IMPACT OF MUSCULOSKELETAL COMPLAINTS ON WORK PRODUCTIVITY AMONG RETAILERS

217 1Ali Hamza Mughal, 2Mehreen kainat, 3Khadija Shehzadi, 4Hooria Habib, 5Shiza Zaidi https://msra.online/index.php/Journal/about Volume 3, Issue 4 (2025) ISSN Online: 3007-1941 ISSN Print: 3007-1933 IMPACT OF MUSCULOSKELETAL COMPLAINTS ON WORK PRODUCTIVITY AMONG RETAILERS Article Details A B S T R A C T Keywords: Musculoskeletal disorders, Work Productivity, Presenteeism, Absenteeism, Lower Back Pain, Neck Pain, and Activity Impairment. Ali Hamza Mughal University of Sialkot ali.hamzamugha[email protected], Mehreen kainat University of Sialkot [email protected], Khadija Shehzadi University of Sialkot [email protected], Hooria Habib University of Sialkot [email protected], Shiza Zaidi Lecturer University of Sialkot [email protected] Objective: This study aims to evaluate the impact of musculoskeletal complaints on work productivity among retailers. Study design: It was cross-sectional study. Place and duration of study: The study was done by collecting data from different Markets and Trading Hubs in Sialkot City. The study was completed within 6 months after the approval from research committee. Materials and Methods: This cross-sectional study was conducted on 374 retailers using a purposive sampling technique. The data was collected with the Nordic Musculoskeletal Questionnaire (NMQ) and the Work Productivity and Activity Impairment (WPAI) questionnaire. Participants were 25–35 years old, with at least one year of retail experience and working an average of 12 hours per day. Exclusion criteria included long-term illnesses, neurological conditions, recent trauma, or absence of musculoskeletal complaints. Data were analyzed using SPSS version 26.0, applying descriptive statistics and linear regression models to assess associations between musculoskeletal pain and productivity outcomes. Result: Lower back (42.7%), neck (36.0%), and knee (29.3%) were the most commonly reported musculoskeletal complaints. Regression analysis indicated that musculoskeletal pain significantly predicted absenteeism (15% variance explained, p < 0.001), presenteeism (28.8%, p < 0.001), and activity impairment (27%, p < 0.001). Overall work impairment was also significant but weaker, explaining 4.7% of variance (p < 0.001). Presenteeism emerged as the strongest predictor, suggesting that retailers often continued working despite pain but with reduced efficiency. Conclusion: This study found that musculoskeletal complaints significantly reduce work productivity among retailers, with presenteeism and activity impairment being the strongest effects, followed by absenteeism. Lower back, neck, and knee pain were the most common issues. The findings highlight presenteeism as a major hidden burden, showing that workers often continue working despite pain but at reduced efficiency. https://msra.online/index.php/Journal/about https://msra.online/index.php/Journal/about Volume 3, Issue 4 (2025) 218 INTRODUCTION: Musculoskeletal diseases (MSDs) are among the most common and significant worldwide health issues. They include a variety of problems that affect the bones, joints, and muscles, resulting in pain and loss of function. DNA damage is one of MSDs' defining characteristics. After the damaged DNA has accumulated in the cytoplasm, it is detected by the cyclic GMP-AMP synthase (c GAS) stimulator of interferon genes (STING) pathway, which sets off the production of inflammatory cytokines and type I interferon. The musculoskeletal and immunological systems are thus linked by this route (1). Musculoskeletal disorders adversely affect employees, as these conditions can result in a worker's inability and incapacity to perform their job. Supermarket cashiers (SC's) work extended shifts in crowded spaces while maintaining mostly fixed positions. These employees consistently manage grocery products of different weights and dimensions while scanning bar-codes with laser readers, processing between 500 and 1000 items per hour. Alongside the physical challenges, SC encounters considerable levels of stress, time constraints, and mental pressure. The role of a supermarket cashier involves many job-related risk factors that could result in MSDs.(2). Musculoskeletal disorders related to work (WRMDs) are commonly seen in market vendors, and participating in health risk behaviors can worsen these conditions, resulting in different health problems. Typical health risk behaviors seen in market vendors involve inadequate levels of physical activity. Nonetheless, there is presently an absence of studies investigating the occurrence of WRMDs and healthrelated risk behaviors among retailers. This research seeks to investigate the effects of musculoskeletal problems and evaluate pain levels in retail workers (3). In the Store 24H setting, three work responsibilities were identified: restocking, customer assistance, and cash register operation. The results show that the indicated high-risk tasks are associated with a significant prevalence of musculoskeletal illnesses. The main ergonomic risk factors for these occupations were found to be repetitive motions, uncomfortable postures, extended standing, and