BACKGROUND: The prevalence of back pain and neck/shoulder pain among nurses is high. This study reports a detailed description of health related characteristics of experienced nurses with and without severe back pain or severe neck/shoulder pain in Sweden.

METHODS:  = 1525). Severe pain was defined as much discomfort from pain the preceding four weeks. Descriptive statistics were used to summarise general health and pain characteristics, use of health resources and impact of pain on work.

RESULTS: Nurses with severe back or neck/shoulder pain described worse general state of health and lifestyle, such as personal or mental health problems, fatigue, dizziness and pain in other body regions, less physical activity and lower sleep quality, than those with no or little pain. They used more health resources as over-the-counter and prescription painkillers and care seeking for physical ailments. The course of the severe pain was often persistent, and those nurses commonly reduced their working hours, changed work tasks, and had days off work.

CONCLUSIONS: This study describes variations of nurses’ health related characteristics by pain levels. Experienced nurses with severe back or neck/shoulder pain describe worse states of general health and lifestyle, and more use of health resources than experienced nurses with no or little such pain. The course of the severe pain is often persistent and affects work capacity.

CLINICAL TRIAL NUMBER: Not applicable.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12912-026-04542-x.

The aim of this study was to assess the one-year trajectories of psychological distress and of spinal pain intensity in manual therapists during the COVID-19 pandemic in Sweden, and to assess characteristics' association with trajectory membership. In this cohort study, 816 clinically active licensed manual therapists answered four web-based surveys during a year of the COVID-19 pandemic in Sweden, measuring psychological distress and spinal pain intensity. Trajectory modelling was conducted to cluster individual trajectories over time. Association between baseline characteristics and cluster membership of psychological distress, and spinal pain intensity trajectories were analyzed using multinomial logistic regression models, adjusted for posterior probability, age, and sex. Five clusters of psychological distress and five of spinal pain intensity were identified. A majority of participants' psychological distress (89%), and spinal pain intensity (75%) were clustered into low/mild levels. One cluster of increasing psychological distress (2%) were identified. Two fluctuating clusters of moderate/mild (14%), as well as one cluster of stable moderate (11%) spinal pain intensity were identified. Impaired sleep, and not meeting physical activity recommendations were associated with worse trajectories of spinal pain. In conclusion, most manual therapists had favorable trajectories of psychological distress and spinal pain intensity during a year of the COVID-19 pandemic in Sweden.

Background: Neck and back pain are common musculoskeletal conditions in university students and associated with unhealthy lifestyle behaviors such as physical inactivity, unhealthy dietary habits, smoking and risky alcohol use. Cohort studies have investigated the effect of a healthy lifestyle including several lifestyle behaviors on the risk and prognosis for neck and back pain. Studies of an association between an unhealthy lifestyle and musculoskeletal conditions in university students are lacking. This study aimed to assess the association between an unhealthy lifestyle and incident activity-limiting neck/back problems (ALNBP) in university students.

Methods: Participants enrolled in the Sustainable UNiversity Life (SUN) study who did not report baseline ALNBP in the past three months were included (n = 3492). The baseline web-survey assessed unhealthy lifestyle behaviors (physical inactivity, high sitting time, meal skipping and risky use of alcohol, tobacco, and illicit drugs) with valid instruments and single-item questions. Participants with ≥ 3 unhealthy lifestyle behaviors were categorized as exposed to an unhealthy lifestyle. Responses to web-based follow-up surveys every third month until first reporting ALNBP or to the end of the one-year follow-up were used. The outcome ALNBP was defined as reporting limitations in daily activities due to a neck, low back and/or midback problem the past three months, assessed with a modified version of the Nordic Musculoskeletal Questionnaire. Crude and adjusted Cox regression models were built to assess the association between an unhealthy lifestyle and incident ALNBP, reported as a hazard rate ratio (HRR) with a 95% confidence interval (CI).

Results: Sixty percent of the participants were women, and the mean age was 24.5 ± 6.0 years. A total of 574 participants (16%) were exposed to an unhealthy lifestyle at baseline. Having an unhealthy lifestyle generated an adjusted HRR of 1.35 (95% CI 1.12, 1.63) for incident ALNBP, compared to not having an unhealthy lifestyle.

Conclusions: An unhealthy lifestyle, categorized as ≥ 3 unhealthy lifestyle behaviors, is associated with incident ALNBP in university students.

BACKGROUND: For competitive adolescent athletes, injury avoidance is a challenge, and causes of injury are complex and multifactorial. Despite an incidence of 8.2 shoulder injuries per 1,000 hours of tennis played, few studies have investigated the association between shoulder strength, range of motion (ROM), and injury.

HYPOTHESIS: Eccentric and isometric shoulder muscle strength and/or shoulder ROM are associated with new shoulder complaints and/or injuries.

STUDY DESIGN: Cohort study.

LEVEL OF EVIDENCE: Level 3.

