Family doctor

What is Occupational Overuse (OOS)?

Occupational Overuse Syndrome is a collective term covering a range of disorders which cause pain and/or other sensations in muscles, tendons, nerves, soft tissues, and joints.

Occupational Overuse is by no means a new condition - one that has been relabeled. There is documentation of fisher woman's finger in the late 1800s, through last century we have seen muscular dystonia, Repetitive Strain Injury (RSI), and now Occupational Overuse Syndrome (OOS).

The disorders, which fall under the umbrella of OOS, fall into three categories:

1. Localised inflammations. These are specific to a small area, the pain pathway is simple, easily treated and fast recovery is expected. For example:

-Epicondylitis, also know as tennis elbow

-Tenosynovitis = inflammation of the wrist and tendon sheath

-Rotator cuff syndrome = inflammation of the tendons around the shoulder joint

2. Compression syndromes. This is when nerves are compressed, a larger area of pain is incorporated, treatment and recovery takes longer, approximately 6-8 weeks. Guidance is crucial see your G.P who will refer you to skilled therapists at this stage. For example:

- Carpal tunnel syndrome. This is where the median nerves are compressed at the level of the wrist.

3. Pain syndromes. This category takes time to develop, the problem at this stage becomes complex, pain becomes more diffuse effecting the whole body. Not only are there physical symptoms but also emotional frustration, depression or anxiety may be exhibited. This is common at this stage as it is difficult to cope with a chronic pain disorder, and often it is the very capable people who end up in this category. Recovery is potentially reversible taking time - up to months or even years. At this stage it is important to be under the care of a skilled team of professionals. (See treatment). For example:

-Myofascial syndrome (trigger points in the muscle especially in the neck and shoulder)

- Complex regional pain syndrome (a pain syndrome which can develop as a complication of a work-related injury)

What causes OOS?

The disorders have many causes. The prime causes are contributed to by a range of work conditions such as:

• prolonged muscle tension
• repetitive actions
• forceful movements
• sustained postures (holding a position for a long time)
• constrained postures (cramped or awkward body positions)
• organisational factors e.g. excessive workload
• Psycho-social factors e.g. responding to workplace pressures by becoming very tense. It is also quite evident that not only physical workplace characteristics are the only contributors to O.O.S. The psycho-social climate at work is also very important, for example are you happy at work? How well do you get on with your boss? What support do you get when problems arise?
• Stresses outside of work will also play a contributing factor
• General health and life styles (our lifestyle is responsible for 54% of our general health outcome.

What are the symptoms?

Aches and pains in muscles and joints. Remember though aches and pains are a common part of day to day life - be wary of prolonged problems.

Category 1 pain stops when the activity is stopped, e.g. stopping of typing.

Category 2 pain often eases overnight

Category 3 pain is diffuse and affected by not only activity but also other factors such as stress, menstrual cycles for women, diet, sleep, and temperature.

Common symptoms include:

• Tingling and numbness in hands, feet or mouth.
• Swelling in hands and fingers predominantly.
• Changes in skin colour
• Loss of strength or power to muscles
• Burning sensations in tissues
• Disturbed sleep

How can OOS be prevented?

Prevention is better than cure especially for occupational overuse. It is evident that if small problems are ignored they can grow into bigger and more complex disorders. Here are some suggestions for avoiding OOS:

• The golden rule is listen to your body - when you start to feel discomfort respect this. Stop, allow for recovery (a few seconds is all it takes), move and allow the tissue to re-oxygenate.
• Allow for recovery
• Relaxation techniques
• Good breathing patterns - when we breathe well we move, when we move our body is oxygenated.
• Report immediately to your supervisor - most companies in New Zealand now have protocols in place for the necessary steps to take upon reporting.
• Early treatment if this is necessary
• Good postures - movement, rhythm, relaxation and micropauses are all important.
• Good ergonomic workstation/area-
• Healthy life styles this includes:
• Exercise on a regular basis
• A balanced diet
• Relaxation and good breathing skills
• Healthy sleep patterns

A check list do you know :

• About your work station
• Good Posture
• Methods of relaxation
• Correct working techniques
• The use of micropauses
• When to take breaks
• Exercises
• Problems of your work organisation
• Efficient use of software
• Keyboard skills 

Tips to prevent OOS:

• If in doubt always breathe out
• Check your posture. Keep your hips at approximately 90 degrees
• Sit in the chair correctly - that is on your bottom bones
• A foot rest may be beneficial
• Hold elbows at approximately right angles with wrists and hands in a straight position
• Keep the screen a arm's length away
• Your eyebrow should be approximately level with the bottom of the tool bar, at the top of your computer screen.
• Move frequently. Micropause. 1. Breathe out. 2. Rest for a few seconds. 3. Roll your shoulders backwards.
• Take all lunch coffee breaks
• Learn good relaxation skills. Stress is alive and well, and those equipped with the tools to endure and embrace it will be more resilient to conditions such as OOS.

Advanced stretches:

• Chin tuck - Keeping your head straight gently glide your head backward, literally tucking your chin in.
• Shoulder rolls backwards
• Stretch finger and thumbs. Shake them often.
• Forearm stretches: 1. With your elbow straight pull your hand back towards your outer forearm. 2. Placing your hands in the prayer position bring your elbows up the horizontal position. 3. Elbow straight turn your hand towards your inner forearm and stretch assisted by your other arm.

Occupational groups at risk:

The following are highly represented: (statistics ACC 1996)

25% of total clerks

16% elementary occupations (e.g. cleaners and laborers)

12% plant and machine operators and assemblers

What can be done?

This depends upon which category your problem falls into:

Category 1

Localised inflammation - mild symptoms. Firstly tell your supervisor, check your workplace design, check the way you are relating to your workplace - many of us sit in the same position and become totally emerged in our work even to the point of forgetting to breathe.

If in doubt breath out! Breathing creates movement and blood flow ensuring our muscles are literally oiled and greased.

You may need a few sessions with a physiotherapist that will educate you on the appropriate stretches and treat the localised inflammation.

Remember once an acute problem settles you will not harm your self with active movement

Category 2

Do all of the above.

You must consult with your GP, who should know the correct therapist to send you to.

Category 3

Pain syndromes are difficult as they involve treating your whole self - this means you will require a team approach of G.P, physiotherapist, occupational therapist, pain psychologist, and specialist medical consultant where appropriate. Your work organisation should also become involved in your rehabilitation.

If return to work is impossible careers counseling may be necessary. This is to restore purpose to your direction in the work force.

Resources:

Prevention

ACC Accident Compensation Corporation Manual (1996) Prevention. Contact your local ACC office.

Your local OSH office (Occupational safety and Health Service of the Department of Labor) has extensive information, pamphlets, books, brochures on guides to exercises. They also have VDU (visual display unit) guidelines.

Getting help

Your GP

New Zealand Physiotherapists Society, PO Box 27 386 Wellington, Ph 04 801 6500 Fax: 04 801 5571.

New Zealand Society of Occupational Medicine, PO Box 31 459, Lower Hutt.

New Zealand Society of Occupational Therapists, PO Box 12 506 Wellington. Ph 04 473 6501 Fax: 04 473 1841.

Tania Clifton-Smith, specialist physiotherapist, Breathing Works, 1 Maidstone St, Ponsonby, Auckland. Ph 360 1477.