intense exertion. These characteristics contribute to musculoskeletal discomfort in the neck, shoulder, back, hip, and knee. Furthermore, replenishing tasks are associated with substantial hazards of violent exertion and vibration, making it the primary cause of musculoskeletal diseases. Therefore, the results emphasize the necessity of enhanced ERA and mitigation techniques, such as task rotation, ergonomic training, workstation redesign, and accessories, to enhance employee well-being and lower the prevalence of musculoskeletal illnesses among Store 24H personnel (4). Work-related musculoskeletal disorders are those that are brought on or made worse by work-related risk factors, such as prolonged or repetitive physical exertions, rather than being the result of spontaneous events. Regarding the multifunctional nature, patho physiological mechanisms, and an etiology of musculoskeletal illnesses, there is still a great deal of confusion and disagreement. Nonetheless, there is sufficient proof that repetitive motions and musculoskeletal illnesses in many body parts are causally related labour, awkward postures, vibration and strenuous activity. Internal forces generated by worker activity gradually increase circulation, because localized muscular tiredness, and have additional physiological and bio mechanical impacts on the body's tissues. When enough force is exerted, all soft tissues, muscles, tendons, fascia, synovial, and nerves fail, resulting in inflammation, muscle exhaustion, and microscopic failure (5). Muscle knots or trigger points, are formed when a muscle becomes overworked and becomes stuck in a contracted state. A myofascial trigger point (MTRP) is a hyper irritable location that hurts when compressed and can cause motor dysfunction and distinctive referred pain. It usually occurs in the muscle fascia or within a taut band of skeletal muscle. It is very common for computer users to have trigger points (6). Clinical features can determine whether a trigger point is latent or active. Even while the body is at rest, pain is still produced by an active trigger point. It is sensitive to touch, and while a latent trigger point causes pain upon compression and radiates, it can also produce referred pain that mimics the patient's initial complaint pain (7). Myofascial discomfort is a syndrome of soft tissue pain, which originates from local and https://msra.online/index.php/Journal/about Volume 3, Issue 4 (2025) 219 referred sites, resulting in musculoskeletal pain due to trigger points. Myofascial pain and related myofascial syndromes are among the most prevalent instances of both short-term and long-term pain conditions (8). This study on the prevalence of musculoskeletal complaints among retailers holds significant importance for both individuals and society. By identifying complaints which workers face due to improper ergonomic practices, this research will serves as a foundation for initiating targeted interventions to manage workrelated musculoskeletal symptoms effectively. Understanding these challenges will allow the design of actionable strategies to promote workers' well-being and safety. Companies will be able to implement comprehensive policies and regulations to ensure adherence to ergonomic practices, fostering a supportive workplace environment. Ultimately, this research is pivotal in addressing occupational health concerns, improving more sustainable working conditions for retail workers. MATERIALS AND METHODS The study was cross-sectional. In this investigation, the Purposive Sampling Technique was applied. After receiving clearance from the research council, the study was finished in six months. 374 is the estimated sample size (9). Data for the study was gathered from Sialkot City's various markets and trading hubs. The inclusion criteria included 25-35 year old retailers, people who had experienced musculoskeletal issues in the past six months, twelve hours a day of active work and participants with at least one year of working experience (10). The study excluded individuals working in industries outside of retail, such as healthcare, construction or office based jobs, people who had been diagnosed with long-term illnesses, retailers with neurological conditions who had surgery or trauma within the past year and individuals without any reported MSK complaints (11). The Nordic questionnaire is used for the analysis of complaints in musculoskeletal system. This questionnaire consists of structured questions that can be used as an interview questionnaire or be filled in by the respondents themselves. The NMQ has been shown to have good validity and reliability. The validity ranges are 0.50 to 0.82 and reliability was 0.70 to 0.88 (12). The Work Productivity Questionnaire is a structured instrument intended to assess how several elements (such as personal habits, working environment, and health problems) affect an individual's productivity at work. Examining how problems like musculoskeletal (MSK) disorders, stress, or chronic diseases affect daily activities and job performance is a common practice in clinical practice and research. The WPAI Questionnaire had been shown to be a good