METHODS: At baseline 301 adolescent competitive tennis players aged 13 to 19 years completed a questionnaire, were assessed with a shoulder protocol for strength and ROM and followed weekly (for shoulder complaint/injury) for 52 consecutive weeks. Outcomes were a first incidence of a tennis-related shoulder complaint or injury in the dominant arm, defined as a sum score of ≥20 or ≥40, respectively, on the Oslo Overuse Injury Questionnaire. Two cohorts were created for Cox regression analyses, adjusted for age, sex, and playing level: (1) shoulder complaints (n = 204), and (2) shoulder injuries (n = 252).

RESULTS: The most definitive adjusted associations were a hazard rate ratio (HRR) of 1.3 (95% CI 1.0-1.8) for a shoulder complaint in eccentric external rotation (eccER) strength, and a HRR for shoulder injuries of 1.4 (95% CI 1.0-1.9) in isometric internal rotation (IIR) strength in the 90-90 position, and 1.5 (95% CI 1.1-2.0) in eccER normalized to body mass.

CONCLUSION: Higher values of eccER shoulder strength, IIR strength at the 90-90 position, and eccER shoulder strength normalized to body mass, were associated with shoulder complaints/injuries in adolescent competitive tennis players.

CLINICAL RELEVANCE: Incorporating a training program that takes volume and intensity into account in the daily oncourt sessions, to build resilience through a well-planned, long-term training and competition plan to minimize shoulder injury risk may be of importance.

Objectives: To assess the association between (1) dietary habits and knee/shoulder injury incidence in male and female adolescent handball players and (2) menstrual dysfunction and injury incidence in females.

Methods: This study is based on seasons 2020-2022 of the Swedish Handball Cohort including 1144 participants (1703 player seasons) free from a substantial knee and shoulder injury. Participants self-reported meal frequency, meal timing, nutritional intake and menstrual function (season 2022/2023) at baseline. Weekly follow-ups throughout the season assessed training and matches, and substantial knee/shoulder injuries. Cox regression analyses estimated a hazard rate ratio (HRR) with the first event of a knee/shoulder injury (combined), with minutes of handball training and matches as the timescale.

Results: In females, adjusted analyses generated an HRR for knee/shoulder injuries of 1.46 (95% CI 1.08, 1.98) for moderate-high nutritional quality compared with low quality and an HRR of 1.38 (95% CI 1.02, 1.86) for ≥2 unfavourable dietary habits compared with 1 unfavourable dietary habit. For poor meal timing, adjusted analyses generated an HRR of 1.20 (95% CI 0.90, 1.61) compared with adequate timing in females. In males, adjusted analyses generated an HRR of 1.23 (95% CI 0.69, 2.17) for low meal frequency and an HRR of 0.83 (95% CI 0.60, 1.15) for poor meal timing.

Conclusions: In adolescent female handball players, moderate-high nutritional quality and ≥2 unfavourable dietary habits are associated with higher knee/shoulder injury incidence; whereas, no or unprecise associations were found for other dietary habits in females and males and for menstrual dysfunction in females.

BACKGROUND: In Sweden, almost 60% of patients seeking care at primary healthcare centers do so due to musculoskeletal disorders. These patients constitute a strain on the healthcare system. Manual therapists are experts in diagnosing patients with these conditions but are usually not part of healthcare centers in Sweden. Further, there is a significant societal problem with overuse of medications, injections, medical imaging, and unnecessary surgeries, so-called low-value care, for back and neck pain. We aimed to explore the current management of patients with back and neck pain in primary healthcare centers, staff's perceptions regarding the need for improvement, and incentives and concerns about having licensed chiropractors and naprapaths (manual therapists) triage these patients as part of the primary healthcare center team.

METHODS: In this qualitative study, we conducted semi-structured focus group interviews with 20 participants employed at three primary healthcare centers in the Stockholm region, chosen based on location, organization, and exposure to manual therapists. Participants were purposefully selected from different professions. Data were analyzed using inductive qualitative manifest and latent content analysis.

RESULTS: The current management of patients with back and neck pain was described in terms of long waiting times and patients' expectations of seeing a medical doctor and receiving imaging. Thus, there was room for improvement by reducing low-value care. Participants had limited knowledge about the competence of chiropractors and naprapaths and were concerned about the boundaries of professional identity. Decreased physician workload and more choices for patients were mentioned as incentives for manual therapists to take on a triaging role.

CONCLUSIONS: Staff at three primary healthcare centers in the Stockholm area described the current management of patients with back and neck pain as navigating the expectations of patients and their overreliance on seeing their physician, not other caregivers, resulting in long waiting times. Alongside patients expecting imaging, these were incentives for chiropractors and naprapaths triaging these patients as an opportunity to improve care. A lack of knowledge about the competence of manual therapists was a concern, and assigning manual therapists to the primary healthcare team would necessitate a reconfiguration of the care process, potentially challenging the boundaries of professional identity.

Background: This study assessed health and change in lifestyle factors in Swedish manual therapists during one year of the COVID-19 pandemic, and potential differences with regards to age, sex, and business constellation. Further, therapists' strategies for health promotion during the pandemic were explored.

