Musculoskeletal Disorders and the Workplace Low Back and Upper Extremities (2001) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-14
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In 1999, nearly 1 million people took time away from work to treat and recover from work-related musculoskeletal pain or impairment of function in the low back or upper extremities. Conservative estimates of the economic burden imposed, as measured by compensation costs, lost wages, and lost productivity, are between $45 and $54 billion annually.
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Research is needed to clarify such relationships, but research is complicated by the fact that estimates of incidence in the general population, as contrasted with the working population, are unreliable because the two overlap: more than 80 percent of the adult population is in the workforce. The panel approached the complex of factors bearing on the risk of musculoskeletal injury in the work setting from a whole-person perspective, that is, from a point of view that does not isolate disorders of the low back and upper extremities from physical and psychosocial factors in the workplace, from the context of the overall texture of the worker's life, including social support systems and physical and psychosocial stresses outside the workplace, or from personal responses to pain and individual coping mechanisms (see Figure ES.1~.
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that have attempted to explain the relationship. For example, epidemiology typically searches for associations between external loading characteristics and reported outcomes, whereas the relationship between external loads and biomechanical loading is usually explored via biomechanical studies (adapted from National Research Council, l999b)
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In this context, individual risk factors, such as age, body mass index, gender, smoking, and activities outside the workplace, were considered as sources of confounding and were accounted for in the research reviews. The panel was composed of 19 experts representing the fields of biomechanics, epidemiology, hand surgery, human factors engineering, internal medicine, nursing, occupational medicine, orthopedics, physical medicine and rehabilitation, physiology, psychology, quantitative analy
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Workplace factors include the external physical loads associated with job performance, as well as organizational factors and social context variables. A person is the central biological entity, subject to biomechanical loading with various physical, psychological, and social features that may influence the biological, clinical, and disability responses.
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There is also evidence that individual factors, such as age, gender, and physical condition, are important in mediating the individual's response to work factors associated with biomechanical loading. Back Disorders and the Workplace Low back disorder risk has been established through epidemiologic studies of work that involves heavy lifting, frequent bending and twisting, and whole body vibration, as well as other risk factors.
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There is strong support across these bodies of work that high force and repetition are associated with musculoskeletal disorders of the upper extremities; basic biology data provide evidence of alteration in tissue structure. The intervention literature supports the efficacy of tool and workstation design changes, job rotation, and other interventions that directly address these risk factors with regard to upper extremity symptomology.
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CONCLUSIONS Based on a comprehensive review and analysis of the evidence, as described above, the panel has reached the following conclusions: 1. Musculoskeletal disorders of the low back and upper extremities are an important national health problem, resulting in approximately 1 million people losing time from work each year.
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Work-related psychosocial factors recognized by the panel to be associated with low back disorders include rapid work pace, monotonous work, low job satisfaction, low decision latitude, and job stress. High job demands and high job stress are work-related psychosocial factors that are associated with the occurrence of upper extremity disorders.
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A1though automation and the introduction of a wide variety of technologies will characterize work in the future, manual labor will remain important. As the workforce ages and as more women enter the workforce, particularly in material handling and computer jobs, evaluation of work tasks, especially lifting, lowering, carrying, prolonged static posture, and repetitive motion, will be required to guide the further design of appropriate interventions.
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, and NIOSH should repeat, at least decennially, the National Occupational Exposure Survey. · To upgrade and improve passive industry surveillance of musculoskeletal disorders and workplace exposures, the National Institute for Occupational Safety and Health should develop adaptable surveillance packages with associated training and disseminate these to interested industries.
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Some examples include: · Developing new mechanisms and linkages among funding agencies (e.g., the National Institute for Occupational Safety and Health, the National Institute of Arthritis and Musculoskeletal and Skin Diseases) to expand ongoing basic research on relevant tissues (e.g., skeletal muscle, tendon, peripheral nerve)
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In order to implement these suggestions, the scope of research and training activities of the National Institute for Occupational Safety and Health would have to be expanded and funding significantly increased. In addition, other federal agencies (e.g., the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the National Institute of Mental Health)
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