Physical Activity as Cause and Cure of Muscular Pain: Evidence of Underlying Mechanisms

Health consequences of graded, full, and no sickness absence among workers with musculoskeletal disorders: health profiles and six-months symptom changes of patients referred to Norwegian outpatient clinics for chronic neck and back pain

OBJECTIVE

It is generally assumed that graded sickness absence results in favourable health effects due to observed positive consequences of maintaining work participation. To date, however, the direct health benefits of graded sick leave have not been widely explored. Musculoskeletal disorders are among the most prominent health issues resulting in work incapacities. This study examined baseline characteristics and six-months pain-related disability and health-related life quality progression of working age adults who attended a neck and back pain outpatient clinic. Patients prescribed graded sick leave were compared to patients prescribed full sick leave and those working without sick leave.

METHODS

Demographic, health, and treatment information of patients were assessed using clinician and patient self-report questionnaire data collected at neck and back pain outpatient clinics between 2016 and 2022. Data were obtained from the Norwegian Neck and Back Registry and the Norwegian Labour and Welfare Administration. Patient characteristics in the two weeks leading up to clinic intake were described. General linear models for repeated measures were employed to observe six-months changes in pain-related disability and health-related life quality.

RESULTS

A total of 5143 (54% female, M = 44.70 years, SD = 11.50) patients were prescribed full (n = 1411, 27%), graded (n = 1164, 23%), and no (n = 2568, 50%) sickness absence. Patients prescribed graded sick leave reported lower baseline levels of pain-related disability compared to those on full sick leave but higher pain-related disability than patients without sick leave. There were significant main and interaction effects of time and sickness absence, whereby reductions in pain-related disability were greatest among patients prescribed full sick leave, however, this group reported the highest levels of pain-related disability and lowest life quality prior to their clinic intake and six months later.

CONCLUSION

Patients who were prescribed full, graded, or no sick leave exhibited significant, albeit not clinically meaningful, reductions in pain-related disability over a six-months period. Symptom reductions may be due to clinician support or remission trends in line with regression towards the mean. While no superior health effects of graded sick leave were noted, work participation did not appear to have detrimental health effects.

Associations between knee pain and knee-loading physical activities at work and leisure - a cross-sectional study based on accelerometer measurements

BACKGROUND

Knee pain is often an early sign of knee osteoarthritis (KOA). Physical activities (PA) constitute the recommended regime to those affected. However, knee-loading PA at work is linked to an increased risk for KOA. The primary aim of this study was to investigate associations between knee pain and accelerometer-measured knee-loading PA, at work and leisure respectively. The secondary aim was to investigate knee-related problems in relation to self-reported physical effort at work.

METHODS

This cross-sectional study included 107 working participants (aged 30-67) with knee pain. Knee pain was evaluated using the Knee Injury and Osteoarthritis Outcome Scale (KOOS), subscale Pain. Knee-loading PA (including daily steps, time in upright position, stair walking), and sitting/lying were measured by accelerometer for one week. Each knee-loading PA was analysed separately for the measurement periods: (1) total period, (2) time at work, and (3) leisure on workdays. Knee-related problems were evaluated by the KOOS subscales Symptoms, Activities of Daily Living, Function in Sport and Recreation, and Quality of Life. Analyses were made with linear regression, and stratified by high or low self-reported physical effort at work.

RESULTS

Participants with more knee pain walked on average fewer steps per day, and spent less time in an upright position during leisure on workdays, unstandardized coefficient (β) = 0.001, p = 0.044, β = 0.075, p = 0.001 respectively, i.e. spent less time in knee-loading PA. The associations were stronger for those reporting high physical effort at work, β = 0.116, p = 0.016. Participants with high physical effort at work rated their (knee-related) quality of life worse. There were no associations between knee pain and knee-loading PA during work hours.

CONCLUSIONS

Participants with more knee pain were less physically active during leisure, with stronger associations among those with higher physical effort at work. Those reporting high physical effort at work had worse (knee-related) quality of life compared to participants reporting low effort at work. This highlights the importance of taking knee-loading PA at work and leisure into account when recommending exercise regimes to individuals with knee pain.

TRIAL REGISTRATION

ClinicalTrials.Gov (NCT04928170), Date of registration: 2017-12-20.

Effects of biofeedback and strength training interventions on neck-shoulder sensory-motor responses among visual display unit users. A narrative review

Workplace biofeedback and strength training interventions have been conducted to treat neck-shoulder pain among visual display unit users. Biofeedback has been given using surface electromyography, mechanomyography, oculometrics, and spinal posture to promote either muscle relaxation, muscle activation or change in posture. Strength training has been performed mostly using basic exercise equipment according to various progression principles. These two types of interventions would thus result in increased ability to cope with physical workload or improved individual resources. In this narrative review, we analyzed the design, methods, and results of the retrieved studies on neck-shoulder sensory-motor responses among visual display unit users. A few studies have reported both an immediate decrease in neck-shoulder pain and an improvement after the end of the intervention following biofeedback, often based on surface electromyography, and strength training interventions targeting the shoulder girdle. Biofeedback and strength training interventions can respectively modify ability to cope with physical workload and individual resources resulting in increased physical capacity among visual display unit users. The long-term effects and the applicability of these approaches remain to be demonstrated at workplace settings. Future studies could combine both modalities to increase versatility of the interventions.

Influence of self-reported physical exercise on musculoskeletal pain among Chinese medical students

From January to April 2020, the COVID-19 pandemic affected eastern China, leading medical students to adopt home protection measures that significantly altered their physical activity and lifestyle habits. This study aimed to assess the prevalence of musculoskeletal pain (MSP) among medical students during home protection and to analyze the influence of demographic factors, physical exercise habits during normal school life, home protection data on MSP. This research provides a foundation for developing interventions to reduce MSP among medical students. A cross-sectional survey was conducted at Nanjing Medical University in Jiangsu Province from January to April 2020, utilizing the Nordic Musculoskeletal Questionnaire (NMQ) to measure MSP. Multivariate logistic regression identified factors influencing MSP. A total of 859 students participated, with a 40.2% prevalence of MSP during home protection. Multivariate analysis showed that female sex (OR: 1.648; 95% CI: 1.157-2.347), irregular physical exercise during school (OR: 1.648; 95% CI: 1.157-2.347), and less than or equal to six hours of sleep per day during home protection (OR: 1.474; 95% CI: 1.020-2.131) were significant risk factors. The high prevalence of MSP underscores the need for interventions that focus on gender-specific risks, promote regular physical exercise, and ensure adequate sleep.

The associations of the diagnostic criterion pain modified by function with functional limitation and behavioral frequency

The aim is to assess the associations of jaw functional limitation and jaw overuse behavior with pain modified by function as a required diagnostic criterion for painful temporomandibular disorders. This cross-sectional study from the TMJ Impact Project utilized secondary data analyses of 249 participants who met the inclusion criteria of having facial pain in the prior 30 days and valid responses to the pain modified by function (Items 4A-D derived from the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Symptom Questionnaire). Independent t-tests (alpha = 0.05) were used to assess the associations between pain modified by function items with similarly assessed concepts from the Jaw Functional Limitation Scale (JFLS) and Oral Behavior Checklist (OBC). The magnitude of each association was converted to an effect size for interpretation. Pain modified by mastication (item A) and jaw mobility (item B) were significantly associated with the corresponding JFLS items (effect sizes <0.1-1.0) and exhibited a hierarchical pattern. Pain modified by jaw overuse behaviors (item C) was associated with the corresponding OBC items (effect sizes <0.1-0.8). Pain modified by other functions (item D) exhibited associations with the corresponding JFLS items (effect sizes 0.5-0.9). Pain modified by function is an integral part of musculoskeletal disorders and anchored to the interoceptive body experience. Results indicate that the DC/TMD pain modified by function questions used as diagnostic criteria have sufficient scope and the responses fit with data measuring related constructs pertaining to etiology (OBC) or consequences (JFLS).

The work Lifestyle-integrated Functional Exercise program for preventing functional decline in employees aged 55 years and older: development and initial evaluation

BACKGROUND

Despite the global increase in older employees, workplace physical activity interventions (WPAIs) for this target group have not yet been sufficiently developed. The major drawback of existing WPAIs is low adherence due to lack of time or limited motivation. A novel approach could be to integrate tailored neuromotor and strength exercises into everyday working tasks to prevent the functional decline of older employees at the workplace without needing much additional time for training. This approach was tested in the present study by evaluating the proof-of-concept of a novel WPAI based on the Lifestyle-integrated Functional Exercise (LiFE) program integrated into a working environment (wLiFE55 +).

METHODS

The proof-of-concept of wLiFE55 + was quantified within a 4-week pre-post exercise intervention study by measuring (1) feasibility including adherence, activity frequency, adverse events and acceptance (integrability of wLiFE55 + activities, perceived improvement and safety, satisfaction, physical demand, personal trainer session, intervention content) and (2) pre-to-post changes in neuromotor function (12-Level Balance Scale, 12-LBS; Community Balance and Mobility Scale, CBM), strength (60sec Chair Stand Test), and PA (1-week activity monitoring). For statistical analysis, the median and interquartile range (IQR) were computed. For pre-to-post changes, Wilcoxon signed-rank tests with effect size (r) were also performed.

