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

2. Introduction

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

4. Other names used to describe MSDs 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

5. Causation

6. Musculoskeletal disorders are mainly caused by : Repeated use of force Repeated use of force Repetitive movements Repetitive movements Working in unnatural body positions or awkward postures Working in unnatural body positions or awkward postures

7. Force Force is the amount of effort exerted by your muscles. The MSD risk associated with force increases as: The MSD risk associated with force increases as: the amount of force required increases the amount of force required increases the posture used gets more awkward the posture used gets more awkward the number and/or speed of repetitions increases the number and/or speed of repetitions increases the length of time the force is exerted between breaks increases the length of time the force is exerted between breaks increases

8. Activities that often involve high force requirements include: lifting, lowering and carrying lifting, lowering and carrying pushing or pulling, and pushing or pulling, and gripping and manipulating objects gripping and manipulating objects

9. Repetition The MSD risk associated with repetition increases as: the number or speed of actions required increases the number or speed of actions required increases the muscles being used must exert higher levels of force the muscles being used must exert higher levels of force the joints of the body move farther away from the neutral position the joints of the body move farther away from the neutral position the length of time the task is done without a break increases the length of time the task is done without a break increases

10. Awkward Postures For most joints, good posture is near the middle of the full range of motion. This is called the “neutral" posture. The risk associated with awkward postures increases as: the joints move farther away from a neutral posture the joints move farther away from a neutral posture the muscles exert higher levels of force the muscles exert higher levels of force the number of times the posture is adopted increases the number of times the posture is adopted increases the length of time the posture is held increases the length of time the posture is held increases

11. EXAMPLES OF TASKS THAT REQUIRE AWKWARD POSTURES: leaning sideways to reach into a low drawer while sitting leaning sideways to reach into a low drawer while sitting bending down to work at a low level bending down to work at a low level keyboarding on a desk that is too high keyboarding on a desk that is too high reaching over your head (e.g., when painting a ceiling) reaching over your head (e.g., when painting a ceiling) reaching for objects behind your back reaching for objects behind your back bending your wrist when moving objects or keyboarding bending your wrist when moving objects or keyboarding bending your neck down (e.g., looking at small components in poor light) bending your neck down (e.g., looking at small components in poor light) twisting your neck to view documents or the computer monitor twisting your neck to view documents or the computer monitor

12. Secondary factors Use of badly designed tools and machineries Use of badly designed tools and machineries Increased workload Increased workload Working in cold or hot environments Working in cold or hot environments Poor job training Poor job training

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

14. Presentation

15. MSDs include three types of injuries: ●muscle injury ● muscle injury ●tendon injury ● tendon injury ● nerve injury

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

17. Tendon Injury Tendons consist of numerous bundles of fibres that attach muscles to bones. Tendon disorders related to repetitive or frequent work activities and awkward postures occur in two major categories: Tendons consist of numerous bundles of fibres that attach muscles to bones. Tendon disorders related to repetitive or frequent work activities and awkward postures occur in two major categories: 1. Tendons with sheaths, found mainly in the hand and wrist 2. Tendons without sheaths, generally found around the shoulder, elbow, and forearm The tendons of the hand are encased in sheaths through which the tendon slides. The tendons of the hand are encased in sheaths through which the tendon slides.

18. Nerve Injury Nerves carry signals from the brain to control activities of muscles. They also carry information about temperature, pain and touch from the body to the brain, and control bodily functions such as sweating and salivation. Nerves are surrounded by muscles, tendons, and ligaments. Nerves carry signals from the brain to control activities of muscles. They also carry information about temperature, pain and touch from the body to the brain, and control bodily functions such as sweating and salivation. Nerves are surrounded by muscles, tendons, and ligaments. With repetitive motions and awkward postures, the tissues surrounding nerves become swollen, and squeeze or compress nerves. Compression of a nerve causes muscle weakness, sensations of "pins and needles" and numbness. Dryness of skin, and poor circulation to the extremities, may also occur.

