1. OCCUPATIONAL MUSCULOSKELETAL DISORDERS

2. 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.

3. Muscles
Tendons
Ligaments
Bones
Nerves
Blood Vessels
Disks

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

5. 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.

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

7. 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)

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

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

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

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

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

13. 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

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

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

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

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

25. 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

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

28. 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

29. 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 %)

30. 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

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

32. 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

33. Any Questions?