Related Musculoskeletal Disorders Research Articles

Correlation between risk factors and musculoskeletal disorders among classical musicians

Musculoskeletal disorders in humans may originate from biomechanical, environmental, psychosocial and personal risk factors encountered in the working environment. These disorders in musicians are designated as playing related musculoskeletal disorders (PRMD). To investigate the correlation between biomechanical, environmental, psychosocial and personal risk factors and potential incidence of PRMD arising in professional classical musicians. Fifty-nine orchestral classical musicians were observed: They also filled out questionnaires providing information regarding musculoskeletal symptoms, psychosocial factors and demography. Clinical observation using the Rapid Upper Limb Assessment (RULA) showed significantly higher scores in string musicians compared with woodwind and brass players (right RULA score F = 4.77, P < 0.05; left RULA score, F = 3.90, P < 0.05). A multivariate regression model showed statistical significance for five of the six dependent variables regarding prevalence of painful joints, severity of musculoskeletal symptoms and functional limitation. The regression analysis revealed that biomechanical risk factors, perceived physical environment risk factors, instrument weight and average playing hours per week, were the main predictors of PRMD. The biomechanical risk factors that predict PRMD are mainly associated with the upper limbs. A high association between PRMD and clinical observation emphasizes the need for further investigation of these risk factors and to study possible implementations in order to define 'prevention strategies' for musical routines and patterns, as used by classical musicians.

Work related musculoskeletal disorders amongst therapists in physically demanding roles: qualitative analysis of risk factors and strategies for prevention

BackgroundPhysiotherapy and occupational therapy are two professions at high risk of work related musculoskeletal disorders (WRMD). This investigation aimed to identify risk factors for WRMD as perceived by the health professionals working in these roles (Aim 1), as well as current and future strategies they perceive will allow them to continue to work in physically demanding clinical roles (Aim 2).MethodsA two phase exploratory investigation was undertaken. The first phase included a survey administered via a web based platform with qualitative open response items. The second phase involved four focus group sessions which explored topics obtained from the survey. Thematic analysis of qualitative data from the survey and focus groups was undertaken.ResultsOverall 112 (34.3%) of invited health professionals completed the survey; 66 (58.9%) were physiotherapists and 46 (41.1%) were occupational therapists. Twenty-four health professionals participated in one of four focus groups. The risk factors most frequently perceived by health professionals included: work postures and movements, lifting or carrying, patient related factors and repetitive tasks. The six primary themes for strategies to allow therapists to continue to work in physically demanding clinical roles included: organisational strategies, workload or work allocation, work practices, work environment and equipment, physical condition and capacity, and education and training.ConclusionsRisk factors as well as current and potential strategies for reducing WRMD amongst these health professionals working in clinically demanding roles have been identified and discussed. Further investigation regarding the relative effectiveness of these strategies is warranted.

Awareness among Indian dentist regarding the role of physical activity in prevention of work related musculoskeletal disorders

The prevalence of work-related musculoskeletal complaints in dentists is high and the past two decades have witnessed a sharp rise in the incidence of various disorders. The prevalence of musculoskeletal pain ranges between 64% and 93%. The most effected regions have been back and neck. Various studies have been done to record stress levels and health-related behaviors of dentists in other countries but limited data is available among the Indian dentists. Therefore a questionnaire survey was carried out among 102 Indian dentists belonging to different fields having at least one musculoskeletal disorder in last 6 months. The total sample consists of 80 males and 22 females. Out of the 102 over 97 of dentists had sought medical advice for these disorders during the previous 06 months and 74 of them also consulted the physiotherapist for exercises and ergonomic advice. The number of sessions taken for regular physical exercises was minimum 6 till 44 the most. The percentage of improvement in symptoms varied between 20% and 80%. A significant direct correlation between the number of sessions taken for physical activity and the self-perceived improvement in the symptoms was found using the Pearson correlation test. The work-related musculoskeletal disorders among dentists not only decrease their efficiency but also is a major concern among them. Self-awareness and benefits of regular exercise is the need of the hour.

