Background Effective workplace interventions aimed at preventing musculoskeletal disorders (MSD) are characterised by their alignment with the biopsychosocial model and key elements of increasing workers’ knowledge on MSD, their involvement in workplace-change procedures, and physical exercise. Occupational safety and health (OSH) professionals are key stakeholders in delivering such interventions. However, many lack the competencies needed to do so successfully. Using the evidence-based clinical program, Good Life with osteoArthritis in Denmark (GLA:D®) as a starting point, this study aimed to develop a multi-component intervention, PATH@work, targeting MSD in workers with physically demanding work, and a training course for OSH professionals to deliver this intervention. Methods We carried out a development study with a nested qualitative case study. Data were collected using the Exploration, Preparation, Implementation and Sustainment framework in a 4-step iterative process: 1) Identifying, reviewing, prioritising and collecting effective intervention components, 2) Developing the delivery strategy of the intervention in consultation with stakeholders and digital tech developers, 3) Developing the training course for the OSH professionals in collaboration with stakeholders, and 4) Evaluating the initial intervention components through a qualitative case study. Data were collected through researcher logs (steps 1–3) and individual semi-structured interviews (step 4). We analysed data using thematic analysis. Results The resulting intervention, PATH@work, comprises 15 half-hour modules that integrate three core components: musculoskeletal health literacy, physical exercises, and participatory ergonomics. The OSH professional training course comprises a one-day in-person session and digital materials to support delivery. The course content includes education on the three components and planning of intervention delivery. The evaluation indicated that the intervention was perceived as appropriate and feasible. However, workers found it only partly acceptable, particularly regarding the participatory component. Conclusions We integrated core components of GLA:D® with participatory ergonomics to develop a new MSD intervention for workplace contexts and a corresponding training course for OSH professionals. The intervention is yet to be tested and evaluated on a large scale. Our user-focused process contributes to the development of integrated workplace strategies to prevent and manage MSD among blue-collar workers. Trial registration ClinicalTrials.gov NCT07466680. Registered 03/03/2026. This study is retrospectively registered.

BACKGROUND AND PURPOSE:Hypermobility Spectrum Disorder (HSD) is a common musculoskeletal condition that impairs function and quality of life. While exercise therapy has shown to improve outcomes, treatment standardisation is lacking and the relationship between strength and symptoms remains unclear. Therefore, our aim was to investigate the association between changes in shoulder strength and self-reported shoulder function, pain, and perceived effect in patients with HSD and shoulder symptoms. METHODS:This is a secondary analysis of a randomised controlled trial. Data from 76 participants (58 women; median age 35.5) were included. Primary outcomes were percentage change in relative strength (Nm/kg) measured in external rotation, internal rotation, and scaption, the Western Ontario Shoulder Instability Index (WOSI), the Numerical Pain Rating Scale (NPRS) and the Global Perceived Effect: Physical domain (GPEP). Secondary outcomes were achieving the Minimal Clinically Important Difference (MCID) in shoulder function and pain. Covariates were age, sex, Body Mass Index, hand dominance, previous shoulder dislocation, mechanical shoulder symptoms, and assigned intervention group. RESULTS:Increasing strength in external rotation and scaption were linearly associated with an improvement in shoulder function (WOSI adjusted -3.5 (95% CI -5.9; -1.1), and WOSI adjusted -2.6 (95% CI -4.6; -0.6) respectively), while scaption strength was associated with a reduction in shoulder pain (NPRS -0.01 (95% CI -0.02; 0.00)). Improvement in external rotation and scaption were associated with higher odds of reporting an important improvement measured for every 10% increase in strength (adjusted OR 1.18 (95% CI 1.00; 1.38) and 1.30 (95% CI 1.07; 1.59), respectively). DISCUSSION:Increased shoulder strength may be associated with improved outcomes in patients with HSD and persistent shoulder symptoms although our findings suggest limited clinical relevance. Further research is needed to understand the relationship between strength and symptom relief. TRIAL REGISTRATION:The study was registered in Clinicaltrials.gov (11 March 2019, NCT03869307).

