AN ERGONOMIC APPROACH TO ANINVESTIGATION INTO THE RISK FACTORSLEADING TO WORK-RELATEDMUSCULOSKELETAL DISORDERS FORTAIWANESE HAIRDRESSERS.

Hsiao-Lin Fang1*, Robert C.C. Chen1, Hsiao-Ping Fang2, Qin Xu1
1 De Montfort University, UK
2 Styling and Cosmetology Department, Transworld Institute of Technology, Taiwan* Corresponding author: hfang@dmu.ac.uk

ABSTRACT
Nowadays, interventions by ergonomists in the workforce have identified risk factors to prevent
WMSDs among workers. However, the amount of data and research effort to indicate the problem
among hairdressers has been limited. This study aims to investigate the risk factors of WMSDs for
hairdressers by identifying the body regions associated with significant discomfort. Twelve
professional Taiwanese hairdressers were invited to join this pilot study in Taiwan using ahairdresser-oriented musculoskeletal questionnaire to develop the study. The results from thestudy show that 91.7% of subjects reported shoulder discomfort as the most frequent problem
followed by discomfort in the lower back (83.3%) and in the neck region (75%). Moreover, thestudy reveals that the effects of ageing could increase discomfort levels in the lower back and1

lower leg. A further empirical investigation into detailed discomfort areas in relation tohairdressers’ tasks and working postures may benefit the industry to prevent hairdressers from
suffering WMSDs.
Keywords: Work-Related Musculoskeletal Disorders (WMSDs), Ergonomics, Hairdressers

1. INTRODUCTION
Work-related Musculoskeletal Disorders (WMSDs) in the hairdressing industry have increased
significantly over recent years. There are ranges of different terminologies used to describe
WMSDs problems such as Cumulative Trauma Disorders (CTDs), Repetitive Strain Injury (RSI),
Repeated Motions Injury (RMI) and Occupational Overuse Disorders (OODs). This study focuseson how the hairdressing industry performs several different tasks in hair salons in a standing
position. Since a hairdresser typically spends long working hours on various daily tasks, such as
cutting, blow-drying, perming and washing hair, WMSDs are likely to be caused which impact onparticular regions of their body. However, the amount of data and research effort to explore theproblem among hairdressers has been limited. Therefore, this study aims to investigate the risk
factors for WMSD within the hairdressing industry by identifying the body regions which exhibit
significant discomfort. In order to do so, the following objectives need to be met:z

To review literature in the related areas;z

To design a hairdressers’ oriented musculoskeletal questionnaire based on a Nordic
Musculoskeletal Questionnaire;z

To survey twelve Taiwanese hairdressers by using designed an oriented musculoskeletal
questionnaire;z

To identify the risk factors of WMSD problems of the body regions with significant discomfort
among Taiwanese Hairdressers for further investigation.

