Intended for healthcare professionals

Practice ABC of Occupational and Environmental Medicine, 3rd Edition

Musculoskeletal Disorders

BMJ 2014; 348 doi: (Published 21 February 2014) Cite this as: BMJ 2014;348:bmj.g1076
  1. Kim Burton1,
  2. Nicholas Kendall2
  1. 1Centre for Health and Social Care Research University of Huddersfield Huddersfield, UK
  2. 2Occupational Medicine University of Otago Otago, New Zealand

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  • Musculoskeletal symptoms are very common, with lifetime prevalence rates of 75% or more for problems such as low back pain. Causes are frequently assumed, but are actually unpredictable and largely unknown. This makes outright prevention unfeasible

  • Explanations and diagnostic labels can negatively influence responses to symptoms. Care needs to be taken to reassure and emphasize the benefits of maintaining participation, and avoiding prolonged rest and inactivity

  • Clinical management should aim at symptomatic relief with maintenance of activity and work. Most interventions exhibit only weak to moderate treatment effects, and combining or repeating them does not seem to enhance effectiveness

  • Effective occupational management depends on communication and coordination between the key players, with optimal intervention being a combination of work-focused healthcare and accommodating workplaces

  • Psychosocial issues contribute most strongly to absence from work. These obstacles can be identified in three main areas: the person, their workplace and the everyday context in which they function. Actively tackling obstacles results in improved outcomes

Musculoskeletal disorders (MSDs) are commonly experienced across the population from childhood to old age, but are most frequently complained of to healthcare services by working-age people. They encompass the everyday aches and pains that are part of life as well as the consequence of specific injuries. MSDs can and do affect capability for work, both short and long term. They are a principal reason for sickness absence, yet they vary inconsistently by occupation. In terms of self-reported ill health, MSDs dominate the conditions that people believe are caused or made …

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