¹Department of Anatomy and Cell Biology, Temple University, Philadelphia, United States
²Lewis Katz School of Medicine, Temple University, Philadelphia, United States

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Musculoskeletal disorders (MSDs) affect approximately 1.70 billion people worldwide from adolescence to elderly age; due to population ageing, the number of people living with MSDs and associated functional limitations is increasing.

MSDs are the leading contributor to disability causing early retirement from work and costs for employers and the society. According to the GBD study estimates, the peak age of onset and DALYs of MSDs was 50–54 years in 2019 and occupational risk exhibited the highest contribution to MSDs, but also individual conditions were major risk factors.

After decades of epidemiological research on MSDs diagnosis and management in the occupational field, a tentative summary of the major findings as well as issues that are still controversial or deserve further investigation is presented.

First, for both research and clinical practice, the indisputable evidence of the multifactorial nature of MSDs entails to consider individual characteristics as well as the complexity of occupational factors, namely physical and psychosocial risk and their contribution with respect to the level of evidence for association within a specific body area.

Regarding clinical features, work-related MSDs can affect the back, neck, shoulders and limbs going from minor aches and pains to more serious medical conditions.

Studies have shown only a partial overlap between symptoms and anatomical findings in the musculoskeletal system. Degenerative conditions (i.e. disc disease, rotator cuff abnormalities) are so commonly found in imaging studies among asymptomatic subjects to be considered aspects of human ageing. Thus, at individual level, the challenge is to establish whether imaging finding is new and if there is a causal relationship with symptoms or a plausible association with occupational exposure.

Furthermore, the burden of MSDs in all sites is greater among females throughout different job sectors, a condition not attributable to gender segregation alone. Indeed, in addition to the effect of repetitive constrained manual activities, females and males exhibit differences in the way they perceive pain and related disability as well as their coping strategies.

According to clinical guidelines, after ruling out potential serious underlying conditions and having considered biopsychosocial believes and expectations, the management of musculoskeletal pain includes a multimodal approach with education, exercise and pharmaceutical interventions to relieve symptoms and improve physical function. Cognitive/behavioral strategies for persistent pain are also recommended together with staying active and early return to work. There is still a need to harmonize clinical and occupational guidelines especially with respect to proper adaptations for physical activity at work and to improve knowledge on sex/gender differences to set up tailored interventions.

References

[1] Liu S, Wang B, Fan S, Wang Y, Zhan Y, Ye D. Global burden of musculoskeletal disorders and attributable factors in 204 countries and territories: a secondary analysis of the Global Burden of Disease 2019 study. BMJ Open. 2022 Jun 29;12(6):e062183. DOI: 10.1136/bmjopen-2022-062183
[2] Reneman MF, Coenen P, Kuijer PPFM, van Dieën JH, Holtermann A, Igwesi-Chidobe CN, Parker R, Reezigt R, Stochkendahl MJ, Hoegh M. Tensions of Low-Back Pain and Lifting; Bridging Clinical Low-Back Pain and Occupational Lifting Guidelines. J Occup Rehabil. 2024 Sep;34(3):473-480. DOI: 10.1007/s10926-024-10210-1