Introduction
Trapezius muscle is a flat, triangular muscle on the back of the neck and upper back, which is also known as or is designated as the postural muscle which is highly prone to pain and inflammation due to overuse of the muscle in an awkward or unneutral position maintained by an individual for long durations. Trapezitis may cause pain and inflammation in the muscle which may last from a few days to months. If not treated properly, it may worsen which can also affect the quality of life of an individual. Beauticians and hairdressers are highly prone to trapezitis due to the various tasks that include the continual movement of the neck, upper back, and other upper limb muscles, repeatedly for long durations, a high number of clients, and with lesser duration of the rest period. This may lead to a reduction in the efficiency of work, absenteeism, or even resignation from the job. The most prevalent musculoskeletal disorder (MSD) among beauticians is seen in the neck in various studies done in the past.
Anatomy of trapezius muscle
The trapezius is a flat muscle on the back of the neck and the upper back, which is in the shape of a triangle, and muscles on both sides form a trapezoid shape, hence it is termed a trapezius muscle. The upper fibers of the trapezius originate from the medial third of the superior nuchal line and insert downward and laterally onto the posterior border of the lateral third of the clavicle, middle fibers originate from the external occipital protuberance and insert horizontally onto the medial margin of the acromion and upper lip of the crest of the spine of the scapula and the lower fibers originates from ligamentum nuchae, spine of seventh cervical vertebra and spines of all thoracic vertebra and inserts upward and laterally on to the deltoid tubercle at the junction of medial and middle third of the spine of the scapula. The action of the upper trapezius is to elevate the scapula, the middle fibers retract the scapula and the lower fibers depress the medial part of the spine of the scapula, and the trapezius helps to elevate the arm above 90° [1].
Trapezitis—definition, causes, risks, and pathophysiology
Trapezitis is an inflammation leading to pain and spasms in the neck and upper back [2]. Since the trapezius muscle is a postural muscle, it is highly prone to overuse. The neck discomfort starts mild and then the pain and inflammation aggravate, later the muscles in the neck and back stiffen. Early after the injury, due to the overload and overuse of the muscle, spasm occurs which when not treated forms knots known as trigger points [3]. Even when one is at rest, one may still have pain, which aggravates with movement. Episodes of pain and discomfort, difficulties moving the neck, and pain in the hands or arms could occur as the severity increases. From the main site of inflammation, pain may radiate to other areas as well. Due to the unpleasant and protective spasm in the antagonist muscle group, the range of motion may be uncomfortable and limited. It can significantly affect one’s quality of life, especially if they have a job that requires them to spend a lot of time sitting or standing still, performing repetitive activities, or maintaining uncomfortable postures for long durations [4].
According to recent investigations, the pathophysiology of trapezitis involves the involuntary shortening of the muscle fibers caused by overload and damage to the muscle tissue. Trigger points may also be formed which are important to be diagnosed because they may impair functional activities and have been linked to pain which in turn restricts the range of motion [5].
Beauticians and hairdressers—risks of trapezitis in beauticians and hairdressers
Beauticians are a group of professionals who offer services such as haircuts, coloring, and styling as well as manicure and skin care treatments, and so on. Due to the nature of their employment, they are highly prone to trapezitis. They regularly do tasks including facial, threading, and care of the skin, nails, and body, pedicure and manicure, body and face massages, and hair removal from the face, body, and so on. They must work with their neck and trunk flexed for long durations repeatedly to complete all of these tasks, which results in strain of the neck, back muscles, and vertebrae. Beauticians complained of musculoskeletal discomfort and neck pain was the most common musculoskeletal condition that was reported by the beauticians, according to research that was done in the past [6].
On average, hairdressers spend most of their time in hair cutting, hair coloring, blow-drying, and hair washing. For example, washing one’s hair at the washbasin requires bending and twisting of the back repetitively for a long duration, as well as prolonged intervals of stillness. All client-related activities have been reported to include repetitive tasks. Hairdressers raise their arms above the shoulder level for about 15% of their working hours per day at work. Working with arms raised above shoulder level is thought to provide a significant risk for shoulder problems or chronic, excruciating discomfort. Repetitive movements, awkward working postures, standing for long durations, uncomfortable temperatures, and chemicals were the most harmful aspects to health which in turn deteriorates the quality of life and performance of various tasks at the workplace. Hairdressers report MSDs in various parts of the body far more commonly than workers in other occupational groups. According to studies, the main reasons hairdressers leave their careers are related to their health [7].
Major risk factors for trapezitis in beauticians include the physical demands of the job, including extended periods of standing or sitting in one place, repetitive motions, awkward postures, equipment used, and the work environment. The trapezius muscle may become strained and worn out as a result of these circumstances, which may result in discomfort and stiffness. Furthermore, a lack of ergonomic support, insufficient pauses, and a heavy workload can aggravate the signs of trapezitis and raise the risk of getting this condition or may worsen the condition.
