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 Table of Contents  
Year : 2022  |  Volume : 16  |  Issue : 2  |  Page : 89-92

The prevalence of reduced upper cervical mobility and neck disability among taxi drivers in Mumbai

Assistant Professor, Department of Community Physiotherapy, DPO's NETT College of Physiotherapy, Thane, Maharashtra, India

Date of Submission22-Aug-2022
Date of Decision23-Nov-2022
Date of Acceptance30-Nov-2022
Date of Web Publication31-Jan-2023

Correspondence Address:
Yashvi Sudhir Shah
Intern, DPO's NETT College of Physiotherapy, Thane
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/pjiap.pjiap_47_22

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AIM: The aim of the study is to find the prevalence of reduced upper cervical mobility and neck disability among taxi drivers.
MATERIAL AND METHODOLOGY: An observational study was carried out among 120 taxi drivers in the age group of 40–50 years. The assessment was carried out using cervical flexion-rotation test and neck disability index (NDI) questionnaire to assess restriction in the cervical range of motion (ROM) and disability caused in the taxi drivers due to cervicogenic headache (CGH) respectively.
RESULTS: The results revealed that 47.5% of taxi drivers have restriction in the cervical ROM whereas on NDI the taxi drivers had 18.33% of mild disability. Around 17.50% have reported moderate disability and 2.50% a severe neck disability.
CONCLUSION: Thus to conclude the prevalence of reduced cervical mobility was high in taxi drivers that probably are due to long-term driving and bad posture. he prevalence of musculoskeletal disorders especially in low back and knee was high in taxi drivers that probably are due to long-term driving and bad posture. The disability could be prevented by education of correct sitting while driving, work station exercises, having sufficient rest in day and night and design of ergonomically seat based on Indian anthropometric sizes.

Keywords: Cervical flexion-rotation test, cervicogenic headache, neck disability index questionnaire, taxi drivers

How to cite this article:
Shah YS, Saini RK. The prevalence of reduced upper cervical mobility and neck disability among taxi drivers in Mumbai. Physiother - J Indian Assoc Physiother 2022;16:89-92

How to cite this URL:
Shah YS, Saini RK. The prevalence of reduced upper cervical mobility and neck disability among taxi drivers in Mumbai. Physiother - J Indian Assoc Physiother [serial online] 2022 [cited 2023 Jun 5];16:89-92. Available from: https://www.pjiap.org/text.asp?2022/16/2/89/368880

  Introduction Top

Taxis play an important role in Mumbai's urban transport system. They are typically the most accessible form of transport throughout the day, almost anywhere, and every day of the year.[1] Occupational musculoskeletal disorders (OMSDs) have been defined as pains, aches, or discomfort experienced in different body regions that continued for at least 2–3 working days during the past week or year.[2] Work-related musculoskeletal disorders (WMSDs) are one of the major public health concerns, which often leads to work restriction, worktime loss, and consequently, low retirement age. WMSDs are considered the most common and costly occupational health issue among taxi drivers. OMSD include damage to the neck, shoulders, elbows, wrist, back, hand and wrist bones, nerves, muscles, and tendons. OMSDs represent a collection of health problems that are common in the working class than in the general population in society.[2] Work-related risk factors for taxi drivers include physical demands imposed by prolonged periods of sitting, deviations from neutral body alignments, repetitive motions, vibrations, noise, strenuous tasks, and frequent handling of luggage.

