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Factors behind work related neck and upper limb problems: Psychosocial and personal risk factors, and effective interventions from a bio behavioural perspective.

At a glance:
There are physical, psychological, social or personal risk-factors for developing work-related neck or upper limb
upper limb
 pain. This study reviewed the research papers about work-related psychological, social and personal risk factors, and the effectiveness of different strategies to reduce these risks.

Perceived stress, general distress,
Severe suffering, pain, anxiety or sorrow
 and having other pain have been linked to neck and upper-limb pain. High work demands and low control at work also seem to play a role, but the relationship is not clear. Job dissatisfaction does not contribute to neck and upper limb pain.
Work-related neck and upper limb pain is a common problem. High job demands, over-commitment to work and perceived stress at work can put you at risk of developing arm pain. A good ‘work style means using good work techniques, taking adequate breaks and avoiding placing high demands on yourself.

If you develop a neck or arm condition, try not be afraid of your pain, but learn how to manage your condition. Its natural to be anxious about getting back to normal activities when you're in pain, but staying as active as possible will help you recover sooner.

Workplace factors, such as high job demands, low job control, low workplace support and perceived stress at work can put employees at risk of developing work-related neck and arm pain.

Several methods could be used in the workplace to reduce the incidence of work-related neck and arm conditions:

Shortening the work day, or introducing more frequent breaks

Training management to reduce stress in the workplace
To prevent recurrence of neck and arm pain:
Provide modified duties to help the injured worker return to work sooner

Maintain good attitudes to injured workers and encourage co-worker support
High job demands, low job control and high stress are risk factors for developing neck and arm symptoms. Treatment for these conditions should aim to reduce stress, especially in the workplace. Contact your patient's employer to discuss any necessary modification to job tasks on their return to work.

This study reviewed evidence on workplace and personal factors that increase the risk of developing work-related neck and arm pain. High job demands, low control at work, over-commitment to work and job stress put people at risk of developing neck and arm pain.

Interventions in the workplace can reduce stress, which is the clearest risk factor for neck and arm pain.

Original Article, Authors & Publication Details:
P. M. Bongers1,2,3, S. Ijmker1,2,3, S. van den Heuvel1 and B. M. Blatter1,2 (2006).

Epidemiology of work related neck and upper limb problems: Psychosocial and personal risk factors (part I) and effective interventions
A treatment or management program. Interventions often combine several approaches. In this field approaches include training in problem solving, adaptation of work duties, graded activity, an exercise and stretching program and pain relief.
 from a bio behavioural perspective (part II)
. Journal of Occupational Rehabilitation.
The process of helping a person back to their former abilities and quality of life (or as close as possible) after injury or a medical condition.
  Vol 16(3) Sep 2006, 279-302.

1TNO Quality of Life, Work and Employment, Hoofddorp, The Netherlands
2Body@work, Research Center on Physical Activity, Work and Health TNO VU University Medical Center, Amsterdam, The Netherlands
3Institute for Research in Extramural Medicine Institute, VU University Medical Center, Amsterdam, The Netherlands
Background, Study Objectives, How It Was Done:
Work-related neck and upper limb pain is a common problem. Neck and arm symptoms have many causes, and risk factors for developing pain can be physical, psychosocial
Refers to psychological and social factors. Examples of psychosocial factors that affect return to work area include: a person's beliefs about how they will cope with their condition, the attitude of the inured worker's family to their condition and return to work, the employer's return to work policy and the influence of the WorkCover system on a person.
 or personal. A combination of risk factors can be more powerful than individual risks on their own.

For industrial workers, repetitive work, especially if using force, puts them at risk of developing neck or arm pain. The risk factors for office workers are less clear, but using a mouse for more than 10-20 hours per week is associated with hand and arm symptoms. Psychosocial work factors, such as perceived job stress, non-work-related stress and high job demands are now recognized as being risk factors in arm and neck pain.

This study first looked at the evidence that psychosocial factors increase the risk of developing work-related neck and arm pain. It then assessed the research on whether interventions aimed at reducing these risk factors can help prevent neck and arm conditions.
Study Findings:
Workplace psychosocial risk factors:

There is strong scientific evidence that psychological
Refers to a person's perceptions, thought processes, emotions, personality and behaviour. Psychologists can treat mental health problems.
 and social factors contribute to poor health and/or wellbeing.

Psychosocial factors may contribute to the onset of neck and arm pain by increasing physical strain. People with high job demands might be likely to work longer hours, take fewer breaks or change their posture and movement. There are many studies supporting this theory, but they have also shown that physical strain
Injury to a muscle in which the muscle fibres tear or become irritated as a result of overstretching or wrenching
 is not the only explanation for psychosocial risk factors. Another way that psychosocial factors can increase the risk of pain is by increasing stress. Stress has been found to increase muscle tension and change movements.

