Back and Muscle Injuries of Construction Workers in India

Prof. Bonaventura H.W Hadikusumo, Mahesh Kumar Nidumolu

Abstract
Ergonomics is one of the most important study in construction which have a lot of advantages. Despite
advantages it is not an easy task to implement and make sure whether the workers following it or not.
The most common motions perform on all level of projects in construction is lifting. Besides lifting
there are many tasks which workers need to perform in construction workplace. Material handling is
also a major problem in worksite (Stubs and Nicholson, 1979). Especially, In India the most
physically demanded tasks are done by workers. So in order to prevent from these musculoskeletal
injuries researcher decided to work on it. The main objectives of this research are ‘to investigate the
factors affecting back and muscle injuries in construction workers, to develop a model on factors
affecting back and muscle injuries, and to provide recommendations to avoid back and muscle injuries
in construction. The research method used is quantitative and AMOS is used to develop a model.
Among all the factors, Organizational and Psychosocial factors is affecting a lot on the back and
muscle injuries.
Introduction
The construction process is becoming innovative in many countries but in India, the methods and
technology used for transporting materials and lifting, carrying were still at the base level and not
modified. Manual material handling is found to be reason for affecting from musculoskeletal injuries.
Deros et al. (2015) said that workers are unaware of the ergonomics. Manual material handling is
found to be reason for affecting from musculoskeletal injuries. Moreover, the workers in developing
countries is not familiar and habituated to follow ergonomics and safety. Many researchers tried to
explain about importance of ergonomics, safety rules and regulations but the workers are not willing
to accept. Lifting, manual carrying of materials, and manually hoisting etc. are the reasons for these
injuries. By this the productivity will significantly decrease day by day. (Leonhard and Nil Guler,
1993). Many organizations proposed the limit of loads to be lifted by humans, but workers are not
following according to it and resulting in injuries. Stubbs and Nicholson (1979), stated that there is a
strong correlation between carrying/lifting to back and muscle related injuries. The symptoms of
musculoskeletal disorders are movement limitation, swelling, widespread pain, fatigue, disturbed
sleep, sensation of overworked muscles, sore or pain. As these injuries are happening many developed
countries are taken serious action on these back and muscle injuries because it impacts on both
individual and management. According to S.J Linton (1990), ‘monotonous/repetitive movement’
variable is strongly influence on the back and muscle injury in construction workers. From the
Gauchard et al. (2001b) results physical activities such as ergonomic and work factors was found
more correlated to the back and muscle injuries especially when workers are doing manual handling.
Oglesby et.al (1989) mentioned that contractors and those who design structures, equipment and
materials to construction are inattentive and have not taken seriously regarding back and muscle
injury problems. The objectives of this research paper are as follows:
1. To investigate the factors affecting back and muscle injury in construction workers.
2. To develop a model on factors affecting back and muscle injury in construction.
3. To provide recommendations to avoid back and muscle injury in construction.
1
Back and Muscle Injuries in Construction
Ergonomic and Work factors insinuate how the workers are efficient and comfortable in the working
conditions. The ergonomic factors are one of the main reasons for musculoskeletal injuries. It includes
repetitive movement, awkward postures, resisting excessive force, long duration of movement,
manual handling, poor working environment, improper lifting techniques, contact pressure, working
overhead, using vibrating equipment, forceful exertions. (Anderson 1980; Nachemson 1983,
Lipscomb et al. 2000, Devereux et al. 2002, Jensen 2000, Mikkelsen 2000, Sorock et al. 2001, Lee
et al. 2001).
Organizational and Psychosocial factors refer to mental stress of worker through himself or from
management. It includes time pressure, safety worries, team support for work, lack of work breaks,
lack of skill. (Jaffar et al. 2011; Gatchel and Schultz 2012, Gauchard et al. 2001, Bernold and Guler
1993; Stubbs & Nicholson 1979).
Individual and Lifestyle factor risks are about how a person live his life. It includes experience,
knowledge, physical fitness, impact of past injury, influence of alcohol consumption, poor rest and
recovery after work. (Niskanen and Lauttalamni 1989; Deros et al. 2010; Shaliza et al. 2009; Jaffar
et al. 2011; Gatchel and Schultz 2012).
According to Andersson (1981), Nachemson (1983), 85% workers all over worldwide will trouble
with back and muscle pain at one stage of their life during work. Hettinger (1985) and Zuidema (1985)
said that about one quarter of illness absenteeism is due to musculoskeletal disorders. Vallfors (1985)
said that the people who are not affecting from back pain will be more satisfied with the work what
they are doing. Prolonged sitting was correlated with poor muscle endurance.
According to O’Sullivan et al. (2002), over exertion has a criterion of 53% of musculoskeletal
Injuries. Muslimah et al. (2006); Deros et al. (2010a); Deros et al. (2010b); Ismail et al. (2009)
proposed that activities involved with physical demands as high, bending continuously, twisting will
disturb musculoskeletal system. Bernold and Guler (1993) found that, the poor fitness of workers and
bulkiness of construction materials are one of the major reasons for back related accidents. Number
of awkward postures, frequently lifting over 65lb and sudden forces by workers are exposed to be
reasons for musculoskeletal disorders. (Pope et al. 1984, Bernold & Guler 1993). OSHA have
suggested to implement two things to decrease musculoskeletal disorders.
➢ Administrative controls
➢ Engineering controls
Administrative controls include with training of workers, education on mechanics of body and body
fitness. Engineering controls include with redesigning of workstation, adapting equipment,
minimizing awkward movement.
The two basic crucial aspects which important for construction work are:
1) Material handling
2) Occupational skill
Material handling is the term which involves with lifting, pushing, pulling and transportation of load
by hand or human body whereas occupational skill is a set of skill and knowledge that workers or
2
employers need for a particular/specific occupation or job. The body parts and its specific main task
which are affected during the work are:

Lifting
Lower back,
shoulders

Awkward
Postures
Knee, hip,
Shoulders

Repetitive Hand-tool
Wrists
motion vibration Fingers,
wrists

Figure 1. Body part affected with task

Holmstrom (1991) found that there is a correlation for low back pain with increasing age, habits of
individuals and psychosocial factors. According to Holmstrom there is a prevalence that most of the
musculoskeletal symptoms increase with age. we need to check the type, size, shape and most
important thing we need to observe is the weight of the object which we are handling.
Research Methodology and data collection
The research method used is quantitative through questionnaire survey. In this research, after doing
expert verification to factors the data was collected by revising factors. As the respondents are
workers, the pilot study was conducted on five workers to understand and time taking process to fill
the questionnaire. The questionnaire was distributed to 536 workers from 22 sites and 36 are removed
due to incorrect data. The data collection consumed two and half months. And after that Reliability
test was done on SPSS to know the internal consistency of the data. Later model was developed to
the factors through SEM in AMOS.
Hypothesis
Alternative hypothesis:
➢ H1: There is relationship between Ergonomic and work factors to the back and muscle injury
for the workers in construction.
➢ H2: There is relationship between Organizational and Psychosocial factors to the back and
muscle injury for the workers in construction.
➢ H3: There is relationship between Individual and Lifestyle factors to the back and muscle
injury for the workers in construction.
Null hypothesis:
➢ Ho: There is no relationship between factors to the back and muscle injury in construction.

