Musculoskeletal disorders OH&S presentation by Dr. Roy Bertrus Perera WOHIS Volunteer WINDSOR OCCUPATIONAL HEALTH INFORMATION SERVICE.

Musculoskeletal Musculoskeletal disordersdisorders

OH&S presentation OH&S presentation byby

Dr. Roy Bertrus PereraDr. Roy Bertrus PereraWOHIS VolunteerWOHIS Volunteer

WINDSOR OCCUPATIONAL HEALTH INFORMATION SERVICEWINDSOR OCCUPATIONAL HEALTH INFORMATION SERVICE

IntroductionIntroduction

DefinitionDefinition

Musculoskeletal disorders (MSDs) are Musculoskeletal disorders (MSDs) are injuries of the muscles, nerves, injuries of the muscles, nerves, tendons, ligaments, joints, cartilage, or tendons, ligaments, joints, cartilage, or spinal discs. spinal discs. MSDs are not typically MSDs are not typically the result of any acute event (such as a the result of any acute event (such as a slip, trip, or fall) but reflect a more slip, trip, or fall) but reflect a more gradual or chronic development.gradual or chronic development.

Other names used to describe Other names used to describe MSDsMSDs

Repetitive strain injuries Repetitive strain injuries Cumulative trauma disorders Cumulative trauma disorders Overuse syndrome Overuse syndrome Regional musculoskeletal disorders Regional musculoskeletal disorders Repetitive motion injuries Repetitive motion injuries Soft tissue disorders Soft tissue disorders

CausationCausation

Musculoskeletal disordersMusculoskeletal disordersare mainly caused by :are mainly caused by :

Repeated use of force Repeated use of force

Repetitive movementsRepetitive movements

Working in unnatural body Working in unnatural body positions or awkward positions or awkward

posturespostures

ForceForce is the amount of effort exerted by your muscles.

The MSD risk associated with force The MSD risk associated with force increases as:increases as:

the amount of force required the amount of force required increasesincreases

the posture used gets more awkwardthe posture used gets more awkwardthe number and/or speed of the number and/or speed of

repetitions increasesrepetitions increasesthe length of time the force is the length of time the force is

exerted between breaks increasesexerted between breaks increases

Activities that often involve high force Activities that often involve high force requirements include:requirements include:

lifting, lowering and carryinglifting, lowering and carrying pushing or pulling, andpushing or pulling, and gripping and manipulating objectsgripping and manipulating objects

Repetition

The MSD risk associated with repetitionThe MSD risk associated with repetitionincreases as:increases as: the number or speed of actions required the number or speed of actions required

increasesincreases the muscles being used must exert higher the muscles being used must exert higher

levels of forcelevels of force the joints of the body move farther away the joints of the body move farther away

from the neutral positionfrom the neutral position the length of time the task is done without the length of time the task is done without

a break increasesa break increases

Awkward PosturesFor most joints, good posture is near the For most joints, good posture is near the

middle of the full range of motion. This is middle of the full range of motion. This is called the “neutral" posture.called the “neutral" posture.

The risk associated with awkward postures The risk associated with awkward postures increases as:increases as:

the joints move farther away from a the joints move farther away from a neutral postureneutral posture

the muscles exert higher levels of forcethe muscles exert higher levels of force the number of times the posture is the number of times the posture is

adopted increasesadopted increases the length of time the posture is held the length of time the posture is held

increasesincreases

EXAMPLES OF TASKS THAT REQUIRE EXAMPLES OF TASKS THAT REQUIRE AWKWARD POSTURES:AWKWARD POSTURES:

leaning sideways to reach into a low leaning sideways to reach into a low drawer while sittingdrawer while sitting

bending down to work at a low levelbending down to work at a low level keyboarding on a desk that is too highkeyboarding on a desk that is too high reaching over your head (e.g., when reaching over your head (e.g., when

painting a ceiling)painting a ceiling) reaching for objects behind your backreaching for objects behind your back bending your wrist when moving objects bending your wrist when moving objects

or keyboardingor keyboarding bending your neck down (e.g., looking at bending your neck down (e.g., looking at

small components in poor light)small components in poor light) twisting your neck to view documents or twisting your neck to view documents or

the computer monitorthe computer monitor

Secondary factorsSecondary factors

Use of badly designed tools and Use of badly designed tools and machineriesmachineries

Increased workloadIncreased workload Working in cold or hot Working in cold or hot

environmentsenvironments Poor job trainingPoor job training

MSDs develop graduallyMSDs develop gradually

MSDs do not happen as a result of a MSDs do not happen as a result of a single accident or injury; rather, they single accident or injury; rather, they develop gradually as a result of develop gradually as a result of repeated trauma. Excessive stretching repeated trauma. Excessive stretching of muscles and tendons can cause of muscles and tendons can cause injuries that only last a short time; but injuries that only last a short time; but repeated episodes of stretching repeated episodes of stretching causing tissue inflammation can lead causing tissue inflammation can lead to long-lasting injury or MSDs.to long-lasting injury or MSDs.