Between 2002 and 2006, 24 studies examined the effect of job demands and low control on neck and arm symptoms in a variety of workers. These included industrial, health care and office workers. Most of the studies identify either high job demands or low control as a risk factor. Most studies that looked at the combined effect of both factors showed they were related to neck and shoulder symptoms but not hand and arm symptoms. Overall, job demands and job control do affect the development of neck and arm problems, regardless of the physical risks a person is under. However they are not a particularly strong influence.

There is strong evidence that high job stress increases the risk of arm problems. Depressive symptoms were associated with neck and arm problems in three out of five studies. It is possible that making a high effort and receiving little reward might also influence poor health, including neck and arm symptoms. Poor job satisfaction is not related to neck and arm symptoms.

Personal risk factors

Personality traits such as introversion, perfectionism, over-commitment to work and a tendency to “act ill' are associated with neck and arm symptoms. However, there are few studies to support this suggestion.

Several studies have shown that over-commitment to work is associated with neck and arm symptoms. Over-committed people may have higher demands at work and this may be a risk factor for developing neck and arm pain.
A person's “work style' refers to the way they respond to work demands. Work style can affect a person's health. A high-risk work style includes taking shorter or fewer breaks, working through pain unnecessarily, making high demands of their own performance and anticipating negative reactions from colleagues. This kind of approach may contribute to neck and arm pain, although there has not yet been a lot of research done in this area.

Effective strategies to prevent neck and arm pain:

Since perceived stress is a risk factor for work related neck and arm symptoms, interventions to prevent occupational stress may help to prevent neck and arm pain. Interventions can be aimed either at individuals (e.g. improving coping skills, relaxation or work style) or the workplace (e.g. improvements to work culture or changes to job tasks).

Primary interventions aim to prevent symptoms developing. Secondary interventions aim to prevent symptoms getting worse or recurrence of symptoms. Usually, most secondary interventions focus on individual improvements such as decreasing fear and distress, changing beliefs, or resolving conflict or lack of support.

1. Primary interventions

There is currently not a lot of research into workplace strategies to prevent stress, and the effect of these strategies on neck and arm pain.

Workplace strategies:

In one study, training managers to reduce stress in the workplace reduced the number of musculoskeletal
Involving the muscles and the skeleton. This term includes the limbs, neck, shoulders and back. 'Musculoskeletal problem' refers to many different conditions that can affect the tendons, muscles and related structures.
 disorders. Another study found that only one training session for managers was not enough to have an effect.

One study found that shortening the working day from 8 hours to 6 hours reduced the number of people with neck and arm symptoms.

It is unclear whether adding more breaks to the working day prevents neck and arm pain. 3 studies have found that it does, while 4 studies have found that it does not.

Rotating tasks in jobs that involve repetitive work has been investigated in 5 studies, but it has not been found to reduce neck and arm symptoms.

Individual strategies:

Training in work techniques may be a useful approach to reducing arm and neck symptoms. One study found that teaching workers a healthy work style (such as taking breaks) reduced arm symptoms and improved work techniques.

One study found that relaxation techniques helped reduce anxiety and increase work quality.

Behavioural approaches aimed at improving coping skills appear to be more effective than relaxation techniques. Coping strategies are especially effective in improving quality of life and a person's resources, and reducing anxiety. One study specifically looked at the effect of teaching coping skills on arm pain, and showed that symptoms were reduced after six weeks.

One study found that muscle training reduced assembly workers' symptoms for six weeks after the training, but the effect was lost after 32 weeks.

Another possible approach is to combine individual and workplace strategies to reduce stress and neck and arm pain.

2. Secondary interventions

Once an injury has occurred, interventions aim at preventing long-term disability
A condition or function that leaves a person unable to do tasks that most other people can do.
 and helping the person return to work.

Work-related psychosocial factors that influence disability and return to work include:

Workplace organization
The availability of modified duties
Support from co-workers
The attitudes of management

Individual psychosocial factors that influence disability and return to work include:

Fear of pain
'Catastrophising' pain (training pain as a catastrophe)
Lack of confidence
Poor problem solving
Poor expectations about returning to work

The best way to reduce personal and workplace risks are not yet known.
There have a number of studies into the effect work-related psychological and social issues have on neck and arm pain. Most of these studies analysed the effect of high demands, low control and poor workplace support on symptoms of neck and arm pain.

These studies show that high work demands and low control are often factors in neck and arm pain. The combination of low control and high job demands appears to affect neck and shoulder symptoms more than arm or wrist symptoms.

Perceived stress has been consistently linked to neck and arm symptoms. People who are under general stress and have other musculoskeletal pain are more at risk of developing neck and arm symptoms. Personal characteristics and behaviours such as work-style may also contribute to neck and arm symptoms. Job dissatisfaction is not a contributing factor.

There are also personal, psychosocial and workplace factors that increase the risk of disability after a neck or arm problem has developed.

Personal interventions (such as training for relaxation and coping skills) and workplace interventions (such as training for managers and decreasing work hours) can reduce job stress, which is the clearest risk factor for the development of neck and arm pain.
PubMed Abstract

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