RESULTS

Seventeen older employees (mean age 59 years, 8 female) were included of which fifteen completed the study. The intervention adherence was 100%, and the activity adherence was 58% (9 out of 12 maximum possible wLiFE55 + activities implemented). Depending on the specific activity, the frequency of practice ranged between 25-75% of the days of the intervention period, and single wLiFE55 + activities were practiced between one and three times per day. No adverse events occurred, and acceptance was high. Pre-to-post increases with medium effect sizes were found for neuromotor function (CBM, 12-LBS) and specific PA variables (total sedentary time, sedentary bouts > 30 min).

CONCLUSION

The results of the study highlight the feasibility of wLiFE55 + in a work setting with older employees. The pre-to-post increases observed in neuromotor measures and reductions in sedentary time suggest that wLiFE55 + may counteract the age-related functional decline in older employees and justifies future studies in this field. The next steps are program adjustments to boost exercise frequency and evaluating wLiFE55 + in a randomized controlled trial.

Genetic Variations in Susceptibility to Traumatic Muscle Injuries and Muscle Pain among Brazilian High-Performance Athletes

Traumatic muscle injuries (TMIs) and muscle pain (MP) negatively impact athletes' performance and quality of life. Both conditions have a complex pathophysiology involving the interplay between genetic and environmental factors. Yet, the existing data are scarce and controversial. To provide more insights, this study aimed to investigate the association of single-nucleotide polymorphisms (SNPs) previously linked to athletic status with TMI and MP after exercise among Brazilian high-performance athletes from different sports modalities (N = 345). The impact of important environmental determinants was also assessed. From the six evaluated SNPs (ACTN3 rs1815739, FAAH rs324420, PPARGC1A rs8192678, ADRB2 rs1042713, NOS3 rs1799983, and VDR rs731236), none was significantly associated with TMI. Regarding MP after exercise, ACTN3 rs1815739 (CC/CT vs. TT; adjusted odds ratio (aOR) = 1.90; 95% confidence interval (95%Cl), 1.01-3.57) and FAAH rs324420 (AA vs. AC/CC; aOR = 2.30; 95%Cl, 1.08-4.91) were independent predictors according to multivariate binomial analyses adjusted for age (≥23 vs. <23 years), sex (male vs. female), and tobacco consumption (yes vs. no). External validation is warranted to assess the predictive value of ACTN3 rs1815739 and FAAH rs324420. This could have implications for prophylactic interventions to improve athletes' quality of life.

Analysis of physical activity and prescription opioid use among US adults: a cross-sectional study

BACKGROUND

Opioid crisis has become a global concern, but whether physical activity (PA) can effectively reduce prescription opioid use remains unclear. The study aimed to examine the relationship of different domains of PA (e.g., occupation-related PA [OPA], transportation-related PA [TPA], leisure-time PA [LTPA]) with prescription opioid use and duration of prescription opioid use.

METHODS

This cross-sectional study was conducted on 27,943 participants aged ≥ 18 years from National Health and Nutrition Examination Survey (NHANES, 2007- March 2020). We examined the relationship of different domains of PA with prescription opioid use and duration of prescription opioid use using multivariable logistic regression. Stratified analysis and a series of sensitivity analysis were used to elevate robustness. All analyses were conducted using appropriate sampling weights.

RESULTS

Of the 27,943 participants, the mean age was 45.10 years, with 14,018 [weighted, 50.0%] females and 11,045 [weighted, 66.0%] non-Hispanic White. After multivariable adjustment, inverse associations between PA and prescription opioid use were observed for sufficient (≥ 150 min/week) total PA (OR,0.68 95%CI [0.56-0.81]), TPA (OR,0.73 95%CI [0.58-0.92]), and LTPA (OR,0.60 95%CI [0.48-0.75]) compared with insufficient PA(< 150 min/week), but not for sufficient OPA (OR,0.93 95%CI [0.79-1.10]). In addition, the associations were dose-responsive, participants had 22-40%, 27-36%, and 26-47% lower odds of using prescription opioids depending on the duration of total PA, TPA, and LTPA, respectively. Nevertheless, the impact of PA on prescription opioid use varied by duration of opioid use. Sufficient total PA was associated with elevated odds of short-term use of prescription opioids (< 90 days). Comparatively, sufficient total PA, TPA, and LTPA had different beneficial effects on reducing long-term use of prescription opioids (≥ 90 days) depending on the strength of opioids.

CONCLUSIONS

This study demonstrated sufficient total PA, TPA, and LTPA were inversely associated with prescription opioid use and varied depending on the duration and strength of prescription opioid use. These findings highlight PA can provide policy guidance to address opioid crisis.

Physical and psychological impact of surgery on the operating surgeon

The impact of surgery on the surgeon's well-being encompasses both physical and psychological aspects. Physically, surgeons are at risk of work-related musculoskeletal symptoms due to the nature of their work, and this risk can be impacted by theater environment, equipment design, and workload. Many symptoms will be self-limiting, but work related musculoskeletal symptoms can lead to the development of an injury, which can have far reaching effects, including the need for medical or surgical treatment, time away from work, or a change in clinical duties. Additionally, surgery can place a significant cognitive workload on the lead operator and this can be exacerbated, or alleviated, by the surgical environment, experience of the assistance, surgical modality, and case complexity. Measuring and quantifying the impact of surgery on the surgeon is a challenging undertaking. Tools such as motion capture, physiological markers, including heart rate variability and salivary cortisol, and questionnaires can provide insights into understanding the overall impact of surgery on the surgeon. A holistic approach that incorporates injury prevention strategies, communication, and support, is vital in assessing and mitigating risk factors. Injury prevention assessment tools and interventions that can be used within the busy surgical environment are needed, alongside increased ergonomic awareness. Addressing the impact of surgery on the surgeon is a multifaceted challenge, and long term positive changes can only be sustained with the support of the whole surgical team and healthcare organizations by developing and maintaining a supportive working environment.

Optimised return to play: high treatment success rate in core muscle injury with surgical release of the anterior tendon of the rectus abdominis muscle and proximal tenotomy of the adductor longus muscle

OBJECTIVES

Core muscle injury is a debilitating condition that causes chronic groin pain in athletes, particularly common in soccer players. The condition is characterised by pain in the inguinal region and can lead to a significant number of absences from high-intensity physical activity. It is caused by repetitive overload without proper counterbalance from the abdominal muscles, hip flexors, and adductors in susceptible athletes. Surgical indications for core muscle injury consider cases where non-surgical treatments have not provided sufficient relief. The aim of this study was to assess the results of surgical intervention for core muscle injury using the technique employed by the Sports Medicine Group of (Institute of Orthopedics and Traumatology of Hospital das Clínicas - Universidade de São Paulo). The procedure involves releasing the anterior portion of the tendon of the rectus abdominis muscle near the pubic symphysis, along with proximal tenotomy of the adductor longus muscle tendon.

METHODS

This study utilised a consecutive historical cohort analysis of the medical records of 45 male athletes, of which, 75.6% were professional soccer players, who underwent surgical treatment between January 1, 2002, and December 31, 2021. The participants included active athletes aged between 18 and 40 years, with a mean age of 23.9 years, and were diagnosed with myotendinous core muscle injury. These athletes experienced pain in the pubic symphysis and adductor tendon region and had previously undergone medical treatment and physical therapy for a duration of three to six months without significant improvement.

RESULTS

The average time for athletes to return to sport after surgery was 135 days, with a majority of participants being soccer and futsal players. The surgical intervention yielded promising results, with a positive correlation between unilateral injuries and the time taken to return to sport. The complication rate was low, at 6.7%. Notably, the rate of symptom resolution was high, at 93.3%. Furthermore, the analysis indicated that the player's position on the field significantly influenced the discharge period, suggesting that the game position plays a role in the recovery process.

CONCLUSION

The combined surgical procedure involving the release of the rectus abdominis tendon and adductor longus muscle tenotomy demonstrates favourable outcomes for athletes with core muscle injury. This study provides strong support for the effectiveness of this surgical approach in managing the condition and offers a potential path to recovery and return to sports activities.

LEVEL OF EVIDENCE: 4

STUDY DESIGN

Cross-sectional study.

The Role of Physical Exercise in Chronic Musculoskeletal Pain: Best Medicine-A Narrative Review

The aim of this paper is to provide a narrative review of the effects of physical exercise in the treatment of chronic musculoskeletal pain. Physical inactivity and sedentary behavior are associated with chronic musculoskeletal pain and can aggravate it. For the management of musculoskeletal pain, physical exercise is an effective, cheap, and safe therapeutic option, given that it does not produce the adverse effects of pharmacological treatments or invasive techniques. In addition to its analgesic capacity, physical exercise has an effect on other pain-related areas, such as sleep quality, activities of daily living, quality of life, physical function, and emotion. In general, even during periods of acute pain, maintaining a minimum level of physical activity can be beneficial. Programs that combine several of the various exercise modalities (aerobic, strengthening, flexibility, and balance), known as multicomponent exercise, can be more effective and better adapted to clinical conditions. For chronic pain, the greatest benefits typically occur with programs performed at light-to-moderate intensity and at a frequency of two to three times per week for at least 4 weeks. Exercise programs should be tailored to the specific needs of each patient based on clinical guidelines and World Health Organization recommendations. Given that adherence to physical exercise is a major problem, it is important to empower patients and facilitate lifestyle change. There is strong evidence of the analgesic effect of physical exercise in multiple pathologies, such as in osteoarthritis, chronic low back pain, rheumatoid arthritis, and fibromyalgia.

