1. Christian medical college, Vellore, India; ramanisha@cmcvellore.edu
2. Christian medical college, Vellore, India; singh-ramcharan998@cmcvellore.edu
3. University Institute of Physical Therapy, University of Lahore, Pakistan; mahrukhasghar@yahoo.com

*Corresponding author: gupta.ramanisha@cmcvellore.edu

Keywords: neck pain, computer, bankers, posture, musculoskeletal disorder

1. INTRODUCTION

An ache that radiates from the base of the head (occiput) to the top of the back and spreads laterally to the superior and outer borders of the scapula is referred to as neck pain [1]. Cervicalgia is another name for neck pain. Without a workstation, other electrical devices, and internet access, it is difficult to survive in the modern world [2]. The neurological structures of the neck are closely related to the cervicothoracic spine, the upper extremities, or the vital extremity organs. The cervical and brachial plexi, the sympathetic nervous system, and the lower cranial nerves IX through XII and their branches are some of these neural structures found in the neck [1]. The cervical spine, which is made up of the seven cervical vertebrae (C1 through C7), is divided into two main segments: the subaxial spine and the craniocervical junction (CCJ).C1 is known as Atlas, and C2 is known as Axis. There is also a hyoid bone in front of the neck [2]. The ligaments connecting the bones in the cervical spine allow the spine to remain stable. One of the three important ligaments in the cervical spine is the anterior longitudinal ligament. This ligament extends down the front of your cervical vertebra from the base of your skull [3]. It extends to stop the neck from turning back. A ligament connects C2 to the base of your cervical vertebrae, and it is called the posterior longitudinal ligament. It goes farther to prevent forward neck motion. Ligamentum flava, or ligaments, envelop the spinal cord’s passageway on the inside backside of every vertebra. These ligaments surround and protect your spinal cord from the back [4–7]. Regular computer use, prolonged bad posture, and physically demanding activities are all associated with repetitive activities that might induce neck pain [8]. Cervical radiculopathy may manifest as neurological symptoms such as muscular weakness, disordered sensation, and diminished reflex, in addition to pain in the neck and upper limbs [9].  Risk factors include age, sex, poor computer work station design and incorrect posture, sedentary lifestyle, repetitive work, high quantitative job demands, low social support at work, job insecurity, occupational activities, past history of MSK pain, depression, anxiety, and strain on the neck [10]. The majority of cases of neck pain are idiopathic, meaning they have no recognized explanation, despite the fact that metabolic, neoplastic, inflammatory, or viral diseases, stressful events (such as disorders associated to whiplash), and inflammatory or viral diseases can all induce neck discomfort [11]. Cervical proprioception impairment is one of the main issues that people with neck discomfort have, and it leads to abnormalities in cervical sensorimotor control [12]. The characteristics of weaker and force-steadier muscles include altered cervical muscle activity, lower directional specificity, delayed initiation of muscular responses, and increased muscle fatigability. Furthermore, atrophy and fatty infiltration in the muscles have been reported as alterations in their form [13]. For the purpose of treating neck pain, a wide range of pharmaceutical and non-pharmacological treatments have been suggested [14], including massage, acupuncture, yoghurt, laser therapy, and aquatic therapy. In order to minimize health risks and safeguard human health, ergonomics is very crucial [15]. One important step toward the use of ergonomics is the creation of adjustable workstations. Ergonomic design is the process of using science to create a workplace that considers the tasks performed by people, the use of tools, and the surrounding environment. In addition to maximizing worker potential by raising output and job happiness, good ergonomics benefit the business by lowering medical costs and sick leave [16]. A vital element of the neck and head’s stability and functionality is cervical proprioception. The brain uses proprioceptors in the cervical spine to receive important sensory data that it can use to regulate movement, posture, and balance [17]. Although acupuncture was shown to be far more successful in trials than the sham (placebo) control, its applicability as a chronic pain treatment is still up for debate, in part due to its non-biomedical origins [18]. Cervical ROM is a component of physical therapy for severe neck discomfort [19]. A quick (one week) treatment of neck immobilization may help those with acute radiculopathy-related neck stiffness by lowering their inflammatory symptoms. A cervical traction machine at home could help with radicular pain. Usually, 8 to 12 pounds of traction are given at an angle of 24 degrees or less for 15 to 20 minutes [20]. Cervical radiculopathy can be treated surgically as well as with multimodal therapies such as cervical traction, manual therapy methods, neural mobilization, and strengthening exercises [21]. The study’s main objective is to increase bankers’ awareness of the bad posture they employ when using computers. This will help to reduce the amount of work absences brought on by bad posture and increase bankers’ understanding about maintaining good posture.

