Work-related musculoskeletal disorder (WMSD) is a formidable opponent.
You’ve trained your staff.
Educated them on the risks of MSD. Assessed their workstation. Given them ergonomic tools to work with.
Yet WMSD outwits you with a sucker punch.
You’ve also championed health and wellbeing. Designed health challenges to get your staff moving. Invited postural training specialists for your health week.
Yet again, WMSD rates are still up in the stratosphere.
You have even put up suggestion boxes to improve working process. Had toolbox talks on WMSD. Released ‘a slogan like;
“Let’s kick out back pain’’ or ‘’If it hurts, report it’’.
And still, WMSD wreaks havoc.
You’ve had it.
WMSD is winning. You’re tried all that you can.
You want to throw in the towel.
But it doesn’t have to be the end of the game.
Even the Underdog can win
Just like going into battle with a formidable opponent. You need to bring your A-game.
You need to study your opponent’s every move. Study how they punch. Study their stance. How they regain their balance. Their combo. Their strengths. Weaknesses. Stamina.
And like any underdog that have ever won a match. You too can beat WMSD.
But before I tell you all about work-related musculoskeletal disorders facts, let’s rewind back to Human Biology class.
Your staff would never walk up to you and say,
‘‘I have WMSD’’.
Nope! that would never happen.
But words like ‘Back pain’, ‘sprain’, ‘rotator cuff syndrome’, you’ve probably heard, right?
‘’So why are they called WMSD?”
Let’s stroll back memory lane to human biology.
Remember the systems of the body?
Circulatory. Nervous. Urinary. Endocrine. Cardiovascular.
These systems are made up of organs. And the organs are made up of tissues. And the tissues, cells.
These collection of tissue and organs are grouped into systems;
a) Because they work together to achieve a purpose
b) for easy identification.
For example, the circulatory system includes the heart and blood vessel (veins and arteries). They all work together to transport blood around our body.
So, does the musculoskeletal system. It provides support, form and stability.
The musculoskeletal system is made up of;
1. muscles, hence the name (musculo). Muscles contract (shrink) which produces movement. It is the body’s locomotion engine.
2. bones and joints (skeletal). Joints are the junction where bones meet and movement occurs.
3. and the connective tissues and protect and connect the muscles and bones. They include;
a. Ligaments – these are strong band of fibres that connect bones to bones. They stabilise and support the joints.
b. Tendons – they are like strong fibrous pulleys that connect muscles to bones. When the muscle contracts the tendon pulls and moves the bone. They can stretch and help to lengthen the muscle
c. Cartilage – they are protective paddings at the end of long bone that prevent friction in the joints. They also act as shock absorbers in the joint when movement occurs.
d. Fascia – these are thin fibrous sheets of covering that envelope group of muscles or organs to keep them in place or bounded together.
e. Bursa – they are small fluid-filled sacs usually placed in places where friction would otherwise occur. For example, a bursa would be placed between a bulge of a bone and a tendon. This would prevent the bone rubbing against the tendon preventing a tear to the tendon.
f. Intervertebral Discs – they are 23 shock-absorbing cartilages that hold vertebrae (bones of the spine) in place. They allow movement and are crucial to the health of the spine.
But the musculoskeletal system (MS) doesn’t work alone. It need the help of the nervous system.
The UK Science Museum described the nervous system as a network of cells called neurons that transmit information in the form of electrical signals. These neurons communicate with each other at special junctions. It allows us to perceive, comprehend and respond to the world around us, according to Healthline.
There are 2 parts to the nervous system;
Central Nervous System:
This is made up of your spinal cord and your brain which as you well know is the HQ of all things information. It gathers information from our sensory organs (eyes, ears, skin) and other parts of our body. It then uses this information to help you react, remember, think, plan, and then sends out the appropriate instructions to your body.
Peripheral Nervous System
are the nerves that carry these information from your brain to the rest of your body e.g. your heart and musculoskeletal system.
Why are the nerves relevant to the Musculoskeletal System?
In summary, they allow the MS to move.
