the protection of occupational health and
on the Functioning of the European Union safety was signed in June 2016 [1, 2]. This
[7]. Various European hairdressing organi- focuses primarily on protecting the skin
zations participated in this dialogue. These and respiratory tracts and preventing MSD.
were Coiffure EU on the employer side and With regard to work-related skin disorders,
UNI Europa Hair & Beauty on the employee the social dialogue originally called for a
side. The social dialogue centred above all European research project to be initiated.
on two issues: harmonizing vocational trai- Based on scientific findings, this research
ning and protecting workers’ health. project was to issue statements on how the
8 9
The musculoskeletal system 2.2. Musculoskeletal disorders cal and psychomental effects of working in
(MSD) a particular profession and the associated
2 The term “musculoskeletal disorders” co-
overloading or incorrect loading of the loco-
motor system [23-26]. There are many
2
2.1. Structure and function of exercise can prompt degenerative chan- vers a variety of degenerative and inflamm- forms of work-related MSD (figure 1). The
ges – also known as osteo-arthritis – espe- atory injuries and conditions affecting the World Health Organization (WHO) defines
Together, the skeletal elements, joints and cially in older people [13]. locomotor system. They affect both passive these as the interplay of various factors
skeletal muscles make up the locomotor and active structures. These disorders range from the work environment which contri-
system. The body’s supportive framework The active locomotor system consists of from mild short-term symptoms (e.g. tight bute significantly to causing and/or exacer-
consists of bony and cartilaginous skeletal muscles, tendons and ligaments. They are muscles resulting from overloading or incor- bating MSD to different extents [15]. Kro-
elements which are held together by con- primarily responsible for active movement rect loading) to irreversible, chronic condi- emer (1989) defines three stages of
nective tissue. Skeletal muscles move and maintaining an upright posture via tions (e.g. osteo-arthritis). Damage to the work-related MSD: Stage 1: symptoms are
parts of the skeleton or hold them in a cer- voluntary and involuntary contraction and musculoskeletal system occurs when exter- experienced at work but go away; Stage 2:
tain position. The locomotor system is divi- relaxation of the muscles. nal mechanical loads exceed the maximum symptoms last overnight after a day at work;
ded into active and passive structures. The load-bearing capacity of the individual struc- Stage 3: symptoms continue at rest, disturb
bones, joints and cartilage of the skeletal Muscle: There are more than 400 muscles tures within the body [15]. Pain is the primary sleep and last for months or years [27].
system are classed as passive structures in the human body; they make up approxi- symptom of MSD. There are two types of
[13]. They fulfil the following main functions: mately 45% of the body mass. There are pain: acute and chronic. Acute pain acts as The proportion of work-related MSD can only
• Supporting and acting as levers for three basic types of muscle: skeletal a biological warning to prevent further be estimated roughly due to their predomi-
muscles muscle, smooth muscle (e.g. walls of the damage to the locomotor system. Chronic nantly multicausal genesis and high preva-
• Protecting other organs (e.g. ribcage gastrointestinal tract) and cardiac muscle. pain has moved beyond this point and impe- lence among the general population [28]. In
protects the heart and lungs) Unlike the other types, skeletal muscle is des the patient’s use of their locomotor sys- industrialized nations, around a third of all
• Storing the minerals calcium and phos- controlled by a voluntary nerve impulse. At tem [16]. This results in high, intangible costs sickness-related absences are attributable to
phate rest, skeletal muscle accounts for 20–25% for the patient, such as restricted physical MSD. Conditions or injuries affecting the back
• Producing blood cells in the bone mar- of energy expenditure [12, 13]. There are function or a lower quality of life [17, 18]. Pati- account for approximately 60% of these.
