The Knowledge-to-Practice Gap in Safe Lifting and Biomechanical Risks as Determinants of Musculoskeletal Disorders in Manual Material Handling

This study investigated the complex interfaces between knowledge, attitude and practice (KAP); biomechanical risks; and musculoskeletal disorders (MSDs) among heavy manual handling workers. A cross-sectional study surveyed 99 industrial manual lifting workers within manufacturing factories (mean age: 33.4 ± 7.7 years; mean job experience: 7.95 ± 6.5 years) using a validated online questionnaire assessing demographics, occupational conditions, biomechanical risk, lifting KAP, and MSD prevalence via the Extended Nordic Musculoskeletal Questionnaire. Associations with 12-month and active 7-day MSD prevalence were analyzed using multinomial logistic regression. The 12-month prevalence of MSDs was 56.6%, predominantly affecting the lower back (51.0%). The MSD group reported significantly higher biomechanical risks. Chi-square analysis revealed significant differences in safety practices (p = 0.025), particularly regarding pre-work stretching, load-weight assessment, and overhead lifting. Higher biomechanical risk was significantly associated with 12-month MSDs without 7-day pain (RRR = 1.54, 95% CI: 1.10 to 2.16, p = 0.012). Conversely, greater knowledge demonstrated a significant protective association against 12-month MSDs without 7-day pain (RRR = 0.74, 95% CI: 0.56 to 0.99, p = 0.045). Age-related vulnerability significantly increased active 7-day MSDs. MSD prevalence is driven by cumulative biomechanical hazards. Although knowledge is associated with lower long-term risk, a critical knowledge-to-practice gap exists. Interventions must prioritize workplace ergonomic risk reduction with age-tailored adjustments. These should be integrated with active, practice-based training to foster behavioral modification.