Musculoskeletal disorders: enemy number one at work

Think you know your worst enemy at work?

Who do you have in mind?

Your incompetent manager, your tyrant boss or your insufferable colleague? Okay, I get it.

You've got it all wrong! Your worst enemy is RSI...

Yes, the famous musculoskeletal disorders. You doubt it?

Yet they are responsible for 88% of occupational illnesses in France. That's why it's so urgent to take an interest.

Don't panic, we'll give you the lowdown here. You'll know everything!

And don't hesitate to talk about it with those around you (your boss, for example)...

Understanding MSDs to combat them more effectively

Ouch! That's how it starts...

You wake up one morning, and it hurts. And then a little more every day.

We tell ourselves it's our age and we get over it.

And yet... Can you answer no to these questions?

- Do you sometimes feel discomfort, pain or tingling in your joints?

- Do you perform repetitive gestures or tasks at work?

- At work, do you ever have to exert yourself, or have a posture that's uncomfortable or too static?

Did you answer yes to a question?

Then it's likely that you have RSI.

And you're not the only one!

According to a study carried out by IFOP for PERCKO (2023):

- 86% of French employees have already suffered from MSDs.

- 77% believe their work is responsible for their MSDs (93% for teleworkers).

And there's a wide catalog of them: tendonitis, lumbago, neck pain, lateral epicondylitis in the elbow, hygroma in the knee, carpal tunnel syndrome in the wrist, rotator cuff syndrome in the shoulder, etc.

Musculoskeletal disorders: what are they?

Definition:

MSDs are painful pathologies affecting soft tissues (joints, muscles, tendons, nerves). They can give rise to a wide range of disorders: joint and muscle pain, acute and/or chronic illness, inflammation, low back pain, stress and constant fatigue...

MSDs are the result of an imbalance between the body's capacities and the physical demands of work. Repetitive movements, poor posture or excessive workloads can be the cause.

These MSDs occur progressively, leading to work-related pain and frequent work stoppages.

3 key figures for France:

- Nearly 30% of work stoppages are caused by an MSD.

- 87/88% of recognized work-related illnesses for 2019-2020. MSDs are the leading cause of compensated occupational illnesses.

- 45% of MSDs entail a risk of unfitness for work.

What are the symptoms?

This depends on the area affected.

But most often, pain, stiffness in the limbs, swelling (edema), numbness and tingling can be felt and observed...

Note that while these symptoms are more pronounced during exercise, they also appear at rest.

Which business sectors?

Generally speaking, MSDs are more likely to occur in workplaces requiring constant physical effort, with heavy loads, repetitive movements and treading.

But in reality, all sectors are concerned, including the service sector: we see that sitting and sedentary work causes many MSDs.  

The sectors generally most affected:

Here, physical exertion is regular and intense, putting pressure on muscles and joints.

RSIs that cost you dearly

What are the different types of MSD?

According toAssurance Maladie (2020), these are the most common MSDs:

1) The wrist (carpal tunnel or Guyon's syndrome) accounts for 38%. This involves nerve compression.

2) Shoulder (rotator cuff tendinopathy): 30%.

3) Elbow (lateral epicondylitis and epitrochleitis) in 22% of cases.

4) Lower back pain: 7%.

5) Knee (bursitis or hygroma) for 2% of the total

Rarer :

- Cervicalgia for neck pain.

- Tendonitis in the hand.  

- Ankle tendonitis

Note: the IFOP/PERCKO study (2023) gives a different hierarchy, but confirms the importance of MSDs among French employees.

1) The back (69%)

2) Shoulders and neck (58%)

3) Knee (38%)

4) Wrist (30%)

5) Elbow (15%)

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From reduced productivity to work stoppage or even inability to work, the impacts of MSDs are numerous. Employees, companies and government must take them very seriously.

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What are the consequences? The impact of MSDs

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The impact is manifold:

- For the employee first and foremost: pain, physical and psychological fatigue. Under these conditions, working becomes increasingly difficult, even unbearable. MSDs can lead to work stoppages or permanent unfitness for work (almost 50% of MSDs result in serious after-effects). Pain can also lead to inattentiveness and reduced efficiency, resulting in workplace accidents (20% on average).

