Information on the most common musculoskeletal disorders and their impact on work ability
Musculoskeletal disorders are common, but they are rarely serious. They can become recurrent and sometimes chronic, affecting a person’s work ability and ability to function, interpersonal relationships and sleep. This page contains a summary of the most common musculoskeletal disorders in working-age people and their impact on work ability.
Read about these musculoskeletal disorders
- Low back pain
- Neck pain
- Shoulder pain
- Repetitive stress injury symptoms in the upper extremities
Low back pain is a common condition. Eight out of ten adults experience low back pain at some point in their lives. Most have had several pain episodes. Local acute low back pain, called lumbago, has a very good prognosis. In this lumbago-type back pain, no medical imaging is required unless the pain lasts for at least a month.
In roughly one out of ten people with low back pain, the pain radiates into the leg. The most common cause of severe symptoms is intervertebral disc herniation, which can also cause sensory disturbances in the leg and weakness in the ankle muscles. These symptoms usually improve spontaneously. Some people recover to a reasonable extent within a month, and after three months the majority of patients feel significantly better. The symptoms may reoccur. Fewer than one out of ten needs surgery for intervertebral disc herniation.
Physically demanding work, which includes whole-body vibration, heavy lifting, and working in bent and twisted back postures, can be the cause of back symptoms, especially if the pain radiates to the leg. A low level of physical activity, obesity and smoking may increase the occurrence of back disorders. Stress and job dissatisfaction may associate with back pain.
It is the physician’s job to identify any possible, serious diseases or cases of nerve root compression. These rare back diseases include, for example, spinal tumours, inflammation, and vertebral fractures. Tumours and inflammation are characterised by continuous, gradually increasing back pain, and rest does not alleviate the pain. The patient’s general health has often deteriorated, and they may also have lost weight. In cases of common back pain, even with intensive symptoms, the patient is in a state of good general health.
Understanding what causes the pain and how it can be treated often helps in managing the discomfort caused by back pain. Discussing this with a physician or a physiotherapist may be helpful. Bed rest is not recommended as a treatment for back pain, although intense pain may force the patient to lie down for some time. As soon as the pain eases to the point that the person is able to move, it is best to get up and try to live as normal a life as possible. They can do light exercise, such as walking, cycling, and swimming, right from the start. A physiotherapist can give advice on back-friendly daily exercise and drug-free pain management. If necessary, medication can be used to alleviate the pain.
In cases of back pain lasting more than six weeks and significantly impairing the person’s ability to function, exercises that gradually build up the strength of the body and leg muscles and the general physical condition must be started under the guidance of a physiotherapist. Proper care of persistent back pain lasting for more than three months often requires a multi-professional treatment team, which usually comprises a physician, a physiotherapist, a psychologist, and a social worker.
Read below about the impact of back pain on work ability and ways to accommodate work.
A sudden, local low back pain usually only has a short-term impact on work ability. Pain can interfere with sleep, which in turn may make it more difficult to concentrate during the day. Around 75% of patients are able to return to work within two weeks from when the symptoms started.
If back pain lasts for more than six weeks and significantly impairs the person’s ability to function, it is necessary for a physician to prescribe examinations and for a multi-professional team to look into the situation and give personalised treatment instructions. Based on scientific research, this can reduce sick leave and the inconvenience caused by back pain. Transferring to lighter work by means of vocational rehabilitation can be a good solution for those people whose recurrent back pain makes continuing in their current work too difficult. Back disorders form a large proportion of sick leaves and disability pensions caused by musculoskeletal disorders.
Whether a person needs to be absent from work and for how long is affected by
- the person’s ability to function
- the physical and psychological demands of the work
- the workplace’s ability to provide support measures or work arrangements.
The occupational health services can help find a solution.
In short term back disorders, work can be accommodated for a fixed term to support coping at work. The strain caused by heavy lifting, crouched and twisted work postures can be reduced at the workplace with various assistive devices and hight adjustable work platforms. Whole-body vibration can be addressed by reducing or temporarily eliminating the use of equipment that causes vibration, such as forklifts.
