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Stress and work-related hand and arm injuries - implications for prevention and management

At a glance:
Stress and work-related hand and arm injuries are common problems in the workplace. They are related issues: stress contributes to causing injury and also affects the patient's recovery and experience of symptoms. Injuries, in turn, are a significant cause of stress.

There are many personal and workplace factors that contribute to both stress and injury. Because they are interrelated, it might be possible to tackle both issues by combining changes in the workplace with individual approaches to stress-management.
Perspectives:
Employee
Arm pain is a relatively common problem in the community. Up to 20% of people report non-specific arm pain at some point in their lives.

This study investigated how stress can contribute to sore arms. Stress may be personal, or it may relate to the workplace. If you think that stress is contributing to your arm condition, talk to your treating practitioner
treating practitioner
A health professional that treats patients. In return to work this may include doctors, physiotherapists, chiropractors, osteopaths, psychologists, masseurs, etc.
 about what can be done to reduce stress.

This study suggests that stress can be managed by learning about how it is caused and different ways you can reduce it. This includes working out how to resolve any particular issues that may be contributing to your level of stress. Physical exercise, learning coping skills and specific relaxation techniques can also help to reduce stress.
Employer
Managing arm pain is a challenging problem for many employers. Health practitioners try to help by providing treatment.

The study indicates that abnormal stress issues can contribute to arm pain and managing stress can help to improve symptoms. Stress management can include individual approaches, such as learning about stress and how to cope with it.

Workplace management of stress can also make a significant difference. This may include helping the individual to receive treatment, and discussing any workplace issues that may be causing stress. Lack of job control can cause considerable stress. Increasing an employee's sense of control over their job tasks can help alleviate arm problems. Addressing any problematic interpersonal issues can also reduce stress.
Treater
Arm pain often results from a combination of factors. Several studies have suggested that ergonomics
ergonomic
Designing activities and the workplace in a way to minimize discomfort. i.e. Adapting work tasks, hours, or workstation to accommodate people. An ergonomic computer workstation allows the person to work in the best position to relieve load on the muscles of the neck and arms.
 and manual activity contribute to the problem. Other studies have indicated that workplace tension or stress contribute to the problem. Encourage the employers of arm-pain patients to increase job control, address any work-flow issues and resolve negative interpersonal relations in the workplace.

Restricting a person's activities can assist in the short term, but it can also increase their level of stress if they then feel they are unproductive and not contributing in the workplace. There should be a balance between restricting activities and keeping a person at work in a productive and positive role. Don't be too restrictive in work duties when an individual has arm pain, as limiting activity can worsen outcomes in the long term.

Stress management strategies can be of benefit to some people with arm pain.
Insurer
In cases of non-specific upper limb
upper limb
arm
 pain, review workplace ergonomics and work-flow and discuss other factors that may be contributing to tension or stress. Stress is sometimes caused when an individual feels they aren't able to keep up with the workload. There may be other interpersonal issues in the workplace that contribute to tension and pain. Effective longer term management of these issues will reduce work disability
disability
A condition or function that leaves a person unable to do tasks that most other people can do.
 and improve return to work outcomes.

Professional help through the treating practitioner, or a rehabilitation
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.
 provider may be required for more complex cases.
Original Article, Authors & Publication Details:
G. Pransky1,2, M. M. Robertson1 and S. D. Moon3 (2002).

Stress and work-related upper extremity
extremity
arm (upper extremity) or leg (lower extremity)
 disorders: implications for prevention and management.
American Journal of Industrial Medicine; 41(5):443-455.

1Liberty Mutual Research Center, Hopkinton, Massachusetts
2Department of Family Medicine and Community Health, University of Massachusetts Medical School, Hopkinton, Massachusetts
3Division of Occupational and Environmental Medicine, Department of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina
Background, Study Objectives, How It Was Done:
Stress and physical discomfort are related. Stress can increase the risk of injuries in a number of ways, such as causing decreased attention, slower responses, changes in movement and increased muscle tension. Stress also influences symptoms and recovery after an injury.

This article reviews previous studies to establish the role of stress-management in preventing and managing upper limb conditions.
Study Findings:
Managing stress and preventing injuries in the workplace

Previous studies have focused on decreasing work-related hand and arm injuries through education and changes to the layout, equipment, procedures and policies in the workplace. These kinds of interventions
intervention
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.
 have also been successful in reducing stress. Several studies have found that improvements in technology, flexibility in the workplace, supervisor training and rest breaks decreased complaints about both workplace stresses and musculoskeletal
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.
 problems.

