A significant number of people are standing throughout the course of the day, often as a result of their occupation or lifestyle. In the European Union (EU), almost two thirds (62%) of the working population either stand for most of their working day or have jobs that require moderate or heavy physical effort [1]. In the United States (US), over half of the adults surveyed (52%) reported that they experience tired, sore feet during or after work [2], and a recent review in the United Kingdom (UK) found that at least half the working population experience prolonged standing, associated with a negative impact on the body and a high prevalence of musculoskeletal (MSK) disorders of the feet, lower extremities and lower back [3]. Given the association between prolonged standing or walking, repetitive impact forces, and musculoskeletal stress, it is unsurprising that the incidence of lower body pain and discomfort is high in this population [4–6], especially when floor surfaces consist of hard, unyielding ground [4, 5, 7, 8].
Workers who are standing throughout much of their working day are often in occupations such as standing factory workers [9], laboratory workers [10], postal workers [11], healthcare workers or are in the police force [4]. Around 20% of those who spend most of their working day on their feet experience foot pain or discomfort [4], with the nursing profession reporting the highest incidence rate of musculoskeletal disorders (compared with other healthcare professionals), most commonly affecting their knees, ankles and feet5.
The feeling of foot and lower body discomfort and pain after prolonged periods of ‘being on your feet’ is hypothesised to be a result of repetitive stress experienced by the lower body, either due to gait-related biomechanical stress or repetitive impact forces generated through walking, or a combination of the two [12, 13]. At the heel strike phase of gait, forces equal to 60% of body weight for 5ms are generated during each step [14]. Adaptation of gait or body position to absorb the stresses (or ‘shock’) generated through movement can cause additional stress to be transferred to the lower body: discomfort and pain can then develop over time, exacerbated by everyday activities or overuse [13, 15]. Prolonged standing or walking, particularly on hard surfaces, are recognised as key risk factors for the development of back pain, knee pain and heel pain, including plantar fasciitis (PF) [13, 16–19].
The expectation that foot and lower body pain is an unavoidable consequence of lifestyle and occupational demands seems to be a common belief. Many people who experience foot and lower body MSK pain often do not seek treatment and simply endure or tolerate the discomfort. For example, those with Achilles tendon pain commonly present to a health care provider 11 to 12 weeks after the onset of symptoms [20], and many of those experiencing plantar heel pain will have attempted self-remedies before seeking medical advice [21].
Although previous studies have explored the impact of work-related pain on productivity, particularly presenteeism [22] these have predominantly focused on lower back pain or on workers with diagnosed medical conditions [23]. To the authors knowledge there has been no focus to-date on the impact of lower-body work-related pain on health-related quality of life (HRQoL) in general, and specifically on work productivity (in the UK). Therefore, this study aimed to investigate work-related lower-body MSK pain, and the relationship between health-related quality of life and work productivity in a sample of UK workers.