The study was conducted on a nationally representative Slovenian sample of 858 teachers (528 female; age 44.0 ± 9.67 years). To control for between-school variance in occupational health conditions (e.g., gym acoustics, classroom heating), 170 primary (students aged 6–14 years) and upper secondary schools (students aged 15–18 years) were randomly selected from the Slovenian school register (30, 31). A total of 28% of the schools were included in the sample. All PETs from the selected schools were invited to participate. The response rate was around 60%. In the second step, a matched-pair sampling method was used. For those who chose to participate, pairs of teachers from the same school were identified and invited to the study. Where possible, a classroom teacher and a subject specialist teacher from the primary school surveyed were selected for the specialist PET, both of whom were of a similar age and sex to the specialist PET. In a few cases (e.g., when it was not possible to find a subject with the same sex), only age was a criterion for selection. In the upper secondary schools, a subject teacher was selected who was similar to the specialist PET. Music teachers were excluded from the sample as they are generally more familiar with speech therapy. Thus, the sample comprised 340 specialist PETs (141 female; age 45.0 ± 9.04), 201 classroom teachers (184 female; 41.7 ± 7.75), and 317 subject specialist teachers teaching subjects other than PE (203 female; 42.7 ± 8.71).

We used a modified version of a previously conducted survey (18, 23). This survey consisted of the following parts: (1) demographic data (sex, age); (2) anthropometric data (height, weight, and waist circumference), (3) characteristics of the teachers’ workplace (length of work experience, weekly workload), (4) International Physical Activity Questionnaire – Short Form (32), and (5) Chronic Health Disorders Questionnaire (23).

For this article’s purposes, only the results on chronic health disorders are presented. They were examined using the Chronic Health Disorders Questionnaire. They were defined as overuse injuries and/or pain in specific joints (e.g., cervical spine pain, lower back pain) and disorders and problems related to the teacher’s profession (e.g., voice disorders, hearing disorders, colds, etc.) that recurred frequently and lasted longer than 1 year. Dependent variables were the number of each health disorder in the last 12 months.

Once the principals had given their consent, specially trained university physical education (PE) students visited the schools, conducted interviews with the teachers, and recorded their responses on a web-based form. The teachers were informed of the aims of the study and that their participation was voluntary and anonymous. The Ethics Committee of the Faculty of Sport in Ljubljana approved the study.

The data was analyzed using IBM SPSS 27 software (33).

The sample statistics of the variable distributions were calculated and plotted. For this purpose, the number of health problems in the last 12 months was merged into three categories: never (health disorder never occurred in the last 12 months), rarely (health disorder occurred 1–10 times in the last 12 months), and often (health disorder occurred more than 10 times in the last 12 months).

The differences between the different teacher types, controlled for sex and age, were analyzed using binary logistic regression; for this analysis, the categories rarely and often were combined.

The results of this study are consistent with the existing literature on the prevalent health problems among teachers and point to occupational health risks [e.g., (8, 11, 16, 18, 23, 34–36)]. The increased incidence of colds and headaches among all teachers may be attributed to their increased susceptibility to viral infections due to regular contact with numerous children (37). In addition, somatic problems often associated with the stress of the teaching profession may contribute to these health problems as well (5).

The recurrence of lower back problems, hoarseness, and neck pain underpins a well-established trend in the teaching profession that has been observed in various studies [e.g., (7, 8, 11, 12)]. Prolonged standing and awkward posture may contribute to lower back pain (38), while neck pain may be associated with occupational stress (39). The prevalence of hoarseness is related to occupational demands for extensive verbal communication, which often takes place in noisy learning environments (6, 9, 40, 41). In particular, studies indicate a higher incidence of voice disorders in teachers compared to the general population, ranging from 32 to 58%, as opposed to 1% (6, 34, 42). These disorders are likely to be multifaceted and influenced by environmental, organizational, and predisposing factors that may exacerbate or trigger voice-related problems (43).

A comparative analysis of the health problems of different groups of teachers shows that the challenges for specialist PETs go beyond those of classroom and subject specialist teachers. They are about twice as likely to have musculoskeletal or hearing problems than the other two groups of teachers, and the risk of suffering from hoarseness is also significantly higher. These results are consistent with earlier findings (18, 19, 44).