PresentationPresentation

MSDs include three types of MSDs include three types of injuries: injuries:

●● muscle injurymuscle injury

●● tendon injurytendon injury

● ● nerve injurynerve injury

Muscle InjuryMuscle Injury

When muscles contract, they use chemical When muscles contract, they use chemical energy from sugar and produce by-products energy from sugar and produce by-products such as lactic acid which are removed by such as lactic acid which are removed by the blood. A muscle contraction that lasts a the blood. A muscle contraction that lasts a long time reduces the blood flow. long time reduces the blood flow. Consequently, the substances produced by Consequently, the substances produced by the muscles are not removed fast enough, the muscles are not removed fast enough, and they accumulate. The accumulation of and they accumulate. The accumulation of these substances irritates muscles and these substances irritates muscles and causes pain. The severity of the pain causes pain. The severity of the pain depends on the duration of the muscle depends on the duration of the muscle contractions and the amount of time contractions and the amount of time between activities for the muscles to get rid between activities for the muscles to get rid of those irritating substances.of those irritating substances.

Tendon InjuryTendon Injury Tendons consist of numerous bundles of Tendons consist of numerous bundles of

fibres that attach muscles to bones. fibres that attach muscles to bones. Tendon disorders related to repetitive or Tendon disorders related to repetitive or frequent work activities and awkward frequent work activities and awkward postures occur in two major categories:postures occur in two major categories:

1. Tendons with sheaths, found mainly in the hand and 1. Tendons with sheaths, found mainly in the hand and

wristwrist 2. Tendons without sheaths, generally found around the 2. Tendons without sheaths, generally found around the shoulder, shoulder, elbow, and forearmelbow, and forearm

The tendons of the hand are encased in The tendons of the hand are encased in sheaths through which the tendon slides.sheaths through which the tendon slides.

Nerve InjuryNerve Injury Nerves carry signals from the brain to control Nerves carry signals from the brain to control

activities of muscles. They also carry activities of muscles. They also carry information about temperature, pain and information about temperature, pain and touch from the body to the brain, and control touch from the body to the brain, and control bodily functions such as sweating and bodily functions such as sweating and salivation. Nerves are surrounded by salivation. Nerves are surrounded by muscles, tendons, and ligaments.muscles, tendons, and ligaments.

With repetitive motions and awkward With repetitive motions and awkward postures, the tissues surrounding nerves postures, the tissues surrounding nerves become swollen, and squeeze or compress become swollen, and squeeze or compress nerves. Compression of a nerve causes nerves. Compression of a nerve causes muscle weakness, sensations of "pins and muscle weakness, sensations of "pins and needles" and numbness. Dryness of skin, and needles" and numbness. Dryness of skin, and poor circulation to the extremities, may also poor circulation to the extremities, may also occur.occur.

Clinical symptoms of MSDsClinical symptoms of MSDs

• Continuous general weakness

• Restrictions of movements

• Sleep disturbances

• Other physical & psychological

problems

• Discomfort continues

• Sleep disturbances

• Limitation of work

• Pain• Tiredness• Numbness• Tingling• Discomfort• Stiffness in joints• Weakness• Swelling• Burning• Loss of functions

ConditionConditions s

associateassociated with d with MSDsMSDs

Joints & TendonsJoints & Tendons BursitisBursitis TendinitisTendinitis TenosynovitisTenosynovitisWrist & HandWrist & Hand Carpel tunnel SyndromeCarpel tunnel Syndrome Trigger fingerTrigger finger Reynaud's syndromeReynaud's syndrome GanglionGanglionElbowElbow EpicondylitisEpicondylitisNeck & ShoulderNeck & Shoulder Rotator cuff tendinitisRotator cuff tendinitis Thoracic outlet syndromeThoracic outlet syndromeBackBack Degenerative disk diseaseDegenerative disk disease Herniated discHerniated disc Chronic back painChronic back painLegs & FeetLegs & Feet Plantar fasciitisPlantar fasciitisOtherOther OsteoarthritisOsteoarthritis