If the pain radiates into the leg, sitting may also be difficult. Work should be accommodated by reducing the time spent sitting during the pain episode and by providing the employee with the opportunity to take breaks and move around during the workday. Work postures can be varied by using an adjustable chair and by working in a standing posture occasionally.
If pain persists, it is a good idea to make use of the whole range of work accommodation measures, including partial sickness allowance. Flexible working hours and part-time work may be a solution during a period where pain interferes with sleep. Part-time work can also reduce the strain on the back. The supervisor, occupational health professionals and especially an occupational health physiotherapist can help in accommodating work.
Neck pain is a common condition. According to studies, roughly 27% of men and 41% of women over 30 had suffered from neck pain during the past month. Neck pain usually has a good prognosis. It may also be recurrent. Neck pain is classified according to how long the symptoms last: acute neck pain lasts less than three months and chronic neck pain three months or more. Neck pain is also classified according to whether it only affects the neck, shoulder, and shoulder blade area or whether it radiates into the arm or, more rarely, the leg.
There are many different risk factors of neck pain. These include physical load factors (repetitive work, precision work, use of upper extremity strength, bent or twisted neck position, long periods of time spent sitting, working overhead), age, female gender and overweight. The psychosocial factors related to work, such as a large amount of work, poor opportunities to influence one’s work and poor job dissatisfaction, may also increase the risk of neck pain.
Neck pain may also be caused by whiplash due to, for example, a car collision. Whiplash usually heals well, but some patients suffer from symptoms related to the injury for longer.
When establishing the cause of neck pain, the physician examines the painful area and identifies the movements that make the pain worse, assesses the mobility of the cervical spine and looks for potential sensory disturbances and muscle weaknesses in the upper extremities. The physician also determines whether the neck pain could be caused by a serious illness or general disease. Medical attention is required if the person experiences progressive muscle weakness or the neck pain is accompanied by fever, weight loss or deterioration of the general condition.
Persons with neck pain should remain active, continue their normal everyday activities, and do exercises despite moderate pain. Endurance strength exercises and muscle stretches are part of the treatment. Self-treatment is supported by a physician’s or physiotherapist’s explanation of the cause of pain, treatment options and prognosis. Medication and physiotherapy can alleviate the pain. Sometimes surgery is needed for neck pain that radiates into the arm or leg.
Read below about the impact of neck pain on work ability and ways to accommodate work.
A person with neck pain usually continues working without taking sick leave. Sick leave typically lasts 1–3 days. The factors that cause strain on the neck at work must be identified. Psychosocial factors, such as a large volume of work, poor opportunities to influence one’s work and poor job satisfaction, may also increase the risk of neck pain. Therefore, they must also be identified.
If pain cannot be managed through work arrangements, vocational rehabilitation may be required.
Persons with neck disorders rarely need to take sick leave. However, it is worth accommodating work extensively by improving ergonomics. Ergonomics improvements focus, for example, on work postures, the organisation of work, sense of control, tools, working methods, and work-breaks. The workplace survey carried out by an occupational health physiotherapist helps identify the work postures and movements that place strain on the neck and shoulder area and provides recommendations on how to manage them at work. Challenges related to eyesight may also cause neck pain.
An occupational optician and an occupational health physiotherapist can resolve vision-related issues at work. In special cases, an ophthalmologist can be consulted for recommendations. Recurrent or persistent neck pain may affect sleep, and this should be taken into account when planning work accommodation.
Shoulder pain can result from multiple factors. Possible causes include tendon degeneration, injuries, and osteoarthritis. Shoulder tendon disorders occur in around 2% of the working-age population. A tendon disorder may cause symptoms without there being any major structural changes, or a tendon rupture may occur due to degeneration or a sudden injury. The most common cause of shoulder pain is the degeneration of one or more rotator cuff tendons.
The risk of shoulder tendon disorders grows if the shoulder is exposed to high forces, repetitive motions and sustained overhead positions of the upper arm at work or during free-time activities. Aging, female sex, diabetes and metabolic syndrome also increase the risk. Smoking is thought to weaken the rotator cuff, and diabetes and thyroid pathologies seem to increase the risk of calcium deposits in tendons. If the tendon is torn, it is important to establish whether the rupture is caused by a major underlying event or not. The cause of the shoulder pain is established by a physician, who verifies the diagnosis by using an X-ray, ultrasound or MRI scan and sometimes by using electroneuromyography (ENMG), if required.
