Depression is the leading cause of disability worldwide[i] but work-related musculoskeletal disorders (MSDs) also remain costly – in fact, these two categories represent 80% of work-related ill health [ii] in the UK whose economy is very comparable to Canada’s (and they keep great national statistics). Depression is quite complex but logically, can’t we have “beat” MSDs by now?
In Saskatchewan, Canada, where I practice, health care workers in our socially-funded health care system have double the time loss injury rate than average, the majority due to MSDs[iii]. But shouldn’t it be easy to avoid MSDs with better lifting techniques, education, and better availability of assistive devices? If it were that easy we would have won the battles that win the war. And in some organizations, they are seeing a reduction in MSD-related disability. But most are not.
MSDs are a broad spectrum of body problems of the muscles, bones, and joints and encompass everything from “that old football knee injury” that comes and goes to the “pop” someone feels with overexertion and further damages their naturally-aged shoulder rotator cuff. Pooling of data from many research studies show that MSDs are very complex and result from a potent mix of:
- Job demands (heavy lifting, awkward postures, and/or high repetition)[iv]
- Personal factors (smoking, co-morbidities, high body-mass index)[v] and
- High psychosocial job demands (low job control, high job demands, high job strain, high effort reward imbalance, low social support, high workplace bullying, low perceived fairness, high role conflict, low job security, and interpersonal conflicts)[vi].
From personal experience in work-related rehabilitation for more than 18 years I have found fear, injustice, and invalidation to be some of the strongest negative predictors of successful recovery. It is not that people feign physical injury due to psychosocial factors but large scientific meta-analyses (pooling of results from many studies and statistically analyzed) indicate psychosocial factors cannot be separated from physical factors[vii].
So should we throw up our hands and give up? By no means – because these work-related disabilities represent real people such as the Registered Nurse in her 50’s who cannot pick up her grandchildren or a truck driver to who isn’t driving due to his back pain and feels worthless.
Based on leading guidelines, effective management of MSDs could come from:
- Creating a positive Psychosocial Safety Climate where there is communication and action around work conditions[viii] and attention to psychological health and safety through an approach such as the National Standard of Psychological Health and Safety in the Workplace.
- Together with workers, looking at all potential factors in toolkit approach – the Participative Hazard Identification and Risk Management (APHIRM) toolkit looks promising[ix].
- When workers are away from work, use best-evidence in supporting their return to work by maintaining (or re-establishing) relationship to the workplace and offering modified work and accommodation, an environment rich in support. For more information in a great summary see the NICE and Institute for Work and Health summaries[x].
Like all occupational health problems, MSDs are not simple or easy. But they are not hopeless and the people affected by them are truly impacted and we can’t ignore the suffering. We can help by getting started and involving all the stakeholders in identifying risks and strategy.
If you are an employer or perhaps a union representative – I’d encourage you to look at all three of those strategies and commit for the long haul. Skilled workers are in short supply and we can’t afford to be losing more people from the workplace. Preserving your human capital now is a moral imperative and makes good business sense.
[i] World Health Organization, “Depression,” accessed February 4, 2022, https://www.who.int/westernpacific/health-topics/depression.
[ii] Health and Safety Executive, “Health and Safety at Work: Summary Statistics for Great Britain 2020,” November 2020, https://www.hse.gov.uk/statistics/overall/hssh1920.pdf.
[iii] Saskatchewan Workers’ Compensation Board, “Annual Report 2021,” 2021, https://www.wcbsask.com/sites/default/files/2022-05/WCB_2021_annual%20report.pdf.
[iv] Joanne O. Crawford et al., “Musculoskeletal Health in the Workplace,” Best Practice & Research Clinical Rheumatology 34, no. 5 (October 2020): Article 101558, https://doi.org/10.1016/j.berh.2020.101558.
[v] Bruno R. da Costa and Edgar Ramos Vieira, “Risk Factors for Work-Related Musculoskeletal Disorders: A Systematic Review of Recent Longitudinal Studies,” American Journal of Industrial Medicine 53, no. 3 (2010): 285–323, https://doi.org/10.1002/ajim.20750.
[vi] Yacine Taibi et al., “A Systematic Overview on the Risk Effects of Psychosocial Work Characteristics on Musculoskeletal Disorders, Absenteeism, and Workplace Accidents,” Applied Ergonomics 95 (September 2021): Article 103434, https://doi.org/10.1016/j.apergo.2021.103434; Angelika Hauke et al., “The Impact of Work-Related Psychosocial Stressors on the Onset of Musculoskeletal Disorders in Specific Body Regions: A Review and Meta-Analysis of 54 Longitudinal Studies,” Work & Stress 25, no. 3 (July 1, 2011): 243–56, https://doi.org/10.1080/02678373.2011.614069.
[vii] Taibi et al., “A Systematic Overview on the Risk Effects of Psychosocial Work Characteristics on Musculoskeletal Disorders, Absenteeism, and Workplace Accidents.”
[viii] Tessa S. Bailey et al., “Psychosocial Safety Climate, Psychosocial and Physical Factors in the Aetiology of Musculoskeletal Disorder Symptoms and Workplace Injury Compensation Claims,” Work & Stress 29, no. 2 (April 3, 2015): 190–211, https://doi.org/10.1080/02678373.2015.1031855.
[ix] Jodi Oakman and Wendy Macdonald, “The APHIRM Toolkit: An Evidence-Based System for Workplace MSD Risk Management,” BMC Musculoskeletal Disorders 20 (December 2019): Article 504, https://doi.org/10.1186/s12891-019-2828-1.
[x] National Institute for Health and Care Excellence, “Workplace Health: Long-Term Sickness Absence and Capability to Work” (National Institute for Health and Care Excellence, November 20, 2019), http://www.nice.org.uk/guidance/ng146; K. L. Cullen et al., “Effectiveness of Workplace Interventions in Return-to-Work for Musculoskeletal, Pain-Related and Mental Health Conditions: An Update of the Evidence and Messages for Practitioners,” Journal of Occupational Rehabilitation 28, no. 1 (March 2018): 1–15, https://doi.org/10.1007/s10926-016-9690-x.
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