The spine is a fundamental structure that supports the body's posture, facilitates movement, and protects the spinal cord, playing a crucial role in overall musculoskeletal health. However, in today’s fast-paced work environments, poor postural habits, prolonged sitting, and physically demanding tasks contribute significantly to spinal disorders, which are increasingly prevalent among the working population.^1-5 Spinal health is not only essential for an individual’s physical well-being but also directly impacts productivity, quality of life, and occupational efficiency.^6-8 Despite the rising incidence of posture-related ailments such as lower back pain, cervical spondylosis, and musculoskeletal discomfort, awareness regarding spinal health and postural hygiene remains alarmingly low, particularly in developing regions such as Punjab.

Punjab, a state characterized by its diverse workforce, comprises professionals engaged in both sedentary occupations, such as IT and desk jobs, and physically intensive labor, including agriculture, manufacturing, and construction. The nature of these occupations predisposes workers to various spinal issues, often exacerbated by improper ergonomic practices, lack of awareness, and limited access to preventive healthcare measures.^10,11 Studies suggest that poor postural habits and inadequate knowledge about spinal health contribute to long-term complications, including chronic pain, spinal deformities, and decreased work efficiency. Unfortunately, many individuals seek medical intervention only when symptoms become severe, rather than adopting preventive strategies to maintain spinal well-being.^12-15

A growing body of research highlights the need for postural education and ergonomic interventions to prevent spinal disorders. However, limited studies have assessed the level of awareness regarding spinal health among working individuals in Punjab. Understanding knowledge gaps, risk factors, and existing practices is essential for designing targeted educational programs and workplace interventions to promote postural awareness and prevent occupational spinal disorders.

This study aims to evaluate the knowledge and awareness of spinal health and posture among the working population of Punjab. By identifying deficiencies in awareness and potential workplace risk factors, the research seeks to inform evidence-based health initiatives that encourage preventive measures, foster ergonomic workplace adaptations, and enhance the overall well-being of the workforce. Addressing this crucial aspect of occupational health will not only reduce the burden of spinal disorders but also improve work efficiency, productivity, and quality of life for the working population.

Research Design

This study employed a descriptive, cross-sectional research design to evaluate the knowledge, awareness, and perceptions of spinal health and postural awareness among the working population of Punjab. A structured online questionnaire-based survey was used as the primary data collection tool, focusing on workplace ergonomics, postural habits, and musculoskeletal health concerns. The cross-sectional approach was chosen to provide a snapshot of the current knowledge and behaviors related to spinal health among employees in diverse occupational sectors.

Study Area and Population

The study was conducted across Punjab, India, targeting individuals working in various occupational settings, including corporate offices, industrial labor, educational institutions, healthcare facilities, and the agricultural sector. Punjab was selected due to its diverse workforce, which includes both sedentary desk jobs and physically demanding labor, making it an ideal region for assessing workplace-related postural awareness. The study population comprised working adults aged 18 years and above, representing different professional backgrounds to ensure a comprehensive understanding of spinal health awareness and postural practices across varying job roles.

Study Duration

The research was conducted over a three-month period, from October to November 2024. This duration allowed for adequate data collection and ensured diverse representation across multiple occupational sectors.

Sample Size and Sampling Technique

A total of 400 participants were included in the study. The sample size was calculated based on a 95% confidence level, an assumed awareness rate of 50% regarding spinal health, and a 5% margin of error. A convenience sampling technique was employed, using Google Forms as the survey platform. The survey link was distributed through WhatsApp, Facebook, Instagram, LinkedIn, email groups, and workplace communication channels. This approach ensured easy accessibility for participants while capturing responses from various occupational groups across Punjab.

Inclusion and Exclusion Criteria

Participants were eligible for the study if they were aged 18 years or older, permanent residents of Punjab, and currently employed in any sector. They also needed access to the internet and the ability to comprehend the questionnaire in English or Punjabi. Participation was voluntary, with electronic informed consent obtained before proceeding with the survey. Individuals with pre-existing diagnosed spinal disorders, those unwilling to participate, and those with incomplete or inconsistent survey responses were excluded from the study to maintain the integrity of the dataset.

Study Tool: Structured Online Questionnaire

A pre-validated, structured questionnaire was developed and administered through Google Forms as the primary data collection tool. The questionnaire was designed with input from physiotherapists, occupational health experts, and ergonomists to ensure scientific validity. It consisted of three key sections:

1. Socio-Demographic Information – This section gathered details on age, gender, occupation, education level, workplace setting (corporate, industrial, agricultural, etc.), and years of employment to assess participant characteristics.
2. Knowledge and Awareness Assessment – A total of 20 multiple-choice questions covered key topics such as postural habits, ergonomic knowledge, risk factors for spinal issues, preventive measures, and healthcare-seeking behaviors related to spinal health.
3. Self-Reported Practices and Symptoms – This section focused on participants' musculoskeletal pain experiences, frequency and duration of discomfort, use of ergonomic tools (such as chairs, lumbar support, standing desks), and participation in workplace wellness programs.