row [12] gender-specific differences too: men have ents are also less able to work and less pro- They are followed by conditions affecting the
a higher muscle mass than women (30 kg ductive as a consequence [19]. The condi- upper extremities, which are also referred to
Bones: An adult’s skeleton is made up of versus 24 kg on average). This means that tions and symptoms are heterogeneous; collectively as repetitive strain injuries or
approximately 200 bones. Its shape is women only have 65% as much physical they vary considerably depending on their cumulative trauma disorders [15]. In the
determined genetically, while the inner strength as men [12, 14]. location2 and the tissue structure affected Labour Force Survey (EU-27), 8.6% of wor- 2
(1) Upper extremities,
[20]. Musculoskeletal disorders are among (2) cervical vertebrae
structure is influenced by external factors kers (20 million people) reported work-related
(C1–C7),
(e.g. a healthy diet, a supply of calcium and Tendons and additional structures : the most widespread conditions within the health problems in the previous 12 months; (3) thoracic vertebrae
vitamin D, and balanced weight bearing) When muscles contract, tendons joining population. Population surveys conducted most of these were complaints affecting the (Th1–Th12),
worldwide (n = 23) show that between 13.5% (4) lumbar vertebrae (L1–L5)
[12]. the bone to the muscles transmit the force locomotor system [29]. According to the
and
to the skeleton. They consist of tough, fib- and 47% of the general population is affec- European Occupational Disease Statistics
(5) lower extremities[20]
Joints and cartilage: Joints connect car- rous collagen tissue. Depending on the ted by chronic musculoskeletal pain [21]. A (2005), work-related MSD accounted for the
tilaginous and/or bony skeletal structures location, shape and architecture of the recent Europe-wide survey found that back largest share – 38% – of all occupational
and allow the individual parts of the trunk muscle, tendons are classed as tensile ten- pain (43%) and muscular pain in the arms diseases in 12 EU Member States. The inclu-
and the extremities to move. They also dons, compressive tendons or aponeuro- (41%) were by far the most common comp- sion of carpal tunnel syndrome (CTS) takes
serve to transfer energy. Most articulating ses [13]. When muscles work, friction is laints. Women reported MSD significantly this percentage up to 59% [30]. The ten most
surfaces are covered with hyaline cartilage generated. Additional structures such as more frequently than men [22]. common occupational diseases for the
and surrounded by a cavity which is filled muscle fascia, tendon sheaths, bursae and reporting years 2001–2007 include CTS and
with synovial fluid and encased in a joint sesamoid bones are very important in mini- conditions affecting the muscular and tendi-
capsule. The cartilage receives an optimum mizing the energy, which is expended as a 2.2.1. Work-related MSD nous insertions, the tendon sheaths (e.g. ten-
supply of nutrients when it is regularly result [12, 13]. dosynovitis, epicondylitis) and the angioneu-
worked and relaxed by means of move- Epidemiological studies provide sufficient roses, which are caused by mechanical
ment. High unilateral load carrying or a lack evidence that MSD is caused by the physi- stresses (e.g. Raynaud’s syndrome) [31].
10 11
2.2.2. Risk factors for MSD models. Along with occupational demands,
these include genetic predispositions,
2 Epidemiological studies have sufficiently
documented that there is an above-ave-
social factors, levels of training and pro-
ductivity, and stress perception and resis-
2
rage occurrence of degenerative MSD in tance [16] (figure 2). However, not all of
occupations where workers are exposed to these are risk factors as such, i.e. factors
considerable physical strains [23, 25, 26, which contribute towards causing MSD.
35, 36]. However, the ways in which MSD Reference is increasingly made to risk indi-
is explained and viewed have evolved sub- cators which are frequently observed in
stantially in recent years: instead of focu- association with the symptoms, such as
sing solely on biomechanically based cau- work dissatisfaction or lack of gratification
sality theories, there has been a shift to- [12].
wards complex biopsychosocial disease
Neck Back Shoulder
Socio-economic factors Behavioral factors
• Cervical spondylosis • Interverterbral disc disorders • Rotator cuff syndrome
• Thoracic outlet syndrome • Back pain • Bicipital tendinitis • Social class • Physical inactivity
• Tension neck syndrome • Shoulder capsulitis • Age • Malnutrition and malnourish-
• Education ment
• Labour status/unemployment • Tobacco use
Structural factors
Work-related factors • Potential tripping hazards
• Trade sector
• Overload/incorrect loading
Musculoskeletal
• Psychosocial stress
disorders
• Lack of gratification Physical constraints/
• Work dissatisfaction pre-existing conditions
• Lack of social support
• Overweight/obesity
• Sport injuries
• Accidents
Elbow Hand Hip/Knee • Impairment of senses
• Lateral epicondylitis • Carpal Tunnel Syndrome • Hip osteoarthritis
• Medial epicondylitis • DeQuervain‘s disease • Knee osteoarthritis
• Cubital/Radial • Wrist Tenosynovitis • Meniscus injury Psychological factors
Tunnel Syndrome • Hand-Arm-Vibration • Bursitis
• Depressive disorders Health competence
• Non-specific forearm pain Syndrome
• Fear or anxiety
• Trigger finger
• Stress, family pressures • Low health awareness
Figure 1: MSD which can be caused by biomechanical factors (modified from the ILO [32]; Mani & Gerr [33]; Sluiter et al. [34]) Figure 2: Potential influential factors for musculoskeletal impairment and conditions, modified from Walter & Plaumann [12]
12 13
Table 1: Reasonable evidence risk factors for MSD
Work-related risk factors with reasonable evidence
of a causal relationship
2 2
Body region biomechanical psychosocial individual
Neck • awkward posture • low level of work • female gender
satisfaction and • co-morbidity
support
