Tuesday, June 03, 2008

Musculoskeletal disorders: No pain, no gain

Bio-psychosocial methods for combating musculoskeletal disorders ...

"Are traditional approaches aimed at combating musculoskeletal disorders too limited in their scope? Andrew Baird believes so, and argues for a move away from a simplistic ergonomics method to a more sophisticated bio-psychosocial model.

Emotive language is often used to describe the rising incidence of musculoskeletal disorders. Even the director-general of the World Health Organisation has suggested that back pain has reached “epidemic” proportions, while Gordon Waddell, author of The back pain revolution, has described back pain as “a 20th-century medical disaster”.1

If that weren’t enough, the costs are absolutely staggering, with some estimates putting this figure at close to 2 per cent of gross domestic product. To put this into some kind of medical perspective, MSDs have a societal cost greater than that of cancer, heart disease and AIDS combined! It’s no wonder there is a clamour to ‘do something about it’. But before we get too carried away, it may be wise to consider exactly what the latest medical and scientific knowledge is telling us.

When we talk about MSDs, for many people the first thought would be of a specific injury, such as tennis elbow, or a prolapsed disc. However, such conditions are nowhere near as prevalent as one might think. It has been recognised for some time that while most people will experience back pain at some point in their lives, only about 15 per cent will be given a positive diagnosis. The picture for upper-limb problems would appear to be similar, with only about 20 per cent fitting a specific diagnosis. The majority of problems we come across are ‘non-specific’ or ‘idiopathic’ (of unknown origin).

Given that we’re often unsure which tissue, if any, is the source of an individual’s discomfort, it is no great surprise that these conditions are difficult to treat. Many safety professionals will have seen headlines suggesting that physiotherapy doesn’t work, manipulation doesn’t work, and, while acupuncture may help, it doesn’t seem to matter where you stick the needles!2 In its guidance on manual-handling legislation,3 the HSE states that “modern medical and scientific knowledge stresses the importance of an ergonomics approach to remove or reduce the risk of manual-handling injury”, but the effectiveness of ergonomics interventions has also been questioned.

There is an old physio ‘in-joke’, which runs: “Most back pain will resolve itself within a month, but if you go and see a physio, it will only take four weeks!” That is not meant as an attack on physiotherapists, who have an important role to play in the management of these conditions, but it reflects the fact that most of these common conditions will get better almost regardless of any intervention."    (Continued via Safety & Health Practitioner)    [Ergonomics Resources]

Bio-psychosocial Model - Ergonomics

Bio-psychosocial Model

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