- For the company: Health insurance figures suggest 2 months' sick leave and 22 million lost working days (1 in 3 sick leave days is due to MSDs). This represents direct and indirect costs for the company. With a direct cost for companies approaching 2 billion euros (Accidents du Travail/Maladie Professionnelle contributions 2017).

We then obtain the following evolution:

Indeed, when employees are absent or find it difficult to work, performance and therefore productivity suffer. Either the work is less efficient, or the absent person has to be replaced. In some cases, this leads to an increase in staff turnover and the need to retrain a new employee...

The result is a cumulative loss of time, efficiency, productivity and money. Teams are disrupted and the company's brand image is tarnished. Under these conditions, the difficulty of retaining talent or recruiting new talent can become increasingly difficult.

As a reminder:

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Prevention is therefore essential to avoid these negative consequences for employees and the company. To do this, we need to discover the source of these problems.

What causes MSDs?

To combat MSDs effectively, we first need to understand their origins and causes.

MSDs are multifactorial in origin : they result from a combination of different risk factors (however, the occupational factor is the primary known cause of MSDs).

Classic and well-known examples:

- Repetitive movements: performing the same gestures all day long (using a mouse or computer keyboard, or assembling/dismantling parts).

- Bad posture: Holding a static or uncomfortable position for long periods of time.

- Heavy workload: lifting, lifting or moving loads too often and too heavily.

- Unsuitable work environment: having an unsuitable workstation, unsuitable or non-ergonomic tools.

But to really master the subject, you need to take an interest in more in-depth studies.

MSD: What are the factors?

Quickly, we can agree that there are 2 types of factors:

- Intrinsic or individual factors: linked to the individual (physical and mental health, age, etc.).

- Extrinsic factors: external to the individual (biomechanical, environmental, psychosocial and organizational). These factors are found in the workplace and are considered to be determinants.

But specialists go further and propose 5 main categories of factors:

1. Biomechanical factors

These are the details of a task that goes against our body's biomechanics, and is out of synch with our physical capabilities.

This category includes :

- Repetition of movements.

- Uncomfortable positions.

- Intense physical effort.

- Static work over long periods.

In this case, the employee exceeds his or her physical capacity without giving time to recover, leading to the onset of pain.

2. Environmental factors

Here, these factors concern your workstation (tools, premises, work space, etc.).

Examples:

- Noise.

- Lighting.

- Temperature.

- Equipment ergonomics.

Depending on their presence, absence or excess, these elements can either aggravate or relieve biomechanical stress.

3. Psychosocial factors

We don't think about it enough, but stress and mental workload can influence MSDs.

All it takes is low self-esteem and aggressive management to create an emotional imbalance that causes or aggravates MSDs.

Examples:

- Lack of recognition from management.

- Psychological pressure (stress due to the size of a task or deadlines).

- Poor social relations, lack of solidarity between colleagues.

- Job insecurity or a fragile remuneration system.

Employees close to or experiencing a burn-out or brown-out will often report MSDs as warning signs...

4. Organizational factors

Here, we're dealing with the organization of work and production.

Depending on the pace of their work and their working hours, employees can feel more or less tired. The consequences for MSDs are significant: an employee who has time to recover reports fewer MSDs.

Examples:

- Pace of work.

- Working hours, schedules, duration, staggered working hours.

- Recovery time.

- Lead times.

- Insufficient breaks.

- Standardized tasks, rhythmic machine work.

- Lack of task rotation.

5. Individual factors

Here we find the intrinsic factors specific to each individual.

There are a number of medical histories to consider when talking about MSDs.

Other factors, such as being overweight, tired or psychologically fragile, can also contribute to the onset of MSDs.

Criteria to watch out for:

- Age.

- Gender (MSDs affect more women).

- State of health: osteoarthritis, rheumatism, joint trauma, overweight, diabetes, thyroid problems, immune disorders, etc.

- Mental health: anxiety disorders, stress, depression, attention deficit disorders, etc.

- A sedentary lifestyle.

- Length of service.

By understanding these factors, we can then develop a prevention policy to avoid or alleviate MSDs.