2. LITERATURE REVIEW

A study conducted in private banks [10] found that, of the 277 participants, 23 (or 8.3%) worked three to five hours a day, 46 (16.6%) worked six to eight hours, and 208 (or 75.1%) worked nine to twelve hours. There were 82 (29.6%) accountants, 65 (23.5%) cashiers, 49 (17.7%) operation managers, and 34 (12.3%) managers, according the job description. 184 persons (66.4%) said they have experienced neck pain during the preceding half-year. About 50% of those who are in pain are only mildly uncomfortable. Of the 145 (86.8%), 8 (4.7%) reported having severe neck pain, and 14 (8.3%) reported mild pain. According to this study, neck pain affected 64.4% of participants, suggesting that bankers frequently had neck pain as a result of their neck ties [10]. There were 48.33% more women than men among the 120 participants in the India study. Sixty-three of the 120 respondents came from commercial banks, while 57 came from state institutions.Of the participants, 16.67% had keyboards that could be adjusted. Forty percent of bankers reported using back care products. While 95.83% of respondents used adjustable seats, only 3% of bankers did not have access to a chair. A quarter of bankers had seats with armrests. Of the participants, 72.2% made use of monitors with adjustable levels. While the percentage of participants who could move their elbows, knees, and wrists freely was 65.83%, 73.33%, and 68.33%, 71.67% of respondents said they had pain at work, and 48.33% said they had shoulder pain. 78.34% of respondents reported that their level of pain subsided after work [16]. The 154 conditions requiring the greatest amount of health care spending in 2016—an estimated $134.5 billion—were low back and neck discomfort.  In 2017 there were 3551.1 cases of neck soreness worldwide [17]; the incidence rate was 806.6 cases per 100,000 people. It is associated with prolonged periods of bending, holding, or maintaining a twisted posture while working, as well as with repetitive trunk movements. The onset and persistence of various work-related musculoskeletal disorders, such as neck pain, have been linked to a number of risk factors, in addition to working conditions. These risk factors include age, gender, lifestyle choices like smoking, mental stress, alcohol use, prior pain symptoms, psychosocial factors, socioeconomic variables, poor muscle flexibility and strength, physical activity, and physical workload. A study carried out in Kuwait also found that bankers had a 57% prevalence of musculoskeletal issues related to their jobs in the week before the study and an 80% prevalence in the year before [23]. A study on bankers in Surulere Local Government Area, Lagos State, Nigeria, was carried out to ascertain the frequency of complaints pertaining to the arms, neck, and shoulders (CANS) across several banks. Those who satisfied the study’s qualifying requirements received 337 copies of the questionnaire in total, and the completed copies were collected. Rates of CANS prevalence during the course of the preceding 12 months. The findings revealed that 182 respondents (70%) reported at least one complaint in the arm, neck, and shoulder, whereas 102 respondents (39.2%) experienced at least one problem in any upper musculoskeletal extremity, including the elbow, wrist, hand, neck, and arm [24]. Statistics show that 66% of people will at some point in their lives have neck pain.  In 2007, patients most commonly cited low back pain as the main reason they turned to complementary and integrative medicine (CIM). More than one-third of those impacted continue to have low-grade symptoms or recurrences after more than a year of treatment, which frequently lead to chronic pain [25].