Around half of new cases of shoulder pain eases within 2–3 months without any special treatment.
At the early stages, shoulder pain treatment mainly consists of self-treatment. In short-term disorders that are not caused by an injury, no medical imaging is usually necessary before starting treatment. A physician, physiotherapist or other health care professional gives the patient guidance on self-treatment and advice on what their shoulder pain is all about. At the same time, the patient is given practical instructions on how to alleviate the pain with and without medication. Drug-free pain relief methods include, for example, adjustment of the workload, physical exercises, improvement of the work postures and body posture, cold and heat treatments. The upper extremity with symptoms should be used within the limits permitted by the pain. If the initial self-treatment does not alleviate the symptoms in 4–6 months, the most important treatment is therapeutic exercises under the guidance of a physiotherapist. The success of therapeutic exercises cannot be assessed until after three months of regular training.
Surgery is considered in treating a rotator cuff disorder with symptoms if appropriate medication and exercises are not successful. Surgery should also be considered when a rotator cuff rupture is accompanied by a significant loss of strength in the arm. Joint replacement surgery is sometimes the treatment of choice for shoulder osteoarthritis.
Read below about the impact of shoulder pain on work ability and ways to accommodate work.
The impact of shoulder pain on work ability varies according to how much strain the work tasks place on the upper extremities. The need for sick leave should be reviewed at least every 1–2 weeks. If the pain is expected to last several weeks, the occupational health physician and the treating physician (if other than the occupational health physician) should evaluate the work ability together. If the shoulder conditions become prolonged, a rehabilitation plan is drawn up, also containing a vocational rehabilitation plan, if required.
After surgery, the surgeon who has performed the operation evaluates the need for sick leave case by case, based on medical grounds. The occupational health physician or other physician who is more familiar with the employee’s job description can determine in more detail the sick leave periods together with the surgeon. As a rule, the sick leave period after torn rotator cuff surgery is around three months if the work involves lifting.
It is possible to learn to perform many of the tasks required at work and during free time in a way that avoids the painful movement. A shoulder tendon disorder does not necessarily mean that the person needs to take sick leave. By accommodating the work, it may be possible to continue working without putting strain on the shoulder caused, i.e., by working overhead, repetitive work movements at the horizontal level or above it, heavy lifts and pushes, and sustained upper arm postures.
In addition to the supervisor, an occupational health physiotherapist, an occupational health nurse and a physician or a functional therapist can evaluate what work accommodation possibilities are available. Work can be tailored so that harmful strain is reduced or, in the best case, eliminated by using assistive devices, for example. A good way to do this is for the person to get as close as possible to what they are working on, for example using lifts and steps and leaning on armrests and using appropriate lifting platforms or extension arms. Shoulder strain can be reduced by using variety of arm positions and performing work at different heights and by taking breaks.
Repetitive stress injury symptoms in the upper extremities are conditions of the forearm, wrist and hand that are often related to excessive strain caused by repetitive movements. The majority of repetitive stress injury symptoms in the hand and forearm improve within a few weeks, but it is common for the symptoms to reoccur, and a small number of cases become chronic. Repetitive stress injury symptoms are diagnosed based on the patient’s medical history, risk factors, symptoms and examinations performed by a physician. The examination involves various tests, such as muscular strength tests with resistance, pain provocation tests or grip power tests. In some cases, electroneuromyography (ENMG) or an X-ray scan may be required, and in particular cases, an MRI scan or an ultrasound scan may be necessary.
Epicondylitis causes pain in the elbow at the point where the muscles are attached to the bone at the medial (medial epicondylitis) or the lateral epicondyle of the humerus (lateral epicondylitis, also known as tennis elbow). Pain usually occurs when lifting and gripping objects, so this should be avoided. Women and men are roughly equally affected by epicondylitis. Overweight increases the risk, as does smoking. Local anti-inflammatories can be used in the treatment. Cortisone injections are not recommended. Physiotherapy, a splint, or acupuncture is worth a try. Surgery is an option only in rare, well-justified cases.
