Incidence of Musculoskeletal Symptoms in Teachers for the Diagnosis and Management of Specific Preventive Physiotherapeutic Strategies

pos-ture, prolonged elevation of the upper limb and extension of the cervical spine when writing on the board, large number of classes, high number of students per class, insufficient rest period and high workload weekly. Accordingly, the study by Calixto et al. [5], reveals that the musculoskeletal system, as a result of these factors, suffers static and dynamic overload, which progresses to acute disability to chronic painful syndromes with functional disability, which may limit the performance of work and leisure activities. Still, the study by Fernandes et al. [6], points out that besides the biomechanical factors present in work activities, repetitive movements, ergonom-ically unfavorable environment for the teacher and high workload, there are the individual physical characteristics and lifestyle, which found in a study that there is a prevalence of symptoms. musculo-Received: Incidence of in for the Diagnosis and Abstract The present study aimed to investigate the epidemiological profile of musculoskeletal disorders and the perspective on preventive physiotherapy in elementary school teachers. This is a descriptive observational study with cross-sectional cohort, which included a total of 61 teachers of both genders, aged 21 to 56 years. It was found that the most affected body anatomical regions, due to the usual work practice performed in the last 12 months, were shoulders (39.3%), lumbar spine (59%), wrist and hands (45.9%), causing a notable negative impact in work tasks performing. It is concluded that these dysfunctions occur due to static postures and inadequate and repetitive movements and highlight the need for ergonomic information that would prevent the development of such disorders, characterized by primary health care promoted by physiotherapists.

skeletal disorders in young women who perform activities with a higher number of repetitive efforts.
With this in mind, musculoskeletal pain is characterized as a nuisance that encompasses the body segments, with a multifactorial etiology and that can lead to disability or limitation of the individual's daily activities. Dealing this data, several studies relate musculoskeletal pain with negative impact on worker's quality of life [4,7,8]. Regarding the above, preventive physiotherapy is equated with a set of pertinent actions that prevent the development of musculoskeletal disorders and symptoms, since, characterized by health promotion and specific protective measures, it can act in the school environment with teachers of both public and private schools, promoting awareness and ergonomic guidance on the various postural and biomechanical dysfunctions caused by the profession, as well as conducting preventive actions to these dysfunctions by exercising relaxation and stretching exercises with the teaching staff, promoting kinesiotherapy [9]. Therefore, specific evaluations that allow prophylactic conduct seem to be pertinent, in the context of preventive physical therapy, considering the negative impacts on the overall health of the worker, accumulated throughout his career.
Thus, the aim of this study was to investigate the epidemiological profile of musculoskeletal disorders in elementary school teachers.

Participants of Study
A total of 61 participants were included, teachers from the state schools from the city of Aragarças-GO, (52 female and 9 male) aged 21 to 56 years. To be included, participants would have to be in the profession for over 12 months, working in the classroom. Participants who did not complete all evaluation items were excluded.

Ethical Issues
All participants were informed about all procedures and objectives of the study and, after agreeing, were asked to sign a free and informed consent form, assuring their rights. In addition,

Design Study
This is a descriptive observational study with cross-sectional cohort. Data collection was performed during the classes, with the authorization of the direction in each investigated school.
Data were obtained through interviews, where a semi-structured questionnaire was used by the authors of this study, according to the model suggested in Fernandes studies; Rocha et al. [5,7,8]. In addition, the application occurred individually, at times when they were absent from the classroom and during class breaks and had a maximum duration of 15 minutes. The collection period lasted 10 days, and the morning and afternoon shifts were interspersed during February/2019. Also, evaluations were performed by a single evaluator, previously trained, in order to ensure standardized procedures. Initially, anthropometric evaluation was performed, characterized by the evaluation of height, weight, body mass index (BMI) and waist circumference were verified by measuring tape, stadiometer and digital scale. Then the questionnaire was applied.

Procedures
Nordic Questionnaire of Musculoskeletal Symptoms: The Nordic Musculoskeletal Questionnaire used was adapted according to the model suggested in the study by Calixto et al. [5]. For the negative option, 3 reasons were asked, such as: lack of medical referral, lack of time and financial issues. In addition to the questionnaire suggested by Calixto et al. [5], items related to personal information were investigated that included: name, gender and age; practice of physical activity regularly, specifying the modality and number of times a week; Open-ended questions about hours worked per week, length of professional practice, whether there has been sick leave in the last 12 months for health problems, and knowledge of preventive physical therapy for symptoms and injuries.