Electrical signal is transmitted from the brain by the nerves to the muscles, joints and the connective tissues. These signals instruct the MS:
‘Move to the right’,
‘scratch that itch’
‘pick your nose’
‘pick up the tool’
Stayed too long in this bent position, back’s groaning, straighten up’,
‘it’s too hot, take off jumper’
‘Nod to what your manager is saying right now’
(Seriously, that’s what it says. I bet you’ve heard it. And you are responding now. You are about to smile. Or am I too presumptuous? OK, at least you’re thinking about it.)
It doesn’t matter how buff your muscles are, if there’s a disconnection at the nerve-muscle junction (neuromuscular junction), you won’t move.
Nope! Not even a flicker. Nada.
That why the musculoskeletal system is also called the NeuroMusculoSkeletal System or simply the LOCOMOTOR SYSTEM.
What is Musculoskeletal Disorders (MSD)?
Musculoskeletal disorder (MSD) is the injury or damage (disorder) to the tissues and organs of the musculoskeletal system. It is a collective name for a huge number of injuries. And it’s impotant to know that all the structures of the musculoskeletal system could be injured. And also that every injury have a name.
Let me show you the work-related musculoskeletal disorders facts that would help you better understand your opponent.
Let’s start from the very beginning. # a very good place to start …# (sorry couldn’t help myself, love Sound of Music).
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Work-related Musculoskeletal Disorder Facts
Fact#1: WMSD is musculoskeletal injury (disorder) caused or aggravated by work.
Fact #2: Injury caused by trauma, accident, fall, trip or slip is not regarded as WMSD. It’s like having a knockout punch just as the match begins, You win yes! But it’s not the usual fighting match.
Fact #3: WMSD is one of the many terms used to describe
You might know or have heard other terms used, like;
- Cumulative Trauma Disorders
- Occupational Overuse syndrome
- Repetitive Stress (strain) Injury
- Work-related neck and upper limb disorders
If you have, know that they all mean the same thing – injury to the musculoskeletal system caused or exacerbated by work.
WMSD Goes Under Many Aliases
Remember when I said earlier that your employee would never walk up to you and shout out that they have WMSD? Yeah?
For you be to able to identify WMSD when your worker groans with pain or reports an injury, you have to know their names.
These are names they would use to describe their injuries.
Like Mohammed Ali was known as ‘The Greatest’ and Evander Holyfield was known as the ‘The Real Deal’. MSD is a collection of many aliases.
MSD is usually classified by those structures that make up the musculoskeletal system. These aliases include;
Fact #4: Injuries to the ligaments are known as Sprains.
Sprain occur when the ligament is stretched to cause partial or complete tear (severance). A complete tear could also be known as rupture.
Common examples: Ankle sprain and ACL rupture (knee injury).
Fact #5: Injuries to the tendons are known as Tendinopathy, Tendinitis or Tendinosis.
In the hands, tendons are protected and covered in sheaths. These sheaths can also be injured known as Tenosynovitis.
Common examples: Achilles Tendinopathy (heel injury), Rotator Cuff Tendinitis (shoulder injury) and DeQuervian’s Tenosynovitis (wrist injury).
Fact #6: Injuries to the bursa is known as Bursitis.
Common examples: Subacromial bursitis (shoulder injury) or Greater Trochanteric bursitis (hip injury).
Fact #7: Injuries to the cartilage are known as Tears
Common example: Meniscal Tear (knee injury).
Fact #8: Injuries to the muscles are known as Strain or ‘Pulled’.
Common examples: Back strain and Pulled hamstrings.
Fact #9: Injuries to the bones are known as fractures. Fractures are not usually classified as WMSD, except, Stress Fracture which occurs over time by overuse or repetitive activities.
Common examples: Excessive marching (soldiers) or jumping up and down from lorries with Immigration officers at checkpoints.
Facts #10: Injuries to the joints are known as Dislocation where the bones in the joint is completely pulled out of alignment and subluxation, where there is partial separation.
Another common injury to the joint is Osteoarthritis – wear and tear of the joints caused by breakdown of cartilage.
