Assessment & Management of Musculoskeletal

Dysfunctions related to various Industries.

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Work Related Musculoskeletal Disorder
Definition: MSDs are injuries and disorders of the musculoskeletal
system. They may be caused or aggravated by various hazards or risk
factors in the workplace.
MSD is an umbrella term for a number of injuries and disorders of the
MSK system.
Other terms that mean the same include :
• Repetitive strain injury (RSI)
• Cumulative trauma disorder (CTD)
• Work -related musculoskeletal disorder (WMSD)
• Musculoskeletal injury (MSI, MSK)
• Occupational overuse syndrome (OOS) 2
• Sprain and strain.
Work Related Musculoskeletal Disorder in
various industries
1. Carpal Tunnel Syndrome (CTS):
• Industry Example: Data Entry and Computer
Programming Workers who spend long hours
typing on keyboards and using a mouse do
repetitive wrist and hand movements.
2.Tennis Elbow (Lateral Epicondylitis) :
• Industry Example: Construction workers who
frequently use hand tools, such as hammers and
screwdrivers, can develop tennis elbow due to
repetitive gripping and wrist extension.
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3.Golfer's Elbow (Medial Epicondylitis):
Industry Example: Plumbers often use repetitive wrist
flexion and gripping motions when using tools like
wrenches, which can lead to golfer's elbow.
4.Rotator Cuff Tendinitis:
Industry Example: Painting Professional who perform
overhead painting tasks for extended periods can
develop rotator cuff tendinitis due to the repetitive
arm movements.
5.Trigger Finger:
IndustryExample:Agricultural workers who repeatedly
grip and squeeze farm equipment handles may develop
trigger finger.
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6.Back Pain and Strain:
Industry Example: Warehousing and Logistics workers
who frequently lift heavy boxes or engage in repetitive
bending and twisting motions may experience back
pain and strain.
7. Tendinopathies :
Industry Example: Field Construction Workers who
develop tendinopathies in the Achilles tendon due to
repetitive activities like digging and leveling.
8.Neck Pain:
Industry Example: Office workers who spend extended
periods working on computers with poor ergonomics
may develop neck pain and stiffness. 5
Work Related Musculoskeletal Disorder in lower limb.
1) Plantar Fasciitis:
• Industry Example: Retail workers who spend long
hours standing on hard surfaces may develop
plantar fasciitis, which causes heel pain and arch
discomfort.
2) Patellofemoral Pain Syndrome:
• Industry Example: Construction workers who
frequently climb ladders and perform tasks that
involve squatting or kneeling may experience
patellofemoral pain syndrome.
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3) Knee Osteoarthritis:
Industry Example: Carpentry work often involves
prolonged periods of kneeling or squatting, which can
increase the risk of knee osteoarthritis over time.
4) Deep Vein Thrombosis (DVT):
Industry Example: Occupations that involve long periods
of sitting,suchas airline pilots or long-haul truck drivers,
can increase the risk of DVT in the lower limbs.
5) Peripheral Arterial Disease (PAD):
Industry Example: Security guards who stand or patrol
for extended periods, especially in cold weather
conditions, may be at risk of developing PAD.
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Consequences of WRMSD-
• Impact on health
• Decrease productivity
• Absenteeism
• Socio-economic burden
• Change of jobs
MSD Hazards-
1- Force.
2- Fixed or awkward postures.
3- Repetitions.
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1) Force:
• When a task requires to exert a level of force that is too high for any particular
muscle, it can damage the muscle or the related tendons, joints and other soft
tissue.
• Commonly , the damage results when muscles generate moderate to high levels
of force.
With force, it is important to consider not only how much force is involved but also
1) How long workers need to keep exerting the force.
2) How many times the force is exerted in a given period of time.
3) The posture used when exerting the force.

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2) Fixed or Awkward Postures -
• A good or “neutral” posture means that the joints are being used near
the middle of the full range of motion.
• The farther a joint moves towards either end of its range of motion,
or the farther away from the neutral posture, the more awkward or
poor the posture becomes and the more strain is put on the muscles,
tendons and ligaments around the joint.

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Awkward posture evaluated by RULA and REBA Assessment

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Repetition
• The risk of developing an MSD increases when the same parts of the
body are used repeatedly, with few breaks or chances for rest.
• Highly repetitive tasks can lead to fatigue, tissue damage, and,
eventually, pain and discomfort.
• This can occur even if the level of force is low and the work postures
are not very awkward.
• Assessment- For repetitive task,
1. Occupational Repetitive Actions (OCRA)
2. Job Strain Index (JSI)
3. Hand Arm Risk Assessment Method (HARM) 13
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Work Related Musculoskeletal Disorders Hazards

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Other MSD Hazards and Workplace Factors

• Factors that should be considered include:

• Contact stress
• Local or hand/arm vibration
• Whole-body vibration
• Cold temperatures .
• Hot work environment.