Various studies have concluded the prevalence of musculoskeletal disorders among beauticians, in which most research shows that compared to those in other professions, beauticians have a higher chance of having MSDs. In research conducted by Ratzon et al. (2000), for instance, it was shown that 63% of hairdressers had upper extremity pain, with the majority of pain in the neck and shoulder area. Similar to this, Gudmundsson et al.’s (2012) study shows that 20% of hairdressers reported having pain that lasted for more than 6 months in their upper back and neck [8].
Therefore, the primary cause of trapezitis is any activity that requires the neck and back muscles to be used continuously in an uncomfortable position along with many other risk factors in the workplace. Beauticians perform physically demanding work/tasks that are characterized by a high number of repetitions, few intervals of breaks between tasks, and a high number of clients, all of which increase the possibility of risk of pain. Therefore, there should be a concern about the prevalence of trapezitis among beauticians for the prevention and treatment strategies to reduce the risk of trapezitis to improve the quality of life and for the betterment of their health and performance at work. Hence, it is important to find out the prevalence and risk of trapezitis in this population.
Materials and Methods
Data were collected from various beauty parlors and salons in and around Bangalore. An observational study, cross-sectional study was conducted among beauticians and hairdressers in Bangalore. The study was conducted for a period of 6 months. Non-probability convenience sampling was done. Sample size was open ended. The materials used for the study were a consent form, data collection sheet, neck disability index (NDI), and Rapid Upper Limb Assessment (RULA) assessment sheet.
Tools/instruments/equipments used
- RULA: RULA is used to evaluate the exposure of individual workers to ergonomic risk factors associated with upper extremity MSD. This scale considers biomechanical and postural load requirements of job tasks/demands on the neck, trunk, and upper extremities. A single-page worksheet is used to evaluate required body posture, force, and repetition. Based on the evaluations, scores are entered for each body region in section A for the arm and wrist, and section B for the neck and trunk. After the data for each region is collected and scored, tables on the form are then used to compile the risk factor variables, generating a single score that represents the level of MSD risk.
- NDI: NDI is a self-rated questionnaire that is used to evaluate patient’s disabilities and the impact of neck discomfort on their everyday lives. It is a scale consisting of 10 items, 6 items are based on activities of daily living, whereas 4 items are based on the symptoms. The administration of the questionnaire requires no additional special training and just takes 5–10 minutes to complete and score. Subjects receive instructions, then scoring is done. Subjects choose from one of six possible responses, ranging from 0 to 5, for each item. The overall score, ranging from 0 to 50, is calculated by adding the ten items together. A total score of 4 or less indicates no disability, 5–14 indicates mild disability, 15–24 indicates moderate impairment, 25–34 indicates severe disability, and 35 or more indicates total disability.
Inclusion criteria
- Beauticians and hairdressers (both male and female).
- Work experience of more than and equal to 1 year.
- In and around Bangalore.
Job type
- Beauticians.
- Hairdressers.
Physical factors
- Repetitive work.
- Awkward posture.
- High number of clients.
- Lesser duration of rest.
Exclusion criteria
- Other underlying causes causing similar pain such as cervical radiculopathy, cervical spondylosis, and so on.
- Recent surgeries are done in the shoulder or neck region and upper back region.
- Systemic illness.
Results
Statistical analysis
Demographic data such as name, age, gender, years of experience, hours of work/day, duration of work at present place, age at starting work, and so on, was taken from the beauticians and hairdressers. All the data collected were compiled in Microsoft Excel and were statistically analysed by the statistician manually. The mean, standard deviation, and percentages are used to describe the data. Analysis of variance (ANOVA), a parametric test was used to compare the scores of visual analog scale (VAS), NDI, and RULA of the participants according to the site of pain. The probability value less than 0.05 was considered statistically significant.
Baseline characteristic profile
Age distribution
Out of 165 participants, the ages of the participants range from 25 to 39 years of age, in which the mean age is 29.31 and the standard deviation is 3.59.
Gender distribution
Out of 165 participants, 58 (35.2%) of the participants were male and 107 (64.8%) of the participants were female.
VAS scoring percentage wise distribution
In VAS percentage wise distribution, 29.1% of the participants rated 3 out of 10, 28.5% of the participants rated 4 out of 10, 24.8% of the participants rated 5 out of 10, and 17.6% rated 6 out of 10 on the VAS numerical scale (where, 1-mild, 5-moderate, 10-severe) (Table 1).
NDI scoring percentage wise distribution
In NDI percentage wise distribution, 0% of the participants fall under no disability, 96.4% fall under mild disability, 3.6% fall under moderate disability, and 0% fall under severe and complete disability. Hence, most of the participants fall under mild disability (Table 2).
RULA scoring percentage wise distribution
In RULA percentage wise distribution, 0% of the participants fall under low risk (acceptable posture), 64.2% fall under medium risk (further investigation, change may be needed), 24.8% fall under high risk (further investigation, change soon), and 10.9% fall under very high risk (investigate and implement). Hence, more than half of the participants fall under medium risk (Table 3).
Discussion
The statistical analysis presented the frequency of the number of participants in the form of percentage which shows that, out of 165 participants who took part in the study. 58 participants (35.2% of the participants) were male and 64.8% of the participants, i.e., 107 participants in the study were female, which shows that more than half of the participants were female.