Common examples: shoulder dislocation and osteoarthritis of the knee.
Facts #11: Injuries to the fascia are known as Fasciitis.
Common example: Plantar fasciitis (heel pain).
Facts #12: Injuries to the discs of the spine are known as Herniated or Ruptured Discs. And when injured from ageing, they are known as Degenerative Disc Disease (DDD).
fact#13: Sometimes your worker would not have a specific name for their injury so you might hear ‘body area + pain’, e.g. back pain, neck pain, shoulder pain.
WMSD is Not Discriminatory
Unlike boxers that are categorised by weights into featherweights, heavyweights and cruiser.
WMSD is not so.
It doesn’t affect only a certain group of people. So long as the risk criteria is reached, anyone, in any sector or industry, of any age can be affected.
Here are some statistics to prove that;
Fact #14: WMSD affects both male and female.
A report by HSE shows that WMSD affects both male and female in the same pattern. Prevalence in male was slightly higher than in female. But only just.
Fact #15: WMSD affects both young and old
The same report by HSE also reported that although WMSD was significantly higher in older adults than younger adults, all ages still reported injury.
Fact #16: WMSD affects all sectors. It occurs to both labour-intensive and low risk industries.
Similar to the HSE, WMSD 2016 Statistics report of Safe Work Australia shows that social and health care industries had the highest prevalence of WMSD. However, manual handling, awkward posture and keyboard work (seen in low-risk office and service industries) were also common causes of WMSD.
Fact #17: WMSD is the biggest singular cause of sickness absence. A report by US Department of Labour Statistics stated MSD accounted for one-third of all workers off sick for non-fatal occupational injuries.
Fact #18: Low back pain is a major cause of work disability worldwide, according to World Health Organisation.
What These Statistics Means to You
Always assume that WMSD is present in your workforce. Put in place a strategy and action plan for you and your workforce to;
– Identify MSD
– Evaluate and assess the risks
– Control the risks
How WMSD Occurs
The onset of WMSD is not at all mysterious.
Have you ever heard your employee say:
‘’the pain just started’’
‘’I was lifting the box and I felt a sharp pain’’
‘’when I start typing my hand begins to sting’’.
The pain didn’t just start. It has been giving off tell-tale signs of arrival.
But your employee hadn’t noticed.
Or maybe they mistook it for something else.
Or going by the default human response, ‘’I just thought it would go away’’, they brushed it aside.
Yeah I know, I do that too. (I’m only human after all!)
Let me break this down:
When at work, our body interact with the environment and tools we work with. The various tasks we perform exerts pressure on our tissues. Take for example, typing. You hit the keys with your fingers and the recoil of the keys puts pressure on your finger muscles and tendons.
Another example, when lifting a box, the weight of the box puts pressure on the lower back and shoulders. Picking and packing items into boxes. Driving. Using the computer mouse. Holding and talking on the phone. Using a plier. Climbing up the stairs. Are all various load that bombard our tissues throughout the day.
And the body would response:
‘’For every action, there is a reaction’’
The body response by changing its form to withstand these pressures.
Everything is all honky-dory until the tissue is unable to tolerate the load. Repetitive movement, excessive force, awkward static postures are some of the factors that could cause the tissue to exceed its tolerance level.
What Happens Next?
Fatigue sets in. Fatigue is the pre-requisite to pain.
That area of the body gets tired, literally.
Have you ever fidgeted? Yes?
This is a crucial stage. A decision has to be made.
- Should you continue working and ignore the pain?
- Should you stop and rest that area? e.g. go for a mini-break or do something else?
Fact #19: Adequate rest and recovery time from fatigue stops tissue damage.
Fact #20: Inadequate recovery from fatigue leads to tissue damage.
Fact #21: With time, tissue damage leads to ache.
Fact #22: Ache leads to pain
Fact #23: If untreated, pain leads to functional impairment.
Fact #24: If severe enough, impairment could lead to disability (the lack of power to perform a task).
