Musculoskeletal Injuries
Introduction
Repetitive Stain Injury (RSI), Work Related Upper Limb Disorder (WRULD), Musculo-skeletal Disorder (MSDs),
Cumulative Trauma Disorder (CTD), Occupational Overuse Syndrome (OOS),
- whatever you call them they are a complete pain the bodies of workers, millions are suffering, hundreds of thousands of new cases each year – 37% increase in the incidence last year (2007) alone. Huge problem for workers.
Muscle (from Latin musculus, diminutive of mus “mouse”)is contractile tissue of the body and is derived from the mesodermal layer of embryonic germ cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell.
Skeleton or skeletal system is a strong framework that supports the body.
BACKGROUND INFORMATION AND STATISTICS
NATURE OF THE PROBLEM
Musculoskeletal disorders (MSDs) are the most common occupational illness in Great Britain. A number of surveys of self-reported work- related illness have been carried out in conjunction with the Labour Force Survey to gain a view of work-related illness based on personal perceptions. The results presented here are taken from the 2004/05 survey. SWI04/05 shows: 11.6 million working days (full-day equivalent) were lost through MSDs caused or made worse by work. On average, each person suffering took an estimated 20.5 days off work in that 12 month period.
Back pain – about 45% of work-related musculoskeletal disorders (WRMSDs) mainly affect the back accounting for an estimated 4.5 million working days (full-day equivalent) lost. On average, each person suffering took an estimated 17.4 days off work in that 12 month period. Upper limb disorders – about 37% mainly affect the upper limbs or neck. On average, each person suffering took an estimated 21.7 days off in that 12 month period. Lower limb disorders – about 18% mainly affect the lower limbs.
MSD PROGRAMME
HSC/HSE have identified MSDs as a priority. They affect large numbers of people across most industries and occupations. They have the potential to to ruin peoples lives and they impose heavy costs on employers and society.
The key messages are:
• you can do things to prevent or minimise MSDs
• the prevention measures are cost effective
• you cannot prevent all MSDs, so early reporting of symptoms, proper treatment and suitable rehabilitation is essential.
WHAT ARE MUSCULOSKELETAL DISORDERS AND WHERE ARE THEY ARE FOUND?
Musculoskeletal disorders (MSDs) are problems affecting the muscles, tendons, ligaments, nerves or other soft tissues and joints. The back, neck and upper limbs are particularly at risk. There are many conditions including low back pain, tennis elbow and carpal tunnel syndrome. Acute symptoms may arise as a result of an identifiable event such as unaccustomed and/or intense physical exertion resulting in pain and loss or restriction of movement, for example sprains and strains. Alternatively, there may be a more gradual onset of symptoms, with initial tingling, then slight swelling or soreness which may persist and gradually worsen.
Unlike most other workplace health issues, back pain and other MSDs commonly happen outside the work environment and then can be made worse by work. Whatever their cause they can impair ability to work at normal capacity. MSDs are often caused by, or made worse by, work activities. Initially sufferers may adopt new ways of performing tasks, or adapt tools to reduce discomfort, perhaps avoiding use of an affected limb and thus putting strain on other joints. Hence the need for prompt reporting of symptoms so that early intervention can take place to ensure an individual gets the right support and help from their employer (such as temporary modified duties or adaptations to their workplace) for them to manage their condition.
Risk factors causing MSDs can be found in virtually every workplace from commerce to agriculture, health services to construction.
“RSI” and Upper limb Disorder
The term RSI (Repetitive Strain Injury) is generally agreed as an umbrella term for a number of upper limb disorders. However whilst many medical professionals will have their own preferred term for these conditions and disorders, the term RSI is recognised by most people.There are two significant groups of RSI conditions, often known as Type 1 RSI and Type 2 RSI. Type 1 RSI conditions have good pathology (i.e. measurable evidence in the form of swelling, deformation, dysfunction etc). Type 2 RSI conditions do not have clear pathology and consequently some medical professionals do not accept that these conditions exist.
It is generally accepted that there are about 20 different Type 1 RSI conditions, which include carpal tunnel syndrome, and tenosynovitis. For these conditions diagnosis and treatment is generally well understood.
It is more difficult to obtain a diagnosis and treatment for Type 2 RSI conditions. With the lack of good pathology for these conditions, diagnosis relies on eliminating potential conditions where the detailed symptoms and circumstances do not match. This process is difficult without specialising in these conditions.