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OBJECTIVES: Musculoskeletal disorders from repetitive upper arm movements contribute substantially to sickness absence and productivity loss. Despite widespread use of observational and sensor-based assessments, inconsistent definitions hinder comparison across studies and translation to practice. This study explored threshold criteria for defining upper arm movements and static postures across observational and sensor-based approaches and examined conceptual differences between practical observability and biomechanical measurability. METHODS: We conducted a two-round Delphi study following the ACCORD guidelines. We invited 35 European experts to rate agreement on proposed definitions. A consensus criterion was set to ≥75% agreement. A thematic analysis of free-text responses guided definition revisions between rounds. RESULTS: Fifteen (43%) and fourteen (93% retention) completed rounds 1 and 2, respectively. Consensus defined a fast-paced movement as ≤1 second (80% agreement) and static posture as ≥4 seconds with ±5° movements (87% agreement). No agreement emerged regarding the minimum amplitude threshold for defining an arm movement (eg, 10° versus 20°; 53% agreement). Experts’ comments reflected a tension between observability, favoring higher amplitude thresholds, and biomechanical relevance, favoring lower thresholds, while highlighting velocity’s importance. CONCLUSIONS: Expert consensus on time-based thresholds for fast-paced movements and static postures provides a starting point for standardized ergonomic assessment. The absence of consensus on amplitude thresholds highlights the need for field validation studies examining which thresholds capture measurement reliability and prediction of musculoskeletal health outcomes. These findings support efforts toward transparency and alignment in upper arm exposure definitions across research and practice, while acknowledging remaining conceptual and methodological challenges.

The economic literature on health shocks and labour market outcomes largely focuses on acute health shocks at older ages, leaving limited evidence on long-term labour-market consequences. By examining the consequences of incident hospital-diagnosed back disorders among early-career workers, this study addresses that gap in the literature. We link population-wide Danish administrative registers (1996-2017) to follow a cohort of 157,692 individuals who were aged 28-31 in 2006. We apply a staggered difference-in-differences design, to identify the impact on both earnings (productivity) and disposable income (financial burden). We find persistent adverse effects: eight years post-diagnosis, annual earnings have declined by 8% for men and 13% for women relative to the controls. We document a distinct gender divergence in the mechanisms driving these losses. While men primarily adjust through the intensive margin (temporary reduction in hours) and stabilize over time, women face a progressive decline driven by labour market exit (extensive margin). Although the Danish welfare system acts as a significant buffer, compensating for 55-65% of earnings losses, a substantial private financial burden persists. These findings suggest that early-career back disorder shocks initiate long-term trajectories of cumulative disadvantage, particularly for women.

OBJECTIVES:Previous studies have linked activity in the upper trapezius muscle with neck pain. However, no studies have examined whether asymmetric activation of these muscles during the working day is associated with neck pain. This study aimed to investigate this relationship. METHODS:Seven research institutes provided data on bilateral upper trapezius muscle activity on one working day, along with corresponding questionnaire data on cross-sectional (n = 530) and longitudinal (n = 256) neck pain intensity. The asymmetry, defined as the activity difference between the two upper trapezius muscles, was calculated as an average across the entire workday and within various intensity levels in relation to maximum voluntary isometric contraction (MVIC). Unadjusted and adjusted linear regression analyses were executed to examine the association between asymmetric muscle activation and neck pain intensity. RESULTS:In cross-sectional analyses, asymmetry in the levels 0-0.05 and 0.05-2%MVIC was significantly positively associated with neck pain intensity in both unadjusted and adjusted analyses. Asymmetry in the levels of 4-6, 6-8 and 8-10%MVIC was significantly negatively associated with neck pain in unadjusted analyses. In longitudinal analyses, significant positive associations were found for asymmetry in level 0-0.05%MVIC and negative associations for asymmetry in levels > 20%MVIC. CONCLUSION:While asymmetry in the very low levels of muscle activity may be associated with higher neck pain intensity, asymmetry in the higher levels of muscle activity was negatively associated with neck pain intensity. However, the explained variance of the models was small, and the results should therefore be interpreted with caution. The findings suggest that work conditions facilitating simultaneous relaxation during breaks and balanced activation of both muscles during static activities may be relevant for neck pain prevention, though further research is needed to establish causality.