• smoking
• high level of distress
Lower back • awkward posture • negative affectivity • younger age
• heavy physical work • low level of job control • high BMI
• lifting • high psychological
demands
• high work dissatis-
faction
Shoulder • heavy physical work • high levels of distress
• performing monotonous
work
• low level of job control
Elbow • prolonged computer • co-morbidities
work • older age
• heavy physical work
• awkward posture
• repetitive work
Wrist/hand • prolonged computer • high BMI
work • older age
• heavy physical work • female gender
• awkward posture
• repetitive work
A systematic review of longitudinal studies Biomechanical risk factors
Hip • lifting
in various professional groups examined Exposure to biomechanical risk factors at
the influence of work-related and individual work – such as awkward forced postures, • heavy physical work
risk factors for MSD. This determined levels heavy lifting and carrying, frequent bending Knee • awkward posture • co- morbidities
of evidence for the individual risk factors and twisting of the upper body, manually • lifting
3
Reasonable evidence risk
and parts of the body. The evidence ex- handling loads, repetitive work, physicale- • repetitive work
factors—satisfied at least one
of the criteria for causality, but presses the extent to which the statistical xertion or whole-body vibrations – con-
Source: da Costa & Vieira [24]
bias or confounding factors
could not be completely ruled
associations observed in studies can be tributes towards causing and/or exacerba-
out (most of the studies pre- trusted and therefore viewed as a causal ting symptoms. The combination, duration, The European Foundation for Improvement ting or carrying heavy loads, and vibration
sented 1–3 potentially mislea-
ding factors). Strong evidence relationship. Table 1 shows “reasonable frequency and intensity of these factors of Living and Working Conditions (Euro- are the most common physical risk factors
risk factors—satisfied at least evidence” biomechanical, psychosocial can cause considerable damage to anato- found) conducts regular surveys on wor- in Europe (figure 3) [22, 38]. The individual
four of the five criteria for cau-
sality and bias and confoun- and individual risk factors3 for the respec- mical structures such as muscles, tendons, king conditions in Europe every five years. dimensions of the so-called physical envi-
ding factors were controlled tive body regions [24]. It is noticeable that joints and nerves. If adaptability is reduced The sixth survey reaches the conclusion ronment index4 reveal substantial differen- 4
The physical environment
for or were not present (most index (one dimension of job
of the studies presented no there is a very high probability of exposure and there is a lack of compensation mecha- that the physical work environment has ces between professions. For example, quality) comprises 13 indica-
misleading factors). Strong
to biomechanical factors having a dama- nisms, this can give rise to excessive strain, barely improved over recent years. Expo- workers in the skilled trades have the high- tors related to specific physical
evidence was not assigned to hazards (e.g. vibration from
any of the risk factors [24]. ging effect on all regions of the body. The which in turn results in pain and decreased sure to posture-related risk factors remains est and therefore worst score for postural hand tools, tiring positions,
next section takes a closer look at the indi- productivity. Accordingly, the consequen- very frequent. Exposure via repetitive risks at 37 points; the average for the EU-28 temperature or lifting/moving
people, etc.) [22].
vidual risk dimensions. ces vary from person to person [37]. movements, static and forced postures, lif- is 24 points [22].
14 15
Exposed to physical risks over time (% exposed quarter of time or more) among women than men [31, 41, 42]. Gen- Lifestyle:
der-specific difference could also be exp- Weight/diet: Overweight and obese wor-
2 lained by different exposures to occupati-
onal risk factors. A review indicates that
kers have a higher risk of suffering from
MSD and take longer to recover than those
2
Vibrations men are at greater risk of back pain due to whose weight is normal [47]. Furthermore,
1991 EC12 heavy lifting and carrying and for neck/ the Western lifestyle 6 contributes towards
shoulder complaints caused by hand or a negative calcium balance and bone demi-
Noise 1995 EU15 arm vibrations. Meanwhile, women have a neralization [48].
higher risk of neck/shoulder complaints
2000 EU27 resulting from awkward static arm postures Smoking: Bone atrophy and fractures
High temperatures
[43]. have been observed more frequently
2005 EU27 among heavy smokers (including passive
Low temperatures
Socio-economic status: A low SES (low smokers). Smoking also delays healing and
2010 EU27 level of education5, low income or qualifi- increases complications in connection with 5
The assumption is that edu-
Breathing in smoke/ cation – along with access to
dust and/or vapours
cations) correlates strongly with the preva- fractures and trauma [49]. In addition, smo- good employment opportuni-
lence and incidence of MSD (figure 4) [31, king has been linked to local inflammatory ties – also enables healthier
lifestyles and choices, which
44, 45]. Absences from work due to back reactions by the musculoskeletal system can protect individuals from
Chemical substances
pain are more frequent among workers in (e.g. epicondylitis) and greater sensitivity disadvantages later in life.
low-qualified, manual jobs. This observa- to pain [48]. 6
Sedentary living, caffeine and
Tiring or painful tion is virtually constant regardless of gen- alcohol consumption, smoking
positions and possibly high animal pro-
der and age [46]. Exercise: Inactivity is an independent risk tein consumption [48]
factor for back problems [50]. Decreased
Heavy loads production of joint fluid (synovia), which
serves to protect the surface of joints, can
Repetetive hand also exacerbate wear and tear to joints [51].