Assessment and evaluation of work-related musculoskeletal disorders among nuclear medicine professionals in India: A cross-sectional study

BACKGROUND

Musculoskeletal disorders (MSDs) are a severe occupational health issue among medical radiation practitioners. It is mostly linked to personal protective wear, working posture, tools employed and ergonomics.

OBJECTIVE

To assess and evaluate the musculoskeletal disorders among nuclear medicine professionals (NMP) in India.

METHODS

An online survey was distributed to 455 NMP throughout India between November 2021 and March 2022 covering the demographic characteristics and questions for evaluation of musculoskeletal symptoms using the Standardized Nordic Musculoskeletal Questionnaire (NMQ). Participants with any pre-existing musculoskeletal disorder or trauma were excluded. Descriptive statistics summarized the data from the demographics, discomfort, aches and work-related musculoskeletal injuries. Chi-square test was used to examine the association between the obtained values.

RESULTS

91 out of 124 respondents were included based on the inclusion and exclusion criteria. Results shows that there is a significant association between the height of the individual and neck pain, body mass index and elbows pain, age and low back pain, experience in the current work and upper back pain, the weight of the individual and knee pain, use of mobile lead screens and shoulder pain, use of gonad shield, trouble in the ankles and use of lead screens, and QC phantoms for gamma camera / PET and wrists/hands pain.

CONCLUSION

Work-related musculoskeletal disorders among NMP are resulting from factors of individual demographic variables (such as age, height, weight, body mass index), years of experience at the current workplace and of using instruments in their work area.

Exercise Therapy for Chronic Neck Pain: Tailoring Person-Centred Approaches within Contemporary Management

Exercise therapy is considered the best evidence-based approach for managing chronic neck pain. However, the implementation of exercise therapy presents several challenges. Systematic reviews indicate that it has modest effectiveness, while clinical practice guidelines offer limited guidance on the exercise parameters required to optimise clinical outcomes. Moreover, recommendations often fail to differentiate between different types of neck pain. This article addresses the challenges associated with the prescription of exercise for chronic neck pain and provides recommendations for exercise therapy specific to chronic nociceptive, neuropathic, and nociplastic neck pain. The goal of this article is to facilitate the implementation of high-value evidence-based exercise therapy for these distinct types of chronic neck pain with the aim to improve its outcomes and to reduce the related individual and societal burdens.

Baseline predictors related to functional outcomes in patients older than sixty years with complex regional pain syndrome type 1 after distal radius fracture treated conservatively: a prospective observational study

PURPOSE

This study aimed to analyze baseline predictors of functional outcomes six weeks and at one year follow-up in patients older than 60 years with complex regional pain syndrome type 1 (CRPS I) after distal radius fracture (DRF).

METHODS

A total of 120 patients with CRPS I after DRF were prospectively recruited. Presumptive relevant factors were collected and analyzed as potential baseline predictors. Additionally, functional outcomes were assessed at the beginning of physiotherapy treatment, at six weeks after finishing physiotherapy treatment, and at one year follow-up. Patient-Rated Wrist Evaluation; Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire; Jamar dynamometer; and visual analog scale (VAS) were assessed.

RESULTS

All participants completed the study. At 6 weeks, the main results showed an association of lower values of grip strength with female sex (p = 0.010), intra-articular DRFs (p = 0.030), longer immobilization time (p = 0.040), lower levels of physical activity (p < 0.001), higher levels of kinesiophobia (p = 0.010), and anxiety (p = 0.020). At 1-year follow-up, the results showed an association of lower values of DASH with higher BMI (p < 0.001) and longer immobilization time (p < 0.001); and higher values of VAS showed an association with older age (p = 0.010), higher BMI (p = 0.010), and lower levels of physical activity (p = 0.040).

CONCLUSION

At six weeks, factors such as BMI, immobilization time, physical activity, and kinesiophobia are associated with lower functional outcomes. Additionally, at one year follow-up, BMI, immobilization time, and physical activity continue to be associated with lower functional outcomes in patients with CRPS I after DRF treated conservatively.

Neck pain and headache: Pathophysiology, treatments and future directions

INTRODUCTION

Neck pain is a prevalent neurologic and musculoskeletal complaint in the general population and is often associated with primary headache disorders such as migraine and tension-type headache (TTH). A considerable proportion, ranging from 73% to 90%, of people with migraine or TTH also experience neck pain, and there is a positive correlation between headache frequency and neck pain. Furthermore, neck pain has been identified as a risk factor for migraine and TTH. Although the exact underlying mechanisms linking neck pain to migraine and TTH remain uncertain, pain sensitivity appears to play an important role. People with migraine or TTH exhibit lower pressure pain thresholds and higher total tenderness scores compared with healthy controls.

PURPOSE

This position paper aims to provide an overview of the current evidence on the relationship between neck pain and comorbid migraine or TTH. It will encompass the clinical presentation, epidemiology, pathophysiology, and management of neck pain in the context of migraine and TTH.

IMPLICATIONS

The relationship between neck pain and comorbid migraine or TTH is incompletely understood. In the absence of robust evidence, the management of neck pain in people with migraine or TTH relies mostly on expert opinion. A multidisciplinary approach is usually preferred, involving pharmacologic and non-pharmacologic strategies. Further research is necessary to fully dissect the linkage between neck pain and comorbid migraine or TTH. This includes the development of validated assessment tools, evaluation of treatment effectiveness, and exploration of genetic, imaging, and biochemical markers that might aid in diagnosis and treatment.

Exercise Prescription for the Work-Life Population and Beyond

The background for this paper concerns a high frequency of work-related disorders that may result from physical exposure at work being highly sedentary, repetitive-monotonous, or physically demanding. This may result in levels of physical inactivity or strenuous activity impairing health. The aim is to present an evidence-based exercise prescription for the work-life population and beyond. The exercise program is designed to be feasible for use at the workplace and/or during leisure time and to improve health, workability, productivity, sickness absence, etc. The specific concept of Intelligent Physical Exercise Training, IPET, includes the assessment of several health-related variables, including musculoskeletal disorders, physical capacity, and physical exposure at work and/or daily life activity. An algorithm with cut-points for prescribing specific exercises is provided. Exercise programs in praxis are addressed through descriptions of precise executions of various prescribed exercises and possible alternatives to optimize variation and adherence. Finally, perspectives on the significance of introducing IPET and the ongoing, as well as future lines of development, are discussed.

Effectiveness of warm-up interventions on work-related musculoskeletal disorders, physical and psychosocial functions among workers: a systematic review

OBJECTIVES

The aim of this systematic review was to identify from published literature the available evidence regarding the effects of warm-up intervention implemented in the workplace on work -related musculoskeletal disorders (WMSDs) and physical and psychosocial functions.

DESIGN

Systematic review.

DATA SOURCES

The following four electronic databases were searched (from inception onwards to October 2022): Cochrane Central Register of Controlled Trials (CENTRAL), PubMed (Medline), Web of Science and Physiotherapy Evidence Database (PEDro).

ELIGIBILITY CRITERIA

Randomised and non-randomised controlled studies were included in this review. Interventions should include a warm-up physical intervention in real-workplaces.

DATA EXTRACTION AND SYNTHESIS

The primary outcomes were pain, discomfort, fatigue and physical functions. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and used the Grading of Recommendations, Assessment, Development and Evaluation evidence synthesis. To assess the risk of bias, the Cochrane ROB2 was used for randomised controlled trial (RCT) and the Risk Of Bias In Non-randomised Studies-of Interventions was used for the non-RCT studies.

RESULTS

Three studies met the inclusion criterion, one cluster RCT and two non-RCTs. There was an important heterogeneity in the included studies principally concerning population and warm-up intervention exercises. There were important risks of bias in the four selected studies, due to blinding and confounding factors. Overall certainty of evidence was very low.

CONCLUSION

Due to the poor methodological quality of studies and conflicting results, there was no evidence supporting the use of warm-up to prevent WMSDs in the workplace. The present findings highlighted the need of good quality studies targeting the effects of warm-up intervention to prevent WMSDs.

PROSPERO REGISTRATION NUMBER

CRD42019137211.