2. RELATED WORKS

2WMSDs have been a worldwide issue in many countries. In the U.K., the Health and Safety
Executive (HSE, 2006) showed that Upper Limb Disorders are not confined to any one particulargroup of workers or industrial activity over recent years, but are widespread in the workforce.
Hairdressers are amongst the groups which have reported high levels of arm pain. Furthermore,
the HSE reports that WMSDs were the most common occupational illnesses, affecting 1.0 million
people a year, with problems including lower back pain, joint injuries and repetitive strain injuries
of various types. In Taiwan, the Institute of Health and Safety began developing a work injury
prevention strategy and health and safety standards for the Government, employers andemployees in 2002 (Lin, 2003). Moreover, a nationwide study indicated (Guo, 2004) that 37.0% of
18,942 people who returned a questionnaire had WMSDs. In the U.S., the Annual Survey ofOccupational Injuries and Illnesses conducted by the Bureau of Labour Statistics (2001) reported
that there were 522,528 WMSDs cases, with a total of 329, 920 total employees from the service
industries, resulting in absence from work. 1,582 of the cases involved hairdressers, hairstylists,and cosmetologists, and these included 575 cases involving the upper extremities and 245 casesin the lower extremities. In fact, MSD cases are increasing every year; however, there is noworldwide scheme of prevention against these conditions (Lin, 2003).
Amounts of data and research efforts to indicate the problem among hairdressers were limited.
Amongst these, English et al (1995) studied five hundred and eighty cases and 996 controls; thediagnoses of the cases included soft tissue conditions affecting the shoulder, elbow, forearm,wrist, thumb, hand, and fingers; the controls included traumatic, degenerative, and inflammatory
conditions, mostly of the legs and lower back, and found the risk highest for shoulders cases
amongst female hairdressers. In 1988, an investigation reported through the National HealthInterview Survey was analysed by Guo (2002), who pointed out that female Hairdressers andCosmetologist are the third highest risk of the top 15 major occupations for lower back pain
attributable to RA at work. Furthermore, Lin (2003) pointed out that WMSD cases claiming
compensation from labour insurance between 1999 and 2001 showed the highest levels ofcompensation being granted to Taiwanese workers in the Hairdressing and Barber industry for
upper limb disorders. One year later, Wu et al, conducted a questionnaire survey given to 36
hairdressers from thirteen hair salons as part of a study of the musculoskeletal disorders in
employees working in beauty salons in Kaohsiung, Taiwan. As a result, Wu et al, revealed thatmost of the discomfort comes from the shoulders (94.4%), lower back (80.6%), and neck (77.8%).
Moreover, a similar result from a quantitative study (n=360) by Chuang (2005), found that 94.4%
of hairdressers voted that their shoulders were the most uncomfortable body region, followed by3

the lower back and neck. In short, it is obvious that most research into WMSDs indicates thathairdressers suffer from discomfort in their upper limbs, neck, shoulders, lower back and wrists.
One of the common assessment methods used for investigating the prevalence of WMSDs in aparticular occupational status is the Nordic Musculoskeletal Questionnaire (NMQ), presented by
Kuorinka in 1987. The NMQ has been applied in various jobs to reveal their WMSDs problems, as
the scales in the questionnaire are very reliable. Some current studies using the NMQ are
discussed in the following: David and Buckle (1997) considered the ergonomic problems
associated with the use of pipettes using the NMQ. This showed that the occurrence of elbow andhand complaints was significantly higher in the pipette-using population as compared to thecontrol population. In 2001, Miranda et al used a modified version of the NMQ to evaluate theeffects of work-related and individual factors as well as physical activities and sports on theincidence and persistence of shoulder pain among forestry workers in Finland. They found thatthe physical work with a heavy load, awkward work postures, mental stress and obesity were therisk factors. In 2003, Chen et al. investigated the discomfort associated with WMSD andoccupational injuries within the foodservice industry in Taiwan. Chen et al. also highlighted thatthe shoulder, hand/wrist and low back had the highest discomfort levels, based on the five-point
scale using the NMQ, where a higher score indicated more severe pain and tingle. Moreover,
Choobineh et al. (2004) utilized the NMQ as a questionnaire to identify musculoskeletal disorders
in carpet menders following the observation with the Rapid Upper Limb Assessment (RULA)
technique. As a result, Choobineh et al. recommended a new workstation, which improved
working posture in 57% of the cases, and the comfort was increased. In 2005, Lei presented astudy that investigated the risk factors for the prevalence of musculoskeletal symptoms, i.e. ache,pain or discomfort, among foundry workers in China using the NMQ, and the results suggested
interventions for low back pain should be the first priority.
Since there was no reliability outcome relevant to this research into hairdressers, a reliable NMQ
must be selected and then modified, based on hairdressers’ specified tasks, with the purpose of
meeting the needs of this research. In this study, a hairdresser-oriented musculoskeletal
questionnaire was conducted, based on the study conducted by Chen et al (2003) and Miranda etal (2001). Furthermore, a step-by-step confirmation approach is employed in the present study inorder to increase reliability, shown as follows:z

The background information regarding independent variables such as age, working
experience, and occupational status, i.e. working hours per week, break-taking;4zTasks and Equipment;zErgonomic assessment such as repetitive wrist movement, arm up above shoulder, lower
back bending in work;z

The WMSD history from clinical diagnosis, i.e. Tendinitis, lower back pain, Carpal Tunnel
Disorders;zSelf-assessment of level of discomfort and symptoms associated with twelve body regions.

