Objectives: Prolonged sitting with a flexed back and neck is recognized as being associated with an increased risk of neck and back pain disorders among overhead crane operators. The aim of this study was to compare back and head postures over a full shift of work between operators who experience back and neck pain, and healthy operators. Methods: In a first phase, the prevalence of musculoskeletal symptoms was assessed using the Nordic questionnaire among 120 crane operators. Based on first phase results, 17 operators with back/neck disorders were matched with 15 healthy operators based on age and selected to participate in the second phase of the study. Postures and movements were continuously measured over an 8 h shift using inclinometers. Results: The highest 12-month prevalence of musculoskeletal disorders was found in the lower back, neck and knees. Case and control groups differed significantly in back and head flexion angles at the 50th percentiles APDF (p < 0.05). There was also a significant difference in the time spent working in an extreme posture of the back and head between groups (p < 0.05). Conclusions: This is the first study to document work postures assumed during a full work shift and to compare postures between symptomatic and healthy overhead crane operators. Physical exposure in case group operators was characterized by more awkward and extreme postures in the back and head. The results of this study demonstrate that effective prevention strategies directed towards musculoskeletal disorders are required that address awkward work postures for overhead crane operators.