Musculoskeletal Musculoskeletal Disorders (MSDs) Disorders (MSDs)

Control and PreventionControl and Prevention

ObjectivesObjectives You will be capable to

identify the most common MSD in the society identifying risk factors.

You will be also capable to identify strategies that help in the prevention and creation of suitable society for those patients.

MSDs in KSA

On the top of the health problems encountered in urban Primary Health Care in Riyad, 1996.

Out of 1001 patients, 381 (38.1%)had MSDs.

Out of 404 male patients 132 (32.7%) had MSDs.

Out of 597 female patients, 249 (41.9%) had MSDs.

Musculoskeletal DisordersMusculoskeletal Disorders

MSD is an injury or illness to soft MSD is an injury or illness to soft body tissue such as:body tissue such as:

• MusclesMuscles• NervesNerves• TendonsTendons• LigamentsLigaments• JointsJoints• CartilageCartilage• Spinal DiscsSpinal Discs

Musculoskeletal Disorders Musculoskeletal Disorders includeinclude

Strains & SprainsStrains & Sprains Soreness or PainSoreness or Pain Carpal tunnel syndromeCarpal tunnel syndrome Connective tissue disordersConnective tissue disorders

Musculoskeletal Musculoskeletal Disorders Disorders

are medical conditions that are medical conditions that develop gradually over a period of develop gradually over a period of timetime

do not typically result from a do not typically result from a single instantaneous event.   single instantaneous event.  

MSDs are causedMSDs are caused byby•BendingBending•ClimbingClimbing•CrawlingCrawling•ReachingReaching•TwistingTwisting•OverexertionOverexertion•Repetitive ExposureRepetitive Exposure

What are the Risk Factors?

Risk FactorsRisk Factors Work-related (applied Work-related (applied

also to household?) RFalso to household?) RF•Environmental FactorsEnvironmental Factors•Activity FactorsActivity Factors

Non work related RFNon work related RF•Certain Medical ConditionsCertain Medical Conditions

Environment Risk FactorsEnvironment Risk Factors

Heat or coldHeat or cold LightingLighting VibrationVibration Tool designTool design NoiseNoise

Activity Risk FactorsActivity Risk Factors Static or awkward Static or awkward

posturespostures Improper grippingImproper gripping Improper liftingImproper lifting Repetitive MotionRepetitive Motion

Heat & ColdHeat & Cold Heat Heat affects blood circulation & affects blood circulation &

causes cramps, burns/rashes and causes cramps, burns/rashes and general discomfort. general discomfort.

ColdCold affects the body's blood affects the body's blood circulation, causes hypothermia, circulation, causes hypothermia, loss of flexibility, distraction and loss of flexibility, distraction and poor dexterity.poor dexterity.

Comfortable temperature rangeComfortable temperature range •18-21°c (68 to 74 F)18-21°c (68 to 74 F)•Humidity 20 – 60%Humidity 20 – 60%

VibrationVibration Excessive vibration causes pain to Excessive vibration causes pain to

muscles, joints and internal organsmuscles, joints and internal organs Soft tissue trauma to the hands, Soft tissue trauma to the hands,

arms, feet and legs. arms, feet and legs.

LightingLighting Under & over lighted areas causes:Under & over lighted areas causes:

•HeadachesHeadaches•Muscle strainsMuscle strains•FatigueFatigue•Eye strainEye strain

Poorly lighted areas also Poorly lighted areas also contributes to trip & fall hazards & contributes to trip & fall hazards & poor coordinationpoor coordination

Tool designTool design Handle shapeHandle shape Control typeControl type Control locationControl location VibrationVibration ImpactImpact PressurePressure

NoiseNoise Noise peaks above 100 decibels Noise peaks above 100 decibels

cause:cause:•Headaches•Increased blood pressure

•Muscle tension & fatigue

•Irritability & distraction

Force & ExertionForce & Exertion Forceful exertions place higher Forceful exertions place higher

loads on the muscles, tendons, loads on the muscles, tendons, ligaments, and joints ligaments, and joints

Factors Factors •Weight Weight •BulkinessBulkiness•SpeedSpeed

PosturePosture Prolonged standingProlonged standing - -

varicose veins, back stress, varicose veins, back stress, pooling of blood in legspooling of blood in legs

Sitting without back Sitting without back supportsupport - low back stress - low back stress

Seat too highSeat too high - decreased - decreased circulation, (legs dangling circulation, (legs dangling over end) bruisesover end) bruises

PosturePosture Shoulders roundedShoulders rounded - Upper/lower - Upper/lower

back stress, respiratory distressback stress, respiratory distress

Leaning forwardLeaning forward - Lower back - Lower back stressstress

Arms extendedArms extended or over-reaching  or over-reaching  - Stress to arm muscles, upper - Stress to arm muscles, upper back stressback stress

PosturePosture Elbows "winged"Elbows "winged" - Joint stress at - Joint stress at

shoulder, poor use of bicep shoulder, poor use of bicep musclesmuscles

Stepping backwardsStepping backwards - Loss of - Loss of balance, displaced gravity, balance, displaced gravity, muscle stressmuscle stress

Locking kneesLocking knees - Stress to back - Stress to back of knee, poor blood circulationof knee, poor blood circulation

Bent WristBent Wrist – excessive force – excessive force when grippingwhen gripping

RepetitionRepetition Frequent & prolonged repetition Frequent & prolonged repetition

of the same movements cause of the same movements cause muscle fatigue and stressmuscle fatigue and stress

Factors that increase repetition Factors that increase repetition hazardshazards

•Number of cycles per minuteNumber of cycles per minute•Force requiredForce required•PosturePosture

GrippingGripping Factors that increase gripping Factors that increase gripping

hazardshazards•Bent wristBent wrist•Surface areaSurface area•Surface frictionSurface friction•VibrationVibration•Type of gripType of grip

LiftingLifting Factors that increase lifting Factors that increase lifting

hazardshazards•WeightWeight•SizeSize•RepetitionRepetition•TwistingTwisting•BendingBending•ReachingReaching•MethodMethod

Non-work Risk FactorsCertain Medical Conditions

Such as: Rheumatic Arthritis, Diabetes, Obesity, Hormone Imbalances and Pregnancy.