Since the Type 1 RSI conditions can be diagnosed more readily, a more specific term is usually used to describe the condition. The overall terms of RSI, or Work Related Upper Limb Disorders (WRULD) are therefore often used for the Type 2 RSI conditions. Other terms used to define Type 2 RSI conditions include ‘diffuse RSI’, ‘cumulative trauma disorder’, ‘occupational overuse syndrome’, ‘non-specific pain syndrome’, ‘non-specific arm pain’ and ‘myofasic pain syndrome’.
Unfortunately diagnosis and treatment of Type 2 RSI conditions is not always well understood either within the medical profession, or within the working environment.
Type 2 RSI conditions can be the result of intensive computer operation, particularly if care is not taken with posture and positioning of equipment. In particular many sufferers of this condition consider that intensive use of the mouse has been a major cause of their RSI condition. The initial early signs and symptoms of aches in the fingers, hand or arm at the end of a long day are often not recognised. It will often not be recognised until acute and possibly debilitating pain is experienced.
There is no easy cure for Type 2 RSI conditions, although preventative measures have been known for some time and are included within health and safety legislation.
Treatment of Type 2 RSI conditions will often require a number of complimentary approaches. Often lifestyle changes will be helpful. Treatment can include some of the following: removal of causative activities; physiotherapy; trigger point therapy; acupuncture; medication (low doses to relax muscles); neural stretching exercises; improvements to diet; careful exercise (swimming is often found useful); postural improvements (e.g. Pilates, Yoga, Alexander Technique).
Recovery from Type 2 RSI conditions may be achieved. The earlier the condition is recognised and effective action taken, has a significant impact on recovery time. Recovery in some cases can be achieved in a few months, but it is often measured in several years. Recovery can also occur in stages, allowing a gradual return to normal activity. However full recovery is not always possible.
How RSI affects the Employee
What Can Happen?
When people first begin to experience symptoms due to RSI they are unsure of what is happening to them. The symptoms initially can be quite mild twinges with a bit of numbness or tingling. However as the condition develops the pain increases until it is with the person for 24 hours, leading to weeks on end of pain and disability, reality sets in, usually confirmed by doctor’s diagnosis.
Difficulties
During this time, difficulty occurs in carrying out workplace tasks, domestic tasks, any hand-orientated hobbies have to be given up (sport, crafts etc.). Being off work on long-term sickness absence results in reduced salary, financial worry and stress fear of job loss, leading to depression, which in turn exacerbates pain levels, and the downward spiral of ill health begins.
Taking Action
Employees have a responsibility to report their injury once they realise what is happening, record the pain in the accident book, and pursue accurate diagnosis and treatment. They must also ask for a risk assessment to be carried out at work, and plan their home life by obtaining help from friends and family, if possible, to reduce the strain on their hands and arms. RSI must not be ignored, you can’t wish it away, and you must get treatment and adjust your life to the condition.
The Employer
In the event of Repetitive Strain Injury symptoms being experienced, there are various strategies that need to be implemented. Reasons for ignoring RSI can include fear of disclosure and keeping the accident book “tidy”, seeking to avoid potential litigation, embarrassment and guilt at having caused someone to become ill, which affects the image of the company, annoyance and irritation because targets are not being met, thereby inviting criticism from a higher tier of management.
Acknowledge the Situation
We ask employers to be unafraid to admit there is a problem, as ignoring RSI does not make it go away but makes things worse. Evidence of good practice within the workplace could be a way of keeping down insurance premiums. Certainly frequent legal claims are one way of increasing insurance premiums.
Taking Action
Encourage workers to report pain and record it. Body mapping is a useful tool showing where pain and inflammation are occurring. Encouraging the worker to seek effective diagnosis and treatment, pursue a pain management programme, consider alternative therapies, is the way forward.
It is important to note that working over the pain can cause further damage, the more chronic the condition the longer it takes to make a recovery, therefore the correct balance must be found.
Consultation
Conduct an effective risk assessment in consultation with the worker, looking at equipment, workload and stress. Just issuing a questionnaire to the worker is a useless exercise. The workstation needs to be observed and measurements taken, as well as posture being assessed, talking to the worker about any problems with equipment and posture, and about the volume of work expected to be undertaken.