Musculoskeletal pain is a leading cause of seeking care and imposes an immense economic burden to the healthcare systems. The guidelines recommend physical activity for managing musculoskeletal pain but do not differentiate between occupational and leisure-time physical activity. Research indicates that occupational physical activity may not have similar health benefits as leisure-time physical activity. Thus, we investigated the association between occupational and leisure-time physical activity and musculoskeletal-related primary healthcare utilization. At baseline, physical activity data (sitting, standing, light physical activity, moderate-to-vigorous physical activity and time in bed) were collected from 824 blue-collar workers using a thigh-worn accelerometer during work and leisure for up to five days. Musculoskeletal-related primary healthcare utilization (i.e., contacts with general practitioners, physiotherapists and specialists) was retrieved from the Danish National Health Services Registry during a 4-year follow-up from baseline. The association between occupational and leisure-time physical activity and musculoskeletal-related primary healthcare utilization was analyzed using a generalized linear model adjusted for potential confounders. During follow-up, 62%, 42% and 10% of the workers had at least one musculoskeletal-related contact to the general practitioner, physiotherapist and specialist, respectively. Leisure-time moderate-to-vigorous physical activity was associated with a decreased risk of a general practitioner contact (RR = 0.78; p value = 0.02), a tendency for a decreased risk of a physiotherapist contact (RR = 0.83; p value = 0.23), but with a tendency for increased risk of a specialist contact (RR = 1.49; p value = 0.20). On the contrary, occupational moderate-to-vigorous physical activity was not associated with a decreased risk of a general practitioner contact (RR = 1.04; p value = 0.75), physiotherapist contact (RR = 1.00; p value = 0.99) or a specialist contact (RR = 1.80; p value = 0.05). Our findings indicate that the domain of physical activity is of importance for musculoskeletal-related primary healthcare utilization. While leisure-time physical activity was associated with a decreased risk of a general practitioner and physiotherapist contact, occupational physical activity was not associated with such benefits.

Workplace health enhancing physical activity (HEPA) programmes are associated with physical activity promotion and reduction of sedentary time among employees. Whilst the workplace is often considered an appropriate setting for such programmes, however, ethical and implementation challenges remain. Furthermore, debate still exists concerning programme rationale, efficacy, effectiveness, and impact. In 2024, 24 researchers from twelve countries collaborated to establish evidence-based consensus statements concerning such programmes. The consensus was developed through an iterative process involving experts from sociology, psychology, sport policy, physiology and promoting and assessing movement behaviours. In total 36 consensus statements and 23 areas identified for further research were produced. A broad definition of HEPA was adopted that included structured and unstructured activities, whilst HEPA was distinguished from occupational and leisure-time activities. Consensus highlighted, for example, the importance of multi-level approaches to programme implementation, the need for managerial support, and the need to tailor programme design. The consensus also demonstrated the need for more research on the long-term impacts of workplace HEPA programmes, to investigate the potential role of technology, and to further understand the influence of socio-cultural and individual factors on participation.

Background/Objectives: This study presents a secondary analysis from a previously published trial on strength training and postural correction in chronic headache patients. Here, we investigate changes in neck muscle function and tenderness, and their relationship with headache symptoms. Methods: A total of 22 headache patients from a single-arm open-label trial were included in this study to assess muscle function and tenderness. The maximum voluntary contraction of neck flexion and extension, shoulder elevation, and craniocervical flexion test were performed at baseline, week eight, and week 14. The extension/flexion ratio of the neck, the rate of force development, and the early rate of force development for shoulder elevation were calculated. Muscle tenderness was analyzed using the total tenderness score (TTS) and correlations between these outcomes and headache changes were explored. Results: After the intervention muscle tenderness significantly decreased (−5.6 ± 6.4; p < 0.001) and significant improvements in muscle function were observed. Correlations of muscle function showed a significant and moderate correlation between TTS and extension/flexion ratio (Spearman rho: 0.567, p = 0.014). Conclusions: The results indicate that strength training and postural correction improve muscle function and reduce pericranial tenderness in patients with chronic headaches. These findings suggest that muscle tenderness and extension/flexion ratio may be useful for monitoring exercise interventions focused on improving the strength and balance of the neck in patients with chronic headaches.

