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

Neck and low back pain are among the most common musculoskeletal conditions worldwide, affecting individuals across a wide range of professions. Although often self-limiting, these conditions may become recurrent or chronic, leading to functional limitations, reduced productivity, and diminished quality of life. Occupational and training-related factors such as prolonged sitting, sustained computer use, awkward postures, repetitive spinal movements, and poor ergonomics are well-recognised contributors to spinal pain. It is estimated that approximately 37% of low back pain is occupation-related, with neck pain strongly associated with forward head posture, sustained flexion, and repetitive movements.

Physical therapy (PT) students represent a unique population at increased risk for musculoskeletal pain, with vulnerability beginning during their training years. The physical and academic demands of physiotherapy education expose students to multiple risk factors in both preclinical and clinical phases of training. During the preclinical phase, students spend prolonged hours attending lectures, studying, and completing assignments, frequently involving sustained sitting and extensive use of electronic devices. During clinical training, students are exposed to physically demanding tasks including prolonged standing, manual therapy techniques, therapeutic exercise demonstration, patient transfers, and assisted mobility activities. These repetitive and load-bearing activities may place significant stress on the cervical and lumbar spine.

International literature demonstrates a high prevalence of neck and low back pain among physical therapy students. Systematic reviews report low back pain prevalence rates ranging from 60-80% during training. Comparative studies suggest that physical therapy students may experience higher rates of low back pain than medical students, likely due to the physically demanding nature of manual therapy training and patient handling. Neck pain is also highly prevalent, with studies reporting rates between approximately 50-70%, often attributed to prolonged studying, suboptimal posture, electronic device use, and psychosocial stress. Identified risk factors are multifactorial and include poor ergonomics, repetitive manual techniques, prolonged standing, sedentary behaviours during study periods, elevated academic stress, and variable personal exercise habits.

Despite this growing body of international evidence, there is currently no published research examining the prevalence of neck and low back pain among physical therapy students in Jamaica or the wider Caribbean. At The University of the West Indies (UWI), Mona, approximately 120 physical therapy students are enrolled across three years of training, with an estimated 40 students per cohort. Understanding the burden of musculoskeletal pain within this population is essential, particularly given their future professional role in musculoskeletal rehabilitation and injury prevention.

Exercise therapy is widely recognised as one of the most effective non-pharmacological interventions for both acute and chronic spinal pain. Evidence supports structured exercise programmes in improving muscular strength, flexibility, endurance, spinal stability, and functional outcomes, while reducing pain intensity. Targeted spine-specific and core-strengthening exercises enhance neuromuscular control and promote optimal spinal alignment, thereby reducing mechanical strain and risk of recurrent injury.

This study aims to determine the prevalence of neck and low back pain among physical therapy students at The University of the West Indies, Mona, and to assess their knowledge, attitudes, and practices regarding spine health. It also seeks to evaluate the effectiveness of an eight-week standardised spine-specific exercise programme in reducing pain and improving functional status among students reporting musculoskeletal discomfort.

The study will be conducted in two phases using descriptive and experimental frameworks. In the first (descriptive) phase, a cross-sectional design will be used to assess the prevalence of neck and low back pain among all enrolled PT students. Participants will complete questionnaires assessing musculoskeletal discomfort, as well as knowledge, attitudes, and practices related to spine health.

In the second (experimental) phase, students who report neck and/or low back pain will be prospectively randomised into either an intervention group or a control group. The intervention group will participate in an eight-week standardised spine-specific exercise programme, while the control group will receive a non-spine-specific exercise programme administered in parallel to minimise placebo effects. Outcome measures will include the Numeric Rating Scale (NRS), the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ), and structured questionnaires assessing functional status and spine-health knowledge, attitudes, and practices. Participant confidentiality will be strictly maintained. Each participant will be assigned a unique study identification number, and only demographic, occupational, clinical, and outcome data relevant to the study will be recorded. All data will be securely managed using REDCap, a password-protected web-based platform compliant with national data protection standards. Statistical analysis will be conducted using IBM Statistical Package for the Social Sciences (SPSS), and all study records will be securely stored and destroyed three years after study completion.

• Knowledge, Attitude and Practice towards Musculoskeletal Problems of Neck and Low back Pain (Questionnaire A) [Срок оценки: Done at the time of enrollment (Baseline)]
• Change from Baseline in Knowledge, Attitude and Practice Towards Musculoskeletal Problems of Neck and Low Back Pain (Questionnaire B) [Срок оценки: From Enrollment to the end of treatment at 8 weeks]
• Change from Baseline in the Numeric Rating Scale (NRS) [Срок оценки: From Enrollment to the end of treatment at 8 weeks]