Maycon Cesar Jaques do Nascimento*

mayconjaques@gmail.com
Igor Gabriel Mendes Costa**

imendes97@hotmail.com

Luciana da Silva Brito***

lucianabrito26@yahoo.com.br

Klícia Martiniano Conte+

klicia_raquel@hotmail.com

Elder Nascimento Pereira++

eldernasc@hotmail.com

*Fisioterapeuta formado pelo Instituto de Saúde

e Biotecnologia da Universidade Federal do Amazonas (UFAM)

**Graduando em Medicina pela Universidade Federal do Amazonas (UFAM)
***Doutoranda em Biociências pela Universidade de Coimbra em Portugal

Professora Adjunta IV no Departamento de Morfologia

do Instituto de Ciências Biológicas da UFAM
+Fisioterapeuta Especialista em Atenção Neurofuncional

pelo Hospital Universitário Getúlio Vargas

Professora Substituta de Fisioterapia no Instituto de Saúde

e Biotecnologia da Universidade Federal do Amazonas (UFAM)
++Doutorando em Biociências pela Universidade de Coimbra em Portugal

Professor Adjunto II no Departamento de Morfologia

do Instituto de Ciências Biológicas da UFAM
(Brasil)

Reception: 01/28/2020 - Acceptance: 03/18/2024

1st Review: 03/16/2024 - 2nd Review: 03/16/2024

Accessible document. Law N° 26.653. WCAG 2.0

Suggested reference: Nascimento, M.C.J. do, Costa, I.G.M., Brito, L. da S., Conte, K.M., & Pereira, E.N. (2024). Epidemiological profile of spinal musculoskeletal disorders in Amazonian physiotherapy patients. A characterization study. Lecturas: Educación Física y Deportes, 29(311), 83-98. https://doi.org/10.46642/efd.v29i311.1958

 

Abstract

    This study aimed to characterize the epidemiological profile of musculoskeletal disorders of the spine in patients seeking physiotherapy treatment in the Brazilian Amazon region. A cross-sectional, descriptive, and quantitative study was conducted using the medical records of patients treated at the physiotherapy college of the Federal University of Amazonas, Campus Coari. Epidemiological aspects, medical history, and physical examination data of 283 patients of both sexes, aged between 10 and 70 years, were included, with 155 medical records used for analysis.The results indicated a higher prevalence of musculoskeletal disorders in the lumbar spine, particularly among women aged between 31 and 40 years, with teachers being the most affected group.In light of these findings, the predominance of these disorders among women and in the lumbar region is emphasized, underscoring the importance of specific attention to this patient group in the studied region. Additionally, understanding the epidemiological profile of these conditions can assist in directing appropriate preventive and therapeutic measures to improve the quality of life and well-being of patients with musculoskeletal disorders of the spine in the Brazilian Amazon region.

    Keywords: Epidemiological profile. Spine disorders. Physiotherapy patients.

 

Resumo

    Este estudo teve como objetivo caracterizar o perfil epidemiológico dos distúrbios musculoesqueléticos da coluna em pacientes que buscaram tratamento de fisioterapia na região da Amazônia Brasileira. Foi realizado um estudo transversal, descritivo e quantitativo, utilizando os prontuários dos pacientes atendidos na faculdade de fisioterapia da Universidade Federal do Amazonas, Campus Coari. Foram incluídos aspectos epidemiológicos, anamnese e exame físico de 283 pacientes de ambos os sexos, com idade entre 10 e 70 anos, sendo 155 prontuários utilizados para análise.Os resultados indicaram que houve uma maior prevalência de distúrbios musculoesqueléticos na coluna lombar, especialmente entre mulheres com idade entre 31 e 40 anos, sendo os professores o grupo mais afetado. Diante do exposto, ressaltam-se a predominância desses distúrbios entre as mulheres e na região lombar, destacando a importância de atenção específica a esse grupo de pacientes na região estudada. Para além disso o conhecimento do perfil epidemiológico dessas condições pode auxiliar no direcionamento de medidas preventivas e terapêuticas adequadas para melhorar a qualidade de vida e bem-estar dos pacientes com distúrbios musculoesqueléticos da coluna na Amazônia Brasileira.

    Unitermos: Perfil epidemiológico. Distúrbios na coluna. Pacientes de fisioterapia.