The number of participants who are dominant on their right hand and left hand were presented in the form of percentages. The number of participants who are dominant on their right hand is 159, i.e., 96.4% of the participants are right-handed and 3.6% of the participants in the study are left-handed. The majority of the participants who took part in the study were right-hand dominated.
Table 1.
VAS score percentage wise distribution.
| VAS score | Frequency | % |
|---|---|---|
| 3 | 48 | 29.1 |
| 4 | 47 | 28.5 |
| 5 | 41 | 24.8 |
| 6 | 29 | 17.6 |
Table 2.
NDI scoring percentage wise distribution.
| NDI | Frequency | % |
|---|---|---|
| No disability | 0 | 0 |
| Mild | 159 | 96.4 |
| Moderate | 6 | 3.6 |
| Severe | 0 | 0 |
| Complete disability | 0 | 0 |
Table 3.
RULA scoring % wise distribution.
| RULA | Frequency | % |
|---|---|---|
| 1–2 | 0 | 0 |
| 3–4 | 106 | 64.2 |
| 5–6 | 41 | 24.8 |
| 7 | 18 | 10.9 |
The percentage of participants according to the site of pain reported was found, which shows that 65 of the participants, or 39.4% participants complained of pain in the neck, 11, i.e., 6.7% of the participants complained of pain in the neck and upper back both. 59 or 35.8% of the participants complained of pain in the shoulder region. 18 participants or 10.9% of the participants complained of pain in the shoulder which radiates to the arms as well. 12 participants or 7.3% of the participants complained of pain in the upper back.
The statistical analysis shows that the age of participants out of 165, ranges from 25 to 39 years of age. The mean age is 29.31 and the standard deviation is 3.59, i.e., 29.31 + 3.59 or 29.31 − 3.59. The mean and standard deviation of the number of hours of work per day were statistically analyzed, which was found to be 6.88 + 0.49 or 6.88 − 0.49 in which 6.88 is the mean of the data set and 0.49 is the standard deviation. Therefore, the beauticians and hairdressers work for 6.39–7.37 hours per day with the number of hours of work per day ranging from 6 to 8 hours per day.
The age at starting work was statistically analyzed. 165 participants, reported age of starting work ranging from 23 to 26 years of age, with 24.37 being the mean and 0.73 being the standard deviation of the data set, i.e., 24.37 years ± 0.73.
165 participants reported years of experience as a beautician and hairdresser, ranging from 1 to 17 years. The mean years of experience is 4.65 and the standard deviation is 3.76 which means that the participants have 4.65 ± 3.76 years of experience in this field of work.
Comparison of VAS, NDI, and RULA scores according to the site of pain was done statistically by using a parametric test—ANOVA denoted by the letter “F” and p < 0.05 was considered to be statistically significant as mentioned earlier.
The comparison of VAS scores according to the site of pain using ANOVA showed that the participants having neck pain rated an average score of 4.25 ± 0.95 on the pain rating scale out of 10. Similarly, participants having pain in the neck and upper back rated 5.0 ± 0.00. Participants having shoulder pain rated a VAS score of 4.0 ± 0.91, and participants having pain in the shoulder and arms rated 6.0 ± 0.00. Participants having upper back pain rated a VAS score of 3.0 ± 0.00. The score of the ANOVA test for VAS score according to the site of pain is 31.37 with p < 0.001 which is statistically significant.
The comparison of NDI scores according to the site of pain using ANOVA showed that the NDI scores of participants having neck pain are 0.21 ± 0.08 on the pain rating scale (a mean of 0.21 and standard deviation of 0.08), participants having pain in the neck and upper back scored 0.18 ± 0.00. Participants having shoulder pain obtained a score of 0.13 ± 0.02, and participants having pain in the shoulder and arms scored 0.16 ± 0.00. Participants having upper back pain scored 0.12 ± 0.00. The score of the ANOVA test for NDI score according to the site of pain is 20.39 with p < 0.001 which is statistically significant.
The comparison of RULA scores according to the site of pain using ANOVA showed that the RULA scores of participants having neck pain are 4.43 ± 1.16 on the pain rating scale, and participants having pain in the neck and upper back scored 4.00 ± 0.00. Participants having shoulder pain obtained a score of 3.81 ± 0.75, and participants having pain in the shoulder and arms scored 0.7 ± 0.00. Participants having upper back pain scored 0.3 ± 0.00. The score of the ANOVA test for NDI score according to the site of pain is 56.19 with p < 0.001 which is statistically significant.
Conclusion
This study provides evidence of a high prevalence of neck pain among beauticians, with significant functional limitations and pain intensity. The NDI, RULA, and VAS assessments collectively contribute to a comprehensive understanding of the issue, highlighting the urgent need for interventions aimed at improving workplace ergonomics and addressing the specific needs of beauticians. By implementing ergonomic modifications, such as adjustable workstations, regular breaks, and postural education, it is possible to reduce the prevalence and severity of neck pain, enhance functional abilities, and promote the well-being of beauticians and hairdressers.
