Musculoskeletal Disorders and Their Relationship with Physical Activities Among Office Workers: A Review

Authors: Ardalan Shariat, Shamsul Bahri Mohd Tamrin, Manohar Arumugam, Mahmoud Danaee, Rajesh Ramasamy

Affiliations: Department of Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia; Department of Orthopaedics, UPM; University of Malaya

Published: Malaysian Journal of Public Health Medicine, 2016, Vol. 16(1): 62–74  |  ISSN: 1675-0306

Last reviewed: March 2026

Background

Musculoskeletal disorders (MSDs) constitute the most significant occupational health burden among office workers in both developed and developing nations. The global prevalence of work-related MSDs among office populations ranges from approximately 38% to over 95%, depending on the body region assessed and the population studied. These conditions encompass a spectrum of pathology affecting muscles, tendons, ligaments, nerves, and joints, manifesting as pain, stiffness, weakness, numbness, and functional limitation. The economic impact is substantial — MSDs account for the largest proportion of occupational disease compensation claims and are the leading cause of years lived with disability worldwide.

The relationship between physical activity and musculoskeletal health in office workers is complex and bidirectional. Insufficient physical activity is associated with increased risk of developing MSDs, while MSDs themselves may reduce an individual’s capacity or motivation for physical activity, creating a self-reinforcing cycle of inactivity and musculoskeletal deterioration. Understanding the specific mechanisms through which different types of physical activity influence MSD outcomes is essential for designing effective workplace intervention programmes.

Prevalence and Distribution of MSDs in Office Workers

The review confirmed that lower back pain, neck pain, and shoulder pain represent the three most prevalent MSD complaints among office workers. Lower back pain affects an estimated 35–60% of office workers at any given time, while neck pain prevalence ranges from 42–69% and shoulder pain from 33–58%. These conditions are not mutually exclusive — many office workers experience pain in multiple body regions simultaneously, a pattern known as multi-site musculoskeletal pain that is associated with poorer prognosis and greater functional impairment than single-site conditions.

The ergonomic demands of computer-based office work create predictable patterns of musculoskeletal stress. Sustained cervical flexion during screen viewing loads the posterior cervical muscles and intervertebral discs, contributing to neck pain. Static shoulder elevation during keyboard and mouse use creates sustained tension in the trapezius and deltoid muscles. Prolonged sitting increases intradiscal pressure in the lumbar spine, particularly when chairs lack adequate lumbar support or when workers adopt slouched postures.

Evidence for Physical Activity Interventions

Strength Training

The strongest evidence supports targeted strength training for the neck and shoulder muscles as an effective intervention for reducing pain in these regions among office workers. Programmes involving progressive resistance exercises for the trapezius, deltoid, and cervical extensors have consistently demonstrated significant reductions in pain intensity and frequency. The evidence indicates that even brief, high-intensity training sessions (as short as two minutes of targeted exercise) can produce clinically meaningful improvements when performed regularly.

Stretching and Flexibility Programmes

Stretching exercise programmes have moderate evidence for reducing MSD symptoms, particularly when targeting the cervical spine, pectoral muscles, thoracic spine, and hip flexors — regions that tend toward adaptive shortening in habitual seated postures. However, stretching alone appears less effective than resistance training for managing established pain conditions, suggesting that stretching may be more valuable as a preventive strategy or as a component of a combined intervention programme.

Combined Interventions

The review found that combined approaches — integrating targeted exercises with ergonomic workstation modifications — produced the most comprehensive and sustained benefits. This finding aligns with the biopsychosocial model of MSD, which recognises that workplace musculoskeletal conditions arise from the interaction of physical, psychological, and organisational factors. Addressing only one dimension (e.g., exercise without ergonomic correction, or ergonomic modification without exercise) is less effective than a holistic approach.

Mechanisms and Pathophysiology

The review explored the pathophysiological mechanisms linking sedentary work to MSD development. Sustained static muscle contractions at low levels (as occur during computer work) lead to the selective recruitment of type I (slow-twitch) muscle fibres. These fibres, if continuously activated without adequate rest, develop metabolic fatigue, local ischaemia, and eventually structural damage — a process described by the Cinderella hypothesis. Over time, this chronic low-level loading produces myofascial trigger points, localised inflammation, and sensitisation of peripheral and central pain pathways, resulting in chronic pain conditions that may persist even after the original mechanical stressor is removed.

Implications for Workplace Health Promotion

The findings support the integration of evidence-based physical activity programmes into workplace health promotion strategies for office workers. Employers should invest in comprehensive MSD prevention programmes that combine ergonomic assessment and workstation optimisation with structured exercise interventions delivered during working hours. The return on investment for such programmes includes reduced absenteeism, improved presenteeism, lower workers’ compensation costs, and enhanced employee wellbeing and job satisfaction.

Limitations

The review acknowledged several limitations in the existing evidence base. Most intervention studies have been conducted in Western populations, particularly Scandinavian countries, with limited evidence from Asian and developing country contexts where work patterns, ergonomic standards, and healthcare access may differ significantly. The heterogeneity of study designs, outcome measures, and intervention protocols across published studies makes direct comparison and meta-analytic synthesis challenging. Long-term follow-up data beyond 12 months remain scarce, and the optimal exercise prescription (type, intensity, frequency, duration) for specific MSD conditions has not been definitively established.

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