The risk of musculoskeletal disorders in taxi drivers has been shown to be high because they have long-time exposure to machine vibrations, statics and nonmobility work, prolonged sitting, and poor posture while driving, which may affect the quality of life with consequent economic loss in terms of sickness, absence, and cost of treatment.[3]

Neck pain can also be seen among occupational drivers. The presence of neck pain is due to excessive use of repetitive muscles. Factors that are related to neck pain among taxi drivers can be due to work- or nonwork-related activities, workplace design, and health-related factors such as body mass index, dietary intake, and smoking. When it comes to driving, there are factors such as driving hours and ergonomic factor that affect the drivers' neck and give rise to pain.[4]

Likewise, The International Headache Society published the classification of headache disorders, wherein headaches are classified into two basic categories as primary and secondary. The primary headaches are those of vascular origin like migraine and muscular origin like tension-type headaches. The secondary headaches occur from another source, including inflammation or head and neck injuries. The term "cervicogenic headache (CGH)" was coined by Norwegian physician, Dr. Ottar Sjaastad, in 1983 by recognizing a subgroup of headache patients with both head and neck pain; thus, CGHs are considered "secondary headaches."[5]

The diagnostic criteria for CGH include headache associated with neck pain and stiffness. CGHs are unilateral, starting from one side of the posterior neck and head, migrating to the front, and sometimes are associated with homolateral arm discomfort. Sjaastad et al., in their study, identified another type of CGH with bilateral head and neck pain, aggravated by the neck positions and specific occupations such as hairdressing, carpentry, and truck/tractor driving.[5] The headache is followed by the neck pain, or headache may coexist with the neck pain. It can also be aggravated by specific neck movements or sustained postures.[5]

When it comes to stress association with neck pain among drivers, there are some studies stating that neck pain are also associated with stress due to heavy traffic jams during the day, vibrations felt on the road, driving hours, and exposure to violent behavior.[4]

CGH is a headache due to cervical origin and may be aggravated by the sustained neck positions taxi drivers are prone to develop CGH due to continuous neck movements such as rotation and acquire a poor neck posture while driving for prolonged periods.

The aim of this study was to find the prevalence of reduced upper cervical mobility and neck disability among male taxi drivers in Mumbai.

  Method Top

This was an observational study where the convenient sampling of a total of 120 taxi drivers in the age group of 40–50 years was selected.

Inclusion criteria

  • Taxi drivers willing to participate in the study
  • Participants were between the age group of 40 and 50 years.

    • Chronic conditions are developed over the years; thus, taxi drivers below the age of 40 were excluded, and degenerative changes will be present in the cervical spine, thus reducing the mobility of the cervical spine; thus, taxi drivers above the age of 50 years are excluded.

  • Having a driving experience of more than 5 years
  • Working hours of 8 h or more for 6 days a week.

Exclusion criteria

  • Drivers who have undergone any surgery around the head/neck region.


This study was undertaken after the approval of the Institutional Ethical Committee. A written consent was taken from all the participants in the language best understood by them. The participants were explained about the procedure and the purpose of the study before the study. Selection of the participants was made as per the inclusion and exclusion criteria of the research study. Demographic data were recorded where the working hours/day and number of working days/week were recorded. Cervical flexion-rotation test was performed on the participants to check restriction in the cervical range of motion (ROM). Following which the participants were asked to complete the neck disability index (NDI) questionnaire to assess the disability of the neck caused by CGH.

Outcome measures

Cervical flexion-rotation test

The patient was in supine lying position and the examiner flexed the cervical spine fully to block the rotational movement below the atlantoaxial joint. Then, the examiner passively rotated the head left and right. The ROM and end feel were determined. A firm end feel with limited ROM was presumed limited rotation of the  Atlas More Details on axis.

A study done by Toby Hall and Kim Robinson found that the overall diagnostic accuracy of cervical flexion-rotation test is 91%, and this test significantly assists in the differential diagnosis of CGH and movement impairment at C1\2 segment.[7],[8],[9]

Neck disability index questionnaire

The NDI questionnaire is a patient-completed, condition-specific functional status questionnaire with 10 items, including pain, personal care, lifting, headaches, concentration, work, driving, sleeping, and recreation. The NDI has a fair-to-moderate test–retest reliability in patients with neck pain.[10]

The NDI has 10 sections in which the participant is asked to answer every section, and in each section, mark only one box that applies to the participant [Table 1].
Table 1: Neck disability score in each domain

Click here to view

Each section is scored on a 0–5 rating scale, in which 0 means "No Pain" and 5 means "Worst imaginable pain." Points are then summed to a total score. A higher score indicates more patient-rated disability.

