Measuring elemental time and duty cycle using automated video processing

A marker-less 2D video algorithm measured hand kinematics (location, velocity and acceleration) in a paced repetitive laboratory task for varying hand activity levels (HAL). The decision tree (DT) algorithm identified the trajectory of the hand using spatiotemporal relationships during the exertion and rest states. The feature vector training (FVT) method utilised the k-nearest neighbourhood classifier, trained using a set of samples or the first cycle. The average duty cycle (DC) error using the DT algorithm was 2.7%. The FVT algorithm had an average 3.3% error when trained using the first cycle sample of each repetitive task, and had a 2.8% average error when trained using several representative repetitive cycles. Error for HAL was 0.1 for both algorithms, which was considered negligible. Elemental time, stratified by task and subject, were not statistically different from ground truth (p < 0.05). Both algorithms performed well for automatically measuring elapsed time, DC and HAL. Practitioner Summary: A completely automated approach for measuring elapsed time and DC was developed using marker-less video tracking and the tracked kinematic record. Such an approach is automatic, repeatable, objective and unobtrusive, and is suitable for evaluating repetitive exertions, muscle fatigue and manual tasks.

Job stress dimension and work-related musculoskeletal disorders among southeast Nigerian physiotherapists

BACKGROUND

Although publications describe physical demands of the job in the physiotherapy profession, there is a dearth of literature on job stress dimensions (JSDs), and their relationship to work-related musculoskeletal disorders (WMSDs).

OBJECTIVE

To investigate JSDs and their relationship to WMSDs among physiotherapists currently practicing in southeast Nigeria.

METHOD

A cross-sectional study using items related to the Job Content Questionnaire and the Nordic musculoskeletal questionnaire. Data were summarized with descriptive statistics, and the relationship between WMSDs and JSDs was analyzed with the Mann-Whitney U test.

RESULTS

A total of 126 physiotherapists responded. There were high levels of stress in most of the job dimensions investigated: 82.1% and 22.8% of the physiotherapists had WMSDs in at least one body region in the last 12 months and the last 7 days respectively. The lower back was the most commonly affected in both periods. No specific domain was related to development of WMSDs.

CONCLUSION

Over 80% of physiotherapists in southeast Nigeria have WMSDs. However, despite high levels of physical demands on the job, physiotherapists have job control and good social support. Intervention programs aimed at reducing WMSDs in physiotherapists should focus on risk factors that target the physical demands of the job.

Associations between work-related musculoskeletal disorders, quality of life, and workplace stress in physical therapists

This study was performed to determine the associations between work-related musculoskeletal disorders (WMSDs), quality of life (QoL), and workplace stress among physical therapists (PTs) in South Korea. Self-reporting questionnaires were given to 855 PTs. Variables examined included general characteristics, WMSDs, QoL, and workplace stress. Of the 788 PTs who responded, 745 (94.5%) reported WMSDs affecting at least one body site. The most affected WMSDs site was the shoulder (23.3%), and the most reported number of body sites affected by WMSDs was one (50.9%). QoL was significantly improved (p<0.05) among PTs over 39 years old, who had 10-15 years of professional experience, worked in general/university hospitals, and had only one site affected by WMSDs. Factors influencing QoL included number of body sites affected by WMSDs, presence/absence of WMSDs, working venues, workplace stress, and age. Factors affecting workplace stress included number of body sites affected by WMSDs, QoL, work hours, and gender. The results showed a high prevalence of WMSDs among PTs in South Korea, and this negatively affected both QoL and workplace stress.

Impact of Work Organizational Factors on Carpal Tunnel Syndrome and Epicondylitis

OBJECTIVE

The aim of this study was to identify relationships between work organizational variables (job rotation, overtime work, having a second job, and work pacing) (These work organizational variables and their relationships with biomechanical and psychosocial exposures were studied previously and published in a separate paper.) and health outcome measures [carpal tunnel syndrome (CTS), lateral and medial epicondylitis (LEPI/MEPI)].

