Cosmetology is one of the most rapidly developing branches of medicine. Its progress is driven by innovative technologies and improved methods for correcting aesthetic defects and age-related skin changes. Among other reasons are the changing needs of people to refine their appearance as a factor affecting their quality of life and social status. In many cases, aesthetic medicine improves not only the looks but also the feelings of the patients, their psychological state. Today, more than 35% of Russian citizens seek medical assistance from cosmetologists, and women do so four times as often as men. According to the BusinesStat agency, in 2023 Russians spent a record 269 billion rubles on cosmetology, and the number of cosmetology clinics and offices exceeded 28000 [1].

Cosmetology developed on the basis of dermatovenerology. As a discipline in higher medical education institutions, cosmetology appeared only in 2009, and the occupational standard "Cosmetologist" was approved in 2021 [2, 3].

The currently available research papers cover legal issues associated with cosmetology and the problems of assessment of quality of medical assistance rendered by cosmetologists [4–6]. There are practically no publications exploring the subject of occupational health of cosmetologists, which justified the search for potentially harmful and (or) dangerous work-related factors, a methodological approach used by the occupational safety and health specialists in the context of assessment of working conditions [7].

The working posture was established as a potentially harmful factor shaping the overall degree of hardness of the cosmetologists' labor. Overall, studies investigating work-related ergonomic risks of musculoskeletal disorders (MD) among medical doctors of all specialties are considered relevant [8–10]. Thus far, the problem of MD has received the greatest attention in relation to the health of dentists. For them, the main reasons for becoming incapable of work are pain and the musculoskeletal disorders resulting from "incorrect, traumatic working posture" [11–14]. The unnatural body position, repetitive movements, and constant tension can lead to osteochondrosis, local neuroticisms, arthritis, tendovaginitis, and other related conditions. The most common of those unnatural body positions among dentists involve an excessive forward tilt of the head with strained neck, a tilted torso semi-rotated to one side, a raised shoulder or both shoulders, a less than 90° hip angle [15].

The assessment of the hardness of work of cosmetologists performed by the authors earlier substantiated adoption of the following indicators contributing to the said hardness, including: static loads in the context of the procedures (photo rejuvenation, ultrasound peeling, etc.) performed with one hand; a significant number of small-amplitude, local, repetitive movements that involve the hand and finger muscles; and periodical assumption of uncomfortable or unnatural working postures [16].

In connection with the above, the purpose of this study was to assess the ergonomic aspects of the working posture of cosmetologists and evaluate the risk of MD among them.

PATIENTS AND METHODS

The study involved three cosmetology clinics in Volgograd and spanned 2024 and 2025. We monitored the work of the cosmetologists for 12 man-shifts and assessed the collected data against the provisions of the "Guidelines for the Hygienic Assessment of Working Environment Factors and the Labor Process. Criteria and Classification of Working Conditions (R 2.2.2006-05)." There were two study groups: the first consisted of 35 people aged 28–39 years with an average work experience of 7.2 ± 3.75 years, and the second consisted of 33 people aged 40–59 years with an average work experience of 19.4 ± 7.12 years. 

A questionnaire was developed to study medical complaints related to prolonged retention of an uncomfortable fixed working position. The participants were surveyed at the end of the working day.

The working posture of the cosmetologists was registered photogoniometrically. The total number of the examined participants was 12, five in the 1st group and seven in the 2nd; we have built distribution diagrams for all of them. Photographs were taken from the side, when the doctors assumed their working postures, sitting and standing. The parts and areas of interest on the pictures were as follows: the external auditory foramen, the great humerus, the outer condyle of the humerus, the styloid process of the ulna, the metacarpophalangeal joint of the third finger, the great trochanter of the femur, the outer epicondyle of the femur, the ankle of the fibula, the joint area of the second or third toe, the calcaneal tubercle. The values recorded for them were compared to the recommended ranges of goniometric angles [17].

We performed digital goniometry of the shoulder joints using the Artro-Pro hardware and software complex (certificate of state registration of the computer program No. 2023667718 of 17.082023) developed by the specialists from the Volgograd State Medical University (Russia). The assessment of the functional state of the shoulder joint involved computer registration of a number of bone landmarks, processing of the obtained data, and compilation of the conclusion on functional and/or structural deformities. We studied the flexion, extension, abduction, and adduction in the shoulder joint. The software drew a graph, goniometrogram, based on the values, which allowed evaluating the function of the joints.

For statistical processing of the results, we used the IBM SPSS Statistics Version 22 software package (IBM; USA). The Kolmogorov-Smirnov test was used to verify the normality of the distribution of the indicators, and the results confirmed that the distribution was normal. The mean (M), the standard error of the mean (m), and the 95% confidence interval (95% CI) were used to describe the quantitative data. The significance of the differences was calculated using the Student t-test. To compare the two independent study groups, we applied Fischer's F-test. The differences were considered statistically significant at p ≤ 0.05.