Scope of the problemScope of the problem

WSIB received the following lost WSIB received the following lost time claims in 2008time claims in 2008

Sprains & strainsSprains & strains 3951339513 50.5% 50.5% TendonitisTendonitis 1675 1675 2.1% 2.1% Herniated or slipped Inter vertebral disc 832Herniated or slipped Inter vertebral disc 832 1.1% 1.1% Carpal tunnel syndromeCarpal tunnel syndrome 687 0.9% 687 0.9% EpicondylitisEpicondylitis 582 582 0.7% 0.7% BursitisBursitis 182 182 0.2% 0.2% Rotator cuff tearRotator cuff tear 260 260 0.3% 0.3% TenosynovitisTenosynovitis 153 153 0.2% 0.2% SciaticaSciatica 137 137 0.2% 0.2% GanglionGanglion 39 39 0.0% 0.0% CapsulitisCapsulitis 16 16 0.0% 0.0% Synovitis Synovitis 07 07 0.0% 0.0% All other MSDs,work related diseases & injuriesAll other MSDs,work related diseases & injuries 34173 43.8% 34173 43.8%

TOTALTOTAL 78256 100.0% 78256 100.0%

Diagnosis & treatmentDiagnosis & treatment

Evaluation & DiagnosisEvaluation & Diagnosis The evaluation of MSDs includes identifying The evaluation of MSDs includes identifying

workplace risks. Evaluation begins with a workplace risks. Evaluation begins with a discussion of the person's employment and discussion of the person's employment and requires a detailed description of all the processes requires a detailed description of all the processes involved in a typical workday. Consideration is involved in a typical workday. Consideration is given to the frequency, intensity, duration, and given to the frequency, intensity, duration, and regularity of each task performed at work.regularity of each task performed at work.

Diagnosis of MSDs is confirmed by performing Diagnosis of MSDs is confirmed by performing laboratory and electronic tests that determine laboratory and electronic tests that determine nerve or muscle damage. One such test, nerve or muscle damage. One such test, electroneuromyography (ENMG), encompasses two electroneuromyography (ENMG), encompasses two areas: electromyography (EMG) and nerve areas: electromyography (EMG) and nerve conduction velocity (NCV). Magnetic resonance conduction velocity (NCV). Magnetic resonance imaging (MRI), an alternative to x-rays, provides imaging (MRI), an alternative to x-rays, provides images of tendons, ligaments, and muscles and images of tendons, ligaments, and muscles and improves the quality of the diagnostic information.improves the quality of the diagnostic information.

Treatment of MSDsTreatment of MSDs

The treatment of MSDs involves several The treatment of MSDs involves several approaches including the following: approaches including the following:

RestRest Application of heat or cold Application of heat or cold Exercise, massage Exercise, massage Splints, bandagesSplints, bandages PhysiotherapyPhysiotherapy MedicationMedication SurgerySurgery

PreventionPrevention

MSDs PreventionMSDs PreventionThe essential keys to prevent MSDs in The essential keys to prevent MSDs in

the workplace are:the workplace are:

■ ■ management commitment and management commitment and supportsupport

■ ■ a documented MSD prevention a documented MSD prevention process that is communicated to all process that is communicated to all workplace partiesworkplace parties

■ ■ worker participation in the prevention worker participation in the prevention processprocess

■ ■ training on MSD prevention for all training on MSD prevention for all workplace partiesworkplace parties

Recognize MSD hazards and related concernsRecognize MSD hazards and related concerns

NoNo

Do MSD Hazards or Related Concerns Do MSD Hazards or Related Concerns

exists ?exists ?

YesYes

Conduct an MSD risk assessmentConduct an MSD risk assessment

Increased RiskIncreased Risk NoNo

of MSD and/or Other Indicatorsof MSD and/or Other Indicators

that Controls are Required ?that Controls are Required ?