How to prevent RSI?

This means limiting risk factors as far as possible. In this context, and for the good of all, employees and employers must act together.

1) Legal obligations: what does the Labour Code say?

In this context, it is worth recalling the employer's obligation to "ensure the safety and protect the physical and mental health" of its employees:

- Articles L 4121-1 to -5 of the French Labor Code.

- Articles R. 4541-1 et seq.

A tool not to be overlooked: the "document unique d'évaluation des risques professionnels" (to be drawn up once a year).

- Article 4121-3 of the French Labour Code

Please note: the employer's obligation is to provide the means, not the results.

For example, employers are required to assess, inform and take preventive action against all occupational risks.

There are also standards to which a company must adhere.

Examples:

- Standard NF EN ISO 14738 (X 35-104, 2008) concerns work equipment. It provides anthropometric recommendations on workstation design, machinery and workstation sizing.

- Standard NF EN 12464-1 (X 90-003-1, 2011) concerns workplace lighting.

2) An MSD prevention policy is based on 3 pillars:

- Risk assessment and detection through analysis of work situations.

- Implementation of an action plan to control risks.

- Regular review to adjust and adapt actions.

(Please refer to the general principles of risk prevention set out inarticle L.4121-2).

To begin with, you need to ensure the participation of all those involved in the company, with a view to obtaining as much information as possible (employees, managers, employers, trade unions, works council, etc.). The aim is to mobilize them all by informing them about the implementation of a truly effective prevention policy. Health professionals (ergonomists, physiotherapists or osteopaths) could also be involved.

Step 1: Assess the risks

Based on the aforementioned factors, the aim is to examine how the company operates.

Objective: identify and analyze various high-risk work situations in order to understand their causes.

This means carrying out precise analyses of workstations and employee movements. This research will reveal the situations conducive to the risk of MSDs (organization of the workspace, quality of machines, tools and equipment, furniture and environmental conditions, etc.).

To do this, each employee must be questioned, if possible with the assistance of the occupational physician. Specialized questionnaires are available (e.g. the Nordic questionnaire or the SALTSA protocol).

During these interviews, the employee must be able to describe his work, his workspace and his tools with precision. Then, the way they feel and experience their working day.

Various sources of information can be consulted and mobilized:

- Employee consultation.

- Consultation of company data.

- Consultation of the social and economic committee (CSE).

- Consult information on staff turnover, absenteeism, social and physical characteristics of employees according to their position, etc.

- Occupational medicine consultation.

- The single document for assessing professional risks

Step 2: Managing risks

Once the problem situations have been identified, a new stage begins: transformation. The company then draws up a real plan to eradicate or reduce the difficulties identified.

Immediate solutions can then be put in place:

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Technical solutions

- Adaptation of equipment and workstations to improve ergonomics (purchase of equipment such as ergonomic chairs, space reorganization, etc.).

- Investment in machine tools (choosing to bend the tool rather than the wrist, having the least vibrating machines possible)

Organizational solutions

- Adjusting work methods (pace, hours, variability, alternating tasks, giving more breaks, etc.).

- MSD awareness training for your teams, in groups (QVCT workshops, training days on postures, healthy living, etc.).

- Individual interviews to teach them the right personal gestures.

Step³: Regular check-ups

Every prevention initiative must include a final evaluation phase. You must regularly ask for an assessment of the actions implemented.

To achieve this, it is essential to observe certain indicators:

- The number of work-related accidents, sick leave or occupational illnesses, complaints or visits to the infirmary.

- Turnover and absenteeism rates.

- The number of conversions.

We then need to check whether MSDs are linked to these figures and, if so, take further steps to improve and adjust previous, insufficiently effective measures.

Now you know all about MSDs! Their symptoms, causes and factors.

You now have all the information you need to discuss preventive measures in your company. And I wish you every success in contributing to this necessary work.

In the following article, we'll take you a step further.

We've talked about prevention, but we can't stop there. We also need to talk about relief.

But sport and physical activity, when used properly, can make a major contribution to well-being.

So get ready to learn some useful exercises to combat RSI.

See you soon.

By Edmond Kean.