validity and reliability. Validity range was 0.79 (13) and reliability range was 0.90 (14). RESULTS The data analyzed using the SPSS Version 26.0. The percentage distribution of gender 95.5% males (357) and 4.5% females (17) out of 374 total participants. This chart displays the percentage distribution of participants' weights, with the majority (48.1%) weighing between 60 and 74 kg out of 374 total participants. https://msra.online/index.php/Journal/about Volume 3, Issue 4 (2025) 220 This chart shows that the percentage distribution of participants by age group. The majority of participants (44.9%) were between the ages of 25 and 28, while the fewest (19.0%) were between the ages of 33 and 36. There were 374 in total. This chart displays the percentage distribution of respondents' employment experience across the years. https://msra.online/index.php/Journal/about Volume 3, Issue 4 (2025) 221 Table 1: Frequency and Percentage of Nordic Questionnaire Region 12 months 7 days LW Yes No Yes No Yes No Neck 27 (36.0%) 48 (64.0%) 12 (16.0%) 63 (84.0%) 9 (12.0%) 66 (88.0%) Shoulders 18 (24.0%) 57 (76.0%) 10 (13.3%) 65 (86.7%) 5 (6.7%) 70 (93.3%) Elbows 12 (16.0%) 63 (84.0%) 6 (8.0%) 69 (92.0%) 3 (4.0%) 72 (96.0%) Wrists/Hands 15 (20.0%) 60 (80.0%) 7 (9.3%) 68 (90.7%) 4 (5.3%) 71 (94.7%) Upper Back 20 (26.7%) 55 (73.3%) 9 (12.0%) 66 (88.0%) 6 (8.0%) 69 (92.0%) Lower Back 32 (42.7%) 43 (57.3%) 15 (20.0%) 60 (80.0%) 10 (13.3%) 65 (86.7%) Hips/Thighs 17 (22.7%) 58 (77.3%) 8 (10.7%) 67 (89.3%) 4 (5.3%) 71 (94.7%) Knees 22 (29.3%) 53 (70.7%) 11 (14.7%) 64 (85.3%) 7 (9.3%) 68 (90.7%) Ankles/Feet 14 (18.7%) 61 (81.3%) 6 (8.0%) 69 (92.0%) 3 (4.0%) 72 (96.0%) This table shows the frequency and percentage of musculoskeletal discomfort in various body locations based on the Nordic Questionnaire during 12 months, 7 days, and last work (LW). Table 2: Frequency and Percentage of Problem Impact on Work Productivity Impact Level n % No effect 108 28.9 Very slight effect 43 11.5 Slight effect 74 19.8 Mild effect 58 15.5 Somewhat moderate effect 29 7.8 Moderate effect 37 9.9 Moderately severe effect 10 2.7 Severe effect 1 0.3 Very severe effect 4 1.1 Almost complete impairment 4 1.1 Completely prevented work 6 1.6 Total 374 100.0 Table 3: Frequency and Percentage of Problem Impact on Daily Activities Impact Level n % No effect 131 35.0 https://msra.online/index.php/Journal/about Volume 3, Issue 4 (2025) 222 Very slight effect 52 13.9 Slight effect 66 17.6 Mild effect 43 11.5 Somewhat moderate effect 27 7.2 Moderate effect 35 9.4 Moderately severe effect 5 1.3 Severe effect 1 0.3 Very severe effect 3 0.8 Almost complete impairment 5 1.3 Completely prevented work 6 1.6 Total 374 100.0 Table 4: Linear Regression Results Predicting Work Productivity and Activity Impairment from Musculoskeletal Pain Outcome (DV) R R² Adj. R² Std. Error F(df) p B (Unstd.) SE β t p Absenteeism (% work time missed) .388 .150 .148 11.69 65.60 (1,371) <.001 1.737 .214 .388 8.10 <.001 Presenteeism (% impairment while working) .537 .288 .286 18.85 150.36 (1,372) <.001 4.239 .346 .537 12.26 <.001 Activity impairment (% activity impairment) .519 .270 .268 19.23 137.26 (1,372) <.001 4.131 .353 .519 11.72 <.001 Overall work impairment (%) .216 .047 .044 6.86 18.13 (1,371) <.001 0.536 .126 .216 4.26 <.001 Absenteeism: accounted for 15% of variance, showing that higher pain was linked to more missed work time. Presenteeism: the strongest association, explaining 28.8% of variance, indicating pain had a substantial negative effect on productivity while at work. Activity Impairment: explained 27% of variance, showing pain strongly limited daily activities outside work. Overall Work Impairment: significant but weaker, accounting for only 4.7% of variance, suggesting other factors beyond pain also contribute to overall work impairment. DISCUSSION The present study aimed to investigate the impact of musculoskeletal complaints on work productivity among retailers in Sialkot, Pakistan. Using the Nordic Musculoskeletal Questionnaire (NMQ) and the Work https://msra.online/index.php/Journal/about Volume 3, Issue 4 (2025) 223 Productivity and Activity Impairment (WPAI) questionnaire, the study evaluated both the prevalence of musculoskeletal pain and its relationship with productivity outcomes. The results revealed that musculoskeletal pain significantly predicted absenteeism, presenteeism, and activity impairment. Specifically, pain explained 15% of the variance in absenteeism, 28.8% of variance in presenteeism, and 27% of variance in activity impairment, while overall work impairment was weaker at 4.7%. These results highlight that while absenteeism is present, presenteeism and functional impairment in daily life activities are the dominant pathways through which musculoskeletal pain reduces productivity. These findings support the concept that musculoskeletal disorders (MSDs) are not only a health concern but also an economic and occupational challenge, directly limiting the efficiency of retailers. The data demonstrate that the lower back, neck, and knees were the most commonly affected body regions, consistent with the physical demands of retail work. Retailers often engage in prolonged