What is Repetitive strain injuries?

Work-related Pain
Pain in the upper limb is frequent among employees with repetitive and forceful job tasks. Pain may originate from activation of peripheral nociceptors due to tissue damage. However, when the perception of pain for some reason persists beyond the expected time for tissue healing, chronicity has occurred. The subjective experience of chronic pain is the result of the transduction, transmission and modulation of sensory information, signifying the involvement of central mechanisms in the perception of pain. Hence, general hyperalgesia, evidenced by reduced pressure pain threshold (PPT) in a non-painful part of the body, is present in many variants of chronic pain including carpal tunnel syndrome, fibromyalgia, chronic low back pain, and trapezius myalgia. Work-related upper limb disorder (WRULD), repetitive strain injury (RSI), occupational overuse syndrome (OOS) and work-related complaints of the arm, neck or shoulder (CANS) are the most frequently used umbrella terms for disorders that develop as a result of repetitive movements, awkward postures and impact of external forces such as those associated with operating vibrating tools. However, evidence of a central component to work related chronic pain in the upper limb is lacking. Work related chronic pain is often accompanied by an escalating imbalance between work demands and individual resources, consequently affecting work ability. In line with this, workers exposed to highly repetitive and forceful exertion, lack of sufficient recovery, and awkward postures have an elevated risk of both impaired work ability and musculoskeletal disorders. Additionally, impaired work ability has been associated with loss of productivity, sickness absence, early retirement and all-cause mortality. Physiotherapy Management typically involves Display screen Equipment ( DSE) assessment, JDA ( job demand analysis ), Ergonomic assessment in addition to other modalities like Manual therapy, Exercise therapy, Electrotherapy, Massage, Heat and advice on change in work routine.

Work-related Musculoskeletal Disorders
Musculoskeletal disorders represent the most common occupational diseases in the European Union. Besides the direct effect on employee health and work disability, work-related musculoskeletal disorders impose a major socioeconomic burden due to extensive use of health care services, sickness absence, disability pension and loss of productivity. The prevalence of work-related musculoskeletal disorders, especially in the shoulder, neck and upper extremity is higher in occupations involving a high rate of repetitive movements compared with less repetitive job settings. In 2005 about 23% of European workers reported that their work negatively affected their health in the form of significant pain in the shoulder, neck, and/or upper/lower limbs.

Most Common Pain Conditions related to Work:

Back Pain
The effectiveness of physical conditioning as part of a return to work strategy in reducing sick leave for workers with back pain, compared to usual care or exercise therapy, remains uncertain. For workers with acute back pain, physical conditioning may have no effect on sickness absence duration. There is conflicting evidence regarding the reduction of sickness absence duration with intense physical conditioning versus usual care for workers with subacute back pain. It may be that including workplace visits or execution of the intervention at the workplace is the component that renders a physical conditioning programme effective. For workers with chronic back pain physical conditioning has a small effect on reducing sick leave compared to care as usual after 12 months follow-up.

It is intuitive that disability caused by illness should be reflected in illness severity. For example, there may be numerous reasons why persons with fibromyalgia (FM) may have poor sustainability in the workforce. Studies have pointed to work disability being associated with higher ratings of pain and symptom severity, increased physical demands of the job or alternately more sedentary work, and workplace stressors. Whereas continued work is promoted by individual strategies such as the ability to handle symptoms, work day, and long-term work life, as well as social support from colleagues and employers. To better understand factors that may be contributing to work disability, examiners examined patients with FM currently working compared with those unemployed for non-FM reasons, and those receiving disability payments for illness identified as FM.

Chronic Upper Limb Pain
Other study investigated biopsychosocial differences, with specific focus on rate of force development (RFD) and work ability, between workers with and without chronic upper limb pain.

Generally, there were very low-quality evidence indicating that pain, recovery, disability and sick leave are similar after exercises when compared with no treatment, with minor intervention controls or with exercises provided as additional treatment to people with work-related complaints of the arm, neck or shoulder. Low-quality evidence also showed that ergonomic interventions did not decrease pain at short-term follow-up but did decrease pain at long-term follow-up.

Physiotherapy and/or Ergonomic Interventions
Lowering the physical exposure through participatory ergonomic interventions may represent a strategy to reduce musculoskeletal loading intensity and/or rehabilitate musculoskeletal pain. Studies how shown partial to moderate evidence that participatory ergonomic interventions are effective in improving different health outcomes. The main reason for not finding full evidential support was due to the low number of methodologically sound studies available in the literature. Many examiners found moderate-quality evidence to suggest that the use of arm support with alternative mouse may reduce the incidence of neck/shoulder MSDs, but not right upper limb MSDs. There is moderate-quality evidence to suggest that the incidence of neck/shoulder and right upper limb MSDs is not reduced when comparing alternative and conventional mouse with and without arm support. However, given there were multiple comparisons made involving a number of interventions and outcomes, high-quality evidence is needed to determine the effectiveness of these interventions clearly.

An alternative strategy to reduce or prevent work-related musculoskeletal pain may be achieved by increasing the workers physical capacity through strength training interventions. Strength training performed at the workplace may in fact be regarded as a complex biopsychosocial intervention modality that reaches further than the specific physiological benefits of training. Therefore, health professionals need to re-evaluate a client’s situation on a regular basis.

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