How Your “Musculoskeletal Mindset” Can Impact Injury Risk at Work

While the study of orthopedics has traditionally placed emphasis on the physical influencers impacting our bones, tendons, ligaments and other surrounding soft tissue comprising the musculoskeletal system, new research now spotlights the increasingly important role of workplace “psychosocial” factors on musculoskeletal disorders (MSD).Tired man being overloaded at work

According to the Canadian Centre for Occupational Health and Safety (CCOHS), a workplace psychosocial factor is defined as “a non-physical aspect of the workplace that is developed by the culture, policies, expectations and social attitude of the organization.” [1]

Basically, psychosocial factors umbrella the different emotional responses to the demands placed on workers while performing their job –  including frustration, dissatisfaction, depression and despair. The resulting stress induces physiological responses that can contribute to the development of musculoskeletal disorders.

New research reported by the CCOHS identifies some physiological responses to psychosocial factors, including:

  • Increased blood pressure, which in small joint spaces can increase pressure on tendons, ligaments and nerves.
  • Increased fluid pressure over a prolonged period of time can also increase pressure in joints and on surrounding soft tissue as well as the carpal tunnel.
  • Reduction of growth functions can reduce production of collagen and consequently the body’s ability to heal or recover after performing work functions.
  • Over time a decreased sensitivity to pain can prompt workers to work beyond their body’s physical capacity, predisposing it to injury.
  • Increased muscle tension can increase pressure on and around the joints and may cause excessive use of force during certain activities and movements.
  • The body’s heightened state of sensitivity may overburden the musculoskeletal system by prompting a person to lift more, work faster, etc.

It is difficult in our current healthcare environment to directly attribute “workplace psychosocial factors” as a cause of workplace MSD, because of the many other factors that contribute to such disorders/injuries (biomechanical, etc.). Increasingly, though, evidence and newly published scientific research studies are helping to spotlight the role that these factors play, and the link between “stress induced physiological changes” and musculoskeletal disorders.

Additionally, a growing number of research studies are reporting a link between emotional disorders (anxiety, depression) and medical and surgical complication rates, lower patient satisfaction scores and readmission risk in joint replacement patients. [2,3]

There will likely be much more research on these topics in the coming years.

This new information underscores the importance of identifying and addressing psychological stressors and our response to them, as they are proving to have a significant impact on not only the cardiovascular but also the musculoskeletal system – two vital contributors to overall health and well-being.

 

References

  • Canadian Centre for Occupational Health and Safety (CCOHS), cchos.ca , https://www.ccohs.ca/oshanswers/psychosocial/musculoskeletal.html .
  • Wood TJ, Thornley P, Petruccelli D, et al. Preoperative predictors of pain catastrophizing, anxiety and depression in patients undergoing total joint arthroplasty. J Arthroplasty. 2016 Dec;31(12):2750-2756.
  • Gold HT, Slover JD, Joo L, et al. Association of depression with 90-day hospital readmission after total joint arthroplasty. J Arthroplasty. 2016 Nov;31(11):2385-2388.

 

 

What Spring and Summer Mean to Our Musculoskeletal Health

Spring has finally arrived and time isn’t the only thing jumping forward.  Our enthusiasm for the outdoors is renewed and our activity schedule is ramped up.  From the slopes to spring sports, new plantings and training for one of the biggest bike rides in Texas, the potential for overuse injuries is particularly high this time of year – following less active winter months.

Some of the musculoskeletal injuries and conditions most commonly seen in the spring and summer months include:

  • Skier’s Thumb
  • Friction Blisters
  • Allergy-Related Muscle Fatigue / Joint Pain
  • Carpal Tunnel Syndrome
  • Golfer’s Elbow

Skier’s Thumb

Though the skies and poles are packed away, signs of a common injury following an active ski season may linger a bit longer.  Skier’s thumb, also known as Texter’s Thumb skiers-thumb gardening cycling MLB: Oakland Athletics at Chicago White Sox golfing tennisamong millennials, refers to injury of the unlar collateral ligament (UCL) of the thumb’s metacarpal phalangeal (MP) joint.  This occurs when the abnormal pulling of the thumb, such as that from a fall or harsh pull while affixed to the ski pole/hoop, causes a forced abduction or hyperextension of the proximal phalanx of the thumb. If unaddressed, this injury is further exacerbated by the repetitive use of the injured thumb in texting.