At this stage, your employee might be thinking of going off sick. Because it’s just too painful and unproductive to be at work.
So, you see WMSD doesn’t just happen.
The first step to preventing WMSD is to design jobs that;
- Allow your employee to change tasks
- Gives them autonomy to choose when to perform their tasks
- Allows for breaks and rest
- Has variety of tasks using different muscle groups.
That way they can take the responsibility of changing their job tasks when they get fatigued. Of course, they should be trained to know the clear signs of fatigue and pain.
Time is of the Essence
Being a fighting champion takes time and practice. You would have to spend time crafting your moves, toning your muscles and polishing your endurance. You can’t just jump off from the street into the rings. Well, street brawls don’t count.
Same with WMSD, it doesn’t just happen.
FACT #25: WMSD occurs over time. It occurs from overuse or continuous exposure of load on the tissue.
Fact #26: It is cumulative. It might take weeks or even years before they set in or symptoms are noticed.
Fact #27: It is episodic. MSD may come and go. They return again and again even after treatment. Not all WMSD are episodic. But, a classic example is back pain which can happen many times in a lifetime.
Fact 28: WMSD is transient. Pain can be triggered only by certain tasks. When other tasks are performed, the pain stops.
Fact 29: WMSD can be non-specific, i.e. the symptoms are less well-defined and diagnosis is poor.
How to Use Time to Your Advantage
WMSD occurring with time means you, my friend, has found your opponent’s Achilles heel. Use the time to your advantage. Get your staff reporting pain early. Inform of the symptoms that they might experience. If they can identify symptoms, it makes it easier to report.
And if reported early, it’s easier to prevent and manage.
WMSD also Goes Through the Rounds
You can’t wait for the bell to ring. You’re biting at the bits waiting for the referee’s hand to go up. You have the ringside seat at this amateur match.
But wait, both opponents are seizing each other. A feeler jab here. A Russian hook there.
You were expecting punches: Cross punches and uppercuts. But no! Just feeler jabs and defences stances.
What’s going on?
That’s the first round. The time to size up the opponent. Know how they move, how they respond and defend.
Same with WMSD. WMSD undergoes through different stages.
Fact #30: The beginning stage (1st Round) is the Acute Stage.
A bit of pain here. A bit of ache there. Yes, swelling and redness would be present but the pain is manageable.
Your immune system (defences) are up and running. Lasts up to 2 weeks.
Oh! Oh! Here comes the 2nd Round.
It’s getting more fierce.
The punches are getting painful. Signature moves are coming a-plenty.
Fact #31: The second stage is the Sub-acute Stage.
Your immune system is weakening. It’s not firing up like it should. MSD is winning. The pain is becoming more frequent. It hurts more. Any activity can easily trigger the symptoms. It can last up to 4 weeks.
But you can still have a comeback.
There is hope. Prognosis is good. With the right treatment, the pain can go away.
Fact #32 Then comes the 3rd Round: The Chronic Stage.
Everything has slowed. Immune system shot. Pain skyrocketing. Injury spreading. It’s not responding to treatment. Healing crawling along like a snail. Prognosis awful. Worklessness at the corner. Long term sickness absence looming.
What Can You Do?
Same as Physiotherapists advice. Treat the injury on time.
Encourage your staff to report early. Encourage them to seek medical attention. Whether by NHS, in-house Occupational Health team or through Workers’ Compensation. The earlier caught, the quicker it heals.
WMSD and its Signature Moves
Mohammed Ali was known for his quick footwork (and probably his fighting talks). Anthony Joshua is known for his power punches.
WMSD has its own moves too. Signs and symptoms that would tell you it’s MSD.
Fact #33: The commonest symptoms of WMSD is pain e.g. back pain.
Fact #34: Tingling sensation is synonymous with nerve pain, commonly found in sciatica (a type of back injury)
Fact #35: Numbness also relates to nerve involvement e.g. neck radiculopathy ,i.e., pain in the neck with numbness in the hand.
Fact #36: Swelling in the muscle or around the joint.e.g. ankle sprain.
