Musculoskeletal injuries

Musculoskeletal injuries are a range of disorders involving muscles, bones, joints, tendons, ligaments, blood vessels, nerves and other soft tissues. Some examples of musculoskeletal injuries are fractures, dislocations, sprains, strains, carpal tunnel syndrome, tendinitis, tenosynovitis and bursitis. The top three most common causes of musculoskeletal injuries are lifting, carrying or putting down objects, falls, and repetitive movement or strain, with low back pain being the single leading cause of disability globally.

Symptoms of musculoskeletal injury may include:

• Pain in the hands, arms, shoulders, neck, back, legs or feet
• May include swelling, numbness, tingling and a feeling of heaviness and/or tiredness in the affected area
• Some workers may experience multiple symptoms due to more than one injury

Musculoskeletal injuries are typically characterized by pain (often persistent) and limitations in mobility, dexterity and functional ability, reducing people’s ability to work and participate in social roles with associated impacts on mental wellbeing, and at a broader level impacts on the prosperity of communities.

Musculoskeletal injury causes

The cause of musculoskeletal injuries can include:

• Accidents.
• Poor training practices.
• Improper gear.
• Being out of condition.
• Not warming up or stretching before you play or exercise.

Work-related risk factors for musculoskeletal injury

Workplace design plays a crucial role in the development of an musculoskeletal injury.

When a worker is asked to do work that is outside his body’s capabilities and limitations, he is being asked to put his musculoskeletal system at risk. In these situations, an objective evaluation of the workstation design tells us the worker’s recovery system will not be able to keep up with the fatigue that will be caused by performing the job. The evaluation will tell us that ergonomic risk factors are present, the worker is at risk of developing a musculoskeletal imbalance and a musculoskeletal disorder is an imminent reality.

There are three primary ergonomic risk factors.

1. High task repetition. Many work tasks and cycles are repetitive in nature, and are frequently controlled by hourly or daily production targets and work processes. High task repetition, when combined with other risks factors such high force and/or awkward postures, can contribute to the formation of musculoskeletal injury. A job is considered highly repetitive if the cycle time is 30 seconds or less.
2. Forceful exertions. Many work tasks require high force loads on the human body. Muscle effort increases in response to high force requirements, increasing associated fatigue which can lead to musculoskeletal injury.
3. Repetitive or sustained awkward postures. Awkward postures place excessive force on joints and overload the muscles and tendons around the effected joint. Joints of the body are most efficient when they operate closest to the mid-range motion of the joint. Risk of musculoskeletal injury is increased when joints are worked outside of this mid-range repetitively or for sustained periods of time without adequate recovery time.

Exposure to these workplace risk factors puts workers at a higher level of musculoskeletal injury risk. It’s common sense: high task repetition, forceful exertions and repetitive/sustained awkward postures fatigue the worker’s body beyond their ability to recover, leading to a musculoskeletal imbalance and eventually an musculoskeletal injury.

Musculoskeletal injuries prevention

These tips can help you avoid musculoskeletal injuries:

• Don’t bend your knees more than halfway when doing knee bends.
• Don’t twist your knees when you stretch. Keep your feet as flat as you can.
• When jumping, land with your knees bent.
• Do warmup exercises before you play any sport.
• Always stretch before you play or exercise.
• Don’t overdo it.
• Cool down after hard sports or workouts.
• Wear shoes that fit properly, are stable, and absorb shock.
• Use the softest exercise surface you can find; don’t run on asphalt or concrete.
• Run on flat surfaces.

For adults:

• Don’t be a “weekend warrior.” Don’t try to do a week’s worth of activity in a day or two.
• Learn to do your sport right. Use proper form to reduce your risk of “overuse” injuries.
• Use safety gear.
• Know your body’s limits.
• Build up your exercise level gradually.
• Strive for a total body workout of cardiovascular, strength training, and flexibility exercises.

For parents and coaches:

• Group children by their skill level and body size, not by their age, especially for contact sports.
• Match the child to the sport. Don’t push the child too hard to play a sport that she or he may not like or be able to do.
• Try to find sports programs that have certified athletic trainers.
• See that all children get a physical exam before playing.
• Don’t play a child who is injured.
• Get the child to a doctor, if needed.
• Provide a safe environment for sports.

For children:

• Be in proper condition to play the sport.
• Get a physical exam before you start playing sports.
• Follow the rules of the game.
• Wear gear that protects, fits well, and is right for the sport.
• Know how to use athletic gear.
• Don’t play when you are very tired or in pain.
• Always warm up before you play.
• Always cool down after you play.