Tenosynovitis causes pain and possibly swelling in the sheath around the tendon and the surrounding tissue. The movement of the tendon inside the tendon sheath may be affected, which leads to stenosing tenosynovitis. Movement is limited and moving the affected area worsens the pain. The pain is usually worst in the morning and eases as the arm is used. There are tendon sheaths above and below the wrist. If stenosing tenosynovitis occurs in the finger flexor muscle, the condition is called a trigger finger. If the inflammation occurs in the thumb, the condition is called De Quervain’s tenosynovitis. The treatment consists of relieving the affected area, using a local pain relief gel and, in some cases, a cortisone injection or surgery. A splint can be used if it makes coping at work easier.
Carpal tunnel syndrome occurs in around 2% of men and around 5% of women in Finland. Risk factors are being overweight, pregnancy and certain diseases (diabetes, rheumatoid arthritis, underactive thyroid, and renal diseases). Smoking also increases the risk. Carpal tunnel syndrome can also occur after a wrist fracture. Carpal tunnel syndrome causes numbness in the thumb, forefinger, and ring finger. The symptoms usually worsen at night, and shaking the hand reduces them. The hand may also ache, and it can feel clumsy and weak. If it is obvious that the condition is transitory, caused by, for example, pregnancy, physical strain or a fracture, and the symptoms are mild or have lasted for a short period of time, no other treatment is necessary besides safe pain medication, guidance, and follow-up. Sometimes a splint is helpful, for example a night splint. The nerve compression may get better without surgery, but if the symptoms are severe or the results of examinations suggest possible nerve damage, surgery is needed.
The objective of treatment is to alleviate the pain and restore the person’ s’s work ability. The objective of medication is to treat pain safely, which is why local pain relief creams and gels and paracetamol are the primary options. Carrying out normal everyday activities, such as exercise and household chores, within the limits permitted by the pain, promotes recovery. It is possible to speed up the return to work and reduce sick leave by doing appropriate exercises. Other options are having the occupational health physician contact the supervisor, making new work arrangements, seeking support from the occupational health physiotherapist, and taking partial sick leave.
Read below about the impact of repetitive stress injury symptoms in the upper extremities on work ability and ways to accommodate work.
The most important risk factors associated with epicondylitis, tenosynovitis and carpal tunnel syndrome are
- repeatedly performing the same movements at work, i.e., repetitive work
- tasks that require a lot of strength from the hands
- working in bent wrist positions
- cold and vibration.
When these factors occur at the same time, they also increase each other’s impact.
If the work requires the use of the affected limb, a short sick leave of 3–5 days may be appropriate during the most painful stage. In the most severe cases, epicondylitis, tenosynovitis, and carpal tunnel syndrome can also be classified as occupational diseases based on certain criteria. The condition for receiving compensation for occupational diseases is that the repetitive stress injury symptoms in the upper extremities are likely and primarily caused by work. If the repetitive stress injury symptoms in the upper extremities last for a long period of time and it is not certain that the employee is able to cope in their current job, a change of career and vocational rehabilitation must be considered.
Occupational health services play a key role in the prevention, identification, and treatment of repetitive stress injury symptoms. When planning work, the aim is to minimise repetitive movements. If repetitive work is involved, it is important that new employees get accustomed to it gradually. The tools used in the work should be chosen carefully and the employee should be instructed on how to use them properly to reduce strain on the upper extremities. Depending on the tasks, it is also beneficial for the prevention and rehabilitation/treatment of repetitive stress injuries to consider possibilities to reduce the weight of the loads to be moved and to use better lifting techniques, to add short breaks, to use gripping aids and voice recognition software, for example.
If the employee has already had a repetitive stress injury caused by work, the occupational health services can recommend that the employee not be placed in tasks where it might reoccur.
Osteoarthritis is the most common joint disease in the world. In Finland, more than 6% of men and 5% of women over 30 are affected by hip osteoarthritis. More than 6% of men and 8% of women over 30 are affected by knee osteoarthritis. The occurrence of osteoarthritis increases considerably with age.