Back to Work
When someone is on the road to recovery it can be conducive to their physical and mental state to embark on a gradual return to work, with shorter hours increasing gradually. This rehabilitative approach means that some of their work is being done, a valued and knowledgeable employee can be retained, and there is some financial benefit to both employer and employee. This may indicate a need for sickness absence policies to be rewritten, taking into account state benefits and salary payment.
Communication
Encourage “open channels” between worker, line manager, senior management, occupational health professionals, and human resources officer. Each one of these has an important role to play, together with a helpful and supportive attitude from colleagues.
If trades union membership is established within your organisation learn from trades union safety representatives. A unionised workplace is a healthy workplace, a healthy workplace saves money. Be aware of the dangers and educate yourself and your staff by encouraging a positive health and safety culture within the organisation.
Who Can Help
There are many organisations that are able to help in this day and age. The Department of Work and Pensions’ Disabilities Adviser can arrange for the provision of an ergonomic assessment and equipment, and funding to pay for a support worker to assist the injured person. A wealth of advice is available from the Health and Safety Executive, and various web sites on the Internet. RSI help-lines are for people with RSI, their families and also for employers.
Costs to the Employee
RSI and other long-term medical conditions can be an expensive business.
Costs to the employee include lost salary, medication and medical treatment expenses, and travel costs whilst obtaining treatment. In the event of a long-term illness people can lose their car, their home, and suffer breakdown of family relationships caused by the stress of their illness, leading to a downward spiral into poverty.
Costs to the Employer
Costs to the employer include lost salary, lost productivity via absence of a knowledgeable employee, additional salary costs for temporary employees, legal and medical specialist fees in the event of litigation, and increased insurance premiums caused by litigation.
Costs to Government
Costs to the Government, include loss of income tax and national insurance contributions, payout of various benefits, cost of medical treatment from the GP through to consultants at hospital, plus medication and therapy. There is also the cost of administrator’s salaries within the benefits system, Social Security Appeals Tribunal’s staff and medical specialists fees.
Repetitive strain injuries are preventable disabilities
This is why we must all work together and stop the spread of RSI
Strain Injuries At Work: Prevention and Management
Excessive force imposed on muscles, tendons, joints and the nervous system by some job demands and working practises are the starting point to strain injuries occurring.Provided the forces exerted are of a short duration, with adequate rest periods, they will generally be within the physical capacity of the body sinews and tissues. However overloading of the tissues caused by very frequent exertions of forced static postures can be harmful, resulting in loss of capacity in the affected limbs.
Examples
Holding a tool with a bent wrist whilst having to apply pressure combines force and awkward posture, and having to perform the same task repeatedly adds to the frequency factor further increasing the risk involved, so in that movement you have got static load and repetitive movement.
Working overhead with the arms extended upwards, (wiring cable in) or having to work with the back bent and the arms extended horizontally in an awkward part of the building to reach the area needing attention, or holding a trowel and tray with mortar whilst plastering or pointing brickwork.
Painting ceilings, where the head and neck is extended at an awkward angle and one arm applying the paint with brush or roller, and the other arm holding on to maintain balance.
The Three Main Factors
FORCE – the application of excessive manual force
FREQUENCY AND DURATION OF MOVEMENT – including rates of working which are too intense and repetitive whether of a single or combined nature, and
AWKWARD OR RIGID POSTURE – of hand, wrist, arm or shoulder, and where kneeling or crouching posture is required there will be strain on the legs, ankles and feet.
The human body is designed to cope with a wide variety of movements, forces, pressures and stresses, but what is often not realised are the points in the body which give way under the strain, and that is where the limbs connect to the spine. At the top of the spine where shoulders and neck connect, this is known as the cervical spine area, and when damage occurs here pain can appear in the arms and sometimes the legs. This is known as referred pain, and is due to the damage in the discs, where a build up of tissue can cause pressure trapping the nerves. In the lower part of the spine, known as the lumbar area, again referred pain can occur in the legs, which is a pain similar to sciatica.
Prevention
When carrying out work which involves the three factors, it is important to take short rest breaks, particularly when working at a keyboard, to refresh the muscles/tendons, and perhaps incorporate a short exercise of flexing the limb, to remove the feeling of strain, stimulating the circulation, thereby refreshing the system and removing the toxins that build up in the system when you are still for too a long time. In the case of the head and shoulder stiffening, there are exercises available which again can correct the posture.
For anyone experiencing pain, tingling, numbness, it is important to recognise what is happening to your body, report symptoms, look at the risk assessment on your job, seek help from your General Practitioner and a physiotherapist who is suitably qualified to a postgraduate level and who is knowledgeable about treating RSI.