OBJECTIVES:To compare pain trajectories and acute exercise-induced pain over a 16-week period in patients with hypermobility spectrum disorder (HSD) undergoing high-load (HEAVY) or low-load (LIGHT) shoulder exercise. METHODS:In this secondary analysis using data from a randomized controlled trial, we included men and women aged 18-65 with HSD and shoulder complaints >3 months. Participants were randomly allocated (1:1 ratio) to 16 weeks of HEAVY or LIGHT shoulder exercise program, performed three times weekly. The HEAVY program consisted of progressive strengthening and full range of motion exercises, while the LIGHT program included low-load exercises performed in neutral to mid-range. Pain was assessed using the numeric rating scale (NRS) before and after each exercise session. Pain trajectories were assessed using pre-exercise pain scores at the final session each week. Exercise-induced pain was evaluated as the change in pain before and after exercise, using the mean of the three sessions each week. Both outcomes were analyzed using linear mixed models. RESULTS:Data from 64 out of 100 patients (HEAVY 34, LIGHT 30) were analyzed (80% women, mean age 39.6, mean Beighton score of 5.8). Shoulder pain was reduced by 0.89 NRS in HEAVY (95% CI 0.4 to 1.4) and 0.33 NRS (95% CI -0.25 to 0.91) in LIGHT. The between-group difference in change in pain from baseline to week 16 was 0.56 (95% CI -0.20 to 1.33, p = 0.149). There was no between-group difference in pain trajectories (group × time interaction, p = 0.321). The mean exercise-induced pain over time was similar in both groups (group × time interaction, p = 0.614), with pain below 0.5 NRS throughout the 16 weeks. CONCLUSIONS:Pain trajectories over 16 weeks were similar in patients with HSD and persistent shoulder complaints performing high-load or low-load shoulder exercises. There was minor to no exercise-induced pain during high-load strengthening exercise, challenging previous beliefs.

Background: Few studies have examined exercise-based treatments for migraine and tension-type headache (TTH), and even fewer have focused on strength training and chronic headache, as these present greater challenges. Objectives: This study aimed to evaluate the effectiveness of a group-based neck and shoulder strength training intervention combined with postural correction for patients with chronic headache. Methods: This prospective, single-arm, uncontrolled pilot study with a pre–post design included patients with chronic migraine (n = 10) and TTH (n = 12) who participated in an 8-week group-based program consisting of neck and shoulder strength training three times per week, along with instructions for postural correction. The primary outcome was change in headache frequency. Secondary outcomes included changes in the intensity and duration of headache, number of days of analgesic use, and functionality. Results: In total, 22 patients completed the intervention and were included in the analysis. Headache frequency decreased at follow-up for the overall group (r = 0.531; p = 0.014). In-depth analysis showed that 45% of participants experienced an average reduction of 38% in headache frequency. Additionally, large to moderate effect sizes were observed for the secondary outcomes. Conclusions: This is the first study to introduce a group-based exercise program targeting the neck and shoulder muscles, combined with postural correction and standard pharmacological treatment, for patients with chronic primary headache. It was found to be a safe, well-tolerated, useful, and promising intervention for improving headache frequency, duration, and functionality.

Musculoskeletal pain is the biggest contributor to burden of disease, causing excessive use of pain-relief medication. Non-pharmaceutical measures are called on for handling this burden. Guidelines recommend physical activity as an effective non-pharmaceutical measure. However, it is unknown if occupational physical activity has the same preventive effects on redeeming pain-relief medication as when performed during leisure-time ("The Physical Activity Paradox"). We aimed to investigate if the paradox contributes to the redemption of prescribed pain relief-medication. 24-h device-measured physical activity data [sitting, standing, light physical activity, moderate-to-vigorous physical activity (MVPA) and time in bed)] were collected from 824 workers using a thigh-worn accelerometer during work and leisure-time. Redeemed pain-relief prescribed medication was retrieved from the Danish National Prescription Registry during a 4-year follow-up. The prospective association between occupational and leisure-time physical activity and number of redeemed pain-relief prescribed medication was analyzed using a generalized linear model, adjusted for potential confounders. During follow-up, 53% of the workers redeemed a pain-relief medication. In leisure-time, 30 min more of MVPA per day were associated with 23% lower risk (RR = 0.77; 95% CI 0.64 - 0.94) of redeeming pain-relief medication. In contrast, occupational physical activity was not associated with the risk of redeeming pain-relief medication [RR = 1.04 (95% CI 0.89 - 1.20)]. Leisure-time MVPA was associated with lower risk of redeeming pain-relief medication, while no beneficial association was found for occupational MVPA. These findings support the paradox that the domain of physical activity is important for redeeming pain-relief medication. PERSPECTIVE: Leisure-time MVPA differs from occupational MVPA in its association with redeeming pain-relief medication. Increasing leisure-time MVPA may serve as an effective non-pharmacological strategy to reduce pain-relief medication redemption. These findings could potentially inform guidelines for managing musculoskeletal pain, highlighting the need to differentiate between occupational and leisure-time physical activity.