 

Resumen

    Este estudio tuvo como objetivo caracterizar el perfil epidemiológico de los trastornos musculoesqueléticos de la columna en pacientes que buscaron tratamiento de fisioterapia en la región Amazónica Brasileña. Se realizó un estudio transversal, descriptivo y cuantitativo, utilizando las historias clínicas de pacientes atendidos en la Facultad de Fisioterapia de la Universidad Federal de Amazonas, Campus Coari. Se incluyeron aspectos epidemiológicos, anamnesis y examen físico de 283 pacientes de ambos sexos, con edades entre 10 y 70 años, para el análisis se utilizaron 155 historias clínicas, los resultados indicaron que hubo mayor prevalencia de trastornos musculoesqueléticos en la columna lumbar, especialmente entre las mujeres con edades comprendidas entre 31 y 40 años, siendo los docentes el grupo más afectado. Por lo anterior destaca el predominio de estos trastornos entre las mujeres y en la región lumbar, destacando la importancia de una atención específica a este grupo de pacientes en la región estudiada. Además, el conocimiento del perfil epidemiológico de estas afecciones puede ayudar a orientar medidas preventivas y terapéuticas adecuadas para mejorar la calidad de vida y el bienestar de los pacientes con trastornos musculoesqueléticos de la columna en la Amazonía brasileña.

    Palabras clave: Perfil epidemiológico. Trastornos de la columna. Pacientes de fisioterapia.

 

Lecturas: Educación Física y Deportes, Vol. 29, Núm. 311, Abr. (2024)

---

 

Introduction 

 

    The spinal column constitutes the major subcranial portion of the axial skeleton. Its elements are joined by a series of intervertebral joints that form a flexible support and capable of protecting neurological structures. Anatomically it consists of 33 vertebrae being divided into 7 cervical mobile segments from C1 to C7, 12 thoracic T1 to T12 and 5 lumbar from L1 to L5 and rigid segment 5 sacral from S1 to S5 and 4 coccygeal (Moore, 2019). The malformed vertebral column is rectilinear in the anteroposterior plane, but exhibits physiological curves when seen in the sagittal plane. Mean thoracic kyphosis is 30 to 35° (ranging from 10 to 50°) and lumbar lordosis presents a mean curvature of 50 to 60 ° (ranging from 35 to 80°). (Illés et al., 2019)

 

    In most published studies, spinal deformities are characterized by the occurrence of coronal plane deviation greater than 10 (Negrini et al., 2018). They can be divided according to the location of the apex of the curve, classified as cervical (between C2 and C6), cervicothoracic (between C7 and T1), thoracic (between T2 and T11), thoracolumbar (between T12 and L1), lumbar (between L2 and L4) and lumbosacral (L5 or below).

 

    Diseases and injuries of the musculoskeletal system cause pain, deformities and loss of function. They limit activity and cause disability in larger numbers of people than disorders of any other system in the body. Congenital malformations such as congenital scoliosis occur more often than malformations in any other system. The causes of musculoskeletal disorders are traumatic and immune, inflammatory, degenerative, neoplastic, neuromuscular, hereditary, and developmental disorders. (Weinstein, & Buckwalter, 2000)

 

    Musculoskeletal disorders (AMD) include a wide range of inflammatory and degenerative conditions that affect muscles, tendons, ligaments, joints, peripheral nerves, and supporting blood vessels. Musculoskeletal morbidity associated with these disorders is becoming a relevant public health problem worldwide, being the most frequent health problems related to work in all countries, regardless of the degree of industrialization. This morbidity therefore represents a high social, economic and human cost resulting in pain, sequelae or incapacity for work. This leads to lost productivity, increased benefits granted and medical expenses and until retirement. (Sundstrup et al., 2020)

 

    Exposure to high levels of physical demands can trigger a series of health problems, such as the appearance of musculoskeletal symptoms, technically called Work-Related Musculoskeletal Disorders (DORT) (Alencar, & Merlo, 2018). According to the Ministry of Health, DORT are musculoskeletal injuries, a consequence of excessive use of such structures, associated with insufficient recovery. They are characterized by the appearance of symptoms such as pain, paresthesia, sensation of weight and fatigue, concomitantly or not. They cover clinical pictures of the musculoskeletal system, acquired by the worker under certain working conditions (Paula, & Amaral, 2019). The causative or aggravating factors of the RSI / DTS have been well discussed and can be grouped as follows: physical and biomechanical factors, such as inadequate postures, repetitive movements, speed during the task, lighting, noise and others; organizational factors, such as breaks, rhythms, seasonality of production, schedules, improper methods of work, production methods and others; individual factors such as pregnancy, chronic diseases such as arthritis and diabetes, sex, heredity, sports, among others; and, finally, psychosocial factors, such as job satisfaction, relationship with colleagues, anxiety and individual expectation. (de Paula, & Paula, 2021)