Statistical Analysis
The collected data were tabulated, stored and analyzed

Result
A total of 61 teachers were included, working in 6 state schools in the city of Aragarças-GO, of which 52 (85.2%) were female and 9 (14.7%) were male. Regarding anthropometric characteristics, information regarding the minimum, maximum, mean, standard deviation and p-values were calculated for age, height, weight, BMI, activity time and hours worked per week. Of these, there was a statistically significant difference between genders for weight (p = 0.0032) and height (p = 0.0002) variables. The information described regarding the anthropometric characteristics of the participants is presented in Tables 1 & 2 presents the outcomes related to the Nordic questionnaire of musculoskeletal symptoms, stratified by anatomical region, prevalence in the last 12 months, limitations due to the problem, medical care received and pain symptoms in the last 7 days. Thus, on these data, it was found that the most affected anatomical region in both genders, by the usual labor practice were shoulders, lumbar spine, wrist and hands. All summary data are presented in Table 2.  with bursitis (5, 7%) and ankles / foot (11.5%) with sprain (3.8%).
For these injuries, 15.3% of the female group and 11.1% of the male group sought treatment with a physical therapist and reported improvement of the problem. Already 26.9% of the first and 11.1% of the second group did not seek, for predominant reason for both, being respectively 17.3% and 11.1% for lack of medical referral.
Regarding the search for physiotherapeutic treatment, it was found that the female group surpassed the male group and regarding nonseeking, the reason why the doctors consulted did not choose to refer them to physiotherapy.

Discussion
Regarding the predominance of females in this profession, other studies also verify the same characteristic [4,7,8,11,13,14]. In this sense, the high prevalence of females in the teaching profession of primary education seems to be related to a persistent labeling of study and work areas, associated with gender segregation, being such profession mistakenly considered by many as "feminine".
Therefore, there is a decline in male participation due to a resistance exerted by them for mainly cultural reasons [15][16][17] Fernandes; Rocha and Fagundes [7] with 93%.
In this sense, the high incidence of musculoskeletal symptoms is attributed to the set of the following factors: structural overloads suffered due to ergonomic, anthropometric factors, weekly hours and length of work. Thus, the body regions with the highest number of complaints in women were the lumbar spine (63.4%), neck (50%), wrists / hands (50%) and shoulders (40.3%). For men they were lower back and shoulders (33.3%), being lighter for neck and wrist / hands (22.2%). In both sexes, it was reported involvement in more than one region. In other studies, such regions were also prevalent [3,7,8]. These structures, correlated to the profession, tend to suffer greater overload, affecting the symptomatology, being higher in females when compared to males.
Regarding structural overloads, a recent study [11] demonstrates that activities perceived by teachers themselves as being stressful for the lumbar spine correspond to the activity of per- both. The most cited modalities were walking (18%), weight training (13.1%) and dancing (6.5%). About this, it is observed that the musculoskeletal structures of the male group tend to be more resistant to dysfunctions than the female group, considering the practice of physical exercises.
In the study by Santos and Marques [14], the health condition of public-school teachers was assessed through the perception of general health (PSG) on a scale with five ordered categories (poor, fair, good, very good and great).

Conclusion
From the outcomes presented, it is possible to conclude that the regions with the highest prevalence of pain were lumbar spine, neck, wrists / hands and shoulders, with greater involvement in females. Given this, the influence on the execution of work and daily tasks, the low demand for medical help and the existence of chronic dysfunctions represent a significant problem for these professionals. Finally, it is believed that the relevance of this study to the class of professional educators, in proposing a solution to the painful problems faced in detriment of the lack of ergonomic guidelines that would help in the prevention of dysfunctions, consequently acting for the good performance of their work functions and points out solutions, stressing the pertinent and necessary action of physical therapy in schools.

Conflicts of Interest
None declared. The authors declare that the research was conducted with no features that could be construed as a potential conflict of interest.