standing, lifting, and awkward bending postures activities that are biomechanically taxing. According to (15), retail employees frequently reported similar musculoskeletal complaints, particularly in the lower back and shoulders, which negatively affected work capability. The present findings echo these results, confirming that physical workload and poor ergonomic practices are primary contributors to MSDs. Furthermore, the strong correlation between pain and activity impairment beyond the workplace suggests that MSDs not only reduce occupational performance but also limit daily functioning and quality of life. This aligns with (3), who found that vendors with MSDs often adopted unhealthy coping mechanisms such as reduced physical activity, leading to long-term health risks. The regression analysis indicated that musculoskeletal pain significantly predicted absenteeism, accounting for 15% of the variance. This is consistent with (16), who found that 40% of minimarket employees experienced productivity losses due to absenteeism related to posture issues. Similarly (17) reported that 46% of load porters experienced musculoskeletal pain in the previous week, with the lower back and neck being the most affected, directly leading to missed work days. Presenteeism emerged as the most significant outcome of musculoskeletal pain, explaining nearly 29% of productivity variance. This result corresponds with studies on supermarket cashiers by (2) which identified presenteeism as a major challenge since workers often continued working despite discomfort to avoid financial loss. The Pakistani context mirrors this, where job security is low and retailers cannot afford to miss work, forcing them to work while in pain, albeit at reduced efficiency. The present study also demonstrated that musculoskeletal pain explained 27% of variance in activity impairment, suggesting that complaints extend beyond occupational tasks into daily living. This agrees with (18) who found that traffic enforcers with MSDs reported functional impairments not just at work but also in domestic and social activities. Similarly, (19) reviewed computer users and noted that musculoskeletal complaints reduced both occupational performance and overall quality of life. Interestingly, while musculoskeletal pain predicted overall work impairment, the explained variance was modest (4.7%). This may suggest that other psychosocial factors such as job stress, lack of managerial support, or coping strategies contribute more strongly to overall perceptions of impairment. For instance, (20) found that posture and ergonomic design strongly predicted productivity loss in European contexts, but in Pakistan, cultural and economic pressures may encourage workers to underreport impairment, masking the full effect. The contrast between absenteeism and presenteeism is critical. While absenteeism is often easier to quantify, presenteeism represents a “hidden burden” of productivity loss. Our findings show that presenteeism contributes more substantially to reduced efficiency, supporting (21), who argued that fatigue and stress caused by ergonomic deficiencies often lead workers to remain at work but perform sub optimally. In lower and middle-income countries, workers rarely take sick leave due to financial insecurity (22) found similar patterns among Pakistani office workers, where musculoskeletal pain was prevalent but absenteeism remained relatively low compared to presenteeism. This emphasizes the need for interventions targeting https://msra.online/index.php/Journal/about Volume 3, Issue 4 (2025) 224 presenteeism, as it is the more substantial driver of productivity loss. The body regions most affected in this study lower back, neck, and knees correspond directly with occupational exposures: Prolonged standing: linked to knee and lower back pain (23). Repetitive lifting and twisting: associated with trunk and upper limb strain (24) . Static postures and awkward bending: contributors to neck and shoulder pain (25). (26), who highlighted that manual laborers often face biomechanical and postural stresses that undermine long-term work capacity, reported similar ergonomic risk factors. The consistency of these results across retail and non-retail occupations highlights the universality of ergonomic risks in musculoskeletal health. Cross-sectional design limits causal interpretation, conducted only in Sialkot; results may not generalize to other regions and age range and gender imbalance (mostly male participants) may have restricted variability. Further recommendation included introduction of ergonomic interventions (workstation redesign, lifting aids, rest breaks), provide training and awareness on posture, safe lifting, and early reporting of pain, establish occupational health support (physiotherapy access, periodic screening) and encourage policies to address presenteeism, not only absenteeism, in retail settings. CONCLUSION This study found that musculoskeletal complaints significantly reduce work productivity among retailers, with presenteeism and activity impairment being the strongest effects, followed by absenteeism. 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