Effects of a warm-up intervention at the workplace on pain, heart rate, work performance and psychological perception among vineyard workers

OBJECTIVES

Warm-up sessions before physical activity are widely used in sports to help prevent injury and improve performance. Nowadays, companies assume that the effects observed in a sport context can be transferred to the workplace, particularly among workers exposed to biomechanical strain. Yet research on the use of warm-up interventions at the workplace is rather scarce and, when available, leads to conflicting results due to the low quality of the studies. To the best of our knowledge, there are no published studies to date assessing the effects of warm-up sessions among vineyard workers. The present study was designed to investigate if and how a single supervised warm-up session could be effective on perceived pain intensity, heart rate, work performance, and psychological perceptions among vineyard workers.

METHODS

A total of 31 vineyard workers completed a randomized crossover study at the workplace. They were observed in real work settings, i.e. during the pruning activity. Each participant performed the activity under two conditions: 1) with a warm-up session beforehand (WU) and 2) without any warm-up (NWU). Heart rate (HR) was assessed continuously before and during the warm-up, and during the first hour of pruning. Perceived pain intensity over fifteen anatomical locations was assessed before (T0) and immediately after (T1) warm-up, and after the first hour of work (T2). Readiness to work was assessed at T1. Work performance was assessed in terms of the number of completed tasks (number of pruned vines). Perceived work quality and perceived work ability were assessed at T2.

RESULTS

Perceived pain intensity over the lumbopelvic region was significantly higher at T2 than at T0, and at T2 than at T1, in both WU and NWU. Perceived pain intensity was not significantly different at T2 in WU and NWU. HR at T1 was significantly higher in WU than in NWU. Work performance, readiness to work, and perceived work ability were significantly higher in WU than in NWU.

CONCLUSION

This study showed that offering vineyard workers a supervised warm-up session at the workplace can lead to promising results where work performance and psychological perception are concerned.

The longitudinal association between working from home and musculoskeletal pain during the COVID-19 pandemic

OBJECTIVE

This study investigates the associations between working from home and the presence of MSP during the COVID-19 pandemic. Working from home often involves a lot of sedentary computer screen work and the home working environment might not be optimally equipped, which can lead to health problems, including musculoskeletal pain (MSP).

METHODS

Longitudinal data from 16 questionnaire rounds of the Lifelines COVID-19 cohort during the first year of the COVID-19 pandemic (March 2020-February 2021) were used. In total, 40,702 Dutch workers were included. In every round, participants reported whether they worked on location, from home, or hybrid. Logistic Generalized Estimating Equations were used to study the association of work situation with the presence of MSP and the presence of severe MSP.

RESULTS

Working from home was associated with higher risks of having MSP in the lower back (OR: 1.05, 95% CI 1.02-1.08), in the upper back (OR: 1.24, 95% CI 1.18-1.31), and in the neck, shoulder(s) and/or arm(s) (OR: 1.18, 95% CI 1.13-1.22). Hybrid working was associated with higher risks of having pain in the upper back (OR: 1.09, 95% CI 1.02-1.17) and in the neck, shoulder(s) and/or arm(s) (OR: 1.14, 95% CI 1.09-1.20). Both home and hybrid workers had higher risks of severe MSP in the different body areas.

CONCLUSION

Home workers, and to a smaller extent hybrid workers, had higher risks of having MSP than location workers during the first year of the COVID-19 pandemic. The results indicate the importance of measures to prevent MSP in future policies involving working from home.

The mediating role of physical activity and sedentary behavior in the association between working from home and musculoskeletal pain during the COVID-19 pandemic

Introduction

Working from home during the COVID-19 pandemic has been associated both with physical inactivity and musculoskeletal pain. However, it has not been examined whether physical activity and sedentary behavior are underlying mechanisms in the association between working from home and musculoskeletal pain. Therefore, we examined their mediating role in this association.

Methods

Data were used from 24 questionnaire rounds of the Lifelines COVID-19 cohort (March 2020-January 2022). Longitudinal information on work situation (location, home, hybrid), physical activity, sedentary behavior, and musculoskeletal pain was collected among 28,586 workers. Analysis of physical activity/sedentary behavior as mediators of the association between working from home and musculoskeletal pain was performed using multilevel structural equation modeling.

Results

Home workers more often had pain in the upper back [odds ratio (OR) = 1.17, 95%-confidence interval (CI) = 1.02-1.34] and arm, neck, and/or shoulder (ANS) (OR = 1.32, 95%-CI = 1.19-1.47) than location workers. Furthermore, home workers were more often sedentary for >9 h per work day than location workers (OR = 2.82, 95%-CI = 2.56-3.09), and being more sedentary was associated with musculoskeletal pain (upper back: OR = 1.17, 95%-CI = 1.06-1.30; ANS: OR = 1.25, 95%-CI = 1.16-1.34). Corresponding indirect effects were OR = 1.18 (95%-CI = 1.04-1.33) and OR = 1.26 (95%-CI = 1.12-1.35). No indirect effect was found for physical activity. Similar indirect effects were observed for hybrid workers.

Conclusion

Home and hybrid workers were more likely to have pain in the upper musculoskeletal system during the COVID-19 pandemic than location workers, which was partly mediated by increased sedentary behavior, but not by reduced physical activity. Measures to reduce sedentary time in home workers may contribute to preventing musculoskeletal pain.

LifeStyle and Exercise Relation to Neck and Back Pain in Saudi Arabia

BACKGROUND

Personal anguish, incapacity, and a decline in work and life quality are all associated with neck and low back pain, making it a significant socioeconomic burden for individuals and society. It is well known that engaging in regular physical exercise has considerable health benefits.

OBJECTIVE

The purpose of this research was to investigate the factors contributing to the high rates of musculoskeletal pain experienced by the Saudi Arabian population.

METHODS

This population-based, cross-sectional study was done in Saudi Arabia with 2,717 participants aged 18 to 60. A questionnaire was provided online to assess neck, shoulder, and lower back discomfort, time spent in general or aerobic physical activity, time spent sitting, sleep problems, general health, work satisfaction, and nutrition. Using logistic regression, we observed potential risk factors for musculoskeletal pain.

RESULTS

The prevalence of neck pain, shoulder pain, and lower back pain (LBP) were found to be 48.1%, 47.6%, and 63.8%, respectively. It was found that being a female (OR=1.78 [1.41-2.25], p<0.001), married (OR=1.58 [1.34-1.86], p<0.001), and having poor general health status (OR=3.78 [2.2-6.49], p<0.001), sleep disturbances (OR=2.46 [2.04-2.97], p<0.001) and poor job satisfaction (OR=1.29 [1.05-1.60], p=0.016) were independently associated with the prevalence of musculoskeletal pain. The diet of the individuals did not significantly influence the prevalence of MSPs.

CONCLUSION

Good general health, good sleep, and good job satisfaction were associated with a reduced risk of experiencing neck or shoulder pain, but there was no association between physical activity and MSPs Longitudinal studies are required to acquire a better understanding of the relationship between MSP, aerobic activity, sleep, and diet.

Association between the time of physical laboral activities and leisure over shoulder pain in fruitculture workers: A cross-sectional study

BACKGROUND

Fruitculture workers are exposed to shoulder pain disorders due to long working times in overhead activities.

OBJECTIVE

This study aims to analyze the association between the time of physical work and leisure activities over the perception of shoulder pain intensity in fruit growing workers.

METHODS

This is a descriptive and correlational cross-sectional study. The sample consisted of 180 fruit-growing workers. Multivariable logistic regression was used, with an estimate of the Odds Ratio (OR) and 95% confidence intervals. The dependent variable: Numeric Pain Rating Scale (NPRS) (0-10 points), was categorized as low and high, with cutoff points of NPRS > 3 and NPRS > 4, and was associated with the independent variables (level of physical activity, personal, labour and psychosocial).

RESULTS

Workers which are insufficiently active in leisure time are more likely to report high-intensity shoulder pain, NPRS > 3 (OR: 2.39; p = 0.049) and NPRS > 4 (OR: 2.85; p = 0.036). In addition, working time in overhead activities is a risk factor for high-intensity pain for NPRS > 3 and NPRS > 4 (OR = 1.01; p < 0.001). Underweight and normal-weight workers were less likely to report shoulder pain in NPRS > 3 (OR = 0.35; p = 0.020) and in NPRS > 4 (OR = 0.20; p = 0.001).

CONCLUSION

Fruit-growing workers had a high prevalence of severe shoulder pain. In addition, workers who are insufficiently active at leisure, overweight and obese are more likely to report severe pain. It was observed that overhead tasks increase the chances of reporting high-intensity shoulder pain among workers.

Ergonomic and individual risk factors for musculoskeletal pain in the ageing workforce

Background

The present study aimed to investigate the possible association between specific ergonomic and individual risk factors and musculoskeletal pain (MSP) in the back, shoulder, hip and knee region in workers aged 50-65y.

Methods

The study was a population based cross-sectional survey. The study population comprised citizens born between 1952–1966, living in Esbjerg municipality, Denmark, ultimo 2016 (n = 23,463). A questionnaire was sent electronically or by mail. The analysis included the working population only. A multivariate logistic regression was used for each of the following dependent variables; musculoskeletal pain for the past 3 months in the back, shoulder, hip and knee, where independent variables included ergonomic exposure, age, sex, body mass index (BMI) and leisure time physical activity (LTPA).