Thus, this study intends to employ the questionnaire approach to a risk factors investigation into
Taiwanese hairdressers’ work-related musculoskeletal disorders.

3. METHODS

3.1 SUBJECT SELECTION
Twelve professional Taiwanese hairdressers were invited to join this pilot study in Taiwan using ahairdresser-oriented musculoskeletal questionnaire developed for this study. Their average age
was 22.75 ± 3.79 years; the average working experience was 70 ± 43.95 months; the mean
working hours was 49.58 hours per week. All subjects are right handed.

3.2 HAIRDRESSERS’ ORIENTED MUSCULOSKELETAL QUESTIONNAIRE
A hairdresser-oriented musculoskeletal questionnaire was conducted, based on the NMQ, andthen developed. The NMQ has been modified and applied to other oriented occupations such as
restaurant workers in Taiwan by Chen et al (2003), and forestry workers in Finland (Miranda et al,2001). The survey data were collected and analysed using SPSS version 13. Because thesample size is small, non-parameter analyses, such as the Pearson χ2 test and Spearman
Correlation Analysis, were applied to these raw data.

4 RESULTS

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4.1 RELIABILITY
The hairdresser-oriented musculoskeletal questionnaire approach has represented a very highlevel of reliability on a five-point scale of discomfort for twelve body regions (Cronbach's alpha =0.95). Therefore, the results collected, based on a step-by-step confirmation approach, arereliable.

4.2 DISCOMFORT IN BODY REGIONS
91.7% of subjects reported shoulder discomfort, followed by lower back (83.3%) and neck (75%).
This result validates a level of discomfort among body regions as being the same as in previous
research by Wu et al (2004) and Chuang (2005). Moreover, 33.4% reported a ‘mild-to-moderate’level of shoulder discomfort, followed by neck (25%) and lower back (25%). Therefore, among
hairdressers, the shoulder region is the most likely to suffer bodily discomfort.
Furthermore, Spearman Correlation Analysis indicates that the level of discomfort has thestrongest positive relation with the level of discomfort in the body region of the neck (r=0.664,
p<0.05), followed by the upper arm (r=0.661, p<0.05) and the wrist/fingers (r=0.542, p<0.05).
Therefore, the body regions showing discomfort are likely to be associated with the upper limbs.

4.3 SYMPTOMS
The study investigates the symptoms of discomfort reported by the subjects. The results showthat 88.9% of subjects reported arthritic pain in the neck, followed by the shoulder (66.7%) andlower back (66.7%). Moreover, 22.2% of subjects reported numbness and pins and needles in theneck, followed by shoulder pain (16.7%) and lower back pain (16.7%). The result further provesthat the body regions suffering most discomfort are likely to be the neck, shoulders and lowerback.

4.4 AGE
Participants were approximately 22.75 ± 3.79 years old and were divided into two groups: (1) 19 ~22.75 years old, 7 females, and (2) 22.75 ~ 32 years old, 5 females. After that, the Pearson χ2

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test indicates that there is a significant effect of age on discomfort in the lower back and lower leg(p<0.05). Therefore, the ageing effect could be one of the risk factors leading to discomfort thelower back and lower leg.

4.5 TASKS
The Pearson χ2 test indicates that using a bottle of water when washing clients’ hair significantly
increases the level of discomfort in the upper arm (p<0.01). Therefore, standing-up when washingclients’ hair should be avoided. However, the other hairdressing tasks do not significantly affectdiscomfort in body regions (p>0.05).