Fact #37: Limited movement (stiffness) in the joint e.g. frozen shoulder (joint adhesion)
Fact #38: Clicking sound which would indicate injury to one of the connective tissue e.g. shoulder tendinitis or knee meniscal (cartilage) tear
Fact #39: Grating sound, a distinctive sign of arthritis e.g. osteoarthritis of the knee
Fact #40: Pins and Needles (parathesia) which indicates that the nerve connectivity to that area of the body has been compromised e.g. carpal tunnel syndrome – parathesia in the fingers.
Fact #41: Weakness. It usually occurs with pain e.,g. Tennis elbow.
I can remember my dodgy attempt at shadow boxing in a box-exercise class. It was cool. I was cool. I was getting into the groove until the combo.
Jab-jab-cross. Jab-cross -hook-cross.
Getting harder I thought but could still do it.
But at jab-right uppercut-left hook-cross, I gave up.
I couldn’t do it quick enough.
Risk factors are like combinations.
But unlike boxing, where the players execute the combo, work exposes workers to risk factors. The work activities, work environment and how your organisation is structured, exposes the risk of WMSD to workers..
Fact #42: The causes of WMSD present in your workplace is multifactorial.
Fact #43: Risk factors are broadly grouped into Individual and workplace factors.
Fact#44: The influence of individual factors is relatively outside your control. Take for instance, generic disposition that might increase the rest of arthritis.
Fact #45: Workplace risk factors can be eliminated, minimized and controlled. e.g. minimizing excessive repetitive movement. Automating the transportation (carrying) of loads greater than 5kg, thereby eliminating manual material handling.
Fact #46: The interaction between workplace and individual risks factors could Increase the risks of WMSD. E.g. low employee engagement (organisational workplace risk factor) could affect a worker’s willingness to report WMSD.
Fact #47: Like boxing, the complex the combination the higher the risk of WMSD e.g. high job demand + awkward posture + excessive force + fatigue rate = greater probability of WMSD.
Fact #48: Just like with my dubious attempt, the various combination makes it almost impossible to predict the onset of WMSD.
So That Will Mean That:
Fact #49: Not every worker exposed to these risk factors would develop WMSD.
WMSD FACTSHEET: How to Use to Your Advantage
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The Underdog’s Arsenal
It has taken me over 3500 words to share with you work-related musculoskeletal disorders (WMSD) facts. I have shared its characteristics, offences and power play. You might now be wondering if WMSD can be defeated. If you have any arsenal to successfully manage it.
So, before you become disheartened and throw in the towel.
You do have arsenals.
You have management tools that you can put in place, and deploy to defend and protect your employees.
Fact #50: Managing WMSD requires two main tools;
- Reactive measures
Fact #51: The very first step to preventing WMSD is by a good job design.
Designing out the risk factors. Designing in adequate rests within job tasks. Designing in
autonomy to allow your employees perform their task as it suit them. For example, a worker choosing to take mini-breaks every 45 minutes.
Fact#52: Ergonomics has been proven to be the major driver of WMSD Prevention. Adhering to the Ergonomic Principles, minimises risk factors e.g. working in the neutral sitting position (#1 Ergonomic Principle) eliminates awkward posture (risk factors).
Fact #53: Absence Management are usually stand-alone measures. But they are essential in WMSD Management. Remain at Work (RAW) and Return to Work (RTW) Programmes reduce the number of employees lost to disability and sickness absence.
Triple up Your Knockout Punch
Yes, I agree with you that WMSD is a formidable force.
Saw this quote that buttresses what I have been saying all along;
You have the moves, combo, and people (employee) to fight back. Not just fighting to defence but to knock out.
Get your employees involved. Get them up a speed with WMSD facts. Give them the tools to easily report injuries.
Map out how you would capture, identify and mange work-related injuries. Keep your ears to the ground to hear the pounding steps of WMSD arrival.
And you’ll never miss to knockout WMSD.
This blog post is Part 1 of the Work-Related Musculoskeletal Disorders 101 Series. I hope you’re as excited as I am to get started.
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