We pilot-tested movement breaks lasting < 1 min at the University of Southern Denmark (SDU) with an initiative called PauseNørd. Our mixed-methods feasibility study explored the acceptability, practicality, expansion, and limited efficacy of the PauseNørd breaks (PN breaks) via observation, questionnaires, and short interviews. Three groups of students tested lectures with and without the PN breaks. The PN breaks were well accepted by students and lecturers, and they were practically easy to implement. Suggestions to improve practicality related to timing and frequency. Potential barriers to expansion were identified in relation to student familiarity with exercise and lecturer comfort in leading the breaks. Preliminary data on effectiveness indicated that the PN breaks could support alertness, concentration, enjoyment, motivation, positive mood, and the social interactions within the class. The learning from the pilot study will be used to inform future PN research.

OBJECTIVES:Sustained activity of the upper trapezius muscle during work has been linked to the development of neck pain. Women have higher occurrences of neck pain than men, even in the same occupations. This study aimed to investigate sex-specific associations between upper trapezius muscle activity time-related variables and neck pain using a meta-analysis of pooled data. METHODS:Seven Scandinavian research institutes provided surface electromyographic (EMG) data on the upper trapezius muscle activity during work and related questionnaire-based data on neck pain severity. EMG and questionnaire data were harmonized and pooled. Associations between upper trapezius muscle activity variables [median muscle activity, frequency of muscular rest periods, and periods with sustained muscle activity (SUMA)] and neck pain severity were investigated separately for women (N=293) and men (N=418) using linear regression analyses. RESULTS:In the cross-sectional analyses, women showed significant positive associations between the number of short SUMA periods and negative associations for long SUMA periods in regard to neck pain severity. In the longitudinal analyses, women showed no significant associations. In the cross-sectional analysis for men, one significant positive association was found between median upper trapezius muscle activity and neck pain severity. CONCLUSIONS:Compared to men, neck pain severity among women appears to be more dependent on upper trapezius muscle activity patterns at work. Therefore, ergonomic and organizational recommendations for work should be sex-specific or adjusted for women to reduce their prevalence of neck pain. Further research is needed to elucidate the underlying mechanisms of these sex differences.

Background People with low back pain (LBP) are often recommended to self-manage their condition, but it can be challenging without support. Digital health interventions (DHIs) have shown promise in supporting self-management of LBP, but little is known about healthcare providers’ (HCPs) engagement in implementing these. Aims We aimed to examine HCPs’ engagement in patient recruitment for the selfBACK app clinical trial and explore their perceptions of the app. Methods In a mixed-methods design, we conducted a process evaluation alongside the selfBACK trial, triangulating quantitative data from trial recruitment logs and a vignette-based survey, and qualitative data from trial procedure documents, interviews with HCPs, and survey free-text responses. From 2019 to 2020, we recruited 57 HCPs from Norway and 39 health clinics in Denmark and collected quantitative and qualitative data in parallel. Results were integrated using displays. Results Overall, 825 patients were recruited by the HCPs. The vignette-based survey showed high agreement among HCPs (n = 62) with the self-management plans generated by the app (84.1–88.9%) but also highlighted concerns about tailoring and content. Interviews with HCPs (n = 19) revealed challenges with recruitment due to busy schedules, competing tasks, and varying levels of interest and engagement in the study. Conclusions The study identified factors that impact HCPs’ engagement in recruiting patients for the selfBACK trial and highlighted overall positive views of the selfBACK app, although some concerns about the content and tailoring of the app were raised. Understanding HCP motivations and workload is crucial for the successful implementation of DHIs in clinical practice.