Effect of yogic exercises on symptoms of musculoskeletal disorders of upper limbs among computer users: A randomised controlled trial

Upper extremity musculoskeletal disorders (MSD) are very common in regular computer users and leading cause of work related illness. The objective of the present study is to evaluate effectiveness of yogic exercises in the improvement of symptoms of MSDs of upper limbs. 60 study participants were randomly divided into two groups that is yoga with counselling and only counselling group for 12 weeks. Symptom severity and functional status were assessed using the self administered Boston Carpal Tunnel Questionnaire and predesigned symptom questionnaire before and after intervention. There was significant reduction in symptom severity score (P = 0.002) and improvement in functional status score in yoga with counselling group when compared to only counselling group. There is also a significant decrease in self reported symptoms like CT myalgia symptom (P = 0.019) and improvement in weakness. The present study showed a yoga based regimen is more effective than counselling alone in relieving symptoms of computer related musculoskeletal disorders.

Antecedents of work related musculoskeletal disorders in software professionals

In this paper, the present Indian burden of work related musculoskeletal disorders are studied. Adult musculoskeletal disorders (MSD) such as neck and low back pain have been widely reported as being of significant health and economic concern due to increased globalisation and industrial advancements. This study is an attempt to find whether these disorders are also prevalent amongst Indian software professionals. The paper also reveals the role of gender differences in MSD. Neck pain is found to be the most prevalent pain. Posture, body fatigue, hours of computer usage and lack of ergonomic knowledge etc. are found to be causal factors determining work related MSD. A total of 355 software professionals were studied and the research draws conclusion that it is important to have conscientisation about the changing world and the increased need for ergonomics interventions in today’s work places.

Clinical, Biomechanical, and Physiological Translational Interpretations of Human Resting Myofascial Tone or Tension

Myofascial tissues generate integrated webs and networks of passive and active tensional forces that provide stabilizing support and that control movement in the body. Passive [central nervous system (CNS)-independent] resting myofascial tension is present in the body and provides a low-level stabilizing component to help maintain balanced postures. This property was recently called "human resting myofascial tone" (HRMT). The HRMT model evolved from electromyography (EMG) research in the 1950s that showed lumbar muscles usually to be EMG-silent in relaxed gravity-neutral upright postures. Biomechanical, clinical, and physiological studies were reviewed to interpret the passive stiffness properties of HRMT that help to stabilize various relaxed functions such as quiet balanced standing. Biomechanical analyses and experimental studies of the lumbar multifidus were reviewed to interpret its passive stiffness properties. The lumbar multifidus was illustrated as the major core stabilizing muscle of the spine, serving an important passive biomechanical role in the body. Research into muscle physiology suggests that passive resting tension (CNS-independent) is generated in sarcomeres by the molecular elasticity of low-level cycling cross-bridges between the actomyosin filaments. In turn, tension is complexly transmitted to intimately enveloping fascial matrix fibrils and other molecular elements in connective tissue, which, collectively, constitute the myofascial unit. Postural myofascial tonus varies with age and sex. Also, individuals in the population are proposed to vary in a polymorphism of postural HRMT. A few people are expected to have outlier degrees of innate postural hypotonicity or hypertonicity. Such biomechanical variations likely predispose to greater risk of related musculoskeletal disorders, a situation that deserves greater attention in clinical practice and research. Axial myofascial hypertonicity was hypothesized to predispose to ankylosing spondylitis. This often-progressive deforming condition of vertebrae and sacroiliac joints is characterized by stiffness features and particular localization of bony lesions at entheseal sites. Such unique features imply concentrations and transmissions of excessive force, leading to tissue micro-injury and maladaptive repair reactions. The HRMT model is now expanded and translated for clinical relevance to therapists. Its passive role in helping to maintain balanced postures is supported by biomechanical principles of myofascial elasticity, tension, stress, stiffness, and tensegrity. Further research is needed to determine the molecular basis of HRMT in sarcomeres, the transmission of tension by the enveloping fascial elements, and the means by which the myofascia helps to maintain efficient passive postural balance in the body. Significant deficiencies or excesses of postural HRMT may predispose to symptomatic or pathologic musculoskeletal disorders whose mechanisms are currently unexplained.

Can the Fear-Avoidance Beliefs Questionnaire predict work status in people with work-related musculoskeltal disorders?