Named Types of Injuries
Most publicity these days is given to cases of computer-induced injury, due to the increased computer usage in working life, and which is the least understood injury. Research at University College Hospital London calls this “Diffuse RSI” which seems to be nerve injury. However it is well documented that many manual trades suffered from various types of repetitive strain injuries, (Washer woman’s wrist, telegraphist’s finger, etc.) and I use the term RSI as an umbrella term to cover various named medical conditions.
This collection of diseases and injuries, in itself a history of the afflictions that visit working people, shows the breadth and depth of illness and injury. In order to be recognised, for industrial injuries purposes, the medical condition must have been proved clinically beyond all doubt, and this is known as the epidemiology of the condition, and must have been approved by the Industrial Injuries and Advisory Commission, commonly known as IIAC.
A4 Cramp of the hand or forearm due to repetitive movements. For example writer’s cramp. Anyone involved in prolonged periods of handwriting, typing of other repetitive movement of fingers hand or arm, for example typists, clerks and routine assemblers. (So you see even that is not necessarily totally due to clerical work – a routine assembler usually works in the electronics industry where small components are assembled).
A5 Subcutaneous cellulitis of the hand (Beat Hand). Manual labour causing severe or prolonged friction or pressure on the hand, for example miners and road workers using picks and shovels. But this also could include gardeners digging, or even the use of a screwdriver causing pressure in the palm of hand.
A6 Bursitis (swelling) or subcutaneous cellulitis arising at or about the knee due to severe or prolonged external friction or pressure at or about the knee. (Beat Knee). Manual labour causing severe or prolonged external friction or pressure at or about the knee, for example workers who kneel a lot.
A7 Bursitis or subcutaneous cellulitis arising at or about the elbow due to severe or prolonged external friction or pressure at or about the elbow. (Beat Elbow). Manual labour causing severe or prolonged external friction or pressure at or about the elbow, for example jobs involving continuous rubbing or pressure on the elbow
A8 Traumatic inflammation of the tendons of the hand or forearm, or of the associated tendons sheaths. (Tenosynovitis). Manual labour, or frequent or repeated movement of the hand or wrist, for example routine assembly workers. (However it is common among keyboard and computer mouse operators, and those whose arms and hands are involved in jobs as varied as stirring large containers of soup, butchering meat, planing wood, using a manual screwdriver regularly, and other repetitive/static load jobs too numerous to mention.
A11 Vibration White Finger – the symptoms of episodic blanching (whiteness due to circulation seizing up) occurring throughout the year, in thumbs and fingers. Caused by handheld chain saws in forestry, or handheld rotary tools in grinding, sanding or polishing of metal, or the holding of material being ground or polished by rotary tools, or the use of handheld percussive (vibrating) metal working tools, are the use of handheld percussive drills or hammers, offer holding of material being worked upon by handling machines. (So you see this covers a wide range of tools).
A12 Carpal tunnel Syndrome – this is caused by the use of handheld powered tools whose internal parts vibrate so as to transmit without vibration to the hand, but excluding those which are solely powered by hand. (Excluded for example, are sewing machines, which do vibrate, and upon which the hands do rest, but are not classed as causing the injury, as the machine is not handheld).
Claiming Benefits
What also is not generally known is that claim for industrial injuries benefit can be made even if you are still working, but you are injured due to a work-related condition. Another thing that is not generally known when claiming for industrial injuries benefit, is that if you have an accident whilst on the way to work, travelling to and from work or at lunchtime and on the way home, you can also claim for industrial injuries benefit.
Therefore it is always beneficial to check via your union office, and then the citizens advice bureaux or local welfare rights advice centre, on whether or not you would qualify in the event of this happening to you. Useful leaflets, which can help regarding claiming benefits, are available from the Benefits Agency.
Links:
National Library for Health, Musculoskeletal Specialist Library
RSI ACTION.
help us to support those with this debilitating condition and work to ensure others do not develop it.
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Hazards lone working factsheet 
London Hazards Centre Factsheet
The risk to the health of workers increases as conditions move further away from those generally accepted as comfortable. Risk of heat stress arises, for example, from working in high air temperatures, exposure to high thermal radiation or high levels of humidity, such as those found in foundries, glass works and laundries. Cold stress may arise, for example, from working in cold stores, food preparation areas and in the open air during winter.