or arm movements
0% 10% 20% 30% 40% 50% 60% 70%
Figure 3: Percentage of physical risk factors for workers in Europe – results of earlier Eurofound
surveys [38]
Eurofound (2012), Fith European Working Conditions Survey, Publications Office of the European Union,
Luxembourg
Individual, lifestyle-related influential Age: Aerobic and muscular performance
factors decrease with age, which impairs the phy-
Like most chronic conditions, MSD are trig- sical ability to work [39]. Older employees
gered by multiple risk factors. In addition to are more prone to work-related MSD than
stress at work, aspects such as sport, lack younger ones due to their reduced functio-
of exercise, diet and substance use play a nal capacity [40]. However, the increase is
significant role in their development. Fur- less marked among 55 to 64-year-olds.
thermore, systemic diseases such as diabe- This phenomenon is also known as the
tes and rheumatoid arthritis can have a “healthy worker effect”, i.e. employees who
negative impact on the pathogenesis. The are unwell retire early [31].
risks vary with age, gender and ethnicity or
socio-economic status (SES) [37]. A number Gender: According to several studies,
of factors are listed here by way of example: there is a higher overall prevalence of MSD
16 17
2.2.3. Economic relevance France, 2007: Work-related MSD caused
100 %
the loss of 7.5 million working days, which
2 90 % MSD are responsible for 40% of all global
payments in kind and compensation for
went hand in hand with financial damage
of € 736 million [62].
2
80 %
occupational diseases and work accidents
70 % (figure 5) [59]. Work-related back comp- Germany, 2016: All MSD (ICD8 M00–M99) 8
ICD – International Classifica-
tion of Disease.
laints in connection with all occupational were responsible for the loss of 154 million
60 %
health problems are estimated to cost the working days, associated with production
50 % Member States’ economies between 2.6% downtime costs of € 17.2 billion and € 30.4
and 3.8% of the gross social product [60]. billion in lost gross value added [63].
40 %
Estimates put the cost of work-related
30 % MSD in the upper extremities at between Finland, 2004: Work-related MSD caused
0.5% and 2% of the gross social product direct costs of € 222 million.
20 %
[61]. A comparison of the cost of work-rela-
10 % ted MSD is made more difficult by differen- Austria, 2004: MSD were responsible for
ces in the individual countries’ insurance the loss of 7.7 million working days.
0
Low educational level Intermediate educational level High educational level systems, a lack of standardized recording
criteria and the way in which costs are Slovenia, 2006: MSD were responsible for
Figure 4: Percentage of work-related health problems (MSD; stress, depression or anxiety; other) logged. As a result, the following list only the loss of 2.47 million working days [62].
7
“Low educated wor- in the EU-27 population by educational level7 [31] sets out to present a number of examples
kers reported work-
related problems from specific countries:
more often and were Musculoskeletal health problems Stress, depression or anxiety Other health problems
more likely to report
MSDs as the most
serious work-related
problem. In 68% of
those with low edu-
cational level with a
work-related health
14 % Accidents
problem MSD was
the main problem.
For those in the high
level of education
cla s sif ic ation this 3 % Tumors
was true for 44%” Psychosocial and work-organizational Lengthy sickness-related absences caused
(Eurostat, 2010). influential factors by MSD have been observed more fre- 3 % Skin Diseases
Systematic reviews show links between psy- quently in employees who face intense time
chosocial factors and MSD [24, 52-54]. pressure at work and have little job control 40 %
These can have a negative effect on the [55]. The following additional factors stem- Musculoskeletal 9 % Respiratory Diseases
Disorders
condition’s progression with regard to beha- ming from the work environment and orga-
viour and dealing with pain. Psychological nization can also have a negative impact on
tension resulting from conflicts at work or workers’ health [56-58]:
8 % Central Nervous System Impairments
within the family can manifest itself physi- • fast-paced work,
cally and impair the autonomic nervous sys- • monotonous workflows,
tem. The body reacts with increased muscle • insufficient breaks,
tone, which in turn can trigger muscle tight- • precarious employment,
ness. Mobility is severely limited by the pain, • unfavourable remuneration systems and 16 % Heart & Circulatory Diseases
resulting in inactivity and compensatory working time models. 7 % Mental Health Disorders
postural adjustments. Possible long-term
physical effects are muscle loss and joint
misalignment [12]. Figure 5: Worldwide compensation costs for work-related diseases and accidents (ILO[59])
18 192.2.4. The economic benefit of MSD In studies with negative or inconsistent out-
prevention within companies comes, there was a lack of support from
2 Sultan-Taïeb et al. (2017) produced a cost-
managers, the intervention did not meet
employees’ needs and the “intervention
2
benefit assessment of ergonomic work- dose” was too low [64].
place-related interventions for the preven-
tion of occupational MSD. They also As part of a further study, 300 companies
examined factors which had a favourable from 15 countries were asked for their sub-
or obstructive effect on the implementation jective assessment of the overall economic
process. The cumulative savings after the effects of prevention and health protection
intervention were higher overall than the in the workplace (return on prevention).
total investment (with a payback period of According to this, the direct effects of pre-
3 to 5 years for employers and 0.82 to 9 vention measures were a reduction in
years for accident insurance companies). hazards, greater awareness of occupatio-
All of the studies showed that ergonomic nal risks, and a decrease in dangerous
equipment and an overall strategy signifi- behaviour and work accidents. The most
cantly reduced accidents and claims for significant indirect effects were improved
compensation. In studies with positive eco- image and improved workplace culture
nomic outcomes, there was substantial (figure 6) [65]. However, it must be added
support from upper and middle manage- as a caveat that these results are based on
ment and staff participation was also high. self-assessments by companies.