To investigate the predictive validity of fear avoidance beliefs as assessed by the Work Subscale (FABQ-W) of the Fear Avoidance Beliefs Questionnaire in a sample of 117 patients with a work-related musculoskeletal disorder, and identify two FABQ-W cut off points that identified participants as high or low risk of non return to work, following an interdisciplinary rehabilitation program. A retrospective analysis of patient data collected in conjunction with the Victorian Workcover Authority "Sprains and Strains" program. Sequential logistic regression analysis was used to construct a model of prediction from the baseline variables of age, disability (using the Pain Disability Index), gender and FABQ-W scores. Receiver Operator Characteristic (ROC) curves were used to identify FABQ-W cut off points that best predicted the return to work outcome. Age and initial FABQ-W scores significantly improved the predictive capabilities of the model, but gender and disability did not. The model explained between 13.1% and 18.2% of the variability in the RTW outcome. ROC curves showed maximum sensitivity was 100% for a score of ≤ 27.5, with a score of > 39.5 identified as having optimum specificity (81.9%). Individuals with low FABQ-W scores are likely to return to work, however those with high scores will not necessarily have a poor outcome. This study supports the limited utility of the FABQ-W score for screening for risk of a poor return to work outcome in patients with a work related musculoskeletal disorder.

반복적인 들어올리기 작업시 작업자의 생체정보, 인체활동량 및 허리부하 분석

Workers in the agricultural industry have been exposed to many work-related musculoskeletal disorders. So, our objectives in this study were to measure and analyze worker’s physiological bio-information to reduce musculoskeletal disorders in relation to agricultural works. We investigated worker’s bio-information of physiological signals during the repeated lifting work such as body temperature, heart rate, blood pressure, physical activity, and heart rate variability. Moreover, we analyzed the workloads of lumbar spine during the repeated lifting work using the 3-axis acceleration and angular velocity sensors. The changes of body temperature was not significant, but the mean heart rate increased from 90/min to 116/min significantly during 30 min of repeated lifting work (p<0.05). The average worker’s physical activity(energy consumption rate) was 206 kcal/70kg/h during the repeated lifting work. The workers’ acute stress index was more than 80, which indicated a stressful work. Also, the maximum shear force on the disk (L5/S1) of a worker’s lumbar spine in static state was 500N, and the maximum inertia moment was 139 N․m in dynamic state.

Risk Assessment and Application of Engineering Controls to Reduce the Number of Occupational Related Musculoskeletal Disorders in a Large Pharmaceutical Production Facility

The high number of discomfort and lost work time cases in one department of a large pharmaceutical production facility, created a unique opportunity for ergonomics study and intervention. The first step in the project identified the three highest risk tasks using safety incident data. Each task was analyzed for ergonomics risk factors. Interventions were developed and implemented for these tasks. Biomechanical and subjective data were collected before and after all interventions to assess the effectiveness of the interventions. Three-dimensional dynamic flexion of the lower back data were collected using a Lumbar Motion Monitor (LMM). Electrogoniometers were used to measure wrist flexion. We used a force gauge, scale, and a tape measure to assess moments, forces, and weight. Subjective data were collected by questionnaire. A quantitative comparison of the subjective and electronic data showed reduced risk factors for Work-Related Musculoskeletal Disorders (WMSDs) of the wrist and back for all three tasks. All the interventions were shown by empirical methods to reduce the risk factors for WMSDs. The interventions were permanently implemented.

근골격계질환예방을 위한 국내외 제도

The presence of musculoskeletal burden tasks and work related musculoskeletal disorders (WMSDs) at Industrial workers was not well-known until 2000 in Korea. Since The Occupational Safety & Health Law was registered a business of proprietor duty in preventing work-related MSDs of workers In July of 2003 WMSDs became a big issue in Korea. A social previous interest was focused on the manufacturing industry just like auto and shipping industry in manufacturing sectors but nowadays it is spreading out to non-manufacturing fields gradually. Nevertheless, we have WMSD prevention Law and System in Korea to reduce WMSDs effectively and systematically we recognized some mistakes and problems of WMSD Law and System. In this paper we study these recent problems in Korea from about 10 years experience and proposed some proposals as discussion.

