Musculoskeletal Disorders Require a New Approach
"Musculoskeletal disorders" (MSD) is an umbrella name covering pain, tingling or numbness and/or loss of strength or of some range of motion of bones due to an overload of joints, muscles, tendons, ligaments or nerves and blood vessels.
The neck pain that you feel after having worked too long behind a screen is a typical example of MSD, but there are many other forms of them.
MSD are common among the workforce: depending on the profession, between 40 and 60% of the European workers report symptoms of MSD.
Some are caused or aggravated by work, some are age-related (e.
g.
, osteoarthritis), and still some others are caused by an accident.
I will discuss the two first kinds only, but bear in mind that MSD usually have multiple causes.
According to the World Health Organization, MSD occur when the load on the tissues is higher than their capacity.
Imagine your body (or a given region of it) as a tank that you fill by accumulating load (or strain) throughout your daily life activities, and that you empty by "resting" (not sleeping, but rather relaxing the tissues).
If you accumulate more load than you evacuate, the tank will overflow, and symptoms of musculoskeletal disorders will appear.
When, depends on the capacity of the tank.
Note that the "last drop" (the one that causes the tank to overflow) is not necessarily the biggest cause of the overflow: you have to identify the biggest load factors, not the last ones.
By comparison, let' see the model for accidents.
The accident model is called the Swiss cheese model.
In this model, different parameters (for example, you, your skiing blades, the weather conditions) are represented as a slice with holes.
Each hole is a "weak spot".
The slices keep moving with respect to each other.
If by any chance the holes come into corresponding positions, there is a window of opportunity for an accident.
In the skiing example, this could be you being tired, your skiing blade not being well fastened, and the snow forming an ice plate.
If you come tired on the ice plate with a loose skiing blade, you can be sure that you will fall.
Treating accidents is therefore different in essence than treating cumulative disorders.
The chance that the same accident occurs again is very low because chance plays an important role.
You can afford to just treat the symptoms.
The chance that an MSD occurs again (at the same or at another location) is high, because the overflow of the tank is an almost mechanical and foreseeable event.
You therefore need not only to fix the symptoms, but also to fix the underlying causes of the overflow.
The first step is to identify all the factors influencing load, evacuation and capacity throughout your daily life activities.
A few common factors influencing the load are: - how good are your usual postures (sitting, standing, carrying, etc.
)? - do you sit for prolonged periods of time (e.
g.
in the car, behind the screen)? - how good is the ergonomics at your workplace? - are you overweight? - do you often wear high heels? Influencing the evacuation: - how well do you sleep? - how often do you do relaxation / stretching exercises for the back? Influencing your capacity: - do you smoke? - how is your psychological state (are you frustrated, stressed, etc.
)? - do you have a regular physical activity? Depending on the answers, the second step is to rank all these factors by order of importance.
The third step is to establish a treatment plan.
The general structure is to first reduce the load and increase the evacuation, and then to work on the capacity.
This means that you will have to learn how to do things differently , i.
e.
how to better use your body.
This is by definition not the job of a hands-on therapist, who is trained to use his hands (or other tools) to restore the normal mobility of your body (i.
e.
to empty the tank).
It is much more the specialty of a (hands-off) posture therapist, i.
e.
someone who will help you improving your body awareness and knowledge of body's mechanic.
However, this hands-off therapist will have to cooperate with other specialists such as ergonomists and psychologists.
The neck pain that you feel after having worked too long behind a screen is a typical example of MSD, but there are many other forms of them.
MSD are common among the workforce: depending on the profession, between 40 and 60% of the European workers report symptoms of MSD.
Some are caused or aggravated by work, some are age-related (e.
g.
, osteoarthritis), and still some others are caused by an accident.
I will discuss the two first kinds only, but bear in mind that MSD usually have multiple causes.
According to the World Health Organization, MSD occur when the load on the tissues is higher than their capacity.
Imagine your body (or a given region of it) as a tank that you fill by accumulating load (or strain) throughout your daily life activities, and that you empty by "resting" (not sleeping, but rather relaxing the tissues).
If you accumulate more load than you evacuate, the tank will overflow, and symptoms of musculoskeletal disorders will appear.
When, depends on the capacity of the tank.
Note that the "last drop" (the one that causes the tank to overflow) is not necessarily the biggest cause of the overflow: you have to identify the biggest load factors, not the last ones.
By comparison, let' see the model for accidents.
The accident model is called the Swiss cheese model.
In this model, different parameters (for example, you, your skiing blades, the weather conditions) are represented as a slice with holes.
Each hole is a "weak spot".
The slices keep moving with respect to each other.
If by any chance the holes come into corresponding positions, there is a window of opportunity for an accident.
In the skiing example, this could be you being tired, your skiing blade not being well fastened, and the snow forming an ice plate.
If you come tired on the ice plate with a loose skiing blade, you can be sure that you will fall.
Treating accidents is therefore different in essence than treating cumulative disorders.
The chance that the same accident occurs again is very low because chance plays an important role.
You can afford to just treat the symptoms.
The chance that an MSD occurs again (at the same or at another location) is high, because the overflow of the tank is an almost mechanical and foreseeable event.
You therefore need not only to fix the symptoms, but also to fix the underlying causes of the overflow.
The first step is to identify all the factors influencing load, evacuation and capacity throughout your daily life activities.
A few common factors influencing the load are: - how good are your usual postures (sitting, standing, carrying, etc.
)? - do you sit for prolonged periods of time (e.
g.
in the car, behind the screen)? - how good is the ergonomics at your workplace? - are you overweight? - do you often wear high heels? Influencing the evacuation: - how well do you sleep? - how often do you do relaxation / stretching exercises for the back? Influencing your capacity: - do you smoke? - how is your psychological state (are you frustrated, stressed, etc.
)? - do you have a regular physical activity? Depending on the answers, the second step is to rank all these factors by order of importance.
The third step is to establish a treatment plan.
The general structure is to first reduce the load and increase the evacuation, and then to work on the capacity.
This means that you will have to learn how to do things differently , i.
e.
how to better use your body.
This is by definition not the job of a hands-on therapist, who is trained to use his hands (or other tools) to restore the normal mobility of your body (i.
e.
to empty the tank).
It is much more the specialty of a (hands-off) posture therapist, i.
e.
someone who will help you improving your body awareness and knowledge of body's mechanic.
However, this hands-off therapist will have to cooperate with other specialists such as ergonomists and psychologists.