 

    Degenerative diseases of the spine are responsible for an increasing number of visits to orthopedic medical offices and to the Brazilian emergency room. It is estimated that 77% of the population will present at least one episode of incapacitating low back pain at some point in life and 35% will present radiating pain in the path of the sciatic nerve (Gotfryd, & Avanzi, 2009). Among the degenerative changes of the lumbosacral spine, the herniated disc is the most common diagnosis, affecting 2 to 3% of the population. (Guida et al., 2020)

 

    These disorders may have a specific origin such as obesity, which is a nutritional disorder that can trigger numerous changes in the locomotor apparatus, associated with an increased risk of pain and injuries involving all body segments, particularly the spine (Veiga et al., 2019). The distribution of body fat, central or peripheral, directly interferes with the body alignment of the obese patient, promoting an overload and predisposing to the appearance of postural deviations (Cardoso, 2019). According to the World Health Organization (WHO), in 2005 there were around the world approximately 1.6 billion adults and 20 million under five underweight children, in addition to at least 400 million obese adults. The WHO estimates that by 2025 there will be approximately 2.3 billion overweight adults and more than 700 million obese adults (Santos et al., 2020). Excess weight affects almost the entire organism and can lead to numerous complications, including degenerative orthopedic and spinal diseases. (Pessoa, 2021)

 

    Low back pain is common in industrialized societies, temporarily or permanently incapacitating people for professional and daily activities, being the most frequent cause of physical limitation in individuals under 45 years of age. (Jensen et al., 2020)

 

    The present study aimed at the different musculoskeletal disorders that affect the vertebral column through the data collected from the charts available in the clinical school of physiotherapy.

 

Methods 

 

    It was a cross-sectional, descriptive and quantitative study of patients affected by pathologies that affect the spine. In which a data collection of the patients that were attended at the Physiotherapy school clinic of the Federal University of Amazonas located in the municipality of Coari - AM between the years of 2010 and 2014 was carried out. Participants in this study participated in the study of patients who sought care in this area clinical school of Physiotherapy, who would be affected by any signs and symptoms of pathologies that reaches the spine. The charts were analyzed, where the data of people of both sexes, with ages ranging from 10 to 70 years, without regard to race, weight and height, were extracted. Data collection was done through the analysis of data from patients enrolled in the respective school clinic, by means of detailed and detailed observation of all patients who went through this sector in search of treatment with a total of 283 patients registered in the medical records, among the years of 2010 and 2014.

 

    It was quantitatively demonstrated the most affected region of the spine, observing the gender and the most prevalent age group, and the relationship with the profession, all these data were tabulated in the Excel program.

 

    Patients who presented any signs or symptoms of spine pathologies, aged 10 to 70 years, with clinical or physiotherapeutic diagnosis clearly described and enrolled in the Clinical School of Physiotherapy of the Institute of Health and Biotechnology - ISB of the Federal University of Amazonas - UFAM, thus remained 155 medical records. Patients with unrelated disorders were excluded from the registry, without medical or funiconal kinetic diagnosis, pointing to alterations in the dorsal region, incomplete records, and thus 128 medical records were excluded.

 

    The data collection was done through a descriptive analysis of the records of the patients who sought care in the clinical school of Physical Therapy. After obtaining the collected data, we analyzed in a descriptive way all the disorders of patients attended at the mentioned clinic school. Waiver of Free and Informed Consent was requested to the Research Ethics Committee of the Federal University of Amazonas, under the CAAE number 38856014.0.0000.5020.

 

Results 

 

    A total of 155 medical records contributed to this study. It was verified that the majority of the population studied had the most affected region of the lumbar spine, with a prevalence of 56.77% (n = 88), where the most commonly reported signs and symptoms were low back pain. In relation to the female, the prevalence was higher corresponding to 60% (n = 93). The most affected age group was between 31 and 40 years old, with 27.74% (n = 43). And the professions that had the highest prevalence with signs and symptoms associated with musculoskeletal disorders of the spine were 12.25% (n = 19) teachers; 10.97% (n = 17) students; 6.45% (n = 10) farmers; 6.45% (n = 10) retirees; 6.45% (n = 10) domestic (Table 1).

