Neck and Low Back Pain in Physical Therapy Students at The University of the West Indies, Mona, Jamaica

Overview

The purpose of this study is to identify the prevalence of neck and low back pain in physical therapy students enrolled at the University of the West Indies, Mona; to assess their knowledge, attitude and practice of good spine health and to determine the outcome of a standardised spine exercise program on physical therapy students experiencing neck and low back pain, using a prospective randomised control design.

Neck and low back pain are common musculoskeletal problems that affect most persons at some point in their lives, cutting across various professions. These conditions may be self-limiting, but in many cases, they become disabling and significantly impact productivity, social life, and activities of daily living. It is estimated that approximately 37% of back pain is associated with occupational factors. Prolonged sitting and awkward postures considerably increase the risk of low back pain, while neck pain is closely linked to slouching and repeated or prolonged neck movements. Health care professionals, including physical therapists, are one such group highly susceptible to musculoskeletal pain, and this vulnerability begins as early as their training years. Physical therapy training involves both preclinical and clinical phases that expose students to unique risk factors. During the preclinical period of training, physiotherapy students spend long hours sitting during lectures, studying, and completing assignments, often with sustained use of computers or electronic devices. In the clinical periods, students are immersed in a physically demanding training environment involving prolonged standing, manual patient handling and therapeutic exercises. A systematic review by Smith et al. found that low back pain was reported by 60-80% of physical therapy students during their education. Similarly, Johnson et al. revealed that 66.8% of physical therapy students experienced low back pain, with a significant proportion reporting limitations in daily activity. Comparative studies suggest that physical therapy students are at even higher risk of low back pain than medical students, with prevalence rates of 77.9% versus 54.3%, respectively. This difference is attributed to the physical nature of physical therapy training, which requires manual therapy techniques, patient transfers, and prolonged standing during clinical practice. Neck pain is also highly prevalent among physical therapy students. Brown et al. reported a 69% prevalence of neck pain among physical therapy undergraduate students, most of whom attributed symptoms to prolonged studying, poor posture, and excessive electronic device use. Regional studies in Saudi Arabia and Pakistan further reported neck pain prevalence rates of 48.8% and 51.8%, respectively, with postural strain, poor ergonomics, and psychosocial stress identified as major contributors. Risk factors for neck and low back pain pain among physical therapy students are therefore multifactorial, including poor ergonomics while studying or performing manual techniques, the physical demands of training such as lifting patients and prolonged standing, sedentary behaviours during study periods, and psychosocial stress arising from academic pressure. Although physical therapy students are trained in exercise science, their personal levels of physical activity may vary, which may further influence susceptibility to musculoskeletal pain. Exercise therapy is one of the most effective non-pharmacological interventions for musculoskeletal pain. Chou and Huffman (2007), in their review of non-pharmacologic therapies for acute and chronic low back pain, demonstrated significant improvements in both pain reduction and function with exercise compared to other interventions. Exercise enhances spinal strength, flexibility, and stability, while promoting nutrient transfer to discs, ligaments, and soft tissues, thereby reducing the likelihood of injury. Low back and core-strengthening exercises, in particular, are widely regarded as an optimal approach to restoring spinal balance and alleviating pain. At the University of the West Indies (UWI), Mona, there are currently 120 physical therapy students enrolled across three years, with approximately 40 students per cohort. This study seeks to determine the prevalence of neck and low back pain in physical therapy students, to assess their knowledge, attitude, and practice regarding spine health, and to evaluate the outcome of a standardised spine-specific exercise program on reducing pain and improving functional status. Students reporting pain will be prospectively randomised into control and intervention arms, with the latter receiving the standardised spine-specific exercise program over an eight (8) weeks period. Outcome measures will include the Numeric Rating Scale (NRS), the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ), and structured questionnaires to assess function, knowledge, attitude, and practice. To the best of the researcher's knowledge, this will be the first randomised controlled study conducted in the Caribbean investigating the prevalence of neck and low back pain among physical therapy students, while simultaneously assessing the effectiveness of a targeted exercise based intervention.