What are the symptoms of musculoskeletal injuries?

The symptoms of a musculoskeletal injury will depend on the type of injury you have.

Symptoms of an acute musculoskeletal injury include:

• Sudden, severe pain.
• Swelling.
• Not being able to place weight on a leg, knee, ankle, or foot.
• An arm, elbow, wrist, hand, or finger that is very tender.
• Not being able to move a joint as normal.
• Extreme leg or arm weakness.
• A bone or joint that is visibly out of place.

Symptoms of a chronic musculoskeletal injury include:

• Pain when you play.
• Pain when you exercise.
• A dull ache when you rest.
• Swelling.

Musculoskeletal injuries treatment

Acute musculoskeletal injuries vary in type and severity. Doctors first treat minor acute musculoskeletal injuries with P-R-I-C-E (Protection, Rest, Ice, Compression, and Elevation). although this practice is not supported by strong evidence.

• Protection. Protection helps prevent further injury. It may involve limiting the use of an injured part, applying a splint or cast, and/or using crutches.
• Rest. Take a break from the activity that caused the injury. Your doctor may recommend that you use crutches to avoid putting weight on your leg.
• Ice. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly to the skin. Ice is enclosed in a plastic bag or towel and applied intermittently during the first 24 to 48 hours (for 15 to 20 minutes, as often as possible).
• Compression. To prevent additional swelling and blood loss, wear an elastic compression bandage. Injuries can be compressed by a splint, an elastic bandage, or for certain injuries likely to cause severe swelling, a Jones compression dressing. The Jones dressing is 4 layers; layers 1 (the innermost) and 3 are cotton batting, and layers 2 and 4 are elastic bandages.
• Elevation. To reduce swelling, elevate the injury higher than your heart while resting for the first 2 days in a position that provides an uninterrupted downward path allows gravity to help drain edema fluid and minimize swelling.
• After 48 hours, periodic application of warmth (eg, a heating pad) for 15 to 20 minutes may relieve pain and speed healing.

In the first 48-72 hours, the No HARM protocol should also be applied – no heat, no alcohol, no running or activity, and no massage. This will ensure decreased bleeding and swelling in the injured area.

• Heat: Applying heat to the injured area can cause blood flow and swelling to increase.
• Alcohol: Alcohol can inhibit the ability to feel if the injury is becoming more aggravated, as well as increasing blood flow and swelling.
• Re-injury: Avoid any activities that could aggravate the injury and cause further damage.
• Massage: Massaging an injured area can promote blood flow and swelling, and potentially cause more damage if done too early.

This regime should be used for all ligament sprains, muscle sprains and muscle bruises. Referral for bumps and bruises which occur in sport or physical activity, other than those which are minor is recommended.

Your doctor may also recommend other things to treat your musculoskeletal injury.

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, can help decrease swelling and pain.
• Immobilization is a common treatment for musculoskeletal injuries. It keeps you from moving the injured area and prevents more damage. To limit movement of your injured area, your doctor may recommend using a:
  • Sling.
  • Splint.
  • Cast.
  • Leg immobilizer.
• Surgery, in some cases, is needed to fix musculoskeletal injuries. Surgery can fix torn tendons and ligaments or put broken bones back in place. Most musculoskeletal injuries don’t need surgery.
• Rehabilitation is a key part of treatment. It involves step-by-step exercises that get the injured area back to normal. Rehabilitation may include the following tips:
  • Moving the injured area helps it to heal. The sooner this is done, the better. Exercises start by gently moving the injured body part through a range of motions.
  • The next step is to stretch. After a while, weights may be used to strengthen the injured area.
  • As injury heals, scar tissue forms. After a while, the scar tissue shrinks. This shrinking brings the injured tissues back together. When this happens, the injured area becomes tight or stiff. This is when you are at greatest risk of injuring the area again. You should stretch the muscles every day. You should always stretch as a warmup before you play or exercise.
  • Don’t play your sport until you are sure you can stretch the injured area without pain, swelling, or stiffness. When you start playing again, start slowly. Build up slowly to full speed.
• Rest after an injury is an important part of the healing process. Your doctor can guide you on the proper balance between rest and rehabilitation.
• Other therapies your doctor may recommend include:
  • Electrostimulation, which gives you mild electric shocks.
  • Cold packs.
  • Heat packs.
  • Ultrasound or sound waves.
  • Massage.