Methods: In this cohort study, 816 clinically active manual therapists were followed with web-based surveys during a year of the COVID-19 pandemic in Sweden, measuring physical activity, sedentary time, COVID-19-related worries, maladaptive coping, alcohol and tobacco consumption. Health promotion and impact of the pandemic on physical and mental health were explored in free text questions. Generalized estimating equations were conducted to assess changes in sample averages over time, and qualitative content analysis was used to code and categorize free-text answers.

Results: There was a decrease in physical activity and sedentary time increased as well as subjective mental health impact by the pandemic over one year. Maladaptive coping decreased during follow-up, and alcohol and tobacco consumption decreased in younger participants, and women, respectively. Participants stated that the pandemic affected their physical and mental health and reported using health promoting activities primarily targeting physical activity, nutrition, and sleep.

Conclusion: Swedish manual therapists maintained good lifestyle habits except for a small decrease in physical activity and slight increase in sedentary behavior and subjective mental health impact by the pandemic over time. There were small differences in terms of maladaptive coping, alcohol consumption, and tobacco consumption, however, these differences were not likely clinically relevant. The therapists seemed conscientious regarding health promotion measures during one year of the COVID-19 pandemic.

BACKGROUND: It is unclear whether lifestyle behaviours influence use of healthcare for musculoskeletal pain in young adults. This study examined if lifestyle behaviours among college/university students were associated with future healthcare utilisation for musculoskeletal pain.

METHODS: Data from the Students' Health and Wellbeing Study (SHoT2018) were linked with the Norwegian Registry for Primary Health Care, comprising 31,358 college/university students. We analysed associations of physical activity level, sleep duration, alcohol consumption, smoking, illicit drug use and cumulative adverse lifestyle behaviours with healthcare utilisation for musculoskeletal pain over the following three years, including 'any use', 'high use' and for back and neck pain specifically.

RESULTS: High physical activity levels, compared to recommended levels, were associated with a higher risk of 'any' healthcare utilisation for musculoskeletal pain (females: RR 1.14, 99% CI [1.04-1.25]; males: RR 1.20, 99% CI [1.07-1.36]); below recommended physical activity levels were associated with a lower risk (females: RR 0.90, 99% CI [0.85-0.96]; males: RR 0.84, 99% CI [0.76-0.93]). Illicit drug use was associated with a lower risk of healthcare utilisation for neck pain in females (RR 0.77, 99% CI [0.62-0.97]). Four or more adverse lifestyle behaviours, compared to ≤ 1, were associated with a lower risk of high healthcare utilisation for musculoskeletal pain (females: RR 0.66, 99% CI [0.48-0.90]; males: RR 0.68, 99% CI [0.48-0.97]) and a lower risk of healthcare utilisation for neck pain in females (RR 0.63, 99% CI [0.41-0.97]).

CONCLUSIONS: Associations between college/university students' lifestyle behaviours and healthcare utilisation for musculoskeletal pain were identified, but with some unexpected patterns. Future research should explore long-term effects of these behaviours on healthcare utilisation for musculoskeletal pain.

SIGNIFICANCE: High levels of physical activity among college and university students were associated with a greater risk of seeking healthcare for musculoskeletal pain within the following three years. Illicit drug use was associated with a lower risk of seeking healthcare for neck pain in females. Surprisingly, the presence of many adverse lifestyle behaviours appeared to be associated with a lower risk of healthcare utilisation for musculoskeletal pain, particularly healthcare contacts for neck pain in females and repeated healthcare contacts for musculoskeletal pain in general.

BACKGROUND: The Swedish governmental strategy during the COVID-19-pandemic was to impose voluntary recommendations to limit viral spread, but to keep health care and important societal functions running. The objective of this study was to describe the work environment and practice of manual therapists, who were challenged by this strategy, in Sweden during a year of the pandemic.

METHODS: The cohort study Corona And Manual Professions (CAMP) was studying chiropractors and naprapaths, registered in the public register of licensed manual therapists in Sweden, during the pandemic. Mixed methods were used to answer the research aims. Surveys were distributed in November 2020, during the second wave, and in February, May and November of 2021. The quantitative data were presented descriptively, with the development over time illustrated in graphs. The qualitative data from the free-text answers were analyzed using content analysis.

RESULTS: In total, 816 manual therapists (47% of the invited sample) were included in the study, of which between 275 and 662 participants answered the free-text questions. At baseline, most (60-65%) rated their knowledge of viral infections and their spread, of vulnerable patient groups, and of protective gear as fairly good or good. Most (68-70%) were able to follow the official recommendations, but decreased numbers of patients and changes in clinic routines were reported. There was a positive trend in caring adequately for patients and having access to protective gear. Manual therapists reported that they were unable to care for vulnerable patient groups, had to adhere to routines perceived as onerous, and found care to be less personalized.

CONCLUSION: At the time of the outbreak of the COVID-19 pandemic, manual therapists in Sweden encountered challenges regarding knowledge about pandemics and availability of protective equipment. Sweden's official recommendations were possible to implement by the manual therapists, but had adverse impacts on clinic activities and patient care. Despite this, over 50% were able to deliver adequate care for their patients.