AgeSpare time activities.

CONTROL MEASURES

Hazard ControlsHazard Controls Engineering Controls Administrative Controls Work Practice / household

Controls

Engineering ControlsEngineering Controls Re-design of work stationRe-design of work station Re-design of toolsRe-design of tools Lighting modificationLighting modification Vibration controlVibration control Noise ControlNoise Control AutomationAutomation Mechanical LiftingMechanical Lifting Material FlowMaterial Flow

Administrative ControlsAdministrative Controls Employee rotationEmployee rotation Job task enlargementJob task enlargement Adjustment of work pace Adjustment of work pace Redesign of work methodsRedesign of work methods Alternative tasksAlternative tasks Rest breaksRest breaks

Work Practice ControlsWork Practice Controls

Work techniques & proceduresWork techniques & procedures Conditioning period Conditioning period Training Training Lifting techniquesLifting techniques Personal Protective EquipmentPersonal Protective Equipment

Analysis tools at work place / Applicable also in households !!

ChecklistsChecklists GGeneral Risk Analysiseneral Risk Analysis Computer Work StationsComputer Work Stations Hand Tool AnalysisHand Tool Analysis Hazard IdentificationHazard Identification Task AnalysisTask Analysis Workstation EvaluationWorkstation Evaluation

Program Elements

Program ElementsProgram Elements Management LeadershipManagement Leadership Employee ParticipationEmployee Participation Hazard IdentificationHazard Identification Hazard InformationHazard Information Medical Management Medical Management Program Evaluation Program Evaluation Record keepingRecord keeping

Management LeadershipManagement Leadership Assign responsibilities Assign responsibilities Provide authority, resources & Provide authority, resources &

informationinformation Examine existing policies Examine existing policies Take action to correct problemsTake action to correct problems Communicate regularly with Communicate regularly with

employeesemployees

Hazard IdentificationHazard Identification Reports of signs, symptoms &

hazards Recommendations from

employees & supervisors Records review of existing

safety & health records Routine facility safety & health

inspections

Information & TrainingInformation & Training Signs & symptoms Signs & symptoms Importance of early reporting Importance of early reporting Specific hazards & controlsSpecific hazards & controls Reporting MSDs & hazardsReporting MSDs & hazards How to recommend control methods How to recommend control methods Protective MeasuresProtective Measures Ergonomics program & their roleErgonomics program & their role OSHA standard requirements OSHA standard requirements

Employee InvolvementEmployee Involvement Report of signs, symptoms Report of signs, symptoms

& hazards& hazards

Hazard control Hazard control recommendations recommendations

Access to information Access to information

MSD ManagementMSD Management Prompt response Prompt response Work restrictions or other Work restrictions or other

measuresmeasures Prompt access to a health care Prompt access to a health care

professionalprofessional Written Medical OpinionWritten Medical Opinion Medical Follow-upMedical Follow-up

Program EvaluationProgram Evaluation MSD recordsMSD records Engineering ControlsEngineering Controls Administrative ControlsAdministrative Controls Work Practice ControlsWork Practice Controls OpinionsOpinions

RecordkeepingRecordkeeping Reports of MSD or hazardsReports of MSD or hazards Responses to employee Responses to employee

reportsreports Job hazard analysisJob hazard analysis Hazard control recordsHazard control records Ergonomics program Ergonomics program

evaluationevaluation MSD management recordsMSD management records

Forms

Program FormsProgram Forms MSD Symptom SurveyMSD Symptom Survey MSD Survey LocationMSD Survey Location New Equipment SurveyNew Equipment Survey Task Hazard Prevention WorksheetTask Hazard Prevention Worksheet Job Hazard AnalysisJob Hazard Analysis Job Task StepsJob Task Steps MSD Sign/Symptom ReportMSD Sign/Symptom Report MSD Hazard Controls LogMSD Hazard Controls Log Hazard Control ReportHazard Control Report

Solutions

The Solution to prevent MSD The Solution to prevent MSD work related Risk Factorswork related Risk Factors

What is Ergonomics?What is Ergonomics? the science of fitting jobs to the science of fitting jobs to

people. people.

–Ergonomics uses knowledge Ergonomics uses knowledge of physical abilities, limitations of physical abilities, limitations & human characteristics that & human characteristics that apply to job design.apply to job design.

Ergonomic DesignErgonomic Design considers the tasks, considers the tasks,

equipment & equipment & environment to environment to provide efficient use provide efficient use of worker capabilities of worker capabilities while ensuring that while ensuring that job demands do not job demands do not exceed those exceed those capabilitiescapabilities

ObjectivesObjectives You will be capable to

identify the most common MSD in the society identifying risk factors.

You will be also capable to identify strategies that help in the prevention and creation of suitable society for those patients.