19. Clinical 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

20. Conditions associated with MSDs Joints & Tendons Bursitis Bursitis Tendinitis Tendinitis Tenosynovitis Tenosynovitis Wrist & Hand Carpel tunnel Syndrome Carpel tunnel Syndrome Trigger finger Trigger finger Reynaud's syndrome Reynaud's syndrome Ganglion GanglionElbow Epicondylitis Epicondylitis Neck & Shoulder Rotator cuff tendinitis Rotator cuff tendinitis Thoracic outlet syndrome Thoracic outlet syndromeBack Degenerative disk disease Degenerative disk disease Herniated disc Herniated disc Chronic back pain Chronic back pain Legs & Feet Plantar fasciitis Plantar fasciitisOther Osteoarthritis Osteoarthritis

21. Scope of the problem

22. WSIB received the following lost time claims in 2008 Sprains & strains 39513 50.5% Sprains & strains 39513 50.5% Tendonitis 1675 2.1% Tendonitis 1675 2.1% Herniated or slipped Inter vertebral disc 832 1.1% Herniated or slipped Inter vertebral disc 832 1.1% Carpal tunnel syndrome 687 0.9% Carpal tunnel syndrome 687 0.9% Epicondylitis 582 0.7% Epicondylitis 582 0.7% Bursitis 182 0.2% Bursitis 182 0.2% Rotator cuff tear 260 0.3% Rotator cuff tear 260 0.3% Tenosynovitis 153 0.2% Tenosynovitis 153 0.2% Sciatica 137 0.2% Sciatica 137 0.2% Ganglion 39 0.0% Ganglion 39 0.0% Capsulitis 16 0.0% Capsulitis 16 0.0% Synovitis 07 0.0% Synovitis 07 0.0% All other MSDs,work related diseases & injuries 34173 43.8% All other MSDs,work related diseases & injuries 34173 43.8% TOTAL 78256 100.0%

23. Diagnosis & treatment

24. Evaluation & Diagnosis The evaluation of MSDs includes identifying workplace risks. Evaluation begins with a discussion of the person's employment and requires a detailed description of all the processes involved in a typical workday. Consideration is given to the frequency, intensity, duration, and regularity of each task performed at work. The evaluation of MSDs includes identifying workplace risks. Evaluation begins with a discussion of the person's employment and requires a detailed description of all the processes involved in a typical workday. Consideration is given to the frequency, intensity, duration, and regularity of each task performed at work. Diagnosis of MSDs is confirmed by performing laboratory and electronic tests that determine nerve or muscle damage. One such test, electroneuromyography (ENMG), encompasses two areas: electromyography (EMG) and nerve conduction velocity (NCV). Magnetic resonance imaging (MRI), an alternative to x-rays, provides images of tendons, ligaments, and muscles and improves the quality of the diagnostic information. Diagnosis of MSDs is confirmed by performing laboratory and electronic tests that determine nerve or muscle damage. One such test, electroneuromyography (ENMG), encompasses two areas: electromyography (EMG) and nerve conduction velocity (NCV). Magnetic resonance imaging (MRI), an alternative to x-rays, provides images of tendons, ligaments, and muscles and improves the quality of the diagnostic information.

25. Treatment of MSDs The treatment of MSDs involves several approaches including the following: Rest Rest Application of heat or cold Application of heat or cold Exercise, massage Exercise, massage Splints, bandages Splints, bandages Physiotherapy Physiotherapy Medication Medication Surgery Surgery

26. Prevention

27. MSDs Prevention The essential keys to prevent MSDs in the workplace are: ■ management commitment and support ■ a documented MSD prevention process that is communicated to all workplace parties ■ worker participation in the prevention process ■ training on MSD prevention for all workplace parties

28. Recognize MSD hazards and related concerns No No Do MSD Hazards or Related Concerns Do MSD Hazards or Related Concerns exists ? exists ?Yes Conduct an MSD risk assessment Conduct an MSD risk assessment Increased Risk No Increased Risk No of MSD and/or Other Indicators that Controls are Required ? that Controls are Required ?Yes Choose and implement MSD hazard controls Choose and implement MSD hazard controls Follow up on and evaluate success of implemented controls Follow up on and evaluate success of implemented controls Communicate results and acknowledge success Communicate results and acknowledge success Steps in the MSD prevention framework