Individuals with musculoskeletal pain are generally advised to "be active", "reduce sedentary behavior", and "sleep enough", but such broad recommendations can be challenging to implement in daily life. We identified 24-h physical behavior compositions associated with musculoskeletal pain, using cross-sectional data from 817 participants in the Copenhagen City Heart Study. Daily durations of sedentary behavior, standing, light intensity, and moderate-to-vigorous physical activity during leisure and work, and time in bed were measured using thigh- and hip-worn accelerometers (24 h/day for 7 days) and were used as exposure. The outcome was persistent musculoskeletal pain (past 6 months, pain intensity or activity limitation: ≥ 3 on a 0-10 scale). We used logistic regression models to predict 24-h physical behavior compositions with the 15% lowest and highest probabilities of pain. Persistent musculoskeletal pain was reported by 40%. Individuals with a low and high probability of persistent musculoskeletal pain had distinct 24-h physical behavior compositions compared to the mean 24-h composition of the study population. Individuals with a low probability of pain had less leisure time sedentary behavior and time in bed but more sedentary behavior during work ("sweet spot" composition). Those with a high probability of pain had more leisure time sedentary behavior and time in bed but were less sedentary and more active during work ("sour spot" composition). In conclusion, these results can inform the development of actionable domain-specific 24-h physical behavior guidelines for individuals with musculoskeletal pain and aid in developing targeted interventions to improve musculoskeletal health, but we acknowledge the risk of reversed causality.

Leisure time and occupational physical activity (LTPA, OPA) seem to have opposite associations with some health outcomes. Few studies have investigated this for musculoskeletal pain. We investigated the association between (1) LTPA and OPA, and (2) combinations thereof, and persistent pain and number of pain sites, respectively, among adults. We used cross-sectional data from the Copenhagen City Heart Study. LTPA and OPA was measured using the Saltin-Grimby Physical Activity Level Scale. The outcomes were persistent pain and number of pain sites (past six months). Using hurdle models, the association between physical activity and the outcomes was expressed as odds ratios (OR) and incidence rate ratios. We included 2787 individuals. High LTPA was associated with decreased odds of persistent pain and lower number of pain sites, whereas high OPA was associated with increased odds of persistent pain and higher number of pain sites (e.g., high LTPA vs. inactive, OR: 0.38, 95% confidence interval [CI]: 0.26, 0.57; high OPA vs. sedentary work, OR: 2.94, 95% CI 1.66, 5.20). All LTPA-OPA-combinations indicated higher odds for persistent pain and higher number of pain sites when compared to moderate-to-high LTPA and sedentary work. This study highlights that not all physical activity may be beneficial.

Objectives Both high and low levels of occupational physical activity are associated with back pain. Thus, there might be a "sweet- and sour -spot" of occupational physical activity for back pain. Our aim was to investigate if there exists an occupational physical activity "sweet- (lowest risk) and sour -spot" (highest risk) for back pain. Methods A total of 396 eldercare workers from 20 Danish nursing homes participated. Occupational physical activity was measured between 1-4 working days using thigh -worn accelerometry. Back pain intensity was reported monthly on a scale from 0-10 over 1 -year. A zero -inflated mixed -effects model was developed regressing occupational physical activity against back pain, adjusted for confounders. The "sweet- and sour -spot" were defined as the occupational physical activity compositions (sitting, standing, light, and moderate -to -vigorous) associated with the 5% lowest and highest risk for back pain, respectively. Results The composition associated with the lowest risk of back pain - the "sweet -spot"- consisted of 71% worktime spent sitting, 18% spent standing, 5% spent on light physical activity and 6% spent on moderate -tovigorous physical activity. The composition associated with highest risk for back pain -the "sour -spot"- consisted of 8% worktime spent sitting, 66% spent standing, 4% spent on light physical activity, and 21% spent on moderate -to -vigorous physical activity. Conclusions The "sweet -spot" of occupational physical activity for back pain among eldercare workers involves more sitting and light physical activity time, while the "sour -spot" involves more standing and moderate -tovigorous physical activity time. Research on the occupational physical activity "sweet- and sour -spot" is needed.