METHODS

Using a pooled baseline cohort of 1834 subjects, the relationships were studied using logistic regression models.

RESULTS

Varied degrees of associations between the work organizational and outcomes variables were found. Job rotation was significantly associated with being a CTS case [odds ratio (OR) = 1.23, 95% confidence interval (95% CI): 1.00 to 1.50]. Overtime work was significantly associated with lower LEPI prevalence (OR = 0.48, 95% CI: 0.28 to 0.84). No statistically significant associations were found between having a second job and different work pacing and any of the three health outcome measures.

CONCLUSIONS

Work organizational variables were only partially associated with the studied health outcomes.

Upper Limb Muscle Activity among Workers in Large-Herd Industrialized Dairy Operations

OBJECTIVES

The primary aim of this cross-sectional research study was to quantify upper limb muscle activity among workers performing milking tasks in large-herd dairy parlors.

METHODS

Surface electromyography (sEMG) from the trapezius, anterior deltoid, biceps brachii, wrist flexors, and wrist extensors muscles of 26 dairy workers were used to create muscle activity profiles for the milking tasks common in large-herd dairy parlors. Functional maximum voluntary contractions (fMVC) were collected to normalize the sEMG data for appropriate comparisons. Anthropometric measurements were recorded from each worker.

RESULTS

The biceps brachii had the highest muscle activity (14.58% fMVC) of the upper limb muscles measured, exceeding previously established recommendations for working tasks. The anterior deltoid had the least amount of activity, while the upper trapezius had the least amount of muscular rest during milking work. Worker stature was negatively associated with upper limb muscle activity.

CONCLUSION

Milking tasks in large-herd dairy parlors have significant effects on the upper limb muscle activity of workers. The muscle activity of biceps brachii during normal work tasks exceeded the recommended safe limit. Wrist flexors and upper trapezius approached the recommended limit. The study findings suggest that milking tasks in large-herd dairies may increase the worker's risk for developing musculoskeletal symptoms and possibly musculoskeletal disorders.

The occurrence of overload at work and musculoskeletal pain in young physiotherapists

BACKGROUND

A job requiring stooping, lifting, carrying loads and multiple repetitions of the same movement patterns leads to overloading the musculoskeletal system.

OBJECTIVE

The aim of the study was to assess the work-related load experienced by physiotherapists and the occurrence of the musculoskeletal system overload.

METHODS

The study included 108 young physiotherapists, 69 women and 39 men, aged from 25 to 35 years (mean 27.12 ± 3.72 years). The study used an anonymous questionnaire and Quick Exposure Check.

RESULTS

The most common musculoskeletal complaints were as follows: 70 physiotherapists (64.8%) reported low back pain, 60 (55.6%) cervical pain, and 34 (31.5%) pain in the wrists and fingers. Statistically significant positive correlations were revealed between the number of years worked in the profession and shoulder pain. The number of hours of work per week was positively correlated with the occurrence of pain in all analyzed body areas. Professional experience was negatively correlated with the level of stress felt. Physiotherapists dealing with manual therapy and exercise physiotherapy were particularly vulnerable to musculoskeletal overload.

CONCLUSIONS

Popularization of knowledge regarding ergonomics among physiotherapists could reduce the occurrence of musculoskeletal overload.

Allied Health Professionals and Work-Related Musculoskeletal Disorders: A Systematic Review

Work-related musculoskeletal injuries and disorders (WMSD) are a significant issue in the health care sector. Allied Health professionals (AHP) in this sector are exposed to physical and psychosocial factors associated with increased risk of developing a WMSD. Clarification of relevant hazard and risk factors for AHP is needed to improve understanding and inform WMSD risk management. A systematic analysis of the literature was undertaken to determine prevalence and risk factors for WMSD in AHP. Databases of Ovid MEDLINE, CINAHL (EBSCO), EMBASE and the Cochrane Database of Systematic Reviews were reviewed. This quality of articles was low. Outcome measures were varied, with prevalence rates of WMSD reported from 28% to 96% over a one-year time period. The lower back was the most commonly affected body part. Relevant factors identified with the development of WMSD included inexperience in the role and area of employment. Future research needs to focus on undertaking high quality prospective studies to determine the factors associated with WMSD development in AHP.

