Prevalence and Associated Factors of Musculoskeletal Disorders Among Arabic Calligraphers Living in Saudi Arabia: A Cross-Sectional Study

Authors: Ghulam Saqulain, Intessar Sultan, Ambreen Sadaf

Affiliations: Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia

Published: 2018  |  Malaysian Journal of Public Health Medicine, 2018; Volume 18 (2)

Last reviewed: March 2026

Background

Musculoskeletal disorders (MSDs) represent one of the most significant occupational health challenges worldwide, affecting hundreds of millions of workers across diverse professions. While extensive research has examined MSDs among healthcare workers, office employees, and manufacturing personnel, considerably less attention has been directed toward artists and craftspeople whose work demands sustained precision movements and static postures.

Arabic calligraphy is a revered art form with deep cultural and religious significance across the Islamic world. Practitioners spend prolonged periods executing intricate letterforms that require exceptional fine motor control, sustained concentration, and maintenance of fixed postures. Unlike keyboard-based writing, traditional calligraphy involves complex wrist and finger movements with varying pressure applied through reed pens or specialised brushes on surfaces that may not be ergonomically positioned.

Saudi Arabia, as a custodian of Arabic calligraphic tradition, hosts a substantial population of professional and amateur calligraphers. Despite the physically demanding nature of this art form, no previous study had systematically examined the prevalence and risk factors of MSDs specifically among Arabic calligraphers. This study sought to fill this research gap by characterising the musculoskeletal health burden among calligraphers in Saudi Arabia.

Study Design and Methods

This cross-sectional study recruited Arabic calligraphers residing in Saudi Arabia through purposive and snowball sampling methods. Data were collected using a structured questionnaire incorporating the standardised Nordic Musculoskeletal Questionnaire (NMQ), which is a validated tool widely used in occupational health research for identifying musculoskeletal complaints across nine anatomical regions: neck, shoulders, elbows, wrists/hands, upper back, lower back, hips/thighs, knees, and ankles/feet.

In addition to the NMQ, the study instrument gathered information on demographic characteristics, calligraphy practice habits (including daily practice duration, years of experience, and type of calligraphy), workstation setup, use of assistive devices, history of ergonomic training, and health-seeking behaviours related to musculoskeletal complaints.

Findings

Prevalence of Musculoskeletal Disorders

The study revealed a notably high prevalence of MSDs among Arabic calligraphers. The most frequently affected body regions were the neck, shoulders, and wrists/hands—regions that bear the greatest biomechanical stress during calligraphy practice. Lower back pain was also prevalent, likely related to prolonged sitting in non-ergonomic positions.

A substantial proportion of calligraphers reported that musculoskeletal symptoms had interfered with their daily activities and practice sessions within the preceding 12 months. Some participants reported having to reduce their practice hours or take extended breaks due to pain and discomfort.

Associated Risk Factors

Several factors were identified as being significantly associated with the prevalence and severity of MSDs among calligraphers. These included longer daily practice duration, greater number of years engaged in calligraphy, inadequate workstation ergonomics (including improper desk height and poor chair support), lack of regular breaks during practice sessions, and absence of formal ergonomic training.

Discussion

The high prevalence of MSDs among Arabic calligraphers parallels findings from studies of other precision-demanding occupations. The biomechanical demands of calligraphy—sustained grip force, repetitive wrist movements, static neck flexion, and prolonged sitting—create conditions conducive to cumulative trauma disorders.

The wrist and hand findings are particularly noteworthy because these represent the primary tools of the calligrapher’s art. Conditions such as carpal tunnel syndrome, de Quervain’s tenosynovitis, and writer’s cramp can be career-threatening for calligraphers and may develop insidiously over years of practice. The neck and shoulder findings reflect the sustained forward head posture and elevated arm position required when working on a desktop surface.

The finding that most calligraphers had never received ergonomic training represents a significant but modifiable risk factor. Unlike industries where occupational health regulations mandate ergonomic assessments and training, artistic and craft professions often fall outside formal regulatory frameworks. This creates a situation where practitioners may be unaware of simple modifications that could substantially reduce their injury risk.

Public Health Implications

This study highlights the need for occupational health interventions specifically tailored to Arabic calligraphers and similar artistic professions. Practical recommendations include developing ergonomic guidelines for calligraphy workstations—such as adjustable desks tilted at appropriate angles, supportive seating with lumbar support, and proper lighting—as well as promoting regular stretch breaks during practice sessions.

Cultural institutions and calligraphy training centres in Saudi Arabia and throughout the Muslim world should consider incorporating ergonomic education into their curricula. Raising awareness among calligraphers about early warning signs of MSDs and the importance of seeking timely medical attention could prevent progression from acute discomfort to chronic, debilitating conditions. Public health practitioners should recognise that traditional arts and crafts carry occupational health risks that warrant systematic attention and intervention.

Limitations

The cross-sectional design precludes establishing causal relationships between identified risk factors and MSDs. The use of self-reported symptoms through the Nordic Musculoskeletal Questionnaire, while validated, does not substitute for clinical examination and may be subject to recall bias. Sampling through snowball and purposive methods may not yield a fully representative sample of all Arabic calligraphers in Saudi Arabia. The relatively niche population makes recruitment of large samples challenging. Future longitudinal studies with clinical assessments would provide stronger evidence for causal pathways and the effectiveness of ergonomic interventions.