Reduced hazards 5.08
Reduced breaches 5.04
Reduced accidents 4.98
Reduced fluctuations 3.80
Reduced disruptions 4.30
Reduced downtime 4.35
Reduced wastage 3.80
Reduced time for catching up 3.83
Improved quality of products 3.99
Improved adherance to schedules 4.01
Increased number of innovations 4.19
Improved customer satisfaction 4.15
Improved corporate image 4.80
Improved workplace culture 4.75
Increased hazard awareness 5.05
Total average 4.41
1 = no impact
0 1 2 3 4 5 6 6 = very strong impact
Figure 6: Effects of occupational health and safety within the company (ISSA [65])
20 213 3
Scoping review on musculoskeletal health
of hairdressers
3.1. Background
Musculoskeletal disorders (MSD) are common in the working age population and
are conditions that affect passive (bones, joints) and/or active structures of the
body (muscles, tendons, ligaments, peripheral nerves) [37]. Since MSD account
for a high proportion of compensable occupational diseases worldwide many
efforts have been undertaken to ascertain the potential risk factors in the develop-
ment of MSD and its prevention in the workplace setting [23]. MSDs are highly
prevalent in manual-intensive occupations such as manufacturing, construction or
services [26, 35, 36]. Hairdressers are a group of workers whose working ability
and health condition may be affected by specific occupational activities. A daily
task analysis showed that experienced hairdressers spend on average 29% of their
time cutting, 17% dying, 10% blow-drying and 8% washing hair. These activities
required frequent sagittal or lateral bending and twisting of the back (e.g. washing
hair at the sink), static postures and long-standing periods. Repetitive tasks have
been observed during all client-related activities [66]. Results from kinematic pos-
ture analysis revealed that hairdressers spend 9-13% of their total working time
with arms elevated over 60° [67, 68]. Working with elevated arms above shoulder
level is considered a major risk factor for clinically verified shoulder disorders or
persistent severe pain [69, 70]. The relatively high force exertion and wrist velocity
– combined with prolonged exposure – may account for the higher rate of hand/
wrist pain, especially in female hairdressers [71]. In a study on the working condi-
tions of Finnish hairdressers, the most hazardous factors for health were repetitive
movements, awkward working postures, standing, draft, uncomfortable tempera-
tures and chemicals [72]. To understand the impact of MSDs on hairdressers requi-
res quantification of the MSD prevalence, disability or injury, the identification of
potential risk factors for these health consequences as well as effective preventive
or rehabilitative measures. This is the first attempt to systematically map the cur-
rent state of research on these aspects by synthesizing empirical, measurement-
based or interventional studies in hairdressing.
22 233.2. Methods Stage 3: Study selection Stage 5: Collating, summarizing and 3.3. Results
Studies on musculoskeletal health were reporting the results
Due to a variety of study designs and a lack considered for the analysis if they reported To collate and aggregate the data on Our search strategy identified 186 articles,
of summary of evidence, we decided to separate results for hairdressers, assessed disease frequency in a comprehensible of which 44 met the eligibility criteria for the
3 conduct a scoping review. The general pur-
pose of a scoping review is to examine the
MSD frequency, work-related risk factors
and preventive or rehabilitative measures
way, we chose a pooled testing strategy
[74]. However, as we did not appraise the
qualitative data synthesis (see Fig 7). The
characteristics of the included studies are
3
extent and nature of research activity, sum- against MSD. The following inclusion crite- study quality, the estimates may be biased provided in the Annex 1. Of the eligible stu-
marize the relevant findings and to identify ria were applied: and should serve as approximate values dies 29 were conducted in European coun-
research gaps [73]. For methodological (i) Population : includes hairdressers which require further exploration. Where tries. The majority of the included studies
purposes, we implemented the six-stage who continue to work in their job and indicated, 12-month and/or point-preva- (84%) were published after the year 2000,
framework for a scoping review as adopted those who have changed or left their lence data were extracted and pooled11 which indicates that research in this occu- 11
As substantial heterogeneity
— variability in the population
by Arksey and O’Malley [73]. The six stages profession for health reasons. Also using the Excel spreadsheet developed by pational setting has recently increased. Of of effects between studies —
have been implemented as follows: other related professions such as cos- Neyeloff et al. [74]. All potential work-rela- these, one study applied a qualitative was suspected, we used ran-
dom effects models to calcu-
metologists were considered. ted risk factors examined in the studies design with interviews [75] and three were late the pooled effect estimate
Stage 1: Identification of the research (ii) Exposure: includes ergonomic, bio- were extracted and grouped into superor- national surveys of occupation-specific for pain/disorder prevalence in
different body sites. Hetero-
question mechanical, organizational and psy- dinate risk categories. data which included hairdressers [76-78]. geneity was quantified using
The following question should be answered: chosocial factors which occur in the One study examined trends in compensa- the Chi-square (χ2) and I stati-
stics. The latter is expressed
What is known from the existing literature occupational context of hairdressers. Stage 6: Consultation exercise tion claims for WRMSDs [79]. Furthermore, as percentage of the total vari-
ability between studies: the
about the frequency of MSD, work-related (iii) Intervention: includes all interventions The methodology and findings of the sco- seven studies were related to evaluation
higher the percentage, the
risk factors and measures to prevent or that aim to prevent or reduce MSDs. ping review were presented at a European research [80-86], three studies solely mea- higher is the degree of hetero-
geneity.
