Rammy Ingel Physiotherapy

Musculoskeletal problems among tattoo artist and how can we manage them.

I got my first tattoo when I was 19 years old. Since then, my tattoo collection has grown (just like the tattoo industry); I’ve traveled abroad adding more tattoos by my favorite artists to suit the idea and style I had in mind, and finished my physiotherapy studies. Sitting through those long sessions (sometimes six to nine hours), I often noticed that the artists I met suffered from a lot of musculoskeletal pain. This led me to learn and research whatever I could about work related problems among tattoo artists, and to try and raise awareness to these problems and give some helpful tips on how to deal with them.

We know that the popularity and social acceptability of tattoos are at an all-time peak, and it’s estimated that around 45,000,000 Americans have at least one tattoo somewhere on their body.

This growth in popularity has led to an increasing demand for tattoo artists and a growth in the number of people working in the body modification industry in general, and the tattoo industry specifically. In 2015, there were estimated to be about 55,000 people employed in the tattoo industry in the US, and this number is expected to increase to about 77,500 by 2020 (and this trend is the same all over the world).

A French survey from 2017 shows that most tattoo artists today are young (83% are under the age of 45 and 45% are between 36 and 45). However, as these tattoo artists age, it will become important for them to consider the occupational risk factors for musculoskeletal disorders.

Based on casual observation and past studies it’s possible to compare tattoo artists to dentists concerning musculoskeletal risk factors, since work in both professions involves sitting for prolonged periods of time while grasping small tools to perform fine, detailed work on a client.

While the work-related musculoskeletal risks associated with dentistry have been extensively studied, the work-related musculoskeletal risks associated with tattooing have barely been investigated. In fact, only two studies and one general health survey have ever been conducted on the subject.

These three studies (carried out between 2011 to 2017) used questionnaires to collect data such as general information (gender, age, race, height, weight and dominance), work history (years of tattooing, work hours and frequency per day and week, break patterns, tasks during a work day and work satisfaction), health behavior (diet, sport activities, tobacco and alcohol consumption) and Health problems (headaches, eye and musculoskeletal disorders). One of the studies also examined muscle activity and posture.

They found that, on average, the age of tattoo artists ranged between 25 and 54, they had 9∓6.3 years of work experience, the ratio of men to women was 3.6:1, and they were mostly working on short projects (1 - 3 hours) without any breaks and working between 25 and 55 hours per week (4 - 8 hours a day and usually 4 - 5 days a week).

The studies also found high prevalence of musculoskeletal problems among participating tattoo artists (in one study, 31% of the artists lost at least a day’s work as a result of it).

79% of the tattoo artists said that the symptoms got worse while tattooing, and 41% reported seeing a therapist because of it.

The most frequently reported area of discomfort was the lower back, followed by the neck, the shoulders, the hands, the legs, and even eyes problems were found.

Despite the constant buzzing of the machine, the studies did not find any hearing symptoms, and there was no difference between those who worked 4 days per week or more and those who worked less.

In the last study they also examined muscle activity and posture.

Muscle activity was examined using an EMG System with 8 wireless electrodes that sampled muscle activity throughout the tattoo session. The electrodes were placed over the left extrinsic finger extensor, right extrinsic finger flexor, right and left mid-deltoid, right and left upper trapezius and right and left erector spine muscles.

The EMG data was collected for 15 seconds every 3 minutes throughout the tattoo session; recorded sessions lasted between 1 and 3 hours, depending on the stage of the particular tattoo. For each EMG data sample, the researcher indicated whether the tattoo artist was currently in the process of lining or shading and took notes.

All participants displayed a muscle activity level of 10%, exceeding the 2% -5% MVE limit recommendation in at least one muscle or muscle group. The upper trapezius was the most activated muscle, and no evidence of fatigue was seen in the erector spine muscle.

Postural observations were carried out during each tattoo session, and posture was recorded every 5 minutes by the examiner, who took a photo and graded the posture according to 4 action levels
(with scores of 1 - 2 being acceptable).

71% of the overall posture scores were at action levels 3 or 4, where changes are required soon or immediately, and only 1 reading was at action level 1.

But are posture and sitting position really the problem?

I often hear people – sadly, even doctors – say that not sitting in a neutral position puts pressure on the spine and muscles. But would it be better for a person to sit upright all day? Try it yourself and you would soon learn that it’s even more difficult.

Studies that look at either muscle activity or spine loads find only a tiny difference of 2% - 3% in the maximal activity between upright and slump positions.[5] This means that sitting does not tire or load the spine and muscles. If anything, the opposite is true – sitting is too restful for the spine. It feels good to slouch. It can actually be a symptom modifier.

Today, we know that pain associated with sitting does not mean that the way you sit causes it. This misconception is derived from the idea that there is a correct way to sit.

The evidence demonstrates that there is no connection between work-related posture or prolonged sitting and lower back pains, and that correcting posture is both unattainable and unlikely to make any difference to a lower back condition.

So, if posture and sitting are not the problem, what is?

The answer is that most of the time we simply don’t know – it can be anything in your life… you can blame lack of activity, not following training principles, stress or anything else.

So, what can we do to prevent or decrease those problems?

Think about lighting (type, intensity and placement), keep your eyes moist and try to relax your eyes from time to time.

Although ergonomic interventions are doubtful, you can still try to change the placement of some of the equipment and the setting for the tattoo session.

Choose comfortable, supportive chairs (preferably ones that are adjustable). Don’t let manipulative advertisement tactics lure you into buying a fancy and expensive chair that doesn’t fit you. The best chair for you is the one you feel best in while sitting and working.

Try changing the position of your body on a regular basis, alternating between sitting and standing while you work, and take more frequent breaks (even during sessions of 2 - 4 hours).

Think about client positioning. Try to find a position that is comfortable for both you and your client, and try to change it from time to time, if possible. Remember that when clients feel more comfortable, they become more relaxed, pain connected with anxiety decreases and client movement during the tattooing is reduced (and that’s always a good thing…).

But the best way reduce or prevent pain (the only way we have evidence for, in any case) is physical activity. Most of the time, it doesn’t even matter what kind of activity. It could be any general activity that increases blood flow and circulation, or a specific activity directed at some problem that needs special intention.

To sum up, the popularity of tattoos today leads to an increasing number of tattoo artists. Most of these artists are still young and have a lot of tattooing years ahead of them, so they need to consider the occupational risk factors related to musculoskeletal problems (as shown by past studies).
It’s important to understand that these problems are not the result of sitting or “bad posture”, but simply of being human… Try out some of the options I’ve mentioned to help you cope with these problems, like lighting, changing placement and chair (if needed…), taking more breaks and, most importantly – engaging in physical activity.

Want to hear more? Look up my seminars and lectures on the subject in some of the upcoming conventions around Europe.