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Musculoskeletal Disorders on the Rise in Healthcare

How MSDs have spread to those who treat them

A recent report suggests that one in two Americans suffer from some form of musculoskeletal disorder, costing approximately $213 billion a year in treatment, care, and lost wages. Most patients turn to healthcare providers with the expectation that their practitioners will resolve their issues, but few think of the toll patient care has on their own provider’s health.

In addition to the long hours, metric documentation, tedious insurance protocols, job related stress, responsibility, and liability, the occupational hazards leading to musculoskeletal disorders (MSDs) for healthcare providers are rampant. The Center for Disease Control (CDC) offers 590 pages of an extensive review of work-related musculoskeletal disorders and workplace factors.

The leading cause of musculoskeletal injury was awkward posture.

MSDs can be described as debilitating disorders of the muscles, tendons, ligaments, joints, cartilage, nerves, and spinal discs. Some of the better known MSDs are: carpal tunnel, tendinitis, muscle strain, back pain and neck tension. According to World Health Organization (WHO), “Musculoskeletal conditions are the second largest contributor to disability worldwide, with low back pain being the single leading cause of disability globally.”

An analysis of compensation claims for hospital workers in the United States listed musculoskeletal disorders as the most common occupational injury and illness. Namely, 76% of those compensation claims were MSDs. The data indicated that patient handling was a major factor showing an association with MSDs .

This is further compounded by a study from Occupational Medicine, which determined musculoskeletal injuries as the leading category of occupational injury in healthcare. Of the total number of injuries reported, 83% were musculoskeletal; the leading cause of musculoskeletal injury was awkward posture.

“A lot of these work-related MSDs depend on positioning, and on standing in awkward positions for long periods of time, often with heavy equipment, weights on your head, and heavy gowns.”

A survey reported in the International Journal of Surgery sought to investigate the prevalence of pain experienced by surgeons while operating in Britain. Back and neck were the most common areas of pain for surgeons and 80% described pain on a regular basis. Moreover, there are no guidelines from occupational health departments or training courses to help minimize these symptoms.

In a study published by JAMA Surgery, the prevalence of work-related MSDs are higher among surgeons and interventionalists than other physicians. As the lead author of the study, Bernard Lee, MD, MPH, states, “ “A lot of these work-related MSDs depend on positioning, and on standing in awkward positions for long periods of time, often with heavy equipment, weights on your head, and heavy gowns.”

What is more, the research suggests that the surgeon’s work environment poses similar occupational hazards as those of coal miners, manufacturing laborers, and physical therapists. Dr. Lee attests, “I’m a plastic surgeon by training and I do a lot of microsurgery. I wear loops, I wear head lights, and I’m plagued by constant neck pain and back pain.”

Despite the study illuminating the high prevalence of MSDs among surgeons, which often led to early retirement, there was a poor supply of interventions available for the physicians. Dr. Lee is hopeful he and his colleagues won’t continue to live in isolation and suggests education and intervention as ways to improve physicians health.

Alongside surgeons, the healthcare providers most notorious for poor posture are dental professionals. As indicated in the International Journal of Dental Hygiene, the prevalence of general musculoskeletal pain ranges between 64% and 93%, with the back and neck being the most prevalent regions for pain among dentists. A US study of dental hygienists reported that approximately 93% experienced musculoskeletal symptoms.

“As you look into your patient’s mouth, you are bending by collapsing the front of your torso and distorting your spine.”

Dentists, hygienists, and dental assistants spend the majority of their time with patients bent over while examining and treating their mouths. Yet there is no training in dental school or beyond to ensure the postural safety of those working in the dental field.

The detriments of this type of posture are addressed in an article by Dr. Anikó Ball, a prominent dentist from Melbourne, Australia. Dr. Ball explains, “as you look into your patient’s mouth, you are bending by collapsing the front of your torso and distorting your spine.” Additionally, “most dentists, hygienists and OHT’s (Oral Health Therapists) have a preferred work posture sitting close to the edge of the head rest. This means there is no room to bend forward without distorting the spine.”

Dr. Ball is a pioneer among healthcare providers. She is the founder of Optimum Dental Posture, an organization that specializes in the recovery and prevention of work related chronic pain in the dental profession. In addition to her research on musculoskeletal disorders in dentistry, Dr. Ball and her assistant trainers provide practical and interactive training programs and in-practice coaching for dental professionals.