reduce MSD in hairdressers? We were see- (iv) Outcome: includes health disorders workshop within the project ‘ergoHair’. sured working postures while performing
king to present an overview of all themati- related to musculoskeletal system Workshop participants provided further regular hairdressing tasks [68, 71, 87] and
cally relevant material in a clear and com- such as (recurrent) pain, discomfort, ideas and suggestions for interpretation of three studies were from the same cohort of
prehensible manner. Therefore, the study tingling, numbness, stiff joints, swel- study findings and recommendations for students entering working life [88-90]. All
results were summarized and analyzed by ling or dull aches. preventive measures. but one study predominantly included
applying a thematic approach based on the (v) Study design: includes peer review females [91]. In one study, only cosmetolo-
three subsections of the study question: and non-peer-review publications of gist were queried [92].
(1) What is the prevalence and/or incidence all study designs except editorials,
of MSD in the different body sites? commentaries, conference papers
(2) Which work-related risk factors are MEDLINE PUBMED CINAHL Web of Science LIVIVO
Identification
and policy statements.
(n = 44) (n = 110) (n = 47) (n = 46) (n = 62)
associated with MSD?
(3) Which work-related measures are Reports published in English, German,
applied to prevent or reduce MSD in Dutch, French, Italian, Portuguese and
hairdressers? Spanish were included. Two reviewers Records after duplicates removed
(n = 169)
independently assessed the title, abstract
Screening
Stage 2: Identifying Relevant Studies and full text of the articles. In the event of Records identified through
other sources
A systematic literature search was conduc- disagreement consensus was achieved by (n = 17)
Title and abstract screening
ted in the electronic databases MEDLINE, discussion. (n = 186)
9
Population: hairdress* OR
PUBMED, CINAHL, Web of Science and Records excluded
barbering OR cosmetologist* LIVIVO. The key words for population9 were Stage 4: Charting the data (n = 109)
Eligibility
OR beautician* OR coiffeur*OR
combined with key words for outcome10. General information on author(s), year of Full-text articles assessed for eligibility
beauty culture*.
(n = 77)
We also searched the reference lists of publication, study location, publication Records excluded, with reasons (n = 33)
10
Outcome: musculoskeletal (1) Outcome (n = 7)
symptoms OR musculoskeletal identified articles and Google Scholar. The type, aim, design, participant characteris-
(2) No separate description of results (n = 7)
pain OR musculoskeletal dis- search included peer-reviewed and non- tics, methodology and outcome measures (3) Out of focus (n =10)
orders OR musculoskeletal Records included in the qualitative synthesis
peer reviewed literature published from the were recorded. The data was extracted by (4) Population (n = 4)
diseases OR upper limb* OR (n = 44) (5) Language (n = 5)
Included
upper extremity* OR neck pain
inception of the database up to Aug. 17, one person (AK) and verified by another
OR back pain OR shoulder
Information on prevalence
pain. 2017 (Update Nov. 5, 2018). reviewer (TW). (n = 19)
Figure 7: Flowchart of the study selection
24 253.3.1. Prevalence of musculoskeletal 3.3.2. Reasons for leaving the trade 3.3.3. Comparative findings musculoskeletal injuries was significantly
disorders higher among the self-employed (66.8%
A Finnish study assessed the risk of leaving A National German Health Survey provided vs. 29.7%) [99].
