OCCUPATIONAL MUSCULOSKELETAL DISORDERS

Musculoskeletal Disorders Hands , wrists, elbows and shoulders Back and neck Hips, knees and ankles Muscle Strains Tendonitis Bursitis Low Back Pain Carpal Tunnel Raynauds Syndrome Symptoms include Discomfort, pain, fatigue, swelling, stiffness, and numbness and tingling. The wimp factor: If you are bleeding, you get credit for physical pain. Soft tissue injuries we tend to ignore.

Muscles Tendons Ligaments Bones Nerves Blood Vessels Disks

Musculoskeletal Disorders Occupational Low Back Pain (LBP) Cumulative Trauma Disorders (C.T.D)

Introduction LBP is common health complaints. LBP is second most common symptomatic reason for visit physicians. LBP is major cause of disability, compensation, limitation, and economic loss.

Occupational Low Back Pain Definition Epidemiology Cost Risk Factors Biomechanics Prevention Treatment Red flags

Low Back Pain Definition: A pain that occurs in the lumbar region , buttocks, or proximal posterior thighs Low back pain (LBP): Specific LBP: specific cause can be found (disease, injury) Non Specific LBP: specific cause cannot be found(80%of all)

Occupational Low Back Pain Definition Epidemiology Cost Risk Factors Biomechanics Prevention Treatment Red flags

Occupational Low Back Pain EPIDEMIOLOGY Point Prevalence 18% Life Long Prevalence 80% - 90%

Occupational Low Back Pain Definition Epidemiology Cost Risk Factors Biomechanics Prevention Treatment Red flags

Occupational Low Back Pain COSTS DIRECT COST 12 BILION $ INDIRECT COST 50 BILION $

Occupational Low Back Pain Definition Epidemiology Cost Risk Factors Biomechanics Prevention Treatment Red flags

Risk factors for the onset of LBP Individual: Age, smoking, general health status, high birth weight (male) Psychosocial: high levels of stress Occupational: heavy lifting , prolonged forward flexion, Lateral bending, twisting, prolonged standing or sitting, whole body vibration

Occupational Low Back Pain Definition Epidemiology Cost Risk Factors Biomechanics Prevention Treatment Red flags

Keeping loads close to the body reduces forces on the low back.

Too high Avoid high and low object placement, especially as the weight and/or size of the object increases. Too high Too low

Occupational Low Back Pain Definition Epidemiology Cost Risk Factors Biomechanics Prevention Treatment Red flags

Recommended Weight Limit (RWL) RWL=LC x HM x VM x DM x AM x FM x CM LC=Load Constant = 23 Kg HM=Horizontal Modifier=25/H VM=Vertical Modifier=1-(0.003[V-75]) DM=Distance Modifier=0.82+(4.5/D) AM=Asymmetric Modifier=1-(0.0032A) FM=Frequency Modifier=Table CM=Coupling Modifier=Table

Occupational Low Back Pain Definition Epidemiology Cost Risk Factors Biomechanics Prevention Treatment Red flags

Management of NSLBP A careful medical evaluation : for R/O serious spinal or non-spinal pathology In the absence of red flags: Over-the-counter drugs (NSAIDs, Muscle relaxant, TCA, Steroid?) Incomplete bed rest for 48 h, (as active as possible) Leisure and work activities should be resumed as soon as possible Spinal manipulation is helpful in acute NSLBP Temporary symptomatic relief from heat and cold

Laboratory & Imaging X-rays: no routine evaluation within the first 4 weeks. Unless a red flag and high index of suspicion. CBC & ESR: If symptoms >4 weeks MRI: persistent or progressive neurological deficits and an exam consistent with a nerve root impingement (asymptomatic adults, prevalence of disk herniation 22-40%)

Prognosis Up to 90%: recover within 4 weeks and 96% recover between 4-12 weeks 4% of all patients remain disabled after 12 weeks Recurrence: 8.9% to 44% (social system, culture, type of work) Patients do not recover after 4 weeks: At risk for delayed recovery and prolonged disability

Occupational Low Back Pain Definition Epidemiology Cost Risk Factors Biomechanics Prevention Treatment Red flags

Occupational Low Back Pain RED FLAGS Presentation Age <20 or >55 Non mechanical pain Constitutional symptoms (fever, weight loss) Widespread neurology Structural deformity Systemic disease History of cancer Systemic steroid use Recent bowel or bladder dysfunction Saddle anesthesia Violent trauma

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