Occupation related to soft tissue rheumatism or musculoskeletal disorders

by Dr. Sheetal Salvi

Occupation related musculoskeletal disorders are a group of painful disorders of muscles, tendons and nerves.

Work activities which are frequent and repetitive or activities with awkward postures cause these disorders which may be painful at work or at rest. The diseases of persons incident to this craft arise from 3 causes :-

• Constant sitting.
• Perpetual motion of hand.
• Attention and application of mind.

Some back problems also result from repetitive activities. "Wear and tear" from certain activitiescan lead to reversible or irreversible damage.

These disorders are very difficult to define within traditional disease concepts. These disorders have received many names.

They are as follows :-

• Occupational disorders or WMSDS
• Overuse syndrome
• Soft tissue disorders, or
  Region musculoskeletal disorders

Not only the repetition causes these disorders, but awkward postures also contribute.

Occupation related disorders are recognized as leading causes of significant human suffering, loss of productivity and economic burdens on society. They arise from ordinary arm and hand movements such as bending, straightening, gripping, holding, twirling, clenching and reaching.

These common movements are not particularly harmful in the ordinary activities of daily life. What makes them hazardous in work situations is the continual repetition, often in a forceful manner, speed of movements and lack of time for recovery between them. They are associated with work patterns that include :-

• Fixed or constrained body positions
• Continual repetition of movements
• Force concentrated
• A pace of work that does not allow sufficient recovery between movements.

The disorders commonly occur as a result of combination and interactions among them.

Body Position : There are two aspects of body position (posture) that contribute in jobs involving repetitive tasks. For example, tasks that require repetitive movements to the extreme ranges of the joint contribute to the occurrence of painful conditions. Poor layout of the workstation and improper selection of equipment and tools can lead to hazardous body movements. The other postural aspect that contributes is a fixed position of the neck and the shoulders. Muscles in the shoulder, neck contract and stay contracted to hold the position stable for as long as the task requires. This results in fatigue.

Force : More force equals more effect, more forceful movements develop fatigue much faster.

Pace of work : It determines the amount of time available for rest and recovery of the body between cycles of a particular task. The faster the pace, less time is available and higher is the risk. It is a human characteristic to work at varying rates at different times of the day.

One Analytic approach to determining a possible relationship between activity and joint disease is to consider the epidemiologic evidence that degenerative arthritis may follow repetitive movements.

Activities leading to increased risk for premature osteoarthritis have been those involving carrying, lifting, increased physical load, increased static load, kneeling, bending, walking, standing, etc.

Hip and knee osteoarthritis are common in farmers, manual laborers. Squatting is the position frequently assumed for house work and farm work.

Housewives : Pain arising from performing household chores is considered as the commonest health related problem which is seen in housewives, who are constantly doing activities which involve bending, kneeling, standing for prolonged housework in the kitchen.

These activities lead to trauma or result in meniscus tears.

This condition is known as Prepatellar Bursitis, ie. housemaid's knee.

As there is no break in between each activity, a result of which leads to degenerative changes in joints.

Hair Dressers :They are prone to shoulder and arm symptoms as they have to reach out and up and down at varying angles with constant rolling of the wrists.

IT professionals : This job involves constant use of hand muscles with computers and processors that can go on for hours and hours without relaxing, the arm muscles tend to be held tight to allow the fingers to the work.

The other postural aspect that contributes is a fixed position of the neck and shoulders. The muscle gets contracted in leads to fatigue.

Manual laborers and Porters : Construction Industry is one of the trades associated with a high rate of musculo-skeletal disorders including low back pain, which is common in brick layers, workers who lay large sand stones or carry heavy load and as a consequence suffer from back ache.

Physical load has traditionally been regarded as a key risk factor. Heaviness of the loads being lifted or humped over prolonged periods implies bad ergonomics. Such people are more prone to get strains of the shoulder tendons.

Sports and Fine arts : There is overwhelming evidence that the mechanical stresses associated with certain sporting activities are linked with higher incidence of OA, especially those in contact sports such as football. Anterior knee pain is a common problem in adolescent girls, aggravated by sporting activities. Adductor tendinitis is seen in gymnasts or horseback riders.

Apart from sports there are musicians who develop overuse syndromes. String players have trouble with the fingers of the left hand. Violinists and other performing artists are prone to recurrent neck pain of postural origin.

Farmers, Peasants : Constantly working on the farms for years and years with activities such as bending, standing for long hours leads to degeneration of the joints.

DO'S :

• Relax your muscles under resting conditions.
• Take your time while at work.
• Learn to take frequent brief breaks.
• Practice this in a domestic job.
• Practice taking mini-breaks in domestic chores till they become second nature.
• Work up to full pace, but gradually.
• Avoid sudden increases in work load.
• Check the work station for any defects.
• Computer mouse should be close to the keyboard and at the same level.
• A support should be provided for the keyboard.
• Pre-work exercises, stretches and relaxation practice are a good routine, as with sport.
• Re-plan your working technique.

DONT'S :

• Don't work through routine breaks or snatching a sandwich beside the keyboard. This can be disastrous.
• Don't overexert.
• Avoid extra pressures.
• Don't be your own slave driver.
• Don't miss tea and lunch breaks.
• Don't stand for long hours.
• Don't lift heavy loads on your shoulders.
• Don't be a workaholic.