Effect of Yoga on musculoskeletal pain and discomfort, perceived stress, and quality of sleep in industrial workers: Study protocol for a randomized controlled trial

Musculoskeletal symptoms are defined as any pain in the muscles, tendons, and nerves arising from repetitive, continuous, and unnatural movements [1]. Prevalence of musculoskeletal pain/discomfort range between 6.92% to 76.8% in the Indian adult population, with significant rural-urban differences [2]. A study on the Indian population of musculoskeletal pain shows 55.2% prevalence, 60% males and 40% females showing male predominance in an adult population ranging from 31-40 years, and the common anatomical site involved was low back (54.1%) [3]. A narrative review depicts different mechanisms associated with pain. Pain is in a complex interplay with emotional status and cognition, where they can either decrease or increase pain perception [4]. Pain is not only due to physiological causes but also closely associated with the behavioral and psychosocial aspects of an individual.

Work-related musculoskeletal symptoms are found to be the most common cause of occupational injury and physical disability. The highest prevalence was observed in healthcare professionals, followed by manufacturing industries [5]. Centre for Disease Control and Prevention 1997 (last reviewed Feb 2020) defines work-related musculoskeletal disorders as the condition in which the work environment and performance of work for a prolonged period contribute to the condition and its worsening.

Prevalence of musculoskeletal symptoms is strongly associated between years worked and pain in the lower back (44%), shoulders (33.3%), and neck (32%) [6]. Age and work category seems to be found associated with the high prevalence of occurrence in the lower back, wrist/hand, neck, shoulder, and ankle/feet regions in full-time employees of manufacturing industries [7].

Occupational musculoskeletal symptoms are often associated with perceived physical and mental stress, sensation of fatigue, and dizziness [8]. Repetitive, continuous, forceful task performance leads to mechanical tissue injury and microtraumas causing inflammation [9]. Musculoskeletal pain development and disability are found to have an association with the psychological aspect of workplace activity (e.g.; perceived job dissatisfaction, job strain, and boredom with actual work), education, and socioeconomic status of workers [4]. Studies have claimed that musculoskeletal symptoms in industrial workers are associated with factors like gender, age, lack of exercise, nightshift work, longer job tenure, reduced access to health information and health care, and a negative attitude towards seeking healthcare [10].

Work-related musculoskeletal diseases are reported to cause different degrees of functional incapacity, main cause of absenteeism which increases company expenses representing the major cause to retirement among men [11], [12]. A study to quantify the association of stress and musculoskeletal pain with poor sleep among hospital workers concluded that there exists a clear dose-response relationship between perceived stress and poor sleep as well as between pain intensity and poor sleep [13]. The pain interference is a stressor for individuals at the workplace, ultimately leading to negative affect and end-of-workday emotional exhaustion [14]. Exercise and other effective interventional measures are essential to manage and prevent musculoskeletal symptoms of pain and discomfort in working population.

Pain has been found to have relationship with various health behaviors like smoking, unhealthy diet and weight, physical inactivity, poor sleep, and mental stress [15]. Supervised group-based exercise at work and motivational coaching sessions are found effective for workers on musculoskeletal pain intensity and pressure pain threshold [16]. Another study on physical activity in metallurgic industries concluded that leisure-time physical activity and physical exercise helped to reduce absenteeism [12]. Workers committed to a customized set of interventions like preshift stretching program, produce significant, evidence-based health promotion outcomes [17]. A retrospective longitudinal study highlighted four important lifestyle factors (life satisfaction, hours of sleep, exercise habits, and physical fitness) in workers to reduce their risk of subjective musculoskeletal symptom occurrence [18]. These lifestyle behavioral changes help an individual to cope with pain perception and associated stressors in their work environment.

Yoga, as a holistic therapy is a form of complementary and alternative medicine considering 'body as whole'. Yoga has its impact on musculoskeletal pain in various workplace settings like hygiene profession [19], diamond industry [20], professional computer users [21], nursing population in hospital settings [22], home-office workers [23], metallurgic company [12], etc. Previous studies on Yoga have shown its association with a reduction in pain-related disability [24], improvement in flexibility [25], functional capacity and mobility [26], muscular strength [27] and quality of life [28] in individuals with different musculoskeletal disorders.

A review paper has highlighted the potential role of yoga in pain management for a range of conditions that can be chronically painful. Yoga is speculated to produce physiological, behavioral, and psychological changes in pain management. It is found to alter the pain experience by decreasing sympathetic activity, reducing inflammatory markers and stress markers, increase in muscular strength, flexibility, and cardiorespiratory capacity [29]. Yoga dealing with the mind and psychological status helps to cultivate a healthy acceptance in decreasing emotional distress and willingness to learn from pain and other stressful experiences [30]. Yoga aims to recondition and rejuvenate the neuromuscular system by lubricating the joints, muscles, and ligaments, strengthening periarticular muscles, and improving the coordination of joint movements [27].

Yogic meditation and relaxation have been shown to play a significant role in reducing pain, tenderness, disability, and state anxiety and improving flexibility in patients with common neck pain [31]. Mental silence in the form of meditation called Sahaja Yoga has helped to reduce work stress and depressed mood in full-time workers [32]. A meta-analysis has quantified that workplace yoga interventions have been effective in reducing perceived stress among employees when compared to no-treatment [33]. Integrative yoga has also shown its beneficial effect in improving the quality of sleep in individuals, thereby improving their overall health and quality of life [34], [35].

In workplace population, due to their heavy workload, prolonged standing, manual continuous repetitive handling of materials, and unnatural movements, make them prone to get musculoskeletal ailments. Few studies on exercise at work and motivational coaching sessions have been found effective in the reduction of pain intensity and absenteeism associated with their work [12], [16]. Stress and sleep disturbance due to their change in shift work also has adverse health effects on their body and mind. There are many studies of yoga on specific musculoskeletal disorders, but very minimal are on musculoskeletal health in industrial workers. A study on Workplace Yoga has shown its effectiveness in reducing stress, musculoskeletal pain, fatigue, and quality of life among diamond industry employees [20]. In this study, we will try to understand the efficacy of Yoga as integrative therapy in reducing Musculoskeletal pain in manufacturing industrial workers and thereby lower their associated discomfort, perceived stress and improve quality of sleep.

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