The Effect of Exercise and Ergonomics Training Program on Musculoskeletal Disorders in Teachers

All participants attended four individual face-to-face ergonomics training sessions (weeks 1, 4, 8, and 12; 30-45 minutes each) and received a weekly telephone call from the treating physiotherapist about their general condition and adverse events. Participants in the experimental group additionally performed a standardized, largely self-directed exercise program three days a week for 12 weeks (36 sessions of about 45 minutes) after one individual teaching session, using an illustrated guide. The program had three 4-week phases: stretching and postural awareness; added scapular, isometric neck, and trunk extensor strengthening; and added core stabilization. Exercise adherence was self-reported in the weekly calls. Randomization was stratified by school level with an allocation list prepared and held by an independent person. Outcomes were collected by interview by a physiotherapist who was unaware of group allocation.

• ergonomics training (Behavioral): Classroom workstation ergonomics, posture awareness, ergonomics of daily teaching tasks, and break strategies; workstation checklist, brochure, and weekly self-monitoring form. Both arms.
• Structured exercise program (Other): Phase 1 (weeks 1-4): stretching and postural awareness. Phase 2 (weeks 5-8): scapular, isometric neck, and trunk extensor strengthening added. Phase 3 (weeks 9-12): core stabilization added. Low to moderate intensity, body weight only, self-directed with an illustrated guide. Experimental arm only.

Primary outcomes

• Oswestry Disability Index [Baseline and week 12]: The Oswestry Disability Index (ODI) is a self-completed questionnaire used to assess the level of disability in patients with low back pain. In the current study, the ODI will be used to evaluate the impact of low back pain on patients' daily lives.The survey consists of ten sections focusing on different aspects of daily life, such as pain severity, personal care, weight lifting, walking, sitting, standing, sleep, sexual function, social life, and travel. Each section contains six statements scored from 0 to 5; The first expression is zero, indicating no disability. The scores of all questions are summed and then multiplied by two to obtain an index ranging from 0 to 100. The higher the score, the greater the disability.
• Neck Disability Index [Baseline and week 12]: Turkish version; 10 items; score expressed as a percentage from 0 to 100; higher scores indicate greater neck disability.
• Nordic Musculoskeletal Questionnaire [Baseline and week 12]: It is a scale used to determine the extent of pain in the musculoskeletal system. The purpose of this questionnaire is to identify and compare pain and complaints in parts of the body. There is an image showing the 9 parts of the body included in the questionnaire. These body parts; neck, shoulders, back, elbows, hands, waist, hips, knees and feet. The respondents are asked whether they have experienced problems such as pain and discomfort in their body parts in the last 12 months, in the last 4 weeks, and on the day of the assessment, and they are asked to mark this as yes or no.
• Change in Maslach Burnout Inventory-Educators Survey (MBI-ES) emotional exhaustion. [Baseline and week 12]: 9 items scored 1 to 5; range 9-45; higher scores indicate greater burnout.
• Change in MBI-ES personal accomplishment [Baseline and week 12]: 8 items scored 1 to 5; range 8-40; lower scores indicate greater burnout.
• Musculoskeletal symptoms in the previous 7 days (Nordic Musculoskeletal Questionnaire) [Baseline and week 12]: Turkish version; presence (yes/no) of ache, pain, or discomfort in nine body regions (neck, shoulders, upper back, elbows, wrists/hands, low back, hips/thighs, knees, ankles/feet) in the previous 7 days; reported as the number of symptomatic regions (0-9) and as prevalence by region.

Secondary outcomes

• Change in pain intensity (Visual Analog Scale) [Baseline and week 12]: Current pain in the region identified by the participant as most painful at baseline; 0 (no pain) to 10 (unbearable pain); the same region is rated at week 12.

Other outcomes

• Activity-limiting musculoskeletal symptoms and 12-month symptoms (Nordic Musculoskeletal Questionnaire) [Baseline and week 12]: Yes/no by body region.

Sex: All, ages: 30 Years to 60 Years

Inclusion Criteria

* Teacher working at preschool, primary, middle, or high school level
* Age 30 to 60 years
* At least 5 years of teaching experience
* Musculoskeletal pain lasting at least 3 months
* Pain intensity of at least 3 on a 0-10 Visual Analog Scale
* Able to attend the training and exercise program

Exclusion Criteria

* Serious neurological or orthopedic disease
* Musculoskeletal surgery within the previous 6 months
* Any medical or psychological condition that would prevent exercise

• Furuta DT, Tebar WR, Beretta VS, Tebar FG, de Carvalho AC, Leoci IC, Delfino LD, Ferrari G, Silva CCM, Christofaro DGD. Analysis of the association between high workload and musculoskeletal pain in public school teachers according to physical activity level. Work. 2024;78(1):111-117. doi: 10.3233/WOR-230474. PMID 38393875
• de Souza JM, Tebar WR, Delfino LD, Tebar FSG, Gobbo LA, Franco M, da Silva CCM, Oliveira CBS, Christofaro DGD. Association of Musculoskeletal Pain With Sedentary Behavior in Public School Teachers: The Role of Habitual Physical Activity. Pain Manag Nurs. 2023 Apr;24(2):196-200. doi: 10.1016/j.pmn.2022.08.005. Epub 2022 Sep 11. PMID 36100514
• Jahre H, Guddal MH, Grasaas E, Smedbraten K, Riiser K, Pripp AH, Grotle M, Oiestad BE. The Effectiveness of School-Based Interventions on Pain and Disability Outcomes in Adolescents With Persistent Pain. A Systematic Review. Eur J Pain. 2025 Sep;29(8):e70101. doi: 10.1002/ejp.70101. PMID 40814866

• Muharrem AKAR, Study chair, Uskudar University