Results

The overall response rate was 58% and the data of individuals at work (n = 9,263) demonstrated several ergonomic exposures with increased odds for pain in specific regions. Exposure to back twisted or bend, squatting or lying on knees and to carrying or lifting were associated with musculoskeletal pain in the back, whereas exposure to back twisted or bend, arms above shoulder and repeated arm movement were associated with pain in the shoulder. Exposure to back twisted or bend, repeated arm movement, squatting or lying on knees and to carrying or lifting were associated with musculoskeletal pain in the hip. Important individual risk factors were also identified. Increasing age was significantly associated with increased pain in the hip but associated with less risk for pain in the back and shoulder. Males had higher odds for pain in the back and knee compared to females but lower odds for pain in the hip. BMI was particularly important for knee pain. The level of LTPA did not have an important association with MSP in any region.

Conclusion

There is a significant positive association between ergonomic exposures and musculoskeletal pain, which were specific for the back, shoulder, hip and knee. In addition, the data demonstrated a differential association with age, sex and BMI. This needs to be considered for the treatment and classification of musculoskeletal pain and for future preventive initiatives.

Relationship between physical activity and musculoskeletal disorders among low income housewives in Kuala Lumpur: A cross sectional study

Housewives play a crucial role in their families’ and communities’ quality of life. However, musculoskeletal disorders are common among housewives due to housework and lack of physical activity. These musculoskeletal problems have been associated to leisure physical activity. As a result, the goal of this study was to determine the incidence of musculoskeletal problems and their association to physical activity among low-income women in Kuala Lumpur. A cross-sectional research was done among 82 housewives in Kuala Lumpur’s low-income housing area. Housewives were asked to fill out a sociodemographic questionnaire, a short version of the International Physical Activity Questionnaire (IPAQ), the Nordic Musculoskeletal Questionnaire (NMQ), and body mass index were measured by researcher. The total prevalence of musculoskeletal problems was found to be 89.0%, with the lowest frequency in the lower back (35%), followed by the knee (31%), ankle or foot (31%), and elbow (1% %). The subjects spent an average of 117.6 + 474.8 minutes per week on MVPA and 524 + 810.3 MET minutes per week on physical activity. A total of 88% of the participants had a low level of physical activity, 8.5 percent had a moderate level of activity, and 3.7% had a high level of activity. In a Chi-square test, there was no significant association between musculoskeletal problems and physical activity. The primary sociodemographic factors impacting musculoskeletal diseases were body mass index and household income, while the primary variables influencing physical activity were household income and education level, according to a logistic regression test. In a Poisson regression test, only body mass index had a significant relationship with number of musculoskeletal disorders. In conclusion, housewives are likely to suffer from musculoskeletal problems, with a high incidence in the lower back, knees, ankles, and feet, and the majority of them engage in little physical activity. Furthermore, the high percentage of musculoskeletal problems in this study varies with the findings of other research based on the type of housework done by housewives in low-cost housing areas. Future research should look at identifying the sorts of household tasks and positions employed, as well as the amount of hours spent on housework each week.

Exploring the relationships between computer task characteristics, mental workload, and computer users' biomechanical responses

Previous biomechanics studies suggest that higher cognitive mental workload when performing office computer tasks may increase the risk of MSDs among office workers. Cognitive workload can be interpreted in terms of task factors (e.g. task complexity and time pressure) and mental workload factors which include mental demand and mental effort. A laboratory study was conducted to further explore how the task and mental workload factors affected computer users' biomechanical responses, specifically the muscle activation levels and sitting postures. Data were collected as 20 participants worked on computer tasks which varied in their levels of task complexity and time pressure. Visual analog scales were used for assessing mental workload factors. Results indicated that the level of mental effort reported, as opposed to the level of task complexity, was associated with changes in participants' biomechanical responses, but primarily occurred when the chair's backrest was not used. Practitioner summary: A study was conducted to investigate the association between computer users' cognitive workload and biomechanical responses when performing computer task. While task complexity was not directly associated with the changes in participants' biomechanical responses, higher reported mental effort was associated with increased biomechanical responses, but only when the participants did not use the backrest on the chair.

Patellofemoral Pain Syndrome Risk Associated with Squats: A Systematic Review

Patellofemoral pain syndrome (PFPS) is highly prevalent; it can cause severe pain and evolve into progressive functional loss, leading to difficulties performing daily tasks such as climbing and descending stairs and squatting. This systematic review aimed to find evidence, in the literature, of squat movements that can cause or worsen PFPS. This work was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, and its protocol was registered in PROSPERO (CRD42019128711). From the 6570 collected records, 37 were included. From these 37 articles, 27 present a causal relationship between knee flexion and PFPS, 8 describe a relationship, considering the greater existence of muscle contractions, and one article did not describe this relationship in its results. The main limitations stem from the fact that different studies used different evaluation parameters to compare the force exerted on the patellofemoral joint. Furthermore, most studies are focused on sports populations. After analysing the included works, it was concluded that all squat exercises can cause tension overload in the knee, especially with a knee flexion between 60° and 90° degrees. The main causal/worsening factors of PFPS symptoms are the knee translocation forward the toes (on the same body side) when flexing the knee, and the muscle imbalance between the thigh muscles.

From Health Literacy to Self-Care: Contributions of the Specialist Nurse in Rehabilitation Nursing

(1) Background: Initiatives aimed at assessing and intervening in health literacy have the potential to promote adherence to self-care behaviours, which is the main focus of intervention by rehabilitation nurses. Thus, the objectives were to analyse the level of health literacy of working-age citizens and identify priority areas for intervention by rehabilitation nurses. (2) Methods: Quantitative, correlational and cross-sectional study, conducted in a multinational company, with the participation of 161 workers. The data were collected between 14 April and 7 May 2021, using a self-completion questionnaire composed of sociodemographic and clinical characterization and the European Health Literacy Survey, following a favourable opinion from the Ethics Committee and the company’s management. (3) Results: Overall, low to moderate literacy scores were predominant. Age and education were significantly associated with literacy scores. Workers with higher levels of health literacy had no diagnosed illnesses, took less medication, reported less sadness, fewer memory changes and less muscle and joint pain. (4) Conclusions: The fact that higher levels of health literacy trigger self-care behaviours and, consequently, fewer health problems reinforces the need for rehabilitation nurses to invest in this area.

Work-related musculoskeletal disorders among Pakistani construction workers: Prevalence, characteristics, and associated risk factors

BACKGROUND: Worldwide, approximately 350 million people are currently employed in the construction industry. OBJECTIVE: To determine the prevalence, pain characteristics, and associated risk factors for musculoskeletal disorders (MSDs) among construction workers in Pakistan. METHODS: This study was a cross-sectional survey conducted from February to August 2019 among 666 construction workers. The data were collected using a questionnaire consisting of 4 sections: demographic information, a numerical pain intensity rating scale, a Nordic questionnaire to report prevalence, and pain characteristics. SPSS was used for data entry and analysis. RESULTS: The mean age of the construction workers was 34.49 years. Participants who reported pain were 397 out of 666 and 269 were those who reported no pain. The 12-month prevalence of pain among construction workers in more than one body area was 89% (n = 591) and the 7-day prevalence was 52% (n = 343); lower back pain was the most common type of pain with a 12-month prevalence of 27% (n = 180) and a 7-day prevalence of 17% (n = 112). Regarding the characteristics of the pain, 26% (173) of the workers suffered pain occasionally, 27% (180) participants had pain for≤2 hours per day, and 32.9% (219) had dull pain. Moreover, a significant relationship was found (p < 0.05) between MSDs and age, lifestyle, work experience, smoking habits, and absence from work. CONCLUSION: Musculoskeletal pain is highly prevalent, with lower back pain being the most commonly reported type. Absence from work and disability in performing normal daily activities have been reported as consequences of musculoskeletal pain. Moreover, this study underscores the importance of targeted preventive healthcare measures for construction workers.

Attention to Progression Principles and Variables of Exercise Prescription in Workplace-Related Resistance Training Interventions: A Systematic Review of Controlled Trials

Background

The workplace is an important setting for adult health promotion including exercise training such as resistance training (RT). Since the reporting of exercise training interventions is generally inconsistent, the objective of this systematic review was to investigate the attention to principles of RT progression and variables of RT exercise prescription in workplace-related RT interventions.

Methods

A systematic literature search was conducted in the databases LIVIVO, PubMed, SPORTDiscus, and Web of Science (2000–2020). Controlled trials with apparently healthy “employees” and a main focus on RT were included. RT principles and variables were extracted and rated by two reviewers (reported, not reported, or unclear). Sum scores for each RT intervention and percentages regarding each principle and variable were calculated.

Results

Overall, 21 articles were included (18 primary studies, 3 protocols). Summarized narratively, the interventions showed different positive effects on strength- or performance-related and/or health- or complaint-related outcomes. The reporting of the RT principles and variables was varied [progressive overload: 94% of the studies, specificity: 78%, variation (periodization): 39%, muscle action: 94%, loading: 94%, volume; 67%, exercise selection: 89%, exercise order: 47%, rest periods between sets: 33%, rest periods between exercises: 27%, repetition velocity: 44%, and frequency: 100%].