The reported prevalence of musculoskeletal disorders in PETs varies widely in the literature, particularly for back pain, ranging from 4.7 to 76.7% (35). In our study, one-third of specialist PETs reported having had no problems with back pain in the last 12 months, while another third suffered from frequent back pain. The prevalence of neck pain reported in the literature is around 10% (35), while a higher prevalence (20.9% often and 26.5% rarely) was found among specialist PETs in our study. In addition, Slovenian specialist PETs reported knee (25.6% rarely and 11.2% often) and hip (5.9% rarely and 4.4% often) problems more frequently than their Estonian male counterparts (14% knee pain and 3.9% hip pain) (45).

The higher incidence of musculoskeletal health problems in specialist PETs compared to other teachers may be interpreted as a cumulative effect of workload on their musculoskeletal system (46), with activities such as demonstrations, overuse, collisions and carrying objects identified as major causes of injuries in PE (16). A systematic review by Erick and Smith (14) found a positive association between working more than 35 h per week, supervising students in a stooped posture and lifting sports equipment with low back pain. Intense physical activity during leisure time was also positively correlated with neck and knee pain.

Although Slovenian specialist PETs seem to have better working conditions than their international counterparts (e.g., most gyms have wooden floors and working hours are well below 35 h per week), the reasons for the higher prevalence of musculoskeletal disorders among them should be further investigated.

A significant group of common occupational health problems faced by PETs concerns hearing (16, 23, 47) and voice disorders (8, 23, 24, 36). In a meta-analysis by Cantor Cutiva et al. (8), the prevalence of voice problems in teachers ranged from 9 to 37%, with a prevalence of 15–80% within 12 months. Allen and Hu (6) attribute the variability in prevalence to the different terms and definitions of voice disorders in the literature, ranging from general terms such as “voice complaints” to more specific definitions. In our study, about half of the teachers reported having suffered from voice disorders in the last 12 months. The probability of having voice disorders was higher for specialist PETs compared to classroom teachers and there was no difference when compared to subject specialist teachers. The literature suggests that working in noisy environment, as is characteristic of PE, and teaching younger students is associated with a higher incidence of voice disorders in teachers (8), which is not consistent with our findings. We would expect the likelihood of voice disorders to be higher among classroom teachers and specialist PETs than among subject specialist teachers. This discrepancy may suggest that classroom teachers compared to other teachers are more aware of the importance of voice care and may incorporate voice production techniques and voice care principles, such as appropriate hydration, into the classroom. Similar may also apply to PETs compared to other subject specialist teachers.

In addition, the prevalence of hearing disorders in specialist PETs is at least twice as high as in other teacher groups in Slovenia. About a quarter of Slovenian specialist PETs reported having hearing problems (often or rarely), in contrast to 65% of Brazilian teachers (25% with some degree of measured hearing loss) (48) and 46% of Swedish teachers (49).

Several factors contribute to these disorders in teachers. These include environmental, organizational, and predisposing elements that may exacerbate or trigger voice disorders (43). Key risk factors for voice disorders include high noise levels, poor acoustics, gender, upper respiratory problems, caffeine consumption, speaking loudly, teaching hours per week, and experience of dismissal due to voice problems (7, 50). In addition, PETs often work in an environment with dust and multiple classes practicing at the same time (16), which has a negative impact on teachers’ voices. Another important factor contributing to the development of voice disorders is also a lack of knowledge about voice production techniques and principles of voice care (6).

A higher risk of developing hearing disorders in PETs is also associated with several factors (23, 47, 51), including working in spaces with high reverberation, exposure to loud activities, dust and concurrent teaching, all of which are common in PE (16, 52). Noise exposure, particularly in indoor swimming pools and triple gyms, often exceeds acceptable levels for acoustic comfort, reaching around 80 dB(A) (53). Acceptable levels for acoustic comfort are up to 55 dB(A) (54). Sudden loud noises, such as children shouting, and consistent noise levels in classrooms can lead to lesions in the inner hair cells over time (55).

