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Abstract
Work-related musculoskeletal disorders (WMSDs) are prevalent among physiotherapists and occupational therapists due to the physically demanding and repetitive nature of manual therapy techniques. Stretching requires therapists to exert substantial force while holding static postures for extended periods. Assistive devices may mitigate these ergonomic risks. This crossover study evaluated postural risk factors for WMSDs during lower-limb muscle stretching (targeting the hamstrings, calves, iliopsoas, quadriceps, hip adductors, hip abductors, and gluteal muscles) and compared manual with device-assisted techniques among 32 healthy practitioners (highly trained students and licensed therapists). Postural risk was evaluated using the Rapid Entire Body Assessment (REBA), and perceived comfort via a five-point Likert scale. Data were analyzed using mixed-effects regression models. Device-assisted stretching significantly improved therapists’ posture (mean REBA score: 11.35 units lower, P < 0.001) and increased the odds of belonging to a lower WMSDs risk category by 69.17-fold. Furthermore, device-assisted stretching significantly enhanced participants’ comfort for nearly all muscle groups (P < 0.010), with no period or carryover effects. These findings indicate that the assistive device can substantially reduce postural risk factors for WMSDs and improve comfort during lower-limb stretching. However, prospective clinical studies are needed to determine whether these postural improvements reduce the incidence of WMSDs.
Subjects
- Health care
- Health occupations
- Medical research
Abbre
DM:
Device-assisted first, then manual
MD:
Manual first, then device-assisted
OTs:
PTs:
Physiotherapists
REBA:
Rapid entire body assessment
TBZMED:
Tabriz University of Medical Sciences
WMSDs:
Work-related musculoskeletal disorders
Acknowledgements
This article was derived from the MSc thesis of Aliakbar Asil, student of Ergonomics at TBZMED. The authors thank all participants of this study. The authors also thank the head of the Biomechanics Laboratory, Faculty of Rehabilitation Sciences, TBZMED, for supporting this study
Funding
This study was financially supported by the Tabriz University of Medical Sciences [Grant No. 72400]
Author information
Authors and Affiliations
Department of Occupational Health Engineering, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
Aliakbar Asil, Jalil Nazari & Melika Khabbazi
Health Science and Technology Park, Tabriz University of Medical Sciences, Tabriz, Iran
Aliakbar Asil
Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
Neda Gilani
Faculty of Rehabilitation Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
Ali E. Oskouei
Authors
- Aliakbar AsilView author publications
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- Jalil NazariView author publications
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- Neda GilaniView author publications
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- Melika KhabbaziView author publications
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- Ali E. OskoueiView author publications
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Competing interests
The authors declare no competing interests
Ethics approval and consent to participate
This study was approved by the Ethics Committee of Tabriz University of Medical Sciences (Ref. No. IR.TBZMED.REC.1402.504) and was conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all participants prior to participation
Consent for publication
Written informed consent was obtained from all participants prior to participation in the study, including consent for photography and video recording during the performance and receipt of the stretching techniques. In addition, written informed consent for publication of the anonymized photographs presented in Figs. 1, 2, 3, 4, 5, 6 and 7 was obtained from all participants
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Appendix 1: Rapid entire body assessment (REBA)
Appendix 1: Rapid entire body assessment (REBA)
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Cite this article
Asil, A., Nazari, J., Gilani, N. et al. Postural risk factors for work-related musculoskeletal disorders during manual versus device-assisted lower-limb stretching.
Sci Rep (2026). https://doi.org/10.1038/s41598-026-65644-9
Received:10 September 2025
Accepted:03 August 2026
Published:10 August 2026
DOI
:https://doi.org/10.1038/s41598-026-65644-9