Educational intervention for reducing work-related musculoskeletal disorders and promoting productivity

BACKGROUND AND OBJECTIVES

Work-related musculoskeletal disorders (WMSDs) are the main causes of pain, suffering, absenteeism, disability and reduction in productivity. This research aims to determine the role of training intervention based on protection motivation theory in reducing WMSDs and promoting productivity.

METHODOLOGY

The conducted study was based on a quasi-experimental design (control) that was carried out on 158 employees of the Kabl Khodro factory which were divided into two groups of 79 people. After splitting the 158 workers, an experimental and control group was formed. The data collection instruments were made up of two questionnaires and were analysed using a quick exposure check (QEC) method.

RESULT

Before intervention in both the experimental and control groups, there were no significant differences among the average protection motivation theory constructs, productivity and QEC scores (p < 0.05). However, following training intervention there was a significant increase in these factors within the investigated group apart from the perceived response costs and efficacy.

CONCLUSION

The conducted study shows that ergonomic training based on the protection motivation theory is effective in reducing musculoskeletal risk factors and that increased knowledge of the subject can lead to an increase in productivity.

Investigation of work-related musculoskeletal disorders among male kitchen workers in South India

OBJECTIVE

This study aims to quantify the prevalence of work-related musculoskeletal disorders (MSDs) and risks among male kitchen workers in the catering industry.

METHOD

Data were collected with the help of the Nordic musculoskeletal questionnaire and by direct observations.

RESULTS

In total, 114 male kitchen workers from various hostels of a college in South India were considered for this study. The average age and mean years of employment of the workers are 26.4 (SD 7.7) and 7.8 respectively. The statistical analysis carried out reveals that 67.5% of male kitchen workers reported MSDs during the past 12 months. The highest prevalence rate has been found in the lower back (65.8%) and shoulder region (62.3%). Among different categories of kitchen work analyzed, it is evident that chief cooks suffer more from MSDs (79.2%) than assistant cooks (74.3%) and kitchen aides (30.0%). Workers in the older group, i.e., ≥ 41 years, and workers with 6-10 years of experience suffer with higher risk of MSDs, i.e., 93.9% and 87.5%, respectively.

CONCLUSION

The male kitchen workers who participated in this research were found to possess both MSDs and ergonomic hazards.

Prevalence and risk factors of musculoskeletal disorders among Myanmar migrant workers in Thai seafood industries

A cross-sectional descriptive study was conducted with self-administered questionnaires among 368 Myanmar migrant workers to investigate the prevalence of and to determine the risk factors for musculoskeletal disorders (MSDs) in the Thai seafood industry. The results showed the prevalence of MSDs was 45.1% occurring in the last 7 days. Marital status, number of dependents, other health problems, working hours, repetitive hand movements, awkward posture of wrists, prolonged standing, and manual handling of heavy loads were found to be associated with MSDs. Multiple logistic regression indicated that the workers who were married, had more than two dependents, and had more exposure to awkward wrist postures were at significantly increased risk of MSDs. The study findings suggest the need for adequate knowledge of ergonomics and for awareness campaign programs focusing on prevention of MSDs, especially low back pain, to be initiated in industries for earlier detection of symptoms among seafood processing workers.

Prevalence of work-related musculoskeletal disorders among physical therapists

BACKGROUND

Health professions like dentistry, nursing and physical therapy have been reported at high risk for developing work-related musculoskeletal disorders. Results of studies conducted in these occupational groups may help formulate prevention strategies. However, no such data among physical therapists has been reported in India.

MATERIAL AND METHODS

We conducted an online survey among 100 physiotherapists in Delhi.

RESULTS

The response rate was 75%. The prevalence of work-related musculoskeletal disorders is found to be high since 92% of them reported to feel some pain after joining physical therapy which affects daily activities and even sometimes forces them to change their work. Physical therapists specialty, gender, furniture used in clinic and duration of patient contact are found to be related to the pain development (p<0.05).