3. METHODOLOGY

It was a cross-sectional observational research to determine how frequently bankers experienced neck pain. The data was gathered from Indian public and private banks. The study was finished six months following the synopsis’s acceptance in 2022. Using a 95% confidence level and 10% absolute precision, an estimated sample size of 86 patients was calculated, with a predicted percentage of 66.4% experiencing neck pain. The bankers who were employed by banks were included in the study group because they met the requirements for inclusion. In this investigation, a practical sampling strategy was employed. Participants ranged in age from 20 to 55, were bankers with neck pain, cooperative subjects, and used computers for at least 5 hours each day. Any deformity, such as torticollis, cervical spondylosis, cervical spondylitis, or cervical spondylolisthesis were excluded, as well as patients younger than 20 and older than 55. The Institutional Review Board gave their official clearance. Before collecting data from bankers who satisfy the inclusion requirements, informed consent was obtained through the proper written consent form. The inclusion criteria were a sample of 86 bankers, both male and female, who used computers at least 5 hours every day in the bank. The data under evaluation were both subjectively and objectively examined. Name, age, gender, education, employment history, and the location and duration of any pain were among the demographic information. Each participant who met the inclusion criteria completed the modified Maastricht Upper Extremity Questionnaire and the Numeric Pain Rating Scale to provide the basis for the data collection. Statistical Package for the Social Sciences (SPSS) version 22.0 was used to analyze the data. The quantitative variable known as age was displayed as a histogram with a mean and standard deviation (mean S.D.). The qualitative factors, such as gender, were graphically represented in pie charts and tables as frequencies and percentages. Gender and age constituted independent factors. The dependent variables included neck discomfort, body posture, and workstation ergonomics. A non-parametric Spearman test was used to examine the relationship between pain and both work station and body position.

4. RESULTS AND DISCUSSION

Figure 1 shows that among 86 participants; mean age was 35.22 ± 7.806 as 23 years was minimum & 55 years was maximum age and the result shows that among 86 bankers; 61 (70.9%) were male and 25 (29.1%) were females.

Figure 1: Shows that among 86 bankers; mean of years the bankers working in this position was 9.24 ± 6.735.

Table1: How long you have been working in this position?

Q1	N	Mean	Std. Deviation
How long have you been working in this position?	86	9.2442	6.73522

Table 1 shows that among 86 bankers; mean of years the bankers working in this position was 9.24 ± 6.735.

Table 2: How many days do you work per week?

Q2	N	Mean	Std. Deviation
How many days do you work per week?	86	5.2558	.48956

The result shows in Table 2 that among 86 bankers; mean of days bankers work per week was 5.255 ± 0.489

Table 3: How many hours do you work a day?

Q3	N	Mean	Std. Deviation
How many hours do you work a day?	86	9.2326	.99024
Valid N	86

Table 3 result shows that among 86 bankers; mean of hours bankers work a day was 9.232 ± 0.990.

Table 4: How many hours per working day do you work behind your computer?

Q4	N	Mean	Std. Deviation
How many hours per working day do you work behind your computer?	86	7.6860	1.38276

 TABLE 4 shows that among 86 bankers; mean hours per working day behind computer were 7.686 ± 1.382.

The result shows that among 86 bankers; mean hours per working day behind computer were 7.686 ± 1.382.

Table 5: Pain Severities by NPRS

Variable	N	Mean	Std. Deviation
Rate your pain 0 to 10	86	2.3372	1.79286
Valid N	86

Table 5 shows that among 86 bankers; mean rating of pain was 2.337 ± 1.792.

Table 6: Work Station Score by modified MUEQ

Variable	N	Mean	Std. Deviation
score of work station	86	1.16	.866
Valid N	86

Table 6 shows that among 86 bankers; mean work station score of bankers was 1.16 ± 0.86 according to modified MUEQ.

Table 7: Body Posture Score by modified MUEQ

	N	Mean	Std. Deviation
score of body posture	86	11.17	1.886
Valid N (listwise)	86

Table 7 shows that among 86 bankers; mean score of body posture was 11.17 ± 1.886 according to modified MUEQ.

Table 8 shows normality of data assessed through Shapiro Wilk test of normality; Sig. (p) value was less than 0.05 (p<0.05) for all the variables so non-parametric Spearman test applied to find out association / correlation between pain & body posture and pain & work station also.