29. Employers and managers should: incorporate MSD prevention into their health and safety policy and program incorporate MSD prevention into their health and safety policy and program review the health and safety program to include or strengthen MSD prevention activities review the health and safety program to include or strengthen MSD prevention activities make sure that workers and JHSC members or the H&S rep are trained on how to recognize, assess and eliminate or control MSD hazards make sure that workers and JHSC members or the H&S rep are trained on how to recognize, assess and eliminate or control MSD hazards ensure that supervisors know what to do if they recognize MSD hazards or if a worker raises a concern ensure that supervisors know what to do if they recognize MSD hazards or if a worker raises a concern ensure that MSD hazards related to poor design of tools, equipment, workstations or work practices are identified and any associated risks are controlled ensure that MSD hazards related to poor design of tools, equipment, workstations or work practices are identified and any associated risks are controlled make sure that new equipment is designed and installed to reduce exposure to MSD hazards make sure that new equipment is designed and installed to reduce exposure to MSD hazards ensure that workers have the equipment and training they need to reduce their exposure to MSD hazards ensure that workers have the equipment and training they need to reduce their exposure to MSD hazards

30. Supervisors should: ensure that everyone under their supervision is aware of MSD hazards on the job and is trained to do his or her job safely ensure that everyone under their supervision is aware of MSD hazards on the job and is trained to do his or her job safely look for MSD hazards during workplace inspections, job task analyses and discussions with workers, and when reviewing injury reports look for MSD hazards during workplace inspections, job task analyses and discussions with workers, and when reviewing injury reports reinforce proper working techniques and use of equipment and personal protective equipment (PPE) reinforce proper working techniques and use of equipment and personal protective equipment (PPE) encourage and support workers taking scheduled breaks encourage and support workers taking scheduled breaks check that workers have adjusted their workstations to suit themselves and their work, and provide help as needed check that workers have adjusted their workstations to suit themselves and their work, and provide help as needed support workers when they have questions or concerns and be aware of MSD warning signs and indicators support workers when they have questions or concerns and be aware of MSD warning signs and indicators take action on reported MSD hazards and concerns and follow up with workers take action on reported MSD hazards and concerns and follow up with workers

31. Workers should: report MSD hazards and concerns to their supervisors report MSD hazards and concerns to their supervisors take scheduled breaks and take advantage of opportunities to change postures or relax muscles take scheduled breaks and take advantage of opportunities to change postures or relax muscles move around and occasionally change positions move around and occasionally change positions go to their supervisors with questions and concerns or to ask for additional training go to their supervisors with questions and concerns or to ask for additional training offer suggestions to improve working conditions to their supervisor, health and safety representative or the JHSC offer suggestions to improve working conditions to their supervisor, health and safety representative or the JHSC be aware of symptoms of MSDs and report them early if they occur be aware of symptoms of MSDs and report them early if they occur ensure that they understand the information and instructions provided ensure that they understand the information and instructions provided use proper working techniques use proper working techniques use the equipment and tools provided to reduce exposure to MSD hazards use the equipment and tools provided to reduce exposure to MSD hazards know how to make adjustments to the workstation to suit themselves and the work they do, and to ask for help as needed know how to make adjustments to the workstation to suit themselves and the work they do, and to ask for help as needed

32. References: London Occupational Safety & Health Information Service, When Aches Become Injuries( Second edition), 1998 London Occupational Safety & Health Information Service, When Aches Become Injuries( Second edition), 1998 Occupational Health and Safety Council of Ontario, Resource Manual for the MSD prevention Guideline for Ontario, 2007 Occupational Health and Safety Council of Ontario, Resource Manual for the MSD prevention Guideline for Ontario, 2007 http://www.wsib.on.ca/wsib/wsibsite.nsf/Public/ CurrentStatistics http://www.wsib.on.ca/wsib/wsibsite.nsf/Public/ CurrentStatistics http://www.wsib.on.ca/wsib/wsibsite.nsf/Public/ CurrentStatistics http://www.wsib.on.ca/wsib/wsibsite.nsf/Public/ CurrentStatistics http://www.ccohs.ca/oshanswers/diseases/rmirsi.html http://www.ccohs.ca/oshanswers/diseases/rmirsi.html

33. For more information, please contact WOHIS 519-254-5157 or For a free workplace assessment please contact OHCOW (Windsor) Occupational Health Clinics for Ontario Workers, Inc. 519-973-4800

34. Remember, you have the right to a safe & healthy workplace! Thank you