CONCLUSIONS

We need to emphasize the role of ergonomics and techniques of patient handling in development of work-related pain symptoms.

An Analysis of Work-Related Musculoskeletal Disorders Among Butchers in Kano Metropolis, Nigeria

Background

Butchering is often associated with high rates of work-related musculoskeletal disorders (WRMSDs). However, published work on the prevalence of WRMSDs among butchers in Nigeria is scarce. This is important because meat processing practices differ across geographical and cultural locations. This study was therefore aimed at analyzing WRMSDs among butchers in Kano metropolis.

Methods

Sociodemographic and work-settings information was obtained from 102 male cattle butchers (age, 37.49 ± 11.68 years) through survey. Information on the prevalence and pattern of musculoskeletal disorders was obtained from the respondents using the Standardized Nordic Questionnaire. Additional information on health seeking practices was also obtained using a pro forma. Associations between the prevalence of WRMSDs and each of the sociodemographic data and work settings were explored using Chi-square analysis. The level of significance was set at p < 0.05.

Results

The 12-month and point prevalence rates of WRMSDs among butchers in this study were 88.2% and 74.5%, respectively. Whereas lower back complaints (66.7%) were the overall and lower body quadrant's most commonly reported WRMSDs among the butchers surveyed, wrist/hand complaints were the leading upper quadrant's (45.1%) most commonly reported WRMSDs among the respondents. There were significant associations between age and majority of WRMSDs in the body regions. Only 23.3% of the 90 individuals who had WRMSD visited the hospital to seek redress for their WRMSD.

Conclusion

The prevalence of WRMSDs is high among butchers in Kano Metropolis. Few individuals with WRMSD utilize healthcare facilities. Age is a major risk factor in this setting.

Relationships between job organisational factors, biomechanical and psychosocial exposures

The relationships between work organisational, biomechanical and psychosocial factors were studied using cross-sectional data from a pooled dataset of 1834 participants. The work organisational factors included: job rotation, overtime work, having second jobs and work pace. Task and job level biomechanical variables were obtained through sub-task data collected in the field or analysed in the laboratory. Psychosocial variables were collected based on responses to 10 questions. The results showed that job rotations had significant effects on all biomechanical and most psychosocial measures. Those with job rotations generally had higher job biomechanical stressors, and lower job satisfaction. Overtime work was associated with higher job biomechanical stressors, and possibly self-reported physical exhaustion. Those having second jobs reported getting along with co-workers well. Work pace had significant influences on all biomechanical stressors, but its impact on job biomechanical stressors and psychosocial effects are complicated.

PRACTITIONER SUMMARY

The findings are based on a large number of subjects collected by three research teams in diverse US workplaces. Job rotation practices used in many workplaces may not be effective in reducing job biomechanical stressors for work-related musculoskeletal disorders. Overtime work is also associated with higher biomechanical stressors.

Survey of UK sonographers on the prevention of work related muscular-skeletal disorder (WRMSD)

BACKGROUND

To establish whether the current training of student sonographers in both academic and clinical settings is sufficient for educating about the dangers of work-related musculoskeletal disorders (WRMSDs).

METHODS

A dual method of data collection was undertaken. Initially, a focus group was set up, involving a small group of practicing sonographers from a hospital in the United Kingdom, with the results of that survey being used to design a postal survey questionnaire. The questionnaire focused on ergonomics, scanning technique, training in physical techniques, personal general health, risk, stress, and task management. It was sent to seven participating universities across the United Kingdom. Approvals were obtained from the local ethics committees, the hospital Trust, and the academic institution.

RESULTS

The focus group highlighted several areas in which improvements could be made in educating sonographers on the reduction of WRMSDs. The questionnaire results indicated that students are being taught about certain aspects of WRMSD prevention by both their university and clinical mentors. Respondents received training on the prevention of WRMSDs: 97% in the university setting and 81% from clinical mentors.