A study conducted by Ian Young in psychometric properties of the Numeric Pain Rating Scale and NDI in patients with CGH found that the NDI exhibited acceptable reliability and strong construct validity. They also exhibited appropriate responsiveness over time. It also seemed well suited as short-term self-report outcome measure for patients with CGH.[11]

Statistical analysis

The values were documented in Microsoft Office Excel Sheet Version 2007. The descriptive analysis was performed for demographic characteristics and for the outcome measures.

  Results Top

The mean age of taxi drivers was 44.58 ± 2 and the driving experience was 16.91 ± 9.9 years. On performing the cervical flexion-rotation test, 47.50% of people had restriction in the cervical ROM.

The NDI questionnaire was taken in the participants to assess the neck disability caused due to the reduced upper cervical mobility, where the restriction was found to be the maximum in the pain domain and the least in performing recreational activities [Table 1]. Fifty-five percent of people reported no disability, and 2.50% of people reported a severe disability as per the NDI [Graph 1].

  Discussion Top

The aim of the current research study was to find the prevalence of reduced upper cervical mobility and neck disability among taxi drivers using the cervical flexion-rotation test and NDI questionnaire and associated neck disabilities due to pain in the neck. The prevalence rate out of 120 taxi drivers was 47.5%, who had restriction in the cervical ROM on performing cervical flexion-rotation test. It can be explained that the restriction in ROM may be due to pain in the neck and stiffness in the neck which may be due to bad posture acquired while driving for long hours, nonadjustable headrest of the seat, and continuous rotation of the neck required while driving as in a study conducted by Ahmad et al. in Jeddah, Saudi Arabia. Furthermore, a study conducted by Rani M revealed that postural correction and spinal mobilization after 4 weeks of intervention showed a significant improvement in CGH.

In the NDI questionnaire, pain intensity was found to be most affected and recreational activities to be least affected. Pain intensity was reported by 45% of the people. Our study findings are in agreement with various other studies.[5],[6],[3] Also in accordance with a prospective study conducted by Andersen et al. it was found that risk factors resulting in the onset of the neck pain was due to prolong sitting for approximately 95% of the working time and a trend of neck flexion for 60%–70% of the time.[7] The relation between prolonged sitting and neck pain may be due to a continuous static load on the neck muscles; however, this load was not measured.[7]

Affection in the driving component was found to be the second highest (43.83%); this is due to pain in the neck caused by an improper posture while driving for long hours, which prevents the participants for driving without experiencing pain in the neck. Furthermore, the continuous static load on the muscles causes the muscles to fatigue easily and thus prevents driving for long hours. Headaches were found to be the third highest. As it was found in previous studies that neck pain is common in taxi drivers, 43.32% of the people have reported headaches.[5],[6] In a study conducted by Antonaci et al. found that CGH can be provoked by neck movements, awkward head positions, or pressure on tender points in the neck.

Difficulty in reading and concentration was reported by 41.65% and 41.16% of the people, respectively. People have reported that headaches perceived prevent them from reading and concentrating for long hours continuously. Furthermore, pain in the neck prevents flexion of the neck required for reading for long hours.

Sleeping was affected in 31% of the people as sleep and headaches have been associated with each other, which is also been proven in a study conducted by Dodick DW et al. According to this study, the biochemical and functional imaging studies done in patients with primary headaches have led to the identification of potential central generators which are also important for the regulation of normal sleep architecture.[12]

The least affected components are personal care, lifting, and recreational activities: 31.32%, 31%, and 28.32%, respectively. CGH is a secondary headache. The secondary headaches are those caused by underlying conditions like neck injuries. It is a pain that develops in the neck, though a person feels pain in their head. Taxi drivers in Mumbai are mostly unaware of this kind of headache; many investigations are done to find the root cause of these headaches. Most of the times, CGHs are left undiagnosed. There is a need to increase the awareness of CGH in this population so that they can be aware and receive the right treatment.