There is no reason for medical professionals to continue to suffer from musculoskeletal disorders while treating patients, and subsequently cause harm to their own bodies. Practitioners like Dr. Ball, who have suffered from frequent pain and discomfort due to the harmful posture and movement habits of their work, are now revolutionizing the healthcare industry.

Currently, the medical industry does not have an effective prevention or treatment plan for healthcare professionals to offset musculoskeletal disorders. Dr. Ball was unable to find sufficient and long-term solutions for her own chronic pain. She explained that doctors and physical therapists offered short-term symptom relief without identifying her symptoms as work related.

It wasn’t until Dr. Ball discovered the Alexander Technique, a clinically proven method used to identify harmful habits that lead to body tension and pain, that she got her life back. Fascinated by the results of the technique, Dr. Ball trained to become an Alexander Technique teacher in order to teach her colleagues to apply the Inner Ergonomic principles of the Alexander Technique, and save them from occupational pain. In addition to recognizing the habits that cause pain, the Alexander Technique is a psychophysical reeducation tool promoting greater ease, mobility and functioning.

Other medical professionals have also endorsed the Alexander Technique for its efficacy in alleviating chronic pain. Robert Rickover, a distinguished Alexander Technique teacher from Lincoln, Nebraska interviewed several medical and research professionals who explained the benefits of Alexander Technique lessons for those suffering from musculoskeletal disorders.

Dr. Paul Little MD, Professor of Primary Care Research at Southampton University in England, discussed the Alexander Technique’s role as a proven method for helping people with chronic and recurrent back pain. Dr. Little was the lead investigator of a randomized controlled trial published in the British Medical Journal, underscoring the effectiveness of the Alexander Technique.

Pain management experts like Dr. Theodore Steinman, MD, Clinical Professor of Medicine at the Harvard Medical School are also proponents of the Alexander Technique. Dr. Steinman has explained the role that the Alexander Technique has in pain management for those seeking a more affordable and safer option than medication or surgery.

There are a number of studies reifying the efficacy of the Alexander Technique across populations and vocations. In addition to the positive results attributed to the technique for those suffering from MSDs, the Alexander Technique has been proven to be effective for people with Parkinson’s Disease and stuttering. Performers and athletes have also found respite through the technique from performance related injury and strain.

The vast appeal of the Alexander Technique is that it is not invasive and in many cases can reduce or eliminate the need for surgery altogether. This was underscored by Jack Stern, MD, a spinal neurosurgeon and faculty member of Yale School of Medicine, who spoke about the usefulness of the Alexander Technique for people suffering from back pain who want to avoid surgery.

While the Alexander Technique is relatively little-known in the United States, it is a highly regarded modality in Europe and Asia. Alexander Technique lessons are an integral part of the health care systems in places like the United Kingdom and Israel. In the UK, the National Health Service (NHS) offers Alexander Technique lessons as part of their outpatient pain clinics. Clalit Mushlam, one of Israel’s health service organizations, offers substantial discounts for medical coverage of Alexander Technique lessons.

Perhaps this unique century old method might be the solution for both patients and healthcare providers here in the US as well. The Alexander Technique has already helped countless individuals improve their health, posture and quality of life, leading to more funding for the research of its benefits.

The fundamental principles of the technique are rooted in the identification of habits leading to musculoskeletal disorders. Namely, the Alexander Technique brings awareness to the daily repetition of habits that lead to body pain, such as repeatedly bending and twisting the body with strain and tension. Unknowingly engaging in harmful habits is the premise for misuse of the body.

As Dr. Lee wisely noted, “ The number one thing we need to do is improve awareness. We need to know that this is a problem. We need to improve awareness from the earliest levels, whether it’s in residency or even as a medical student. Ergonomics is an important thing in the operating room, and it’s important for a long career.”

In the meantime, healthcare providers should heed the advice of the ancient proverb, “Physician, Physician, heal thine own limp!” The cobbler who was too busy to mend his own shoes, ended up walking barefoot. Healthcare providers too, must learn to tend to their own health just as they do for their patients.

Originally published at on October 29, 2019.


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