RESULTS

The timed observation showed that for about 85% of the working time, the cosmetologists assume an uncomfortable and/or fixed position, which allows putting this occupation under the hardness class 3.2 [16]. We visually assessed the cosmetologist's working posture associated with the most common procedures, and evaluated the doctor's position relative to the patient on the treatment table. Injections, electrocoagulation, etc., require maintaining an uncomfortable pose because of the need to distinguish small (from 0.5 mm) features on the patient's face, neck, and decollete area that are no more than 0.4–0.5 m from the doctor's eyes. Thus, a cosmetologist stays seated for 55-60% of the shift time, and while standing, the specialist has the body tilted forward, straining, specifically, the cervical spine, and rotating spine and shoulder joint. The laboratory chair with height adjustment cannot be considered an adequate piece of workplace equipment.

The results of the survey taken by the study groups revealed that older doctors complained more often than their younger peers (tab. 1). Neck was found to be the most common area of pain among cosmetologists: it as mentioned by 60.0% of the participants from the first group and 85.4% from the second group. There were also a high percentage of respondents complaining of back pain (33.1–53.3% in the first group and 53.5–82.1% in the second) and shoulder joint (62.6% and 80.2%, respectively).

Every third cosmetologist in the first group and almost 70% of doctors in the second group complained of a headache at the end of the working day; 36.67% and 39.28%, respectively, had the eyesight deteriorating. The high prevalence of complaints about MD justified the need to assess the morphofunctional state of joints and spine. We measured the main goniometric parameters of the sitting and standing working poses (tab. 2). It was found that when a cosmetologist is working seated, almost all of these parameters are outside the recommended range. The greatest vertical deviations were seen in the neck and shoulder (head-forward position) area; another common discrepancy concerned excessive flexion of the hip and knee joints. For the standing position, we registered the greatest deviations from the recommended values in the neck and the trunk (deviations from the recommended verticality values) as well as the elbow joint.

Since, according to the doctors, pain in the shoulder joint area causes the greatest discomfort when performing manipulations, we did digital goniometry thereof to determine the amplitude of movements and diagnose the degree of overstrain of the muscular component of the shoulder joint complex.

tab. 3 shows the results of digital goniometry of one of the examined doctors.

The analysis of the digital goniograms showed that in 87.2% of the doctors aged 28–39 years, the static and dynamic loads experienced during the working day did not significantly affect the functional state of the shoulder joint. At the same time, in the older age group (40–59 years old), this was true only for 31.6% of the respondents.

DISCUSSION

It was found that complaints of pain in the neck area are the most common among cosmetologists. This type of pain is known to occur in 20–70% of people during their lifetime, and its prevalence in the general population is 4.9%. The most common variety is non-specific neck pain, the risk factors for which include prolonged static loads in the neck area, failure to follow ergonomic rules at work, and being female [18–20]. The results of this study differ from the data describing the respective indicators in the general population, and this difference suggests occupational conditioning thereof: specifics of organization of the workplace and the need to maintain a working posture. Sitting, a cosmetologist has the body tilted forward and the gaze fixed on the features of face, decollete area below; consequently, the weight of the head increases relative to the cervical vertebrae, and that of the upper body – relative to the lumbar region. According to [21], when the angle of inclination of the head relative to the vertical axis is 30–45˚, the load on the spine can reach 18–22 kg. At the same time, the load on the extensor muscles of the neck and spine increases, which leads to their early fatigue, overwork, and pain [22, 23]. In addition, the cosmetologist's working posture is characterized by a spiral curvature of the spine in the thoracic and lumbar regions, which leads to the development of pain in there, and headaches. For the standing position, we identified the angles of inclination from the neck, shoulder, and spine vertical are more than twice as great as the recommended values, which also creates a risk of straining the muscles of the shoulder girdle, occiput, and back [23]. The lack of an ergonomically adequate seat further exacerbates the established occupational risks associated with the specifics of the working posture of cosmetologists. It has been proven that ergonomic interventions, i.e., provisions of a chair that meets the requirements of the profession, can prevent excessive tension of the neuromuscular system, musculoskeletal pain and discomfort [24]. The "ergonomic" chair proposed by manufacturers, which has inclined surfaces, forces the person counter constant sliding down, which leads to a straighter position of the spine, but entails undesirable hyperactivity of the muscles of the upper and lower extremities [25, 26].  

CONCLUSIONS

The data obtained indicate that the identified ergonomic deficiencies are the main factors conditioning the hardness of work of cosmetologists; they create a real occupational risk of disorders of the musculoskeletal system. It is necessary to continue researching the subject of workplace optimization, since ergonomic interventions can be quite effective in reducing occupational risk and preventing diseases associated with the considered medical activity.