CONCLUSIONS

Improvements need to be made in terms of educating students to perform muscle-strengthening exercises during the workday; to have a system of reporting injury; to consider personal health, well-being, and stress management in the workplace; and to evaluate the ergonomics of computer workstations.

Ergonomic task reduction prevents bone osteopenia in a rat model of upper extremity overuse

We evaluated the effectiveness of ergonomic workload reduction of switching rats from a high repetition high force (HRHF) lever pulling task to a reduced force and reach rate task for preventing task-induced osteopenic changes in distal forelimb bones. Distal radius and ulna trabecular structure was examined in young adult rats performing one of three handle-pulling tasks for 12 wk: (1) HRHF, (2) low repetition low force (LRLF); or (3) HRHF for 4 wk and than LRLF thereafter (HRHF-to-LRLF). Results were compared to age-matched controls rats. Distal forelimb bones of 12-wk HRHF rats showed increased trabecular resorption and decreased volume, as control rats. HRHF-to-LRLF rats had similar trabecular bone quality as control rats; and decreased bone resorption (decreased trabecular bone volume and serum CTX1), increased bone formation (increased mineral apposition, bone formation rate, and serum osteocalcin), and decreased osteoclasts and inflammatory cytokines, than HRHF rats. Thus, an ergonomic intervention of HRHF-to-LRLF prevented loss of trabecular bone volume occurring with prolonged performance of a repetitive upper extremity task. These findings support the idea of reduced workload as an effective approach to management of work-related musculoskeletal disorders, and begin to define reach rate and load level boundaries for such interventions.

A frequency-duty cycle equation for the ACGIH hand activity level

A new equation for predicting the hand activity level (HAL) used in the American Conference for Government Industrial Hygienists threshold limit value®(TLV®) was based on exertion frequency (F) and percentage duty cycle (D). The TLV® includes a table for estimating HAL from F and D originating from data in Latko et al. (Latko WA, Armstrong TJ, Foulke JA, Herrin GD, Rabourn RA, Ulin SS, Development and evaluation of an observational method for assessing repetition in hand tasks. American Industrial Hygiene Association Journal, 58(4):278-285, 1997) and post hoc adjustments that include extrapolations outside of the data range. Multimedia video task analysis determined D for two additional jobs from Latko's study not in the original data-set, and a new nonlinear regression equation was developed to better fit the data and create a more accurate table. The equation, HAL = 6:56 ln D[F(1:31) /1+3:18 F(1:31), generally matches the TLV® HAL lookup table, and is a substantial improvement over the linear model, particularly for F>1.25 Hz and D>60% jobs. The equation more closely fits the data and applies the TLV® using a continuous function.

A hand speed-duty cycle equation for estimating the ACGIH hand activity level rating

An equation was developed for estimating hand activity level (HAL) directly from tracked root mean square (RMS) hand speed (S) and duty cycle (D). Table lookup, equation or marker-less video tracking can estimate HAL from motion/exertion frequency (F) and D. Since automatically estimating F is sometimes complex, HAL may be more readily assessed using S. Hands from 33 videos originally used for the HAL rating were tracked to estimate S, scaled relative to hand breadth (HB), and single-frame analysis was used to measure D. Since HBs were unknown, a Monte Carlo method was employed for iteratively estimating the regression coefficients from US Army anthropometry survey data. The equation: HAL = 10[e(-15:87+0:02D+2:25 ln S)/(1+e(-15:87+0:02D+2:25 ln S)], R(2) = 0.97, had a residual range ± 0.5 HAL. The S equation superiorly fits the Latko et al. ( 1997 ) data and predicted independently observed HAL values (Harris 2011) better (MSE = 0.16) than the F equation (MSE = 1.28).