In total, 19 studies provided data on MSD the profession for health and other reasons a representative analysis of back pain pre-
3 prevalence in at least one body site and were
pooled depending on the given time frame,
among female hairdressers as compared
to workers engaged in commercial work.
valence by occupation category. Hairsty-
lists/beauticians belong to the top 4 high- 3.3.4. Work-related risk factorss
3
e.g. 12-month or point MSD prevalence [78, The relative risk of leaving the profession risk occupations for back pain (e.g. the
86, 92-108]. In a subgroup analysis, studies among hairdressers was increased by 2.7 12-month was 70% and 7-day prevalence Fifteen studies examined potential risk fac-
from European countries were pooled [78, (95% CI 1.1-6.3) for a repetitive strain injury was 47%) [78]. According to the U.S. Natio- tors for work-related MSD (WRMSD) in
86, 92, 94, 96-100, 105]. The greatest of the wrist and elbow and by 1.7 (95% CI nal Health Interview Survey on back pain, hairdressers – either by means of self-
12-month MSD prevalence was reported for 1.2-2.5) for diseases of the neck or shoul- female hairdressers belong to the top 6 high- rating or statistical estimation (Annex 4).
the lower back 48%, neck 43%, shoulder ders [109]. Two studies from Denmark exa- risk occupations for back pain [76]. Epide- They varied greatly in types of risk factors,
42% and hand/wrist 32%. The point MSD mined the health reasons for leaving the miologic surveillance data on carpal tunnel the applied methods and the reporting of
prevalence was on average lower: 34%, hairdressing trade: one with retrospective syndrome (CTS) from Maine and Loire regi- the findings [72, 88-92, 95, 97, 98, 100-102,
31%, 37% and 31%, respectively. The ove- and one with prospective study design. ons in France showed that a substantial pro- 104, 108, 112]. The reported risk factors
rall MSD with no specification of body site Among all former hairdressers the primary portion of new CTS cases (between 2002- were synthesized into the following six
and time frame was 55%. If only studies health complaint causing them to leave 2004) among female hairdressers were main categories:
from European countries were considered, their job was musculoskeletal pain (42%) attributable to work (attributable risk frac-
the 12-month MSD prevalence remained followed by hand eczema (23%), other tions 86.6%). Thus, they belong to the top 1. Strenuous hand or arm postures and
similar for the respective body sites: 45%, diseases (21%) and allergy (18%) [6]. The 10 high-risk occupations for CTS [77]. movements (e.g. arms above shoulder,
47%, 41% and 35% (figure 8). A study from prospective study showed that during the repetition)
Figure 8: Pooled France examined trends in hairdressers‘ 3-year follow-up, 21.8% of the hairdressing In a case-control study, which was con- 2. Awkward postures and movements of
12-month and point MSD
compensation claims for the years 2010- apprentices had left the trade; of them ducted with 147 hairdressers and 67 non- the spine (e.g. bending and twisting the
prevalence of the spine,
upper and lower extremi- 2016. The overall claim rate for work-related 70.4% due to health complaints. The most hairdressing controls, hairdressers repor- back)
ties. Subgroup results: MSD increased by 12.8% (n.s.). Permanent frequently reported reasons were muscu- ted significantly higher levels of MSD, 3. Workload and biomechanical strain
Prevalence from Euro- disability (incidence rate 2/1000) and num- loskeletal pain (47.4%), followed by skin including shoulder (OR 11.6, 95% CI 2.4- (e.g. mechanical workload, overtime,
pean studies are indica-
ber of lost work days significantly increased diseases (42.1%) and respiratory symp- 55.4) wrist/hand (OR 2.8, 95% CI 1.1-7.6), no breaks)
ted by the abbreviation
EU (for detailed results, by 16% respectively. In total 666,461 days toms (23.7%) [110]. upper back (OR 3.8, 95% CI 1.0-14.9) or 4. Prolonged standing and sitting
see annex 2 and 3). were lost due to work-related MSD [79]. lower back pain (OR 4.9, 95% CI 1.5-15.9) 5. Other factors (e.g. work experience,
[96]. In a further comparative study with mental stress and burnout, gender or
office workers female hairdressers repor- low support)
ted pain in all body regions significantly 6. Specific hairdressing tasks (e.g. cut-
more often (neck 36% vs. 8%, shoulders ting, dying or styling hair)
39% vs. 10% or hand/wrists 41% vs. 4%)
[101]. In a case-control study from Turkey Mastrominico et al. [112] showed that all
the frequency of CTS in female hairdres- principle hairdressing activities performed
sers was slightly higher compared to unem- for at least 50% of the working day, exhibi-
ployed female control group (RR 1.35, ted intermediate to high risk for upper limb
95%CI 0.98-1.84). In addition, they showed disorders (ULD). Similarly, Mahdavi et al.
significantly higher pain intensity and func- [102] found that 61% of studied postures
Lower Back Neck Shoulder Hand/Wrist Elbow Knee tional loss levels. Hairdresser who were could be classified as high risk postures for
• 12-mos: 47.5 % • 12-mos: 43.1 % • 12-mos: 41.6 % • 12-mos: 31.5 % • 12-mos: 11.4 % • 12-mos: 26.3 % diagnosed with CTS worked significantly MSD.