3
Data Analysis
From the 500 respondents, there are 91% of male workers and 9% of female workers in the
construction sites which researcher have visited and collected data. And there are 20% of commercial
projects and remaining 80% of the projects are residential projects. Considering the type of
occupation, masonry workers are higher with 14% of the total sample of respondents and 2% of
scaffolding workers who are least from the collected data. The other occupations are carpentry,
excavation, formwork, painter, steel worker, plumber, electricians, tile installers and concrete workers
with 8%, 11%, 11%, 7%, 15%, 8%, 8%, 5% and 11%. The highest percentage of work experience
is 1-5 years with 37%, 6-10 with 27.20%, 11-15 with 23.40%, 16-20 with 7.40%, 21-25 with
2.60%, 26-30 with 1.60%, 31-40 with 0.80% which is least. The percentage age of workers between
18-25 is 20%, 26 to 36 years with 41.20%, 37-47 with 28.20%, 48-58 with 10%, 59-70 with 0.60% in
the collected data through questionnaire in Andhra Pradesh and Telangana, India.
Reliability test
There are 23 variables for this study. Among them there are 11 items in Organizational and work
factors, 6 items in Organizational and Psychosocial factors and 6 items in Individual and Lifestyle
factors. The Cronbach’s Alpha for all the 23 items is 0.887.
After running the reliability test in SPSS software the data is used in AMOS to develop a model on
factors as to know which factor is affecting a lot on back and muscle injury in construction workers.
By that we can conclude and recommend for avoiding back and muscle injuries in construction
workers.
SEM Analysis
Structural Equation modelling is the combination of Path analysis and Factor Analysis. SEM is
classified in measurable category which is having a place to the multivariate measurements. It gives
the relationship between exogenous, endogenous, error and disturbance variables. SEM work
comparable like Multiple Regression analysis, but it has more progress alternative other than multiple
regression analysis because numerous factors with numerous multiple observed variables. It is easy to
understand the causes and effects, correlations of independent and dependent variables and their errors
related with them. There are plenty of statistical techniques in Structural Equation Modelling like
Multiple Regression, Factor Analysis, Path Analysis and Covariance Analysis. (Byrne, 2010). SEM
is analyzed with the help of AMOS.
Here in this model, Back and Muscle Injury is measured by three factors. There are 3 factors as
“Ergonomic and Work”, “Organizational and Psychosocial”, “Individual and Lifestyle”. These
groups are under one name as ‘Human and System factors’ which describes the Back and Muscle
Injuries of construction workers. The Structural Model for Back and Muscle Injury is shown below.
The explanation of the model is:
1. There are three constructs for Back and Muscle Injury and are grouped as ‘Ergonomic and
Work’, ‘Organizational and Psychosocial’, ‘Individual and Lifestyle’.

2. The dimension of ‘Ergonomic and Work’ is measured with 11 items, ‘Organizational and
Psychosocial’ is measured with 6 items, ‘Individual and Lifestyle’ with 6 items.
4
3. All these 3 constructs are named as ‘Human and System factors’ in the model.

4. BM01, BM02, BM03, BM04, BM05, BM06 are the observed variables which are used to
measure the exogeneous latent variable (Back and Muscle Injury).

Table 1. Model fit values of structural model

Measure Estimate Interpretation

CMIN/DF 2.466 Excellent
CFI 0.889 Good
SRMR 0.0563 Excellent
RMSEA 0.054 Excellent
GFI 0.886 Good
AGFI 0.866 Excellent

According to the above table 1, CMIN/DF (Chi Square divided by degree of freedom) value is 2.466.
The value of CMIN/DF should be in between 1-3, then we can say that the model is best fit. Therefore,
this study model is finalized as well fit.
CFI (Comparative Fit Index) value for this study is 0.889. If it is greater than 0.80 then we can say
that it is permissible. Therefore, CFI value for this study is acceptable.
SRMR (Standardize Root Mean Square Residual) of this model is 0.0563. For SRMR the smaller
values are said to be very good fit. If the value is less than 0.08 it is said to be acceptable. (Hu and
Bentler, 1999).
RMSEA (Root Mean Square Error of Approximation) value for this model is 0.054. According to
Browne and Cudeck (1993), if RMSEA value is less than 0.05 it is said to be very good fit. Mac
Callum et al. (1996) stated that the values ranging from 0.08 to 0.10 are acceptable but if it is greater
than 0.10 it is said that model is unfit. Therefore, our model is good fit.
The value of GFI (Goodness of fit Statistic) is 0.886. If the value is greater than 0.95 then it is
considered as very good fit. According to Cheng, Shih-I (2011), the value up to 0.8 is acceptable.
Therefore model can be concluded as goodness of fit.
Adjusted Goodness of Fit (AGFI) value of model ‘C’ is 0.866. If the value is greater than 0.8 it is
said to be good fit. Therefore, the AGFI value is best fit for this model.