Some studies suggest that the management of stress and injuries requires a broad, company-wide approach. Job tasks, work organisation, supervision and workplace policies and procedures all need to be considered. This tends to be more successful when employees themselves are involved in planning and implementing interventions. Workers who are involved are more likely to recognise risks, participate in collecting information and find solutions to problems.

Educating workers and increasing flexibility at work decreases both stress and the symptoms of hand and arm injuries. Overall, however, there is conflicting evidence about the effectiveness of workplace interventions for reducing stress. Some researchers believe individual approaches to stress-management may be more effective.

Individual approaches to managing stress and preventing injuries

Individual approaches to managing stress have been found to improve self-reported stress levels, physical and psychological
psychological
Refers to a person's perceptions, thought processes, emotions, personality and behaviour. Psychologists can treat mental health problems.
 issues and musculoskeletal pain.

This approach usually involves education about the causes, symptoms and consequences of stress, along with training in how to change work-habits and control stress responses. Specific strategies include:
improving coping skills
relaxation
meditation
individual counselling
exercise
improving resilience
 cognitive
cognitive
relating to the mental processes of perception, memory, judgment, and reasoning
 retraining (identifying and changing negative thoughts)
 biofeedback
biofeedback
The technique of using monitoring devices to get information about a reflexive bodily function, such as heart rate or blood pressure, in an attempt to gain some voluntary control over it.
 techniques (becoming more aware of the body's responses to stress)
A recent meta-analysis
meta-analysis
A complex statistical analysis that combines the results of a number of studies on the same subject.
 of previous studies found that cognitive-behavioural treatments were the most effective way to improve self-reported symptoms. Cases where psychological distress
distress
Severe suffering, pain, anxiety or sorrow
 causes physical symptoms were the exception to this finding; relaxation training was the best approach in this situation. This review also found that short, focused programs were more effective than long-term programs.

Although individually-focused stress-management programs can have positive short-term results, if the causes of stress in the workplace have not changed, they might not be effective in the long run. This is especially the case if there are staffing changes and a lack of consistent support at work. Programs that focus on employee support or job content seem to be more effective in white-collar professions than in blue-collar professions.

One recent study evaluated a stress-management program that involved physical exercise, practical workplace changes and a resources hotline for workers. The combination of individual and workplace strategies was effective, and significantly reduced hand and arm injuries and sickness absence.

Individuals react to stress in different ways. Furthermore, both personal situations and work-related factors influence stress, health and work absence. Effective stress-management programs recognise these different factors.

Individuals also react differently to work demands. Research shows that people adopt certain coping strategies soon after beginning a new job, making this an important time to offer stress-management programs.

There is no convincing evidence to support identifying or screening individuals at “higher risk' of hand and arm injuries due to stress.

Workplace strategies for managing stress after injuries have occurred

Previous research suggests that many people do not report work-related hand and arm injuries until they have become so severe that they interfere with work.

Once a worker has been diagnosed with a work-related hand or arm injury, stronger attention to stress-management might be necessary. Abnormal stress responses are also linked to a variety of physical and psychological conditions, including abnormal experiences of pain. Counselling, relaxation, exercise programs and psychological interventions such as cognitive behavioural therapy
Cognitive Behavioural Therapy
a therapy used to modify behaviour by changing a person's assumptions, beliefs and approach to a problem
 are effective ways to reduce stress and improve a variety of medical conditions.

In chronic
chronic
continuing a long time or recurring frequently
 injuries, stress often causes insomnia, anxiety and tremor. One study found that cognitive behaviour therapy (which decreases negative thoughts and their effect on behaviour) decreased the psychological distress of these patients but did not affect their symptoms. Several studies used a combined approach of stress-reduction and cognitive behaviour therapy for patients with chronic disability due to work-related hand and upper limb injuries. This approach effectively improved symptoms and promoted a return to work.

Doctors treating musculoskeletal injuries do not often investigate the psychological factors that might influence the condition. Stress is complex and difficult to diagnose, and there is a lack of evidence regarding the connection between stress and work-related hand and arm injuries. Stress-related conditions may be treated with suspicion, especially when there is compensation involved. The authors of this paper suggested that workers, managers and health professionals should be educated about stress responses and informed that they are a normal reaction. This might increase acceptance of stress-management programs and other interventions.
Conclusions:
Stress and work-related hand and arm injuries are common problems in the workplace. They are related: stress contributes to the cause of injury and it affects the patient's recovery and experience of symptoms. Because they are related, it might be possible to tackle both of these issues by making changes in the workplace and offering individual programs for stress-management. This area requires more research.
References:
PubMed Abstract
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