Conclusion

Several key RT principles and variables were reported inconsistently, reducing reproducibility and pointing to the need for standardized RT intervention reporting in workplace-related interventions. Exercise science and workplace promotion should be further linked, since accurate reporting is a prerequisite for transferring robust findings into practice.

Influence of gender and age on musculoskeletal symptoms in white and blue-collar workers - cross-sectional study

OBJECTIVE

Identify the prevalence of musculoskeletal symptoms among blue- and white-collar workers stratified by gender and age.

METHODS

The sample was composed of 390 blue-collar and 510 white-collar workers. Musculoskeletal symptoms were evaluated using the Nordic Musculoskeletal Questionnaire. Independent t-test or Mann-Whitney test were used for the inter-group comparisons. The Chi-square (χ²) association test was applied for categorical variables. Logistic regression analysis was used to determine the influence of gender and age on musculoskeletal symptoms.

RESULTS

The prevalence of shoulder, lower back, and ankle/foot symptoms was higher among blue-collar workers compared to white-collar workers. In the analysis stratified by gender, female blue-collar workers had a higher frequency of shoulder symptoms and male blue-collar workers had a higher frequency of lower back symptoms. In the analysis stratified by age, younger blue collar-workers had a higher frequency of shoulder, lower back, and ankle/foot symptoms compared to young white-collar workers and older white-collar workers had a higher frequency of neck symptoms compared to older blue-collar workers.

CONCLUSIONS

Gender and age exerted an influence on self-reported symptoms in blue- and white-collar workers.

Workability in the Ageing Workforce-A Population-Based Cross-Sectional Study

Background: The purpose of this study was to investigate the impact of age, musculoskeletal pain and ergonomic exposure on workability in the oldest group of workers. Methods: The study was a population based cross-sectional survey. The study population comprised citizens born between 1952–1966, living in Esbjerg municipality ultimo 2016 (n = 23,463). A questionnaire was sent electronically or by mail. The analysis included the working population only. A stereotype logistic regression was used with the primary dependent variable being workability and independent variables included age, musculoskeletal pain, and ergonomic exposure. Results: The response rate was 58% and the data demonstrated a significant negative association between age and workability. With excellent workability as a reference, the odds for poor workability increased by 97% being 60+ y compared to 50–55 y. Both moderate intensity and severe musculoskeletal pain in the back, shoulder and knee/hip all showed significantly higher odds for poor workability. Ergonomic exposures, such as standing/walking, working with back bent or twisted and carrying or lifting had a significant negative impact on workability. Conclusion: Age, musculoskeletal pain and ergonomic exposures showed a significant negative impact on workability in the oldest group of workers and should be targeted with preventive initiatives.

Factors associated with neck and shoulder pain: a cross-sectional study among 16,000 adults in five county councils in Sweden

Background

Neck and shoulder pain is common in the general population, but studies on factors related to the risk of neck and shoulder pain have produced inconclusive results. Known factors related to pain include general physical activity, exercise, sleep disorders, and lifestyle, but further research is needed to improve our ability to prevent neck and shoulder pain. The aim was to investigate whether neck and shoulder pain are associated with physical domains (i.e., aerobic physical activities, general physical activities, and sitting time), sleep disturbances, general health, job satisfaction, and/or working time.

Methods

This population-based, cross-sectional study was conducted in Sweden in 2017 and included 16,167 individuals, aged 18 to 63 years. We administered a questionnaire to determine neck and shoulder pain, the time spent in general physical activity or aerobic physical activity, the time spent sitting, sleep disturbances, general health, job satisfaction, and the time spent working. Factors associated with neck and shoulder pain were explored using logistic regression.

Results

Significant factors associated with neck and shoulder pain were: overall health, sleep quality, and aerobic exercise. The odds of sustaining neck and shoulder pain increased with moderate or poor health (odds ratios [ORs]: 2.3 and 2.8, respectively) and sleep disorders (OR: 1.7). Conversely, aerobic physical activity performed more than 60 min/week at a level that enhanced respiratory and heart rate was associated with a reduced risk of experiencing neck and shoulder pain (OR: 0.8).

Conclusions

Although no causal relationships could be determined in the present study, the results highlight important associations between aerobic exercise, undisturbed sleep, good health, and the absence of upper body pain. Exercises that enhance breathing and heart rate were associated with a reduced risk of experiencing neck or shoulder pain, but there was no association between general physical activity and upper body pain. Therefore, clinicians may not recommend low-intensity activities, such as walking, for preventing or improving neck and shoulder pain.

Vigorous regular leisure-time physical activity is associated with a clinically important improvement in back pain - a secondary analysis of randomized controlled trials

Background

Neck and back pain are musculoskeletal conditions with serious individual and societal consequences. Current evidence about the prognostic value for neck and back pain is limited and conflicting. This prospective cohort study aimed to assess the association between leisure-time physical activity (LPA) and improvement of neck and/or back pain in a working population receiving manual therapy or general care in one of two randomized controlled trials (RCTs).

Methods

Analyses of data from two RCTs evaluating the effect of manual therapies for neck and/or back pain was conducted. Participants (n = 1 464) answered questionnaires about frequency and effort level of LPA at baseline. LPA on moderate or vigorous levels was compared to no or low/irregular moderate and vigorous levels. Pain intensity was assessed with numerical scales at baseline and 3-, 6-, and 12-month follow-up. The outcome was minimal clinically important improvement in pain intensity, defined as ≥2 points improvement in mean pain intensity at follow-up. Crude- and adjusted risk ratios (RR) with 95% confidence intervals (CI) were calculated with Poisson regression analysis and stratified by pain location.

Results

Participants with neck and/or back pain performing vigorous LPA showed a minimal clinically important improvement after 12 months compared to the control group; RR 1.35 (95% CI; 1.06-1.73). No effect was observed at 3 or 6 months. Moderate LPA did not improve pain intensity in any follow-up. Stratified analyses revealed that the effect of vigorous LPA at 12 months in back pain was RR 1.83 (95% CI; 1.26-2.66) and neck pain RR 1.06 (95% CI; 0.75-1.49).

Conclusions

Persons with neck and/or back pain receiving manual therapy or general evidence-based care have greater chance of improvement after 12 months if they prior to treatment frequently practice vigorous LPA. When analyzed separately, the effect was only present for back pain.

Trial registration

Registration in Current Controlled Trials (ISRCTN), Stockholm Manual Intervention Trial (MINT), ISRCTN92249294 BJORN-trial, ISRCTN56954776

Self-Healing: A Concept for Musculoskeletal Body Pain Management - Scientific Evidence and Mode of Action

Traditionally, musculoskeletal pain management has focused on the use of conventional treatments to relieve pain. However, multi-modal integrative medicine including alternative/complementary treatments is becoming more widely used and integrated into treatment guidelines around the world. The uptake of this approach varies according to country, with generally a higher uptake in developed countries and in females aged more than 40 years. Integral to the concept described here, is that the body has an innate ability to self-heal, which can be optimized by the use of integrative medical strategies. Stress triggers for acute or recurring musculoskeletal pain are diverse and can range from physical to psychological. The mechanism by which the body responds to triggers and initiates the self-healing processes is complex, but five body networks or processes are thought to be integral: the nervous system, microcirculation/vasodilation, immune modulation, muscular relaxation/contraction and psychological balance. Multi-modal integrative medicine approaches include nutritional/dietary modification, postural/muscular training exercises, and cognitive behavioral mind/body techniques. This article will review the self-healing concept and provide plausible scientific evidence where available.

The elixir of muscle activity and kinesiology in a health perspective: Evidence of worksite tailored exercise training alleviating muscle disorders

Physical activity is known to benefit health while muscle activation and movements performed during occupational work in contrast may result in work-related musculoskeletal disorders. Therefore, we posed the research question: which mode of muscle activation may result in a reversal of work-related disorders? To address this, we performed electromyographic (EMG) and kinematic assessments of workers with diverse exposure categories: sedentary monotonous work, prolonged walking/standing, and physically heavy work. The various job-specific exposure variables could be categorized in terms of duration, intensity, repetition, static component, peak force etc. that were subsequently identified as risk factors. Based on sports science principles we developed tailored exercise programs to counteract job exposure. EMG activity during exercise training was monitored to identify principal differences between exercise training and job patterns. Evidence from more than 20 RCT studies including >4000 workers showed positive effects such as decreased muscle pain and increased workability. Finally, we identified plausible underlying mechanisms in muscle tissue - human and animal - that confirmed metabolic, morphological, and hormonal changes with e.g. repetitive work that were reversal to adaptations reported with exercise training. Progress has been made in developing intelligent physical exercise training, IPET, as the best complementary activity to job exposure and includes muscle activations and movements that limit work-related inactivity atrophy as well as overload injury.