Table 8: Test of Normality

	Shapiro-Wilk
	Statistic	Df	Sig.
rate your pain 0 to 10	.862	86	.000
score of body posture	.932	86	.000
score of work station	.863	86	.000

Table 9: Correlations between Body Posture & Pain

			score of body posture	rate your pain 0 to 10
Spearman’s rho	score of body posture	Correlation Coefficient	1.000	.262*
		Sig. (2-tailed)	.	.015
		N	86	86
	rate your pain 0 to 10	Correlation Coefficient	.262*	1.000
		Sig. (2-tailed)	.015	.
		N	86	86
*Correlation is significant at the 0.05 level (2-tailed)

Table 9 shows that among 86 bankers; weak relationship exists between body posture & pain as correlation coefficient is 0.262.

Table 10: Correlation between Work station & Pain correlation

			score of work station	rate your pain 0 to 10
Spearman’s rho	score of work station	Correlation Coefficient	1.000	-.054
		Sig. (2-tailed)	.	.622
		N	86	86
	rate your pain 0 to 10	Correlation Coefficient	-.054	1.000
		Sig. (2-tailed)	.622	.
		N	86	86

Table 10 shows that among 86 bankers; very weak disagreement occurred between work station & pain. The results of the current study showed that poor relationship of neck pain with body posture & work station ergonomics. The most prominent limitation of this study is that it had a narrative approach, rather than a systematic review and meta-analysis, so it is difficult to draw precise conclusions [15]. This study indicated that computer users, particularly Lahore bankers, had a significant prevalence of low intensity neck and arm pain but had a poor relationship with body posture & work station might possible due to low sample size [27] as well as high literacy & state of more health consciousness in bankers [28]. The frequency of arm, elbow, forearm, wrist and hand is much lower than neck and shoulder pain among bankers [28]. It is obvious that the NPRS and the VAS ratings can be used, that they produce accurate results, and that they are related to multiple patient-reported outcome measures. In research and clinical practice involving neck pain, the NPRS can be a valuable single-item evaluation that supports more extensive multi-item patient-reported outcome measures. The majority of bankers had mild ‘2’ NPRS pain with a maximum of 38.4%, as compared to moderate & severe pain [29]. In the last year, very few bankers sought medical attention for arm and neck pain. Only 3.5% of 86 bankers received physiotherapy sessions, while only 14.0% of bankers took painkillers. There may be a number of good reasons not to visit the medical expert. Since Estonians tend to be rather private or introverted, they rarely perceive a need to complain about their sufferings only when the discomfort worsens or they experience repeated pains then they will seek medical attention [30]. In accordance with Estonian law, employees are not entitled to sick pay for the first three days following a sickness, the next five days are paid by the employer, and any additional sick days are covered by the Health Insurance Fund [31]. The main finding of this study was a robust correlation between high perceived exertion when using a computer and an increased chance of acquiring musculoskeletal problems in the relevant body position. The findings support the model’s hypothesis that neck and upper extremity musculoskeletal complaints are preceded by high perceived exertion. The therapeutic implications of these findings include that perceived high exertion and/or low comfort could be utilized to screen computer users for musculoskeletal problems in the neck and upper extremities [16]. The current study’s findings demonstrated that hypermobile participants with non-specific neck pain had higher cervical joint position error and weaker muscle endurance (flexor and extensor holding capabilities) than asymptomatic participants [32]. Major cause of poor relationship of pain with body posture & work station ergonomics is that of shortage of time to give proper information to researcher & also lack of interest of bankers to be a part of this research [33].

5-CONCLUSION

The study concludes that Neck pain and shoulder pain are common occurrences among bankers with a more frequent experience of neck pain during working hours as compared to shoulder pain. Most of the components of workstations of bankers were adjustable but some of them still need attention. As adjustability does not necessarily indicate a reduction in musculoskeletal pain, therefore there is a need for further in-depth ergonomic analysis and introduction of ergonomically approved workstations to the bankers in order to minimize the occurrence of neck and arm pain, improving their productivity at work, educate the bankers & to create awareness about healthy working posture either by physically or social media campaign.

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