• Point: 34 % • Point: 30.8 % • Point: 36.6 % • Point: 30.6 % • Point: / • Point: / longer in their profession than those hair-
• EU 12-mos: • EU 12-mos: • EU 12-mos: • EU 12-mos: Finger Feet dressers without CTS [111]. A study from The following studies examined hairdres-
45 % 47.4 % 40.6 % 34.7 % France analyzed data from occupational sing activities and/or the corresponding
• 12-mos: • 12-mos:
• EU point: • EU point: / • EU point: / • EU point: / health examination of self-employed and body postures and movements of the mus-
24.6 % 26.8 %
38.7 %
wage-earning hairdressers. The risk of culoskeletal system.
26 27In a study by Chen et al. [71], the mechani- that the daily workload of hairdressers is the spine during cutting hair. All four hair- hands. The mean value for palmar wrist fle-
cal exposure of hairdresser’s and barber’s high and aggravated by the lack of regular dressing tasks led to highly repetitive xion, expressed as the 90th percentile, was
wrists were assessed by using electromyo- breaks. Similar results were found in a actions of the upper extremities. The Kil- greater for hairdressers than the overall
graphy (EMG). Female hairdressers exhibi- Dutch study. More than six hours of repea- bom [115] reference values for high repeti- mean for other occupations (21° vs. 10°).
3 ted significantly greater EMG activity
(p2.5 rep/ Moreover, hairdressers exhibited a slightly
3
min), and for the elbow and hand (>10 rep/ higher mean angular velocity (20°/s vs.
xion speed (velocity) in their non-dominant atest strain on the musculoskeletal system. min) were both significantly exceeded, par- 17°/s). With respect to static and peak load
hand (p4 of 52% of the total working day in contrast tive and three rehabilitative measures. One
working day with arms elevated at >60° seconds). Moreover, they often had to to other students (< 33%). The relative time study evaluated a new Ergonomic Tool
(right arm 6.8% and left arm 5.5%). Expo- stretch their arms over the shoulder level of sustained muscle activity showed a sig- Design (ETD) scissors.
sure to elevated arm postures was more and perform tasks with horizontal adduc- nificant correlation with pain (r= 0.21,
strenuous during customer tasks (which tion of the arms. While washing at the sink, p30° exercise program targeted to the cervical and
ted et al. [86]. static postures. During washing and cut- (45% vs. 35%), >60° (11% vs. 1%) and lumbar spine in combination with an ergono-
ting hair, forward flexion of the neck was >90° (2% vs. 0.4%). For every additional mic brochure. The control group received
In a pilot study from Portugal, 77% of the frequently observed. This poor posture unit increase in arm elevation of more than only the brochure. After six weeks of inter-
hairdressers reported that they performed was often combined with hunched back. 60°, an estimated 28% increase in shoulder vention, no significant differences were found
their activities in a standing position, 17% Those who used the rolling stool often pain was found among female students in pain intensity or level of disability between
in a sitting position with rotation of the exhibited a steeply inclined lumbar spine [90]. Moreover, the authors observed a sig- the exercise and control groups.
spine and 7% in a sitting position with ele- and had to raise their hands more often nificant increase in the prevalence of
vated arms above shoulder level. In regards above shoulder level [66]. The same moderate/severe pain for female students Similarly, Veiersted et al. [86] examined the
to upper limb activities during work, 30% authors report that during cutting, dying over the course of 6.5 years (RR 1.5, 95% effect of a short-term intervention, inclu-
performed repetitive and dynamic move- and blow-drying, more than 25% of time CI 1.24-1.81). Mechanical workload and ding five recommendations on working
ments and 60% elevated objects above was spent in flexion (angles >20° and >60°) perceived muscle tension were identified techniques to reduce neck and shoulder
shoulder level (>60°) [97]. and abduction (>-20° and >-60°) for both as risk factors for neck and shoulder pain workload, such as working with less eleva-
shoulders. Pronation (>20 and >40°) of in women [89]. According to a study by ted arms and relaxing the upper body and
Figueiredo da Rocha and Simonelli [113] both elbows was observed during all tasks. Mussi and Gouveia [104], uncomfortable follow-up instructions. The control group
found that hair straightening with a round Extension (>-25° and >-50°) of the left neck and shoulder postures were likewise received a brochure with corresponding
brush requires high mechanical overload of hand was observed for cutting and washing associated with MSD in hairdressers (OR illustrations. Time spent with highly eleva-
the cervical and spinal columns (e.g. hair. A high proportion of time with forward 2.8, 95% CI 1.4-5.5). ted upper arm postures above 90° was
straightening curly hair takes up to one curvature of the spine was recorded during reduced from 4% to 2.5%. No intervention
hour). Moreover, the upper limbs are strai- cutting (66%), washing (62%) and dying Nordander et al. [105] explored the expo- effect was detected on muscular load,
ned from repetitive movements in protrac- (36%). The greatest proportion of time in sure-response relationship between work- velocity of arm movements or neck and
ted extended positions. They concluded static awkward postures was observed on related risk factors and MSD in elbows and shoulder complaints.
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