Future scope

Further studies can be conducted where workstation exercises and postural correction exercises can be taught. Ergonomic advice and awareness program on working with good posture can be initiated for taxi drivers.

  Conclusion Top

About 47.5% of taxi drivers have restrictions in the cervical ROM on performing cervical flexion-rotation tests. Fifty-five percent of taxi drivers have reported no disability in the NDI questionnaire. 18.33% and 17.50% have reported a mild and moderate disability, respectively. 2.50% have reported a severe neck disability. Therefore, CGH results in affecting the cervical range of motion and causes difficulty in carrying out their job related tasks efficiently. This have shown to affect their work productivity and capacity. Thus, leading to affect their socio-economic profile and well-being.


  • Small sample size.


We are grateful to all the participants for cooperating with us and being an integral part of the study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Abledu JK, Offei EB, Abledu GK. Occupational and personal determinants of musculoskeletal disorders among urban taxi drivers in Ghana. Int Sch Res Notices 2014;2014:517259.  Back to cited text no. 1
Ahmad I, Balkhyour MA, Abokhashabah TM, Ismail IM, Rehan M. Occupational musculoskeletal disorders among taxi industry workers in Jeddah, Saudi Arabia. Biosci Biotechnol Res Asia 2017;14:593-606.  Back to cited text no. 2
Ziaei M, Izadpanah S, Sharafi K, Barzegar SA, Izadi LM. Prevalence and risk factors of musculoskeletal disorders in inside and outside-city taxi drivers, Andisheh city, 2011. Razi Journal of Medical Sciences 2014;21:41-50.  Back to cited text no. 3
Ads HO, Zaki M, Abdalrazak HA, Baobaid MF, Abdalqader MA, et al. Stress association with neck and shoulder pain among male taxi drivers in Shah Alam, Malaysia. Int J Community Med Public Health 2020;7:1268.  Back to cited text no. 4
Page P. Cervicogenic headaches: An evidence-led approach to clinical management. Int J Sports Phys Ther 2011;6:254-66.  Back to cited text no. 5
Malavde R, Salunkhe P. Prevalence of cervicogenic headache in dentists. Indian J Public Health Res Dev 2020;11:386-7.  Back to cited text no. 6
Andersen JH, Kaergaard A, Mikkelsen S, Jensen UF, Frost P, Bonde JP, et al. Risk factors in the onset of neck/shoulder pain in a prospective study of workers in industrial and service companies. Occup Environ Med 2003;60:649-54. doi: 10.1136/oem.60.9.649.  Back to cited text no. 7
Hall TM, Briffa K, Hopper D, Robinson KW. The relationship between cervicogenic headache and impairment determined by the flexion-rotation test. J Manipulative Physiol Ther 2010;33:666-71.  Back to cited text no. 8
Ogince M, Hall T, Robinson K, Blackmore AM. The diagnostic validity of the cervical flexion-rotation test in C1/2-related cervicogenic headache. Man Ther 2007;12:256-62.  Back to cited text no. 9
Vernon H, Mior S. The neck disability index: A study of reliability and validity. J Manipulative Physiol Ther 1991;14:409-15.  Back to cited text no. 10
Young IA, Dunning J, Butts R, Cleland JA, Fernández-de-Las-Peñas C. Psychometric properties of the numeric pain rating scale and neck disability index in patients with cervicogenic headache. Cephalalgia 2019;39:44-51.  Back to cited text no. 11
Dodick DW, Eross EJ, Parish JM, Silber M. Clinical, anatomical, and physiologic relationship between sleep and headache. Headache. 2003;43:282-92. doi: 10.1046/j.1526-4610.2003.03055.x.  Back to cited text no. 12


  [Table 1]


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