 

Variables	(n=155)	(%)
Spine Region More Attack
Cervical	10	6,45 %
Toracic	4	2,58 %
Lumbar	88	56,77 %
Multiple Regions	17	10,96 %
Not identified	36	23,22 %
Genre
Male	62	40 %
Female	93	60 %
Age Group
Group 1 (10 - 20 age)	14	9,03 %
Group 2 (21 - 30 age)	28	18,06 %
Group 3 (31 - 40 age)	43	27,74 %
Group 4 (41 - 50 age)	28	18,06 %
Group 5 (51 - 60 age)	27	17,41%
Group 6 (61 - 70 age)	15	9,67 %
Profession
Teachers	19	12,25 %
Students	17	10,96 %
Farmers	10	6,45 %
Retired	10	6,45 %
Domestic	10	6,45 %

Source: Research data

 

    By analyzing separately the most affected regions of the spine, we found that the Cervical Region presented 6.45% (n = 10) of the demand for patient care. In the Thoracic Region we observed a small prevalence of 2.58% (n = 4) of the visits. Pathologies in the Lumbar Spine had the greatest demand for patient care, with 56.77% (n = 88). We observed that pathologies in multiple regions were frequent, with 3.8% (n = 6) in patients with cervical and lumbar spine symptoms; 6.45% (n = 10) in the thoracic and lumbar spine; and 0.64% (n = 1) in each vertebral column, making a total of 10.96% (n = 17). And 23.22% (n = 36) described the names of the pathologies, but without the proper identification of the affected region (Graphic 1).

 

Source: Research data

 

    For the gender variable, we observed that 60% (n = 93) were female and 40% (n = 62) were males (Graph 2).

 

Source: Research data

 

    For the age group was divided separately by groups, where group 1 corresponds to the age group between 10 and 20 years, which represents 9.03% (n = 14) of the sample. Group 2 corresponds to the age group of 21 to 30 years, with representation of 18.06% (n = 28). Group 3 corresponds to the age group of 31 to 40 years, and represents the largest group with 27.74% (n = 43). Group 4 corresponds to the age group between 41 and 50 years, representing 18.06% (n = 28). Group 5 corresponds to the age group from 51 to 60 years old, with 17.41% (n = 27). And group 6, which corresponds to the age range of 61 to 70 years, represents 9.67% (n = 15) of the sample. The overall mean age established was 40.12 years with a standard deviation of ± 14.30 (Graph 3).

 

Source: Research data

 

    Regarding the profession of these patients, 12.25% (n = 19) were teachers; 10.96% (n = 17) were students; 6.45% (n = 10) were farmers; 6.45% (n = 10) were retired; 6.45% (n = 10) were domestic; 5.16 (n = 8) were autonomous; 3.87% (n = 6) were housewives; 3.22% (n = 5) were civil servants; 3.22% (n = 5) were administrative technicians; 2.58% (n = 4) were general service aides; 1.93% (n = 3) were merendeiras; 1.93% (n = 3) were fishermen; 1.93% (n = 3) were drivers; 1.93% (n = 3) were traders; 1.29% (n = 2) were administrators; 1.29% (n = 2) were firefighters; 1.29% (n = 2) were cooks; 1.29% (n = 2) were dentists; 1.29% (n = 2) were clerks; 1.29% (n = 2) were health agents; and 0,64 (n = 1) were of different professions each, as a helper, banker, carpenter, couturier, nurse, deliveryman, shipper, physiotherapist, attendant, gari, manager, laundress, manchante, diver, mechanic, master of works, mototaxista, thermo-fogger operator, secretary, accounting technician, computer technician, laboratory technician and salesman. And 5.80% (n = 9) did not report their professions (Graph 4).

 

Source: Research data

 

Discussion 

 

    Our study highlighted that musculoskeletal disorders predominantly affect the lumbar region in individuals attending the physiotherapy clinic. Various studies assessing musculoskeletal issues align with our findings regarding spinal afflictions. Araújo et al.'s study in 2021 revealed the prevalence of spinal pain in motorbike couriers, with the lumbar region being the most affected. Studies involving other professions investigated in our study showed the lumbar region as the most affected, including truck drivers (Yosef et al., 2019), waste collectors (Silva et al., 2020), professionals in the textile industry (Ventura, 2021), cleaning staff (Souza et al., 2022), teachers (Paula, & Cotrim, 2020), cooks (Isosaki et al., 2011), nursing professionals (Rusch et al., 2022), dentists (Paz, & Feitosa, 2022), electricians (Moriguchi et al., 2009), health plan employees (Matos et al., 2008), and even fellow physiotherapists. (Costa et al., 2021)

 