조선업종에서 인간공학 프로그램의 운영사례

Work related musculoskeletal disorders (WMSDs) became a major problem since 2000 in shipbuilding industry. WMSDs are known to be resulted from awkward postures, high repetitive motions, excessive forces, mechanical stress and vibration. Korean government enacted a law to require companies to take measures to prevent musculoskeletal disorders at work. If there are more than 10 incidences of WMSDs or 5 incidences which are more than 10 percent of all workers in a company, this law requires a company to implement an ergonomics program. A few large companies in shipbuilding industry have already implemented or are in the process of implementing an ergonomics program. This paper presents a case study of an implementation of an ergonomics program in a Korean shipbuilding company. We audited the process of the ergonomics program in this shipbuilding company four times for 3 years. Based on the findings, this paper presents effects and problems of an ergonomics program and improvement measures of them. These findings will help companies which want to implement an ergonomics program in the future.

Effect of backpack weight on postural angles in preadolescent children

Carrying heavy backpacks could cause a wide spectrum of pain related musculoskeletal disorders and postural dysfunctions. To determine the changes in various postural angles with different backpack weights in preadolescent children. Cross-sectional. Healthy male school-children (n=200), mean (SD) age: 12.5 (0.5) years, from high schools in Mangalore, India. Bodyweight and height were measured using a forceplate and stadiometer, respectively. From the weight recorded, 5%, 10%, 15%, 20%, and 25% of the bodyweight were calculated and implemented as their respective backpack loads. The Image Tool version 3.0, digitizing software was used for analyzing photographs to determine craniovertebral (CV), head on neck (HON), head and neck on trunk (HNOT), trunk and lower limb angles. Postural angles were compared with no backpack and with backpacks weighing 5% to 25% of the subject's bodyweight. The CV angle changed significantly after 15% of backpack load (P <0.05). The HON and HNOT angles changed significantly after 10% of backpack load (P <0.05). The trunk and lower limb angle also changed significantly after 5% of backpack load (P <0.05). Carrying a backpack weighing 15% of body weight change all the postural angles in preadolescent children.

Exposição ocupacional do cirurgião-dentista à vibração mecânica transmitida através das mãos: um estudo de caso

O objetivo do presente trabalho foi estimar a exposição a vibrações induzidas pelo uso de instrumentos rotatórios por cirurgiões-dentistas. Os instrumentos rotatórios analisados foram de alta e de baixa rotação. Os efeitos deletérios das vibrações no conjunto mão/braço são uma função da frequência e da amplitude do sinal. Observou-se que os efeitos dependem, ainda, da excitação ser constituída por uma única frequência ou apresentar um espectro complexo. Foram testadas três amostras de cada instrumento rotatório (canetas), a saber: caneta de alta rotação, contra-ângulo de baixa rotação e peça de mão, também de baixa rotação. A utilização por cirurgiões-dentistas dos instrumentos rotatórios avaliados aqui não representa risco ocupacional em termos das vibrações transmitidas às mãos, mesmo que operados continuamente ao longo de seis horas de trabalho; entretanto pode ser importante fator coadjuvante no desenvolvimento de LERs/DORTs. Por outro lado, o conjunto de efeitos fisiológicos das vibrações leva a crer que fortes oscilações mecânicas diminuem a capacidade de desempenho e em muitas situações aumentam o risco de falhas e acidentes.

Working conditions and musculoskeletal pain among Brazilian pottery workers

In the municipality of Pedreira in São Paulo State, Brazil, a large number of workers from the ceramic industry have left their jobs because of work related musculoskeletal disorders. The objectives of this study were to describe the work conditions pertaining to the ceramic industry, to determine the prevalence of musculoskeletal pain and to identify the associations between symptoms and organizational, biomechanical, psychosocial and individual variables. Nine ceramic manufacturers participated. The activities of 18 individuals were analyzed through direct observation. All workers answered a questionnaire about work and health (n = 235). The results found that the general working conditions in the pottery manufacturers were poor. A 38.5% prevalence of musculoskeletal pain was found. Repetition, tool use, lack of control over decisions, worries regarding work demands, relationship issues, work dissatisfaction and the wish to move on to another function were all associated with pain. We concluded that musculoskeletal pain is one of the outcomes of elevated human requirements resulting from working conditions and organization in the ceramic industry.