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Psychosocial Risk Factors

• High perceived work load

• Time pressure
• Low job control
• Perceived stress
• High psychological stresses

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Work Related MSD : COMPUTER USER
(SoftwareDeveloper/Programmer,WebDeveloper,GraphicDesigner,Gamer,AdminWorkerLibrarian)

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 • Slumped Shoulders: Allowing the shoulders to droop forward,
which can lead to shoulder and upper back discomfort.
MSD : Rounded shoulders can contribute to thoracic outlet syndrome
and upper back discomfort.
• Bent Wrists: Typing with the wrists bent upward or resting on a hard
surface without support, increasing the risk of wrist and forearm
strain.
MSD : Carpal tunnel syndrome and repetitive strain injuries (RSI) due
to awkward wrist positions during typing .

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 • Crossed Legs: Sitting with legs crossed at the knees or ankles, which
can disrupt blood circulation and lead to discomfort in the legs.
MSD : Prolonged leg crossing may lead to hip and lower back strain and
increase the risk of varicose veins.
• Feet Off the Ground: Feet not flat on the floor or on a footrest,
causing improper weight distribution and potential strain on the lower
back and thigh region.
MSD : Poor leg support can cause sciatica, lower back pain, and
circulation issues in the legs.

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 • Overreaching :Reaching too far for the mouse or keyboard, forcing
the shoulders and arms into awkward positions.
MSD: Overreaching for peripherals can result in shoulder impingement
and discomfort in the arms and shoulders
• Inadequate Lumbar Support: Sitting without proper lower back
support, leading to poor spine alignment and lower back pain.
MSD : Lumbar discomfort or exacerbation of conditions like herniated
discs due to lack of proper lower back support.

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 • Ignoring Breaks: Same position for extended periods without taking
breaks
MSD : Prolonged sitting without breaks can contribute to deep vein
thrombosis (DVT) and exacerbate existing musculoskeletal issues.
• Using a Non-Ergonomic Chair or Desk: Sitting in a chair or at a
desk that is not adjusted to the user's body, resulting in discomfort and
poor posture.
MSD : Can lead issues,including chronic back pain, sciatica, and RSI.
• Ignoring Discomfort: Continuing to work despite feeling discomfort
or pain, which can exacerbate posture problems and potentially lead to
musculoskeletal issues.
MSD: Continuing to work in discomfort can worsen existing 26
musculoskeletal conditions and potentially lead to chronic pain.
Work Related Musculoskeletal Disorder in
Lifting and Packaging Industry
• Lifting heavy items is one of the leading causes of
injury in the workplace.
• Overexertion and cumulative trauma were the
biggest factors in these injuries.
• Bending, followed by twisting and turning, were the
more commonly cited movements that caused back
injuries 27
• Strains and sprains from lifting loads improperly or from
carrying loads that are either too large or too heavy are
common hazards associated with manually moving
materials.

• When employees use smart lifting practices, they are less

likely to suffer from back sprains, muscle pulls, wrist
injuries, elbow injuries, spinal injuries, and other injuries
caused by lifting heavy objects.
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Work Related MSD : Management

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Work Related MSD : Management
1)Organizational Management
• Engineering Controls
• Administrative Controls
2) Ergonomics.
3) Fitness for work –
• Life style modification ,Workplace exercises.
4) Knowledge and Training
• To provide the necessary information to implement an effective
injury prevention process 32
Organizational Management
• 1) Engineering Controls:
• Redesigning the layout of workstations to minimize reaching and
bending.
• Installing height-adjustable workbenches to accommodate different
employee heights.
• Implementing mechanical assist devices to reduce the physical burden
of lifting and carrying heavy loads.
• Incorporating handles or slotted hand holes in packages to facilitate
manual handling.
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Administrative Controls
• Limiting the length of work shifts or the amount of overtime
to prevent excessive fatigue.
• Implementing job rotation to reduce prolonged exposure to
specific ergonomic hazards.
• Providing more frequent breaks to allow for rest and
recovery.
• Conducting training programs to educate workers about
recognizing ergonomic risk factors and teaching techniques
to ease physical strain and stress during tasks. 35
Ergonomics

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Ergonomically Designed Chair

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Forward Head Position: Adjust monitor height and position to eye level , keeping the head
aligned with the spine.

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• Bent Wrists: ergonomic keyboards and mouse devices. Proper
wrist and hand positioning. Offer wrist supports or pads to reduce
strain.
• Feet Off the Ground: Provide adjustable chairs and footrests to
support proper leg positioning

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• Overreaching :Arrange the workstation to minimize overreaching. Place
peripherals within easy reach. Ensure proper desk layout to reduce strain on the
arms and shoulders.
• Inadequate Lumbar Support: chairs with adjustable lumbar support or cushions.
Conduct ergonomic assessments to customize chair settings for users.
• Ignoring Breaks: Promote regular breaks for stretching and movement.
Implement software reminders or encourage users to set alarms for breaks.