5
Figure 2. Structural Model of back and muscle injuries in construction workers

6
Findings & Discussion
Ergonomic and Work factors
In the Ergonomic and work factors ‘Repetitive work’ have the highest factor loading with 0.72
regression weight and the least is ‘by using vibrating equipment’ with 0.61 factor loading of
regression weight. According to S.J Linton (1990), ‘monotonous/repetitive movement’ variable is
strongly effect on the back and muscle injury in construction workers which is same compared to
current study. Wickstrom et al. (1970) results concluded that ‘awkward postures’ have the higher
influence on the back and muscle pain in construction workers. Devereux et al. (2002) result studies
said that ‘poor working environment’ is more affecting variable to musculoskeletal disorders in the
work factors. ‘Long duration of movement’ from ergonomic and work factor construct has the
regression weight of 0.71 which is second highest in that construct. From the Gauchard et al. (2001b)
results physical activities such as ergonomic and work factors was found more correlated to the back
and muscle injuries especially when workers are doing manual handling.
The least factor loading on the ergonomic and work construct is ‘by using vibrating equipment’
because many of the workers doesn’t work with vibrating equipment and there will be with less
percentage of workers who are using vibrating equipment. The other variables are ‘awkward postures,
resisting excessive force, manual handling, poor working environment, improper lifting techniques,
contact pressure, working overhead, forceful exertions’ with 0.67, 0.67, 0.66, 0.70, 0.70, 0.64, 0.65
and 0.64.
Organizational and Psychosocial factors
This is the factor construct which is affecting with highest regression weight in this current research.
From the Holmstrom et al. (1989) study results organizational factors like ‘high work demands’ or
‘stress’ shows strong relationship and associated with back pain which is same compared to the
current study. ‘High word demands’ variable is the strong affecting variable in this construct with
0.75 factor loading because when management is demanding more work from the workers it leads to
physical stress and muscles affects high. From the results of researcher Linton. J (1991), Psychosocial
factors have contributed significantly same as ergonomic and work factors, individual and lifestyle
factors to the back and muscle injury in construction workers. ‘Time pressure’ is the second highest
variable from the construct with 0.69 factor loading. The least is ‘Lack of skill’ with 0.55 regression
weight because it is the factor which management need to consider by not allowing one occupation
worker to the other occupation activity and they are implementing this variable by not allocating to
other occupation worker hence it is with least effect on the construct. Mostly from previous journals,
many authors mentioned that more studies need to be conducted in order to know whether
organizational and psychosocial factors influence on back and muscle injury in construction workers
or not.
Now by this research we can conclude and unexpectedly, Organizational and Psychosocial factors is
obtained with higher regression weight compared to other two factors but almost every factors have
higher effect and relationship with back and muscle injury. The other variables in this construct are
‘team support for work with 0.64, safety worries with 0.61, lack of work breaks with 0.58 factor
loadings.