Effect of Working Posture on Occurence of Musculoskeletal Disorders among the Sand Core Making Workers of West Bengal

The sand core making process is performed manually in West Bengal involving a large number of workers of lowest economic strata. The core making workers most often work for a prolonged period of time and they are forced to handle various amounts of heavy load during the entire period of work. In this study an attempt was made to identify the work related musculoskeletal disorders among the sand core-making workers. Fifty male workers engaged in carbon dioxide and chemical core making work at an unorganized sector at Baruipur, Calcutta were randomly selected for this study. A detailed modified Nordic questionnaire study on discomfort feeling was performed among the core making workers. REBA method was applied to analyze the working posture. Finally, discomfort level and risk level of the individual working postures were calculated by the use of risk level and discomfort level scale. From the questionnaire study it was revealed that most of the core making workers grind often in awkward postures. The workers were affected by musculoskeletal disorders like pain at low back (100%), hand (40%), shoulder (30%), wrist (20%) and neck (20%). It has been also found that there is a significant (p < 0.05) correlation between discomfort level and risk level of the individual working postures of the workers. It was concluded from the study that health of the core-making workers was highly affected by different awkward postures and that they suffer from posture-related musculoskeletal disorders primarily affecting the low back region.

Evaluating ergonomic risk factors in non-regulated stone carving units of Jaipur

Stone carving at Jaipur in Rajasthan state of India, is a traditional craft employing a large number of local youths. As an unorganized sector problems are many ranging from lack of benefits to occupational ergonomic issues of Work Related Musculoskeletal Disorders(WMSDs) and injury to body parts. Twenty five male workers were selected in each of the three sections of a stone carving unit. The focus was to identify different ergonomic risk factors associated in this profession from the field. Still photography and video photography was used to record different activities. Different types of non invasive tools like Rapid Entire Body Assessment (REBA), Rapid Upper Limb Assessment (RULA), Occupational Repetitive Action Index (OCRA) were used. Psychophysical measures were investigated by Body part discomfort map, rated perceived exertion scale and visual analogue scale. Objective measurements (heart arte and skin temperature) were recorded with stop watch and digital thermometer. The working heart rate after 30 minutes of work was 112.4 beats per minute categorizing the work as moderately heavy. Postural analysis by REBA indicated high score (13/13). Similarly postural analysis by RULA showed high score (7/7). These indicate vulnerability of many of the postures to musculoskeletal disorders and injury. The study indicates that majority of the activities are in the high risk category and demands immediate ergonomic intervention in the form of tool, workstation and process design. This could be done by involving different Non Government Organizations (NGOs), political parties, and the Human Rights Department both at the center and at the state level.

Gender Differences, Work Stressors and Musculoskeletal Disorders in Weaving Industries

A study was undertaken to identify the work stressors among male and female weavers (N=516) in powerloom and handloom and examine the association of work stressors with the prevalence of work related musculo-skeletal disorders (MSDs). Physical and psychosocial stresses of work, job diagnostics, hazards of workplace, working environment and MSDs prevalence were assessed. There is high prevalence of MSDs among weavers. Female weavers in powerloom and handloom were more prone to developing MSDs in upper back (OR 1.8; p<0.05 and OR 2.1; p<0.01) and lower back (OR 1.9; p<0.05 and OR 1.8; p<0.05). Male weavers were more prone to developing pain in the knee (OR 2.9; p<0.001), and hand (OR 2.2; p<0.05). Multivariate analysis indicated that job duration >10 yr (OR 3.7, p<0.05), manual material handling (OR 3, p<0.05), and poor machinery safety (OR 11, p<0.05), contributed to occurrence of MSDs amongst powerloom weavers. Among the handloom weavers, age >25 yr (OR 3.2, p<0.05), poor machinery design (OR 2.2, p<0.01), mental overload (OR 5.7, p<0.001), skill requirement to perform jobs (OR 20.7, p<0.05) had significant influence in the occurrence of pain. Gender differences exist in the prevalence of MSDs and the perception of work and psycho-social stresses among the weavers.