Friction Blisters

While the most common concerns during baseball season include pitch count and the stress that excessive pitching and throwing has on a player’s elbow and shoulder over the course of a baseball season, these generally occur mid to late season following many practices and games.

A lesser known injury often occurs as the season gets started and impacts pitchers in particular – friction blisters.   The repeated trauma created between the baseball seams and the fingers of the pitching hand, predominately at the tips of the index and long fingers, can result in friction blisters.

Friction blisters, which are the result of repetitive friction and strain forces that develop between the skin and various objects, are also common this time of year among those increasing gardening efforts and tennis players hitting the court.

Friction blisters form in areas where the “stratum corneum” and “stratum granulosum” are sufficiently robust such as the palmar and plantar surfaces of the hands and feet [1].

 

Allergy-Related Muscle Fatigue / Joint Pain

With the vibrant colors of spring come seasonal allergies and a host of symptoms that can sometimes make involvement in many of these long-awaited activities a challenge.  While pollen allergies most commonly cause nasal congestion, a runny nose, a sore/scratchy throat and itchy eyes, they can also cause hives, itchy skin, chronic cough, mood changes and body aches/muscle and joint pain. After exposure to pollen, the body reacts to it as a foreign invader by releasing antibodies and natural chemicals called histamines. Histamine is a substance that causes inflammation in the body. Sometimes allergies can advance to bronchitis and mimic flu-like symptoms, including a low-grade fever, body aches and muscle fatigue which can make everyday activity and exercise more challenging if unaddressed. Continuing to train or play while the body fights to overcome allergy challenges can predispose the musculoskeletal system to injury.

 Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is one of the most common overuse conditions seen in hand and upper extremity orthopedic care.  In the spring and summer, it is often the result of new activity excessively engaging the hand and wrist such as gardening and cycling. It is generally the result of irritation and swelling, which causes compression within the narrow carpal tunnel located at the wrist – through which one of the major nerves in the arm, the median nerve, passes.  This nerve becomes irritated in the compressed tunnel and can cause numbness, pain, tingling and weakness in the thumb, index and middle fingers.  CTS can come on quickly and command attention or linger with varying degrees of pain that becomes gradually more intense over time.

Another hand and wrist condition, Handlebar Palsy, also known medically as ulnar neuropathy, is an overuse or repetitive stress condition that affects cyclists, though generally after completion of a long, competitive ride.  It is the result of direct pressure placed on the ulnar nerve at the hand and wrist – from the grip of a cyclist’s hands on handlebars, causing stretching or hyperextension of the nerve.

 

Golfer’s Elbow

While the greens are rarely bare in Houston, golfing tournaments really ramp up in the spring and so too do one of the most common overuse conditions associated with the sport – Golfer’s Elbow.  Also known as medial epicondylitis, Golfer’s Elbow affects the muscles and tendons on the inside (medial) portion of the elbow. The repeated activity of swinging the golf club places strain on the elbow, irritating and inflaming the tendons and muscles at the elbow joint.  This inflammation can cause pain on the inside of the elbow, as well as in the forearm and wrist.

 Preventing Injury

Easing into new activity gradually and preparing appropriately can reduce risk of overuse injuries and conditions.  Strengthening muscle groups equally and stretching sufficiently both before and after activity are key, particularly after less active winter months.

Ensuring proper equipment (cycling and other ergonomic gloves and tools) and products (moisturizing to reduce calluses and blister risk) can protect the parts of the body most vulnerable to some of these spring activities and sports. Behavior/activity modification can also help to distribute stress to different parts of the body, reducing repetitive impact on one particular area.

While allergies are often unavoidable, antihistamines and corticosteroids can reduce symptoms and improve performance.  Understanding the associated muscle fatigue and joint pain will help you modify activity accordingly to avoid injury.

Periodically resting and refraining from the activity causing pain can help restore limb strength and prevent more serious injury or damage to the affected area.

 References

[1] McNamara AR, Ensell S, Farley TD. Hand Blisters in Major League Baseball Pitchers: Current Concepts and Management. Am J Orthop. 2016 March;45(3):134-36.