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Work related injuries

Work Related Musculoskeletal Disorders (WRMSDs) or Repetitive Strain Injury (RSI)

Musculoskeletal Disorders (MSDs):

Musculoskeletal Disorders (MSDs) are injury or disorder of muscles, nerves, tendons, joints, cartilage, or spinal discs. They are not caused by slips, trips, falls, motor vehicle accidents, or other accidents. MSDs are considered work-related when the work activities and work conditions significantly contribute to their development or exacerbation but are not the sole determinant of causation (source: World Health Organization, 1985).


  • Prolonged repetitive, forceful or awkward hand movements
  • “Static loading” or holding a posture
  • Poor conditioning of the heart and lungs, and poor muscle endurance
  • Direct mechanical pressure on tissues
  • Cold work environment
  • Poorly fitting furniture
  • Basic inadequacies of workstation design
  • Work organizational and psychosocial issues


Early Warning Signs and Symptoms

  • Discomfort, fatigue or pain
  • Swelling, redness, coldness or warmth
  • “Catching” or “snapping” with movement
  • Loss of grip strength, heaviness or clumsiness of the hand
  • Stiffness
  • Burning, numbness, tingling
  • Visual strain
  • The injury accumulates slowly leading to difficulty in day-to-day activities such as shaking hands, opening doors, holding newspapers, using a comb, or even holding a teacup.

Classification of WRMSDs

WRMSDs are classified into two broad categories:

  • Specific
  • Non-Specific (Patient presents with pain, discomfort or functional impairment but no specific diagnosis or pathology can be ascertained)

High Risk Groups

  • Computer users
  • Checkout clerks
  • Musicians
  • Hair dressers
  • Health professionals: surgeons, dentists
  • Nurses
  • Butchers
  • Massage therapists
  • Sportspersons
  • Laboratory workers
  • Children
  • Teachers
  • Housewives
  • Manual labourers
  • Assembly line workers
  • Assistants
  • Drivers

Stages of WRMSDs

  • Severity Stage of RSI
  • Recovery period
  • Stage 1: Mild
  • 2 – 4 Weeks
  • Stage 2: Moderate
  • 1 – 3 Months
  • Stage 3: Severe
  • 3 – 6 Months
  • Stage 4: Complicated
  • 6 Months

Non-Specific WRMSDs

  • Myofascial pain syndrome (MPS)
  • Fibromyalgia syndrome (FMS)
  • Complex regional pain syndrome (CRPS)

Specific WRMSDs

  1. Tendon-related conditions
  2. Nerve-related conditions
  3. Circulatory/vascular conditions
  4. Joint-related conditions

Recent Advances in the Management of WRMSDs

It can be treated completely with a skilled hands-on manual therapy approach for release of muscle & fascia,along with joints, nerves and other soft tissue techniques. The effect of this technique is proved by researchers and the studies have been published in indexed journals. This treatment is given in four phases:

PHASE I (Severe Discomfort): Trigger Point Therapy (TPT) (Ischemic compression, PRT, INIT), Myofascial release (MFR), Relaxation & Breathing technique and Stretching exercises.

PHASE II (Moderate Discomfort): Soft- tissue (TPT & MFR), Nerves & Joints Mobilisation, Self- Stretching. (Mild Discomfort): Stretching exercises, Progressive Strengthening Exercises, Postural Retraining, Body Mechanics and Ergonomics Training

PHASE III: In this phase continue with self-stretching exercises, free exercises and begin progressive strengthening exercises followed by relaxation techniques

PHASE IV (Maintenance): Further Strength Training, Aerobic Conditioning and Yoga Therapy

The potential for a quick and complete recovery is enhanced if the patient seeks competent medical interventions like manual physical therapy with ergonomic workplace analysis at an early stage.

SHARAN’S Protocol for RSI

The trademarked Skilled Hands-on Approach for Release of Myofascia, Articular, Neural and Soft-tissue mobilization (SHARAN) rehabilitation protocol management is followed. There are four interlinked phases here.

Phase 1 – Severe discomfort in the initial stage: Management – Myotherapy soft tissue mobilisation, neural mobilisation, rib mobilisation, clavicular mobilisation, scapula thoracic mobilisation and physiotherapeutic modalities like IFT, US. These are followed by assisted stretches.

Phase 2 – Moderate discomfort in the upper limb and neck region: Management – It is a follow up to Phase 1 which includes more self-stretching exercises, a range of motion exercises and relaxation techniques like breathing exercises, Alexander