Given these conditions, the hearing health of specialist PETs is of particular concern. This reflects previous research findings that emphasize the increased risk of hearing damage in this subgroup (23, 47, 51). In addition, the fact that PETs are exposed to noise for prolonged periods of time without adequate protection, often in an attempt to discipline students or counteract environmental noise (e.g., bouncing balls or music), puts stress also on their vocal organs and contributes to vocal problems such as hoarseness, increased effort when speaking, chronic dryness, or pain in the throat (8, 16, 23, 24, 47). The prevalence of voice and hearing problems tends to be higher in female PETs (23, 24).

Our study also shows some sex differences in occupational health problems among teachers. Female teachers have a higher risk of urinary tract problems, hoarseness, colds, headaches, and neck and hip problems than their male counterparts, which has already been confirmed in previous studies [e.g., (6, 35)]. A higher risk of voice disorders in female teachers has also been found in other studies [e.g., (40, 42, 44)]. This can be partly explained by gender-specific differences in the larynx (56). In addition, social and cultural factors (e.g., greater vocal demands in class to maintain class order) may contribute to speech problems in females (41). More frequent colds, headaches, and hip and neck problems in females than males are consistent with trends in the general population (57–60). In contrast, the male teachers in our study were more prone to musculoskeletal problems, with the exception of hip problems. This could be explained by their recreational sports activities, where males choose activities with a higher risk of musculoskeletal problems compared to females (e.g., ball and racket games) (61) or they practice moderate and vigorous intensity sports more often than females (62).

In line with the literature [e.g., (3, 11, 18)], the results of this study also emphasize the positive association between teacher’ occupational health problems and age, with the exception of hoarseness and headaches. We can assume that, as in the general population, teachers’ health problems are influenced by aging processes (63, 64) as well as by the cumulative effect of workload in a given work environment (i.e., vocal demands, many encounters with people, rigorous schedule, standing for long hours) (6, 65, 66).

Understanding the specific health challenges faced by different groups of teachers is therefore crucial for developing tailored interventions and support systems to prevent their work-related health problems (22). Interventions may include raising teachers’ awareness of health risk factors, teaching appropriate tasks to reduce specific health risks (e.g., voice care or injury prevention), introducing school-based exercise for them to increase their general health and well-being, ensuring outdoor teaching conditions, ergonomic adaptations in the classroom (e.g., lifting tables that allow sitting or standing) and, specifically for PETs, teaching strategies for managing physical exertion that meet the particular demands of PE.

Injury prevention measures have already proven successful in reducing injuries among PETs. Vercruysse et al. (67) familiarized an intervention group of PETs with eight injury prevention strategies (seven intrinsic strategies: correct execution, warm-up, cool-down, stretching, core stability, balance, and functional strength and one extrinsic: appropriate footwear) in a 2-day training session. The results showed that teachers in the intervention group had a lower number of injuries per 1,000 h of instruction than the control group and used a broader range of injury prevention strategies. Similar results can also be seen in vocal hygiene awareness programs for teachers. Allen and Hu (6) reported that teachers who had participated in such a program (tips on vocal use and misuse, the importance of drinking water, taking vocal breaks, and avoiding caffeine) showed a statistically significant increase in their awareness of vocal care 3 months later.

As the teaching profession struggles with an aging workforce (25, 26) and a teacher shortage (27–29), addressing these challenges is critical to maintaining a healthy teaching environment that is attractive for future teachers and for teachers to stay in the teaching profession.

The strength of the study lies in the matched-pair sampling method, which controls for hidden variables and eliminates the order effect. The sample is therefore representative nationwide.

Although this study provides valuable insights, certain limitations must be acknowledged. The cross-sectional design limits causal inferences, and future longitudinal studies could examine the trajectory of health problems among teachers. In addition, consideration of general lifestyle factors and psychological well-being could improve the comprehensive understanding of occupational health in the teaching profession.

Our study contributes to a more nuanced understanding of teachers’ occupational health problems and provides insights into the challenges specialist PETs face compared to their teaching colleagues, such as constant physical exertion in a noisy environment. These challenges, if not addressed, could lead to long-term health consequences. This reflects previous studies that have pointed to the significant physical strain of PETs, particularly on the musculoskeletal system and hearing. These findings serve as a basis for training future teachers and for targeted interventions to improve teachers’ overall wellbeing, ultimately promoting a healthier and more sustainable teaching workforce.