4.6 WORKING EXPERIENCE
Participants have approximately 70 ± 43.95 months of working experience and are further divided
into four groups: (1) 15 ~ 42.6 months, 3 females, (2) 42.6 ~ 60 months, 3 females, (3) 60~75.75
months, 3 females and (4) over 75.75 months, 3 females. After that, Pearson χ2 test indicatesthat there is no significant effect of working experience on discomfort in body regions (p>0.05).
Therefore, working experience may not be a risk factor which results in discomfort of body regions.

4.7 WORKING HOURS
Participants work approximately 49.58 ± 19.57 hours per week and are further divided into fourgroups: (1) 16 ~ 33.33 hours, 3 females, (2) 33.33 ~ 52 hours, 3 females, (3) 52 ~ 65 hours, 3
females, and (4) over 65 hours, 3 females. After that, the Pearson χ2 test indicates that longer
working hours significantly increase the level of discomfort in the upper arm (p<0.05). Therefore,
longer working hours are likely to increase the level of discomfort in the upper arm.

4.8 TAKING A BREAK
Participants take approximately 6.25 ± 8.465 mins per break. These were divided into four groups:(1) no break at all, 5 females (2) 5~9 mins, 4 females, and (3) over 9 mins, 3 females. After that,
the Pearson χ2 test indicates that taking a longer break could significantly reduce the level of7

discomfort in the lower leg (p<0.05). Therefore, taking longer a break could possibly prevent lower
leg discomfort.

4.9 OPEN-ENDED QUESTION
The open–ended question is used in the last section of this questionnaire and was completed bythose hairdressers who had any opinions about WMSDs. From the opinions collected, theprovision of a height-adjustable washbasin would improve the facilities. Moreover, poor working
postures induce body discomfort when employees attempt to correct them, and if the ache or pain
appears after work, then a hot compress could be applied to the area where the muscles areaffected.

5. DISCUSSION
The study points out that the majority of subjects report arthritic neck, shoulder and lower backpain, with the body regions showing greatest discomfort being the shoulder, lower back and neck.
The result is consistent with current studies. Moreover, some risk factors have been foundassociated with a level of discomfort among body regions: the ageing effect could increase thelevel of discomfort in the lower back and lower leg; longer working hours are likely to increase thelevel of discomfort in the upper arm; taking a longer break could possibly prevent lower leg
discomfort. In addition, standing-up should be avoided while washing clients’ hair as this might
prevent discomfort of the upper arm.
This study is based on subjective self-assessment; the reason that various tasks may not be risk
factors which increase the level of discomfort among body regions is because these individualtask performances can be investigated only via empirical observation. Thus, the causes of
discomfort in the various body regions remain unknown.
Since shoulder discomfort is highly associated with the arm and neck, this study suggests that afurther investigation into the tasks performed by the upper limbs is required; this may help toidentify causes of shoulder discomfort. Moreover, because the sample size was small and cannot

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be considered to be fully representative of the hairdresser population in Taiwan, it is proposedthat in the future a large quantitative research based on a revised hairdresser-orientatedmusculoskeletal questionnaire be employed to validate the findings of this small study.

6. CONCLUSIONS AND FURTHER STUDYThis study aims to investigate the risk factors of WMSDs among hairdressers by identifying the
body regions with significant discomfort. A comprehensive literature review was given. As a result,a hairdresser-orientated musculoskeletal questionnaire was conducted. The result indicates thatmost discomfort of the body regions is in the shoulder, lower back and neck. The result is
consistent with current studies. Moreover, the study reveals that the ageing effect could increase
discomfort level in the lower back and lower leg and that longer working hours may increase
discomfort levels in the upper arm.
Although no particular hairdressing tasks were found to be associated with a significant effect on
the levels of discomfort in particular body regions, it is suggested that a further investigation into
the tasks required to be performed by the upper limbs and their possible relationship with
employee discomfort should be undertaken. This may help in identifying causes of discomfort andtheir relation with working postures or other risk factors. Moreover, a large number of responses
to the questionnaire from the present hairdresser population in Taiwan is necessary for thevalidation of the findings of this study. Further, an ergonomic investigation will be needed todecrease WMSD problems in order to improve work efficiency in the hairdressing industry.

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