Mechanical stress

This chapter discusses mechanical stressors that are believed to be associated with work-related musculoskeletal disorders. It starts with an introduction to work-related musculoskeletal disorders (particularly those with high incidences in workplaces, such as disorders of low back, neck/shoulder, hand/wrist, elbow, and knee) in high-risk industries, and those mechanical stressors (such as high forces, awkward postures, high repetitions, excessive contact stress, and harmful human vibrations) in workplaces that are responsible for these disorders. Quantification methods of these mechanical stressors are then discussed. Although various quantification methods such as self-report, observational technique, and direct measurement are discussed, details are focused on many of those well-published observational techniques used by practitioners to assess risk levels of these mechanical stressors in jobs. These methods can quantify job mechanical stressors and provide risk level indications that can be used by practitioners to facilitate their decision making. These methods can also be used to evaluate the improvements of ergonomics interventions by comparing the risk levels quantitatively before and after the interventions.

The accuracy of conventional 2D video for quantifying upper limb kinematics in repetitive motion occupational tasks

Marker-less 2D video tracking was studied as a practical means to measure upper limb kinematics for ergonomics evaluations. Hand activity level (HAL) can be estimated from speed and duty cycle. Accuracy was measured using a cross-correlation template-matching algorithm for tracking a region of interest on the upper extremities. Ten participants performed a paced load transfer task while varying HAL (2, 4, and 5) and load (2.2 N, 8.9 N and 17.8 N). Speed and acceleration measured from 2D video were compared against ground truth measurements using 3D infrared motion capture. The median absolute difference between 2D video and 3D motion capture was 86.5 mm/s for speed, and 591 mm/s(2) for acceleration, and less than 93 mm/s for speed and 656 mm/s(2) for acceleration when camera pan and tilt were within ± 30 degrees. Single-camera 2D video had sufficient accuracy (< 100 mm/s) for evaluating HAL. Practitioner Summary: This study demonstrated that 2D video tracking had sufficient accuracy to measure HAL for ascertaining the American Conference of Government Industrial Hygienists Threshold Limit Value(®) for repetitive motion when the camera is located within ± 30 degrees off the plane of motion when compared against 3D motion capture for a simulated repetitive motion task.

The discipline of ergonomics in Cuba within the occupational health framework: background and trends

The concept of ergonomics was introduced in Cuba at the beginning of the 1970s. More than 40 years later, the prevailing approach to workers' health is still generally reactive rather than proactive, despite the commitment of the government to the subject. A factor influencing this issue is, generally, lack of recognition of the benefits of establishing ergonomic principles within most occupational activities. Recent progress to move occupational health practice toward a more preventive approach has been conducted, frequently with international support. The introduction of a set of Cuban standards proposing the necessity of ergonomic evaluations is an example of this progress. The main challenge for Cuban ergonomists is to transfer knowledge to occupational health practitioners in order to be in concordance with basic standards and regulations regarding ergonomics. The article offers a short description of the history of ergonomics and an overview of ergonomics practice in Cuba.

The mediating role of work-related musculoskeletal disorders on the link between psychosocial factors and absenteeism among administrative workers

This study aimed to investigate the association between psychosocial factors (i.e., job demand, decision latitude, social support, physical environment, and personal risk factors), work-related musculoskeletal disorders (WRMDs), and productivity as measured by workers' perceived absenteeism. Data were collected from the selected administrative workers (administrative assistant) and analyzed using cross tabulation. The results indicate that all psychological factors are not significantly associated with WRMDs, except for the association between personal risk factors and hip/thigh disorders. Subsequently, WRMDs do not significantly contribute to explaining absenteeism. The managerial and research implications of this study are deliberately discussed.

A legacy of struggle: the OSHA ergonomics standard and beyond, Part I

In November 2000, the Occupational Safety and Health Administration (OSHA) issued an ergonomics standard to prevent debilitating work-related musculoskeletal disorders (WMSDs). It was rescinded by Congress within four months. We explore how this story unfolded over two decades of collaboration and conflict. Part I provides an overview of the historical context of the struggle for a standard, followed by interviews with key players from labor, academia and government. They provide a snapshot of the standard; discuss the prevalence of WMSDs in the context of changing work organization; give insight into the role of unions and of scientific debate within the context of rulemaking; and uncover the basis for the groundbreaking OSHA citations that laid the foundation for a standard. Part II interviews further explore the anti-regulatory political landscape of the 1990s that led to repeal of the standard, discuss the impact of the struggle beyond the standard, and describe creative approaches for the future.