    Lumbar pain emerged as a prominent feature in our research. Authors describe that lumbar pain results from improper posture during work, coupled with overloading, swift movements, sedentary lifestyles, and prolonged periods in the same position (Costa et al., 2021, Moraes et al., 2021). Other studies, such as Gurgueira et al. in 2003, demonstrated musculoskeletal symptoms occurring in various body regions, with the lumbar region being the most affected and causing the most dysfunction. These symptoms can lead to changes in daily activities, representing a common cause of work absenteeism with significant financial consequences (Valença, & Alencar, 2018). Authors point to potential factors associated with the prevalence of lumbar pain, including repetitive movements, lifting, bending, twisting, vibration, and high physical demands at work (da Silva et al., 2006). At some point in life, 70 to 85% of all individuals will experience an episode of spinal pain. Idiopathic low back pain, formerly known as such because it lacked a specific cause, is now termed common mechanical low back pain or nonspecific low back pain, representing the initial anatomical clinical presentation and the most prevalent mechanical and degenerative cause (Fischer et al., 2022).

 

    In this study, the majority of medical records indicated women as the primary individuals affected by musculoskeletal disorders (60% - n= 93). Regarding gender (Tsuchiya et al., 2009), in their study with 158 participants, observed a prevalence of musculoskeletal pain in women, with 82% of female patients reporting musculoskeletal pain. A study conducted with university workers in Popayán, Colombia, presented the following results: 59.3% of the individuals studied were women (Mozzini et al., 2008). This could be justified by women's dual roles, greater repression leading to fear, tension, and stress, and female workers generally being responsible for more detailed tasks and having a different proportion of muscle fibers than men (Petersen, & Marziale, 2018). Picoloto and Silveira in 2008 asserted that women are more concentrated in activities such as education, health, commerce, office work, and industries like food, textile, and microelectronics. These disorders may be influenced by the demands faced by women at work and in the home environment (Costa, & Costa, 2020); the accumulation of roles in the workplace and at home can contribute to the onset, development, and/or maintenance of musculoskeletal symptoms. (Costa et al., 2013)

 

    Regarding the age group, this study identified that patients who were between 31 to 40 years old had the highest prevalence of musculoskeletal disorders in the spine with 27.74% (n = 43) of the people surveyed. Comparatively, the authors Neto et al. (2009) observed a predominance of lesions in individuals between 27 and 41 years of age in a sample of 200 patients. Reis et al. (2005) it was observed that the higher prevalence of musculoskeletal pain in women aged between 35 and 40 years with an average between 10 and 14.4 years of profession.

 

    Our study revealed a higher prevalence of musculoskeletal disorders in teachers, with reports of pain in various regions of the spine being common. Cardoso et al. (2009) identified in their study with teachers that musculoskeletal pains equally affected the lower limbs and the spine. Painful manifestations were more pronounced among women in the same professional class. Similarly, Carvalho and Alexandre (2006) demonstrated that teachers had a higher occurrence of musculoskeletal symptoms in the lumbar, thoracic, and cervical regions. Musculoskeletal diseases, challenging to diagnose in professions like teaching, have a multifactorial origin involving ergonomic, physiological, and psychosocial factors. (Carvalho, & Alexandre, 2006)

 

    Several factors related to the conditions and organization of teaching work contribute to the appearance of health problems and consequent impairment of the quality of life of these workers, such as social devaluation, low wages, hierarchization and bureaucratization of labor relations, besides the deficiencies of human and logistical resources (Henrique Fernandes et al., 2009). Teaching work is an activity that promotes stress, with repercussions on physical and mental health and impacts on professional performance. These problems of the profession have grown significantly due to social transformations, educational reforms and new pedagogical models that require more of the professional, in addition to that, the academic public has changed along with these reforms all, becoming more critical and demanding. (Cardoso et al., 2009)

 

Conclusion 

 

    In conclusion, the study underscores the pervasive impact of musculoskeletal disorders, with a focus on the ongoing vulnerability of the lumbar region, especially among females in the workforce. The teaching profession, of vital importance, stands out for its increasing prevalence of spinal issues, driven by factors such as heavy workloads, stress, and additional familial responsibilities for women. Physiological differences and hormonal variations further contribute to higher disorder rates in women. While the specific role of age in musculoskeletal issues requires further investigation, aging is generally recognized to increase susceptibility to changes and fragility. These findings offer crucial insights for researchers and healthcare professionals, emphasizing the persistent influence of spine-related discomfort on daily life, potentially resulting in immobilizations, early work withdrawal, and a diminished overall quality of life. Addressing these issues is paramount for improving well-being, enhancing productivity, promoting long-term health, and positively influencing overall quality of life.

 

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Lecturas: Educación Física y Deportes, Vol. 29, Núm. 311, Abr. (2024)