YesYes

Choose and implement MSD hazard controlsChoose and implement MSD hazard controls

Follow up on and evaluate success of implemented controlsFollow up on and evaluate success of implemented controls

Communicate results and acknowledge successCommunicate results and acknowledge success

Steps in the MSD prevention framework

Employers and managers should:Employers and managers should: incorporate MSD prevention into their health and safety incorporate MSD prevention into their health and safety

policy and programpolicy and program

review the health and safety program to include or review the health and safety program to include or strengthen MSD prevention activitiesstrengthen MSD prevention activities

make sure that workers and JHSC members or the H&S rep make sure that workers and JHSC members or the H&S rep are trained on how to recognize, assess and eliminate or are trained on how to recognize, assess and eliminate or control MSD hazardscontrol MSD hazards

ensure that supervisors know what to do if they recognize ensure that supervisors know what to do if they recognize MSD hazards or if a worker raises a concernMSD hazards or if a worker raises a concern

ensure that MSD hazards related to poor design of tools, ensure that MSD hazards related to poor design of tools, equipment, workstations or work practices are identified equipment, workstations or work practices are identified and any associated risks are controlledand any associated risks are controlled

make sure that new equipment is designed and installed to make sure that new equipment is designed and installed to reduce exposure to MSD hazardsreduce exposure to MSD hazards

ensure that workers have the equipment and training they ensure that workers have the equipment and training they need to reduce their exposure to MSD hazardsneed to reduce their exposure to MSD hazards

Supervisors should:Supervisors should: ensure that everyone under their supervision is aware of ensure that everyone under their supervision is aware of

MSD hazards on the job and is trained to do his or her job MSD hazards on the job and is trained to do his or her job safelysafely

look for MSD hazards during workplace inspections, job task look for MSD hazards during workplace inspections, job task analyses and discussions with workers, and when reviewing analyses and discussions with workers, and when reviewing injury reportsinjury reports

reinforce proper working techniques and use of equipment reinforce proper working techniques and use of equipment and personal protective equipment (PPE)and personal protective equipment (PPE)

encourage and support workers taking scheduled breaksencourage and support workers taking scheduled breaks

check that workers have adjusted their workstations to suit check that workers have adjusted their workstations to suit themselves and their work, and provide help as neededthemselves and their work, and provide help as needed

support workers when they have questions or concerns and support workers when they have questions or concerns and be aware of MSD warning signs and indicatorsbe aware of MSD warning signs and indicators

take action on reported MSD hazards and concerns and take action on reported MSD hazards and concerns and follow up with workersfollow up with workers

Workers should:Workers should: report MSD hazards and concerns to their supervisorsreport MSD hazards and concerns to their supervisors

take scheduled breaks and take advantage of opportunities to take scheduled breaks and take advantage of opportunities to change postures or relax muscleschange postures or relax muscles

move around and occasionally change positionsmove around and occasionally change positions

go to their supervisors with questions and concerns or to ask for go to their supervisors with questions and concerns or to ask for additional trainingadditional training

offer suggestions to improve working conditions to their supervisor, offer suggestions to improve working conditions to their supervisor, health and safety representative or the JHSChealth and safety representative or the JHSC

be aware of symptoms of MSDs and report them early if they occurbe aware of symptoms of MSDs and report them early if they occur

ensure that they understand the information and instructions ensure that they understand the information and instructions providedprovided

use proper working techniquesuse proper working techniques

use the equipment and tools provided to reduce exposure to MSD use the equipment and tools provided to reduce exposure to MSD hazardshazards

know how to make adjustments to the workstation to suit know how to make adjustments to the workstation to suit

themselves and the work they do, and to ask for help as neededthemselves and the work they do, and to ask for help as needed

References:References:

London Occupational Safety & Health London Occupational Safety & Health Information Service, Information Service, WhenWhen Aches BecomeAches Become Injuries( Second edition), Injuries( Second edition), 19981998

Occupational Health and Safety Council of Occupational Health and Safety Council of Ontario, ResourceOntario, Resource Manual for the MSD Manual for the MSD prevention Guideline for Ontario, prevention Guideline for Ontario, 20072007

http://www.wsib.on.ca/wsib/wsibsite.nsf/http://www.wsib.on.ca/wsib/wsibsite.nsf/Public/CurrentStatisticsPublic/CurrentStatistics

http://www.ccohs.ca/oshanswers/http://www.ccohs.ca/oshanswers/diseases/rmirsi.htmldiseases/rmirsi.html

For more information, For more information, please contact please contact

WOHIS 519-254-5157WOHIS 519-254-5157

oror

For a free workplace assessmentFor a free workplace assessmentplease contact OHCOW please contact OHCOW

(Windsor) Occupational Health (Windsor) Occupational Health Clinics for Ontario Workers, Inc.Clinics for Ontario Workers, Inc.

519-973-4800519-973-4800

Remember, you have the Remember, you have the right to a safe & healthy right to a safe & healthy

workplace!workplace!

Thank youThank you