Underreporting of musculoskeletal disorders in 10 regions in France in 2009

BACKGROUND

Underreporting of occupational diseases (OD) has been quantified, in particular in the United States, but little information is available in other countries. The aim of this study was to evaluate underreporting of musculoskeletal disorders (MSD) in France in 2009.

METHODS

We calculated an indicator that approximated the underreporting rate of MSD in 10 regions of France. Two databases were used: data on OD compensated by insurance funding and data from the surveillance program for uncompensated work-related diseases. Analyses were performed for carpal tunnel syndrome (CTS) and elbow, shoulder, and lumbar spine MSD.

RESULTS

The underreporting rate was estimated at 59% (range 52-64%) for CTS, 73% (range 67-79%) for elbow MSD, 69% (range 63-74%) for shoulder MSD, and 63% (range 50-76%) for lumbar spine MSD.

CONCLUSIONS

This study revealed that MSD are substantially underreported in France, as in the United States, despite the differences in workers' compensation systems.

Evidence-informed physical therapy management of performance-related musculoskeletal disorders in musicians

Playing a musical instrument at an elite level is a highly complex motor skill. The regular daily training loads resulting from practice, rehearsals and performances place great demands on the neuromusculoskeletal systems of the body. As a consequence, performance-related musculoskeletal disorders (PRMDs) are globally recognized as common phenomena amongst professional orchestral musicians. These disorders create a significant financial burden to individuals and orchestras as well as lead to serious consequences to the musicians’ performance and ultimately their career. Physical therapists are experts in treating musculoskeletal injuries and are ideally placed to apply their skills to manage PRMDs in this hyper-functioning population, but there is little available evidence to guide specific injury management approaches. An Australia-wide survey of professional orchestral musicians revealed that the musicians attributed excessively high or sudden increase in playing-load as major contributors to their PRMDs. Therefore, facilitating musicians to better manage these loads should be a cornerstone of physical therapy management. The Sound Practice orchestral musicians work health and safety project used formative and process evaluation approaches to develop evidence-informed and clinically applicable physical therapy interventions, ultimately resulting in favorable outcomes. After these methodologies were employed, the intervention studies were conducted with a national cohort of professional musicians including: health education, onsite injury management, cross-training exercise regimes, performance postural analysis, and music performance biomechanics feedback. The outcomes of all these interventions will be discussed alongside a focussed review on the existing literature of these management strategies. Finally, a framework for best-practice physical therapy management of PRMDs in musicians will be provided.

Bone loss from high repetitive high force loading is prevented by ibuprofen treatment

We examined roles of loading and inflammation on forearm bones in a rat model of upper extremity overuse. Trabecular structure in distal radius and ulna was examined in three groups of young adult rats: 1) 5% food-restricted that underwent an initial training period of 10 min/day for 5 weeks to learn the repetitive task (TRHF); 2) rats that underwent the same training before performing a high repetition high force task, 2 hours/day for 12 weeks (HRHF); and 3) food-restricted only (FRC). Subsets were treated with oral ibuprofen (IBU). TRHF rats had increased trabecular bone volume and numbers, osteoblasts, and serum osteocalcin, indicative of bone adaptation. HRHF rats had constant muscle pulling forces, showed limited signs of bone adaptation, but many signs of bone resorption, including decreased trabecular bone volume and bone mineral density, increased osteoclasts and bone inflammatory cytokines, and reduced median nerve conduction velocity (15%). HRHF+IBU rats showed no trabecular resorptive changes, no increased osteoclasts or bone inflammatory cytokines, no nerve inflammation, preserved nerve conduction, and increased muscle voluntary pulling forces. Ibuprofen treatment preserved trabecular bone quality by reducing osteoclasts and bone inflammatory cytokines, and improving muscle pulling forces on bones as a result of reduced nerve inflammation.