근골격계 질환 예방을 위한 하지의 불균형 작업자세에서 근전도를 이용한 하지 근육의 작업부하 평가

Work related musculoskeletal disorders(WMSDs) was a leading cause of sick leave and injuries in the industries of our country. Posture was an important consideration in the design of work method and workplaces, because it affected the ability of workers to use various equipments and influenced how long they could perform their job without feeling discomfort, fatigue, and musculoskeletal disorders. Imbalanced lower limb postures such as a squatting posture were awkward working postures common to the shipbuilding shops, farms, automobiles assembly lines in our country. Different awkward working postures were known to be associated with specific musculoskeletal disorders. Eight postures in lower limb postures divided into balanced and imbalanced postures were evaluated by electromyographic(EMG) activity for lower limb muscles. Twelve male subjects participated in this study. This paper was to analyze the effects of lower limb muscles workload according to lower limb postures(knee angle) and working time. The ANOVA results showed that most EMG root mean square(RMS) values were statistically significant effect according to lower limb postures(knee angle) and working time. Therefore, the results of this study will provide the basis to evaluate workload of lower limb postures correctly adopted by workers in various jobs and the ergonomic reference to prevent WMSDs.

Lesões por esforços repetitivos/distúrbios osteomusculares relacionados ao trabalho de cirurgiões-dentistas: aspectos biomecânicos

As patologias denominadas genericamente Lesões por Esforços Repetitivos/Distúrbios Osteomusculares Relacionados ao Trabalho (LERs/DORTs) e que apresentam sinais e sintomas de inflamações dos músculos, tendões, fáscias e nervos dos membros superiores, cintura escapular e pescoço, entre outros, têm chamado a atenção não só pelo aumento de sua incidência mas por também existirem evidências de sua associação com o ritmo de trabalho. O exercício profissional obriga que cirurgiões-dentistas utilizem na execução de suas tarefas os membros superiores e estruturas adjacentes, frequentemente com repetitividade de um mesmo padrão de movimento, compressão mecânica das estruturas localizadas na região e a adoção de posturas incorretas, utilizando força excessiva e, na maioria dos casos, trabalhando, ainda, sob a pressão do tempo de realização. O presente estudo utilizou a análise biomecânica, através da cinemetria e da eletromiografia, para buscar evidências da relação entre as tarefas executadas pelo cirurgião-dentista e as LERs/DORTs. A análise dos dados cinemáticos revelou que as principais atividades realizadas pelos cirurgiões-dentistas submetem duas ou mais regiões do corpo do profissional a posturas consideradas de risco médio e alto, sendo que a análise dos sinais eletromiográficos revelou um grande comprometimento dos grupamentos musculares flexores e extensores do carpo e do trapézio. Finalmente, o presente estudo é mais um indicativo de que a atividade desses profissionais os expõe a risco considerável de adquirir LERs/DORTs.

Work related psychosocial risks and musculoskeletal disorders: Potential risk factors, causation and evaluation methods

Musculo Skeletal Disorders (MSDs) are the focus of considerable attention and research in occupational health, which is in part due to high prevalence rates and associated costs. In the United States, the total cost associated with MSDs increased from $81 billion in 1986 to $215 billion in 2005 [3]. Epidemiological studies have repeatedly shown associations between work-related psychosocial factors and MSDs, and the role of psychosocial factors and stress in these disorders has received increased attention. Several reviews have reported associations between MSDs and work-related psychosocial factors such as high workload/demands, high perceived stress levels, low social support, low job control, low job satisfaction and monotonous work. Several theories have been proposed to explain the apparent relationship between stress and MSDs in the workplace from a biological perspective. These include the biopsychosocial model of job stress, the hyperventilation theory, the migraine theory, the muscle spindle theory and the Cinderella hypothesis. Within the literature, a vast array of questionnaires have been developed in an attempt to measure the psychosocial factors that occur within the workplace. This article presents a discussion of existing knowledge of the psychosocial risk factors potentially linked to MSDs and potential pathways to injury. A discussion of evaluation approaches used to estimate psychosocial risk exposures in workplaces is also presented.