Osteoarthritis affects the whole joint, as it causes changes in the cartilage, bone, joint capsule, and muscles alike. The changes usually occur slowly over the years, and damage to the joint cartilage is irreversible. The exact cause of the disease is unknown, but some of the factors behind it include obesity, joint injury, and physically strenuous work.
Osteoarthritis usually causes a dull ache which worsens when moving and is relieved when resting. As the disease progresses, the pain may become continuous, and it can also occur at night. The joints are stiff in the morning, and it may be difficult for the person to move after sitting, for example. Walking on both a level surface and stairs feels difficult. Osteoarthritis pain in the knee is local, which means that it is mainly felt in the knee, but it can also radiate into the upper part of the shin. Hip osteoarthritis often causes pain in the groin and in the upper part of the front thigh, but the pain can also radiate into a larger area, such as the buttock and other parts of the thigh.
The physician diagnoses osteoarthritis based on the symptoms described by the patient, joint examinations, and X-ray scans. Sometimes other examinations may also be needed.
Self-treatment is the basis of osteoarthritis treatment. This means that the physician or other healthcare professional tells the patient what the disease is all about and what the patient can do themselves to ease the situation. Some of the means that can help ease the situation are appropriate exercise, pain management and treatment, weight loss and dietary advice, and the prevention of joint injuries.
A physiotherapist, an expert in therapeutic exercise, chooses the appropriate exercises for the individual and shows the patient the right way to do them. Whether guided or self-directed, exercise must be regular and continuous. Appropriate exercise depends on a number of factors, such as the patient’s age, mobility, osteoarthritis symptoms and severity, and other diseases. Recommended forms of exercise are those where the joints are not exposed to heavy impacts or rotating movements and where the risk of injury is low. These include walking, cycling, and swimming, for example. If the joint is inflamed, strain must be reduced until the inflammation has been relieved.
Drug-free pain treatments can be used alone or in combination with therapeutic and independent exercise. Cold and ice packs can reduce the swelling caused by knee osteoarthritis and improve the muscular strength of the front thigh. Acupuncture may reduce pain and, at least in the short term, improve the functioning of patients with knee osteoarthritis.
Wearing a knee brace may reduce pain and improve the functioning of patients with knee osteoarthritis. In both knee and hip osteoarthritis, it is recommended to use assistive devices as required, because they reduce the symptoms and make it easier to carry out everyday activities.
Medication can alleviate osteoarthritis pain and improve the ability to function, but there is no medicine that would cure the disease or prevent it from progressing. Medication is available in the form of tablets and capsules taken by mouth, creams, and injections.
If no treatment has been successful in managing osteoarthritis pain, or the person’s ability to function has materially weakened, the physician may, after a thorough individual examination and consideration, suggest surgery. The most effective surgical operation is joint replacement.
Read below about the impact of osteoarthritis on work ability and ways to accommodate work.
The supervisor and occupational health services must monitor the work ability of an employee with osteoarthritis. As osteoarthritis progresses, work ability can be maintained through work arrangements and ergonomics solutions or by placing the employee in tasks that suit their health.
An employee with knee or hip osteoarthritis can often continue working part-time while waiting for their joint replacement surgery. Joint replacement surgery can restore work ability in many cases. In shoulder and hand osteoarthritis, joint replacement surgery often eases the pain. However, it limits lifting considerably, which is why it is usually not possible for the employee to continue performing even medium-heavy work.
If osteoarthritis is caused by an injury or the person has developed osteoarthritis at a young age, vocational retraining is necessary for those performing physically strenuous work. The waiting period for joint replacement may be long even in cases where the person’s ability to function is severely impaired.
Persons with knee and hip osteoarthritis must avoid repeated crouching, walking on stairs and uneven ground, sitting or standing for long periods of time, end-of-range joint positions and lifting of heavy loads.
Those with shoulder, wrist or finger osteoarthritis must avoid lifting and work that requires upper extremity strength. Splints, gripping aids and ergonomic tools, and part-time work can make it easier for the person to work.