Overactivity in Chronic Pain, the Role of Pain-related Endurance and Neuromuscular Activity: An Interdisciplinary, Narrative Review

OBJECTIVES

Decades of research have convincingly shown that fear of pain and pain-related avoidance behavior are important precursors of disability in daily life. Reduced activity as a consequence of avoidance, however, cannot be blamed for chronic disability in all patients. A contrasting behavior, pain-related dysfunctional endurance in a task and overactivity has to be considered. Currently, there is a need to better understand the psychological determinants of overactivity, dysfunctional endurance, and neurobiomechanical consequences.

METHODS

This is a narrative review.

RESULTS

The first part of this review elucidates research on self-reported overactivity, showing associations with higher levels of pain and disability, especially in spinal load positions, for example, lifting, bending, or spending too long a time in specific positions. In addition, measures of habitual endurance-related pain responses, based on the avoidance-endurance model, are related to objective assessments of physical activity and, again, especially in positions known to cause high spinal load (part 2). The final part reveals findings from neuromuscular research on motor control indicating the possibility that, in particular, overactivity and dysfunctional endurance may result in a number of dysfunctional adaptations with repetitive strain injuries of muscles, ligaments, and vertebral segments as precursors of pain.

DISCUSSION

This narrative review brings together different research lines on overactivity, pain-related endurance, and supposed neuromuscular consequences. Clinicians should distinguish between patients who rest and escape from pain at low levels of pain, but who have high levels of fear of pain and those who predominantly persist in activities despite severely increasing pain until a break will be enforced by intolerable pain levels.

The Use of Wearable Sensor Technology to Detect Shock Impacts in Sports and Occupational Settings: A Scoping Review

Shock impacts during activity may cause damage to the joints, muscles, bones, or inner organs. To define thresholds for tolerable impacts, there is a need for methods that can accurately monitor shock impacts in real-life settings. Therefore, the main aim of this scoping review was to present an overview of existing methods for assessments of shock impacts using wearable sensor technology within two domains: sports and occupational settings. Online databases were used to identify papers published in 2010-2020, from which we selected 34 papers that used wearable sensor technology to measure shock impacts. No studies were found on occupational settings. For the sports domain, accelerometry was the dominant type of wearable sensor technology utilized, interpreting peak acceleration as a proxy for impact. Of the included studies, 28 assessed foot strike in running, head impacts in invasion and team sports, or different forms of jump landings or plyometric movements. The included studies revealed a lack of consensus regarding sensor placement and interpretation of the results. Furthermore, the identified high proportion of validation studies support previous concerns that wearable sensors at present are inadequate as a stand-alone method for valid and accurate data on shock impacts in the field.

The role of tax-filing status in uncovering socioeconomic and physical activity differences in college-aged students

This study examined relationships among multifaceted measures of socioeconomic status (SES) and physical activity (PA) in undergraduates. Participants were classified into dependent and independent tax filers to encapsulate the atypical divide in financial responsibility. Participants: 366 diverse American undergraduates. Methods: Participants completed an online survey including three SES metrics and the International Physical Activity Questionnaire. Results: Participants engaged in the same amount of total PA, albeit different proportions depending on SES measure and PA type. Independent tax filers engaged in more occupational PA than dependent tax filers, regardless of SES. Students with low SES engaged in less leisure-time PA than students with high SES. Conclusion: Household Material Hardship and SES proxy measures should be considered in the context of tax filing status among undergraduates. Greater precision with multifactorial SES measures will assist in providing the nuanced context when optimizing interventions and reducing barriers to increase PA in young adults.

Effects of Workplace-Based Intervention for Shoulder Pain: A Systematic Review and Meta-analysis

The main objective of this study is to update the evidence related to the effectiveness of exercise and ergonomic interventions in the perception of shoulder pain intensity in workers considering the shoulder pain intensity and the minimum clinically important change in the analysis. The bibliographic search was conducted in seven databases (Cochrane, EMBASE, SciELO, PubMed, PEDro, Web of Science and Scopus) from March to April 2019. The study selection included randomized controlled trials (RCTs) involving workers with shoulder pain who underwent physical exercises, ergonomics, and combined interventions. To analyze the RCTs, the intensity of pain was divided into two subgroups < 3 and ≥ 3 (0-10 points scale). A total of 27 RCTs were included in the qualitative synthesis considering the perception scales of shoulder pain intensity and the PEDro scale score of assessment of RCTs quality and risk of bias. Within these, seven RCTs were included in the quantitative synthesis. The overall effectiveness of interventions was calculated using a meta-analysis method, and the associated measurement used as a mean difference. The meta-analysis revealed that exercise interventions in workers with shoulder pain > 3 presented a minimally clincially important difference (MCID), but with no difference in workers with pain < 3. The interventions with exercise in workers with pain ≥ 3 at baseline reported a beneficial effect in reducing shoulder pain intensity, and a MCID. However, there was no significant difference for workers with pain < 3 and the effects of ergonomic interventions are still uncertain to reduce shoulder pain in workers.

Smoking Is Associated with Pain in All Body Regions, with Greatest Influence on Spinal Pain

OBJECTIVE

Examine the interrelationship between smoking and pain in the US population.

DESIGN

A cross-sectional population-based study.

SETTING

Nationwide survey.

METHODS

Comprehensive pain reports categorically defined as head, spine, trunk, and limb pain; smoking history; demographics; medical history from a total of 2,307 subjects from the 2003-2004 National Health and Nutrition Examination Survey obtained from the Centers for Disease Control were analyzed. Unpaired t tests were used to analyze independent continuous variables, and chi-square tests were used to analyze categorical variables between smoker and nonsmoker groups. Weighted multivariate logistic regression analyses determined the association of current smoking with the presence of pain in various body regions.

RESULTS

Smoking is most strongly associated with spine pain (odds ratio [OR] = 2.89, 95% confidence interval [CI] = 2.21-3.77), followed by headache (OR = 2.47, 95% CI = 1.73-3.53), trunk pain (OR = 2.17, 95% CI = 1.45-2.74), and limb pain (OR = 1.99, 95% CI = 1.45-2.73).

CONCLUSIONS

Current smoking is associated with pain in every region of the body. This association is strongest for spine and head pain. Given that pain is a strong motivator and that current smoking was associated with pain in all body regions, we recommend that these results be used to further raise public awareness about the potential harms of smoking.

Prevalence and patterns of musculoskeletal pain among undergraduate students of occupational therapy and physiotherapy in a South African university

Background:

Musculoskeletal pain (MSP) conditions are common in the educational leaning environment and are often associated with poor ergonomic conditions.

Objective:

This study investigated the prevalence, pattern and possible risk factors of MSP among undergraduate students of occupational therapy and physiotherapy in a South African university.

Methods:

A cross-sectional survey using an internet-based self-designed electronic questionnaire was used to obtain information about participants’ socio-demography, ergonomic hazards, MSP, and relevant personal information. Descriptive statistics, chi-square, and logistic regression were used in analyzing the data.

Results:

There were 145 participants (females 115 (79.3%); physiotherapy (74) 51.03%), making 36.7% of the present undergraduate student population in the two departments. The most prevalent ergonomic work hazards were prolonged sitting (71.7%) and repetitive movements (53.8%). The 12 months prevalence of MSP among the students was 89.7%. The pattern of MSP revealed that pain on the neck region was most prevalent (66.2%) followed by pain in the low back region (64.4%). Duration of daily travels and participation in regular exercise activities were significantly associated with the prevalence of MSP. Logistic model explained 23.6% of the variance in prevalence of MSP and correctly classified 94.1% of cases (χ2=13.73, p=0.03). The right-handed students were 0.13 times more likely to present with MSP than left-handed students. Also, students who exercised regularly were 9.47 times less likely to present with MSP.

Conclusion:

MSP is highly prevalent among health science undergraduates and is significantly associated with sedentary postures and inadequacy in structured physical activity participation.

How much do we know about the effectiveness of warm-up intervention on work related musculoskeletal disorders, physical and psychosocial functions: protocol for a systematic review

INTRODUCTION

Work-related musculoskeletal disorders (WMSDs) are a growing worldwide burden and effective interventions to prevent them are needed. Physical activity at the workplace is now recognised as a relevant component of WMSDs prevention. Along these lines, warm-up interventions are now offered in a large number of companies to manage WMSDs. Although benefits of warm-up have been previously documented in sports context, to the best of our knowledge, the effectiveness of such intervention in workplaces still remains to be established. Within this context, the aim of the present review is to identify from published literature the available evidence regarding the effects of warm-up on WMSDs and physical and psychosocial functions.

METHODS

The following electronic databases will be searched (from inception onwards to June 2020): Cochrane Central Register of Controlled Trials, PubMed (Medline), Web of Science and Physiotherapy Evidence Database. Randomised and non-randomised controlled studies will be included in this review. Participants should be adult employees without specific comorbidities. Interventions should include a warm-up physical intervention in real-workplaces. The primary outcomes will be pain, discomfort or fatigue. The secondary outcomes will be job control or motivation at work. This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and two team members will independently screen all citations, full-text articles and abstract data. A systematic narrative synthesis will be provided with information presented in the text and tables to summarise the characteristics and findings of the included studies.