The questionnaire was available in both English and Punjabi to ensure accessibility across different demographic groups.

Scoring Criteria

To evaluate knowledge and awareness, responses to the knowledge assessment section were scored and categorized into four levels:

• Very Good Knowledge: ≥80% correct responses
• Good Knowledge: 60%–79% correct responses
• Fair Knowledge: 41%–59% correct responses
• Poor Knowledge: <40% correct responses

This classification helped identify knowledge gaps and populations requiring targeted awareness campaigns and workplace interventions.

Data Collection Procedure

The Google Form survey remained open for responses for three months, allowing participants to complete it at their convenience. The survey took approximately 10–12 minutes to complete, with a brief introductory message explaining the study’s purpose and emphasizing voluntary participation. Participants were required to provide electronic informed consent before beginning the questionnaire. To ensure a higher response rate, periodic reminders were sent via email, WhatsApp, and professional social media platforms.

Data Analysis

Once data collection was completed, Google Sheets was used for initial data management and cleaning. The dataset was then analyzed using Epi Info V7 software, applying descriptive statistics (frequencies, percentages) to summarize socio-demographic characteristics and knowledge levels. To determine significant associations between demographic variables and awareness levels, Chi-square tests were conducted, with p < 0.05 considered statistically significant.

Ethical Considerations

Participants provided electronic informed consent, acknowledging their voluntary participation and the right to withdraw from the study at any time without any consequences. The study adhered to strict confidentiality protocols, ensuring participant anonymity by not collecting any personally identifiable information. All collected data were stored securely and used exclusively for research purposes.

The socio-demographic characteristics of participants (Table 1) provide a comprehensive overview of the working population surveyed in Punjab, ensuring a total sample size of 400 participants. The highest proportion of respondents belonged to the 26–35 years age group (35.0%), followed by 36–45 years (29.5%), highlighting that a significant portion of the workforce falls within the most professionally active age range. The gender distribution was nearly balanced, with 54.5% male and 45.5% female participants, ensuring an inclusive analysis of spinal health awareness across genders. In terms of education, a majority had secondary education (32.5%) or undergraduate degrees (34.0%), indicating that most respondents had received formal education, which is beneficial in understanding ergonomic practices. Occupation-wise, corporate employees (29.0%) formed the largest group, followed by industrial workers (19.5%), healthcare professionals, and teachers, reflecting a diverse workforce exposed to different spinal health risks. The study also showed that 61.5% of participants worked in urban areas, while 38.5% belonged to rural settings, allowing for a comparison of ergonomic awareness across different working environments. Furthermore, work experience was well distributed, with 37.5% having 6–10 years of employment experience, highlighting that the study included both early-career and experienced professionals, making it a well-represented sample for analyzing spinal health knowledge.

Table 1: Socio-Demographic Characteristics of Participants

The knowledge and awareness assessment on spinal health (Table 2) evaluates participants' understanding of spinal function, ergonomic practices, and risk factors contributing to spinal health issues. A high level of awareness was observed regarding critical spinal health aspects, with 88.5% recognizing the negative effects of prolonged sitting, 85.0% correctly identifying proper lifting techniques, and 78.5% understanding the primary function of the spine. However, knowledge gaps remain evident, particularly in areas such as ergonomic workplace training (69.5%), the role of hydration in spinal health (81.0%), and the impact of improper footwear on spinal alignment (74.0%). While a large proportion of respondents understood that osteoporosis increases spinal fracture risks (86.5%), fewer participants were aware of how dehydration affects spinal disc flexibility (81.0%), suggesting the need for targeted educational interventions on lesser-known risk factors. Encouragingly, 89.0% recognized yoga’s benefits for spinal health, and 85.5% acknowledged that untreated spinal issues can lead to reduced mobility, indicating a strong understanding of long-term spinal health consequences. Overall, while the majority of participants demonstrated good spinal health awareness, certain misconceptions and lack of workplace ergonomic training highlight the need for structured intervention programs to enhance spinal health literacy in workplaces.

Table 2: Knowledge and Awareness Assessment on Spinal Health

The classification of knowledge scores (Table 3) further highlights the variations in spinal health awareness among participants. 38.0% of respondents scored in the "Very Good" category (≥80%), demonstrating a high level of spinal health awareness and understanding of postural habits. The largest proportion, 39.0%, fell into the "Good" category (60%–79%), indicating that while they had a strong grasp of fundamental spinal health concepts, they might lack knowledge of certain advanced topics such as ergonomics and hydration’s role in spinal flexibility. Meanwhile, 17.5% were classified under the "Fair" category (41%–59%), suggesting that their understanding was moderate but required improvement, particularly in workplace-specific postural practices. Finally, 5.5% of respondents exhibited poor knowledge (<40%), emphasizing a critical need for awareness programs targeting individuals with minimal spinal health literacy. These findings reinforce the importance of integrating spinal health education into workplace wellness programs, ensuring that employees receive structured training on posture correction, ergonomic workstation setups, and preventive strategies for musculoskeletal disorders.