7
Individual and Lifestyle factors
This is the least affecting construct on the back and muscle injury in construction workers. ‘poor rest
and recovery for the muscles after work’ has the highest factor loading regression weight with 0.68,
it means workers are doing other curricular activities after finishing the work without giving proper
rest to the strained muscles. From the previous studies, some researchers said that individual and
lifestyle factors were not strongly significant to the back and muscle injury but Chau et al. (2002)
study results said that there is relationship between Individual and Lifestyle factors to the
musculoskeletal disorders but not as significant as ergonomic and work factors. In this research
individual and lifestyle factors have strong impact on back and muscle injury in construction workers.
According to Anderson (1980), Nachemson (1983), Gentry (1984), there is a strong relationship
between Lifestyle and Individual factors to the back and muscle injury in construction workers which
the construct is included with influence of alcohol, physical fitness, impact of past accident, smoking.
In that poor physical fitness had a strong effect on back and muscle injury. Gatchel and Schultz (2012)
said that there are no studies and need to research that individual and lifestyle factors contribute to
the musculoskeletal disorders.
In the current study, the least is ‘Influence of Alcohol consumption’ with 0.62 factor loading of
regression weight on the construct because management is not allowing the workers to the workplace
who had alcohol consumption. ‘Impact of past accident/injury’ is the second highest with 0.66 factor
loading. The remaining variables in this construct are level of experience with 0.64, lack of knowledge
with 0.65, physical fitness with 0.64 factor loadings in the construct.
Overall view about the current study is the Ergonomic and work factors which is constructed with 11
items depends on the activity of workers. If we review all the items affecting back and muscle injury
of construction workers, ergonomic and work factor construct items are all related with physical
stress. In Organizational and Psychosocial factors construct, there are 6 items which influence on the
mental stress of the worker, Individual and Lifestyle factor consists of 6 variables depends on the
individual behavior of the worker.
By all the results from the research we can say that ‘Organizational and Psychosocial factors’ are
more significant and dominant factor to the back and muscle injury in construction workers.
Recommendations
According to the findings from the data collected in India on the construction workers, the workers
are affecting with back and muscle injuries from the ‘Organizational and Psychosocial factors’.
Management need to examine the items in this construct to regulate for avoiding injuries to the
construction workers. Mostly workers are affecting with back and muscle injuries because of the ‘high
work demands’ which needs to be reviewed by the management.
In order to reduce the back and muscle injury in construction workers, the workers should get to know
about the lifting techniques when handling the materials. Another is by reducing the physical demands
in the workplace which is more effective. Management need to recommend the workers to carry
within the weight limits which are provided by NIOSH (National Institute of Occupational Safety and
Health). Reorganizing of current strained workers with fresh workers after some duration of time by
the management is good preventive method. Proper planning of work and resource allocation should
8
be ensured by management in order to prevent workers from affecting with ‘high work demands’.
Collective needs of workers like providing camps near the site and transportation are taken into
consideration by management to ensure good health of workers. Maintaining the good working
environment is also another good prevention method to reduce the injuries because poor working
environment is the place which influence a lot of negativity on the workers . Providing proper PPE
and educating workers about safety can help the workers from affecting with back and muscle
injuries. An educational program about postures, body mechanics and exercises can be used to prevent
injuries. Make sure to rest the body muscles after finishing the work and it is also effective to reduce
chronic symptoms.
Conclusion
After collecting the data from 500 workers in India, the internal consistency was calculated in SPSS
software and the data was transferred in AMOS software to know which factor is affecting a lot on
the back and muscle injury of construction workers through SEM model results. And finally this study
can be concluded as ‘Organizational and Psychosocial factors’ are most dominant and significantly
have strong relationship compared to ‘Ergonomic and Work factors’, ‘Individual and Lifestyle
factors’. Eventually we can also say that there is relationship between ergonomic and work factors,
individual and lifestyle factors to the back and muscle injury in construction workers. By this we can
say that our assumed hypothesis is satisfied.
Limitation and further research suggestion
After doing data collection and analysis this research concluded that there are some limitations in this
study. The research was studied on the small and medium construction workplace. This research
focused mainly on the states of Andhra Pradesh and Telangana in India. And this study is not
generalized on all the states of India but some of my respondents are working from different states
and culture in Andhra Pradesh and Telangana during my data collection period, even though still
there is scope to research further. During the data collection some of the respondents may be biased
with the questionnaire. Increase the sample size and try to get more results in different states.
The research studied on the small and medium construction workplace. This research focused mainly
on the states of Andhra Pradesh and Telangana in India.
1. How management is affecting with musculoskeletal disorders in workers.
2. How chronic symptoms are treated by management and workers.
3. Ergonomic interventions and awareness in construction workplace.
4. Muscle fatigue and its relationship with muscle pain.
5. Economic consequences with musculoskeletal disorders.

9
References
Azhar J. (2009). Ergonomics for generating Comfort at Workplace.

Anderson, J. (1984); Shoulder pain and tension neck and their relation to work. Scand J Work
Environment Health 10:435-442.

Anderson, J. A. D, (1980), Back pain and occupation. In M. I. V. Jayson (ed.) The Lumbar Spine
(Pitman medicine, Kent).
Bentley, T.A., Haslam, R.A., (2001). Identification of risk factors and counter measures for slip,
trip and fall accidents during the delivery. Appl. Ergon. 32, 127–134.

Bernold, L. E., and Guler, N. (1993). ‘‘Analysis of back injuries in construction.’’ J. Constr. Engrg.
and Mgmt., ASCE, 119(3), 607–621.

Bureau of Labor Statistics, (1995). ‘‘Workplace injuries and illnesses in 1994,’’ USDL-95-508,
U.S. Department of Labor.

Bureau of labor statistics., (2019). Definition and causes of Musculoskeletal disorders.

Cheung, Hight, Hurley et al. (2009a)., Musculoskeletal disorders in construction. www.asse.org.

Byrne, B. (2010). Structural Equation Modeling with AMOS, basic concepts, applications, and
programming. United Kingdom: Routledge Taylor & Francis Group.
Cheng, Shih-I., (2011)., Comparisons of Competing Models between Attitudinal Loyalty and
Behavioral Loyalty, Vol. 2 No.10, International Journal of Business and Social Science.