ETHICS AND DISSEMINATION

The approval of an ethical committee is not required. All the included studies will comply with the current ethical standards. The results of this review will summarise the effects of warm-up intervention on WMSDs, physical or psychosocial functions. This information could help professionals in decision making related to the use of these interventions to prevent WMSDs. Findings will be disseminated to academic audiences through peer-reviewed publications, as well as to policy-makers.

PROSPERO REGISTRATION NUMBER

CRD42019137211.

[On the move-Prevention of chronic pain with physical activity and movement]

BACKGROUND

Sufficient physical activity and exercise shows a variety of health-promoting positive effects. In the context of pain therapy, promotion of physical activity could be an important contribution to primary, secondary and tertiary prevention of chronic pain.

OBJECTIVES

The aim is to investigate the relationship between physical activity and chronic pain, the preventive effect of physical activity on pain and the factors to successfully promote physical activity in people with chronic pain.

METHODS

For this narrative review databases of the Cochrane Library, MEDLINE (via PubMed) and the Physiotherapy Evidence Database (PEDro) were searched for reviews and studies with the keywords chronic pain, physical activity, movement, exercise and prevention.

RESULTS

A total of 10 reviews, 10 clinical studies and 4 surveys were included and summarized.

CONCLUSION

Although the evidence base on this topic is still insufficient, positive effects of physical activity on the prevention of chronic pain could be demonstrated. Interventions for people with chronic pain that sustainably increase physical activity should take into account individual resources, address barriers such as maladaptive beliefs, and create positive movement experiences.

Full employment history of Danish firefighters potentially involving additional exposures, 1964-2015

BACKGROUND

This study aimed to demonstrate the possibility of using data on full employment history to describe occupational patterns of Danish firefighters that may indicate additional hazards encountered by these workers.

METHODS

An established cohort of Danish full-time and part-time/volunteer firefighters was used in the study (N = 9952) as well as occupational history covering the period 1964-2015, which was retrieved from a nationwide pension fund with compulsory membership. The most frequently held employments other than firefighting, together with temporal patterns of these employments, were explored in descriptive analyses.

RESULTS

Besides working in the firefighter service, both full-time and part-time/volunteer firefighters had frequently been employed in the military and the police (55% and 38%) and more than 10% of both types of firefighters in a number of blue-collar jobs, including construction-related jobs (eg, masonry, joining, carpentry, insulation, and installation), laundry and dry cleaning, the auto industry, and rubber and plastic production. Part-time/volunteer firefighters had more frequently been employed in the machine industry, fabricated metal production, the wood and furniture industry, and farming. Both types of firefighters were initially employed in other jobs before their employment in firefighting.

CONCLUSION

The cohort of Danish firefighters had frequently been working in other professions potentially exposing them to additional hazardous exposures, and occupational patterns varied by type of firefighter employment. Accounting for full employment history is, for that reason, considered essential when exploring associations between specific professions and health outcomes.

Association between physical work demands and work ability in workers with musculoskeletal pain: cross-sectional study

Background

Musculoskeletal pain is common in the working population and may affect the work ability, especially among those with high physical work demands. This study investigated the association between physical work demands and work ability in workers with musculoskeletal pain.

Methods

Workers with physically demanding jobs (n = 5377) participated in the Danish Work Environment Cohort Study in 2010. Associations between physical work ability and various physical work demands were modeled using cumulative logistic regression analyses while controlling for possible confounders.

Results

In the fully adjusted model, bending and twisting/turning of the back more than a quarter of the workday (reference: less than a quarter of the workday) was associated with higher odds of lower work ability in workers with low-back pain (OR: 1.38, 95% CI: 1.09–1.74) and neck-shoulder pain (OR: 1.29, 95% CI: 1.01–1.64). When adding up the different types of demands, being exposed to two or more physical work demands for more than a quarter of the workday was consistently associated with lower work ability.

Conclusions

Work that involves high demands of the lower back seems especially problematic in relation to work ability among physical workers with musculoskeletal pain. Regardless of the specific type of physical work demand, being exposed to multiple physical work demands for more than a quarter of the workday was also associated with lower work ability.

Surgeons' posture and muscle strain during laparoscopic and robotic surgery

Background

It is assumed that conventional laparoscopy (LAP) and robotic-assisted laparoscopic surgery (RALS) differ in terms of the surgeon's comfort. This study compared muscle workload, work posture and perceived physical exertion of surgeons performing LAP or RALS.

Methods

Colorectal surgeons with experience in advanced LAP and RALS performed one of each operation. Bipolar surface electromyography (EMG) recordings were made from forearm, shoulder and neck muscles, and expressed relative to EMG maximum (%EMGmax). The static, median and peak levels of muscle activity were calculated, and an exposure variation analysis undertaken. Postural observations were carried out every 10 min, and ratings of perceived physical exertion before and after surgery were recorded.

Results

The study included 13 surgeons. Surgeons performing LAP showed higher static, median, and peak forearm muscle activity than those undertaking RALS. Muscle activity at peak level was higher during RALS than LAP. Exposure variation analysis demonstrated long-lasting periods of low-level intensity muscle activity in the shoulders for LAP, in the forearms for RALS, and in the neck for both procedures. Postural observations revealed a greater need for a change in work posture when performing LAP compared with RALS. Perceived physical exertion was no different between the surgical modalities.

Conclusion

Minimally invasive surgery requires long-term static muscle activity with a high physical workload for surgeons. RALS is less demanding on posture.

Baropodometric evaluation of foot load distribution during gait in the group of professionally active nurses

OBJECTIVES

Nurses are extremely exposed to musculoskeletal overloads. Prolonged standing postural balance distributions, functional deficits and pain may affect the symmetry of the load on the feet. The study aimed to assess the distribution of foot load during gait among nurses.

METHODS

The sample of this prospective and observational study consisted of 37 female nurses with mean age of 39 years. The Nordic Musculoskeletal Questionnaire (NMQ) was used to evaluate musculoskeletal disturbances and baropodometric gait analysis (BGA) was performed to register distribution of foot load during gait.

RESULTS

We showed that 68% of nurses declare that they know the principles of workplace ergonomics, but only 14% comply with them. NMQ results indicate that as many as 73% of the respondents feel ailments in the "lower back" area. An asymmetry was observed in the load of IV-V of the metatarsal head between the left and right foot (P = .000) and in the load of the left and right lateral part of the heel (P = .028) in the BGA test. Correlations between ailments occurring in the neck area and loading of the lateral arch of the right foot (P = .032) were found. Moreover, the load in this area correlated positively with the occurrence of "lower back" pain (P = .045).

CONCLUSIONS

Nurses have asymmetric distribution of foot load during gait, which results in a discrepancy between the loads on the three main support points of the foot and which may affect nurses' work productivity.

Physical fitness and psycho-cognitive performance in the young and middle-aged workforce with primarily physical versus mental work demands

Aim

The purpose of this study was to examine physical fitness and psycho-cognitive performance and their associations in young and middle-aged workers with primarily physical versus mental work demands.

Subjects and methods

Healthy young and middle-aged workers (73 men, age = 33 ± 7 years; 75 women, age = 35 ± 9 years) were recruited from German small-to-medium-sized enterprises (< 250 employees) and classified into groups with primarily mental (MD) or physical demands (PD) at work. Participants were tested for cardiorespiratory fitness, trunk flexor/extensor muscular endurance, handgrip strength, balance, leg muscle power, perceived stress, cognitive performance, and work ability.

Results

Ninety-four workers were allocated to the MD (53% females) and 54 to the PD (46% females) groups. The MD group showed significantly better balance, trunk extensor muscular endurance, and cognitive performance (p < 0.035, 0.35 ≤ d ≤ 0.55) and less stress compared with the PD group (p < 0.023, d = 0.38). Group-specific Spearman rank correlation analysis (rS) revealed significant small-to-medium-sized correlations between physical fitness and cognitive performance (− 0.205 ≤ rS ≤ 0.434) in the MD and PD groups. Significant small-to-medium-sized correlations were found for physical fitness and stress/work ability (0.211 ≤ rS ≤ 0.301) in the MD group only. Further, associations of trunk extensor muscular endurance and work ability were significantly higher in the MD group (rS = 0.240) compared with the PD group (rS = − 0.141; z = 2.16, p = 0.031).

Conclusions

MD workers showed better physical fitness measures (balance, trunk extensor muscular endurance) and cognitive performance and lower levels of perceived stress compared with PD workers. Small-to-medium-sized associations between physical fitness and psycho-cognitive performance measures indicate that gains in physical fitness may at least partly contribute to psycho-cognitive performance and/or vice versa, particularly in MD workers.

Glucocorticoids and resilience

All organisms endure frequent challenges to homeostasis, or stressors, that require adaptation. Depending on the individual, the context, and the magnitude of stress, this active adaptation can lead to behavioral susceptibility or resilience. The latter is an under-appreciated consequence of stress, as the damaging effects of chronic stress and chronically elevated glucocorticoids have received much more attention. We suggest here that neural pathways promoting resilience are initiated at the time of stress, and that they involve glucocorticoid signaling. By focusing on the neurobiology of resilience induction and the identification of vulnerable individuals, we may be able to intervene in the future at the time of stress to promote positive adaptation.