Table 3: Knowledge Score Classification

The results of this study highlight both strengths and gaps in the knowledge and awareness of spinal health and postural practices among the working population of Punjab. As occupational settings increasingly involve sedentary desk jobs and physically demanding labor, the risk of developing musculoskeletal disorders due to poor ergonomics, improper lifting techniques, and lack of postural awareness has become a major public health concern. The socio-demographic characteristics of participants indicate that the majority belonged to the 26–45 age group, which is a critical working demographic susceptible to spinal issues due to long working hours and inadequate preventive care. The urban workforce (61.5%) was more represented than the rural workforce (38.5%), possibly due to greater access to digital surveys, though both groups face unique ergonomic challenges. The presence of a well-educated workforce (66.5% having an undergraduate or postgraduate degree) suggests a foundation for health literacy, but education alone does not guarantee awareness of spinal health, as evident from the knowledge gaps identified in the study.

The knowledge and awareness assessment revealed a generally good understanding of fundamental spinal health concepts, such as the effects of prolonged sitting (88.5%), the importance of correct lifting techniques (85.0%), and the significance of calcium in spinal health (77.0%). However, deficiencies in workplace ergonomics training (69.5%), the role of hydration in spinal disc health (81.0%), and the impact of improper footwear on spinal alignment (74.0%) indicate that workplace interventions remain insufficient in addressing key aspects of spinal well-being. While a large proportion (89.0%) acknowledged the role of yoga in spinal health, a notable percentage lacked awareness regarding stress-induced spinal pain (75.0%), emphasizing the need for holistic spinal health education beyond just ergonomic corrections. Moreover, knowledge gaps in spinal health prevention strategies were evident across all professional groups, reinforcing the importance of targeted awareness programs that focus on industry-specific risks—for example, lifting safety training for industrial and agricultural workers and ergonomic workstation adjustments for corporate employees.^14-16

The classification of knowledge scores further highlights disparities in spinal health awareness. While 38.0% of respondents demonstrated very good knowledge (≥80%), a substantial proportion (39.0%) fell into the good category (60%–79%), indicating that while basic awareness exists, there are critical areas requiring reinforcement through structured interventions. More concerning is that 17.5% of participants had only fair knowledge (41%–59%), and 5.5% exhibited poor awareness (<40%), reflecting a subset of the workforce at significant risk of developing long-term spinal complications due to lack of preventive measures and poor postural habits. These findings align with previous research emphasizing that knowledge deficits, coupled with behavioral inertia and lack of employer-driven ergonomic policies, lead to increased prevalence of work-related musculoskeletal disorders.^17-19

Given the economic and health burden associated with spinal disorders, these findings call for urgent interventions at both individual and organizational levels. Employers must prioritize spinal health education, including mandatory ergonomic training, posture assessment workshops, and access to ergonomic office furniture. Additionally, government agencies and occupational health organizations should integrate spinal health awareness into workplace wellness programs, with customized approaches for different sectors.^20,21 The use of technology-driven solutions—such as AI-powered posture monitoring tools and workplace wellness apps—could further enhance awareness and proactive behavior modification. Furthermore, encouraging periodic spinal check-ups and integrating movement-based activities into the workplace, such as stretching breaks and ergonomic exercises, could help mitigate long-term spinal health risks.^22,23

Overall, this study underscores the importance of spinal health awareness as a crucial component of occupational health. While awareness levels are relatively high, specific knowledge gaps in ergonomic practices, hydration, and footwear-related spinal alignment persist. Addressing these gaps through workplace interventions, public health campaigns, and digital health solutions can significantly reduce musculoskeletal disorders and improve the long-term well-being and productivity of the workforce. Future research should explore the effectiveness of workplace-based spinal health training programs and examine longitudinal outcomes of ergonomic interventions to inform policy recommendations for occupational health improvement.

This study highlights both strengths and gaps in spinal health awareness among Punjab’s workforce, emphasizing the urgent need for workplace-based ergonomic interventions and preventive spinal care strategies. While awareness of fundamental spinal health concepts is relatively high, significant knowledge deficits persist in ergonomic training, hydration’s role in spinal health, and postural correction techniques. Addressing these gaps through structured educational programs, ergonomic workplace adaptations, and proactive health policies can mitigate spinal disorders, enhance workforce productivity, and improve overall well-being. Employers, policymakers, and healthcare professionals must collaborate to integrate spinal health awareness into occupational wellness initiatives, ensuring a healthier and more efficient workforce.

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