The office work and stretch training (OST) study: an individualized and standardized approach for reducing musculoskeletal disorders in office workers

In industrial nations, the service sector is the dominant economic sector [1, 2], where the majority of working time is spent in a sitting position [3]. About 50% of the employees suffer from moderate pain and about 30% from severe back and neck pain [4, 5]. Risk factors include years spent in an office [6], gender [5‐7], body mass index (BMI) [7] and age [5‐8]. The weighting of the influencing factors can vary depending on the cultural context, as observed in a comparison between Malaysian and Australian office workers [9]. If diseases of the musculoskeletal system (MSD) are not treated, this can ultimately lead to a greater number of work days lost to incapacity [6, 10‐12]. One reason might be, that in physical therapy of MSD occupational factors are not consistently taken into account [13]. In Germany, MSD are the main cause of disability days [14, 15]. From 2011 to 2017, MSD-related diagnoses accounted for an average of 22% of all diagnoses [14]. These were mainly back pain related [15]. In the worst cases, these complaints can become chronic and the temporary inability to work can become an occupational disability. The high rate of MSD related absenteeism [14] is not only a burden for the employees, but also causes greater costs for employers and the health system. In 2016, the loss of gross value added caused by MSD in Germany amounted to 30.4 billion euros, which is equivalent to 1% of gross national income [16].

In the past, behavior oriented prevention and structural prevention in the form of WHPP appears to make sense, as they reach large target groups and are easily accessible [8, 17‐19]. Usually these programmes pursue one of the following strategies: workplace optimisation, workplace policy changes (structural workflow, for example, standing meetings), provision of information (to improve lifestyle and physical activity levels) or multi-modal interventions [17, 20]. Interventions of this kind have been studied intensively. However, meta-analyses found only minor positive effects on physical activity [2, 8], reduction of sitting time [20], weight and lifestyle [8]. The study designs of the included studies were very inconsistent with regard to sample size (n = 40–924), intervention period (9 weeks to 2 years) [8], grouping and target sizes. In total, younger volunteers (≤40 years) seemed to benefit more in these studies [8].

Although they are far less extensively studied, instructed stretching programmes at the workplace offer a more promising approach [12, 21‐24]. For example, the research of Tunwattanapong et al. [21] demonstrated a reduction in neck and shoulder complaints (− 1.4; 95% CI: -2.2, − 0.7 using the visual analogue scale) and an improvement in quality of life (14.0; 95% CI: 7.1, 20.9 using the physical dimension of SF-36). However, to our knowledge, the investigated programs were neither standardized nor individualized, which could be important if a heterogeneous population, such as the many employees present in an office building, is to be reached. Therefore, a new and more global approach, the “five-Business” stretch training programme (“Five-Konzept”, Hüfingen, Germany), is presented in this study. Here, the exercises are executed on an adjustable wooden device (Fig. 1).

The objectives of the present study were to evaluate the “five-Business” stretch training programme in terms of its effects on ROM, its effectiveness in reducing MSD and its effects on the health-related quality of life.

The combination of elements of yoga and the McKenzie fundamentals, taking into account the Myers myofascial pathways in a highly torso-oriented, standardized stretching program, could provide new approaches to reducing MSD and improving the quality of life in workplace health promotion [25, 27‐30]. Device-supported mobility training is suitable for integration into everyday office life as it can be carried out quickly and easily on a single device (TÜV tested). Due to the given exercise execution on the device and the individual adjustment possibilities of the stretching position (body size and range of motion) by the abutment, all exercises are individualized and standardized at the same time. Thus, it can also be used for heterogeneous groups in terms of physical proportions and capabilities. This is also an advantage over the stretching interventions evaluated so far [12, 21‐24]. Shariat et al. [12, 23] evaluated 13 stretching exercises for the neck, shoulders and trunk, which were demonstrated in a video clip. After a two-week familiarization phase, the subjects trained three times a week with progressive exercise duration. A supervisor was available for questions and occasional monitoring. After eleven weeks, a reduction in pain in the trained areas, greater mobility and less perceived exertion could be observed. Using similar stretching exercises, Tunwattanapong et al. [21] also found positive effects in reducing neck pain and improving quality of life. However, the intervention group also received parallel instructions on ergonomic sitting. It is, therefore, unclear as to what influence the stretching had itself. However, the improvements observed were greater in subjects who had stretched at least three times a week than in those who had trained less frequently. In both interventions, the exercises were neither individualized nor standardized. In addition, a broad approach was chosen in both cases, taking into account not only the trunk but also the shoulders/arms and neck. The approach of a short, mainly torso-oriented stretching training exercise using myofascial muscle chains has not yet been investigated.

This stretch training exercise, developed for recreational sports, is now to be used within the framework of a WHPP to stretch muscle chains as a whole (especially in the trunk and hip area), which remain in a flexed position for several hours a day by sitting for long periods in a rigid, unfavorable manner. Despite the positive evidence described for the efficacy of similar stretching exercises, scientific studies have not found any connection between sitting per sé and low back pain [75] so far. Whether this also applies to other forms of MSD has not yet been clarified. Nevertheless, a concrete comparison of the known stretching techniques and the “five Business”, with regard to the influence on the quality of life and prevalence of MSD, should be sought in the future.

A main problem concerning the implementation of WHPP is the small number of participants in relation to the workforce addressed (2–60%) [8] and, also the long-term motivation of the employees. A device installed on site, that promotes an intuitive execution of the exercise and functions as a constantly present “reminder” of the training itself, could promote compliance. In further studies, it should be examined whether the “five-Business” is superior to conventional stretching in this respect. This could also depend on the individuals psychosocial workplace risk, which can be assessed using the Short Questionnaire for Workplace Analysis (KFZA) [76]. Overall, as the physical constitution of office workers cannot be changed and the postural demands can not be significantly altered, it is advisable to optimize health prevention, such as has already been the case with exposure factors in physiotherapists [77] and musicians [78].

This projects aims to provide health management departments information on whether a standardized and individualized stretch training exercise has an impact on MSD of the staff. Effective programs are necessary to reduce the high number of work days lost due to incapacity with MSD. Apart from the self reported MSD and quality of life, it is a further goal of this study to investigate if the training affects physiologically measurable ranges of motion. Based on these outcomes, health managers will obtain evidence-based information on which they can decide whether the program is suitable for their company.