Deros, B.M., D.D.I. Daruis, A.R. Ismail & A.R.A. Rahim, (2010b). Work posture and back pain
evaluation, American Journal of Applied Sciences, 7: 473-479.

Deros, B.M., Khamis, N.K., Ismail, A.R., Jamaluddin, H., (2011). An ergonomics study on
assembly line workstation design, American Journal of Applied Sciences, 8(11): 1195-120.

Devereux, J., Vlachonikolis, I., and Buckle, P. (2002). “Epidemiological study to investigate potential
interaction between physical and psychosocial factors at work that may increase the risk of symptoms
of musculoskeletal disorder of the neck and upper limb.” Applied Ergonomics.
Di Wang, Fei Dai and Xiaopeng Ning (2015); Risk assessment of work-related musculoskeletal
disorders in construction, J. Constr. Eng. Management., 141 (6)

Environment health and safety (2009)., Musculoskeletal disorders.

Gatchel, R. J., and Schultz, I. Z. (2012). Handbook of occupational health and wellness, Springer,
New York.

Gauchard G, Chau N, Mur JM, Perrin P (2001a) Falls and working individuals: role of extrinsic
and intrinsic factors. Ergonomics 44:1330–1339

HSE (Health and Safety Executive reports, 2014). “Musculoskeletal disorders.”

10
Hu, L. and P. M. Bentler (1999). Cutoff criteria for fit indexes in covariance structure analysis:
Conventional criteria versus new alternatives. Structural Equation Modeling 6(1): 1-55.

Jaffar, N., Abdul-Tharim, A. H., Mohd-Kamar, I. F., and Lop, N. S. (2011). “A literature review of
ergonomics risk factors in construction industry.” Procedia Eng., 20, 89-97.

Ismail, A.R., Yeo, M.L., Haniff, M.H.M., Zulkifli, R., Deros, B.M., Makhtar, N.K., (2009).
Assessment of postural loading among the assembly operators: A case study at Malaysian
automotive industry, European Journal of Scientific Research, 30 (2), 224-235.

James T. Albers and Cheryl F. Estill (2007)., Simple solutions- Ergonomics for construction workers.
NIOSH Publication no. 122.

Leonhard E. Bernold and Nil Guler (1993); Analysis of Back injuries in construction, Journal of
Construction engineering and Management, vol.119.
Lee P (2001), Helewa A, Goldsmith C, Low back pain: prevalence and risk factors in an industrial
setting. Journal of Rheumatology;28(2):346–51.
Muslimah, E., Pratiwi, I. & Rafsanjani, F. (2006). Manual material handling analysis using NIOSH
equation, 5(2): 53 – 60.
Nachemson, A. (1983), Work for all those with low back pain, Clinical Orthopedics and Related
Research, 179, 77-85.
Oglesby, C.H., Parker, H.W., and Howell, G.A. (1989). Productivity improvement in construction.
McGraw-Hill, New York.

O’Sullivan. P, Grahams law. K., Kendell. M., et al. (2002), The effect of different standing and sitting
postures on trunk muscle activity in a pain free population. Spine; 27:1238–44.

Shaliza, A.M., Shahrul, K., Zalinda, O. & Mohzani, M., (2009). Ergonomics awareness and
identifying frequently used ergonomics programs in manufacturing industries using quality function
deployment, American Journal of Scientific Research 3: 51-66.
S.J Linton et al. (1990), Risk factors for neck and back pain, International journal of work, Health
and organizations, 41-49.
Sorock GS, Lombardi. D, A. & Hauser. R, B., Eisen. E, A., Herrick. R, F., Mittleman. M, A.,
(2001) A case–crossover study of occupational traumatic hand injury: methods and initial findings.
Am J Ind Med 39:171–179.
Stubbs, D.A., and Nicholson, A.S., (1979). “Manual handling and back injuries in the
construction industry: an investigation.” J. Occupational Accidents, 2:179-190.

Wickstrom, G. (1978), Symptoms and Signs of Degenerative Back Disease in Concrete

Reinforcement Workers. Scand. J Work Environ Health (Suppl 1):54–58
Zuidema, H. (1985), National statistics in The Netherlands, Ergonomics, 28, S 3-7.

11