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ERGONOMICS FOR LIFTING

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Lifestyle Modification for Preventing MSDs:
• Balanced Diet: Choose nutritious foods to support overall health
and reduce the risk of obesity-related MSDs.
• Hydration: Stay adequately hydrated to keep joints and muscles
functioning optimally.
• Regular Exercise: Engage in physical activity to maintain muscle
strength and flexibility.
• Stress Management: Practice stress-reduction techniques to
alleviate tension that can contribute to MSDs.

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On-the-Job Fitness Programs:

• Incorporate Physical Activity: Implement fitness routines during

work breaks to combat the negative effects of prolonged sitting.
• Stretching: Encourage employees to perform simple stretches to
reduce muscle tension.
• Yoga: Offer yoga sessions to improve flexibility and relaxation.
• Brief Walks: Promote short walks to boost blood circulation and
overall well-being during the workday.

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Knowledge and Training
• Workplace Exercises:

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Knowledge and Training
• This initiatives aim to educate employees about the causes of MSDs, risk factors, and
prevention strategies.
• This includes information on ergonomics, proper body mechanics, and recognizing
early signs of discomfort or injury sign.

Effective Injury Prevention Process:

• Comprehensive training helps implement a robust injury prevention process.
• This process involves creating a culture of safety, where employees understand the
importance of preventing MSDs and are equipped with the knowledge to do so 47
 Effectiveness of Workplace-Based Muscle Resistance Training Exercise
Program in Preventing Musculoskeletal Dysfunction of the Upper Limbs in
Manufacturing Workers (2019)
• Study population: Manufacturing workers inWorkers
Limbs in Manufacturing furniture companies with upper limb
(2019)
repetitive tasks.
• Inclusion criteria: Workers up to age 40, with slight upper limb musculoskeletal
pain (VAS ≤ 30 mm), and OCRA score ≥7.5.
• Exclusion criteria: Workers with less than one year of employment, upper limb
trauma history, or cardiovascular/systemic diseases were excluded
• Duration: 16-week intervention,Supervised by 2 physiotherapists
• Participants' tolerance was assessed before increasing resistance.
• Each cycle included concentric, isometric, and eccentric contractions with 10-
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second breaks
Phase 1 (48 sessions):

• Targeted shoulder stabilizing muscles.

• Used Theraband with progressive resistance levels of 4.6 kg, 6.3 kg, and 8.5 kg.
• Each resistance level was used for 16 sessions .
• ;

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1. Elevator muscles; 2. Retractor muscles; 3. Protractor muscles; 4. Abductor muscles; 5. Rotator muscles
Phase 2 (36 sessions):
• Built upon Phase 1 exercises.
• Introduced forearm and hand muscle strengthening.
• Used Theraband with the same progressive resistance levels for 12 sessions
each.

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6. Supinator muscles; and 7. External rotators muscles
Phase 3 (24 sessions):
• Incorporated exercises from Phases 1 and 2.
• Focused on strengthening shoulder external rotation and elevator muscles.
• Utilized Theraband with the same progressive resistance levels for 8 sessions each.

Women's Protocol: Women followed the same protocol as men but with lower
resistance levels:
• Theraband resistances were 3.2 kg, 4.6 kg, and 6.3 kg.

Control Group: The control group followed a daily routine established by the
companies, involving stretching exercises supervised by a trained monitor , under the
guidance of supervising physiotherapists.
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Outcome measure used
• Pain Intensity: Visual Analog Scale (VAS)
• Musculoskeletal History: Nordic Questionnaire.
• Functional Assessment: Assessed using the (DASH) Questionnaire.
• Clinical Tests: Included tests for shoulder (subacromial impingement, supraspinatus
muscle, painful arch) and forearm (epicondylitis) conditions.
Results : The muscle resistance training exercise had a protective effect on the intensity
of pain perceived by workers in their upper limbs (RR: 0.62 95% CI 0.44–0.87) compared
with the group of workers who performed stretching exercises.
Conclusion A workplace-based muscle resistance training exercise program is an
efective preventive strategy in factory workers exposed to risk; however, it is necessary
for companies initially to adopt mechanisms to minimize exposure as a prevention
strategy.
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 Rest break interventions in stoop labor tasks - Farmers (2016)

• Objective: Assess the impact of adding 5-minute rest breaks to each working
hour on symptoms and productivity among farm workers in physically
demanding tasks.
• Population: Farm workers in strawberry harvest.
• Methodology: Randomized control trial , introducing additional rest breaks.
• Intervention Results:Reduced symptom severity in trials.Variations in
productivity noted.
• Conclusion: Frequent, brief rest breaks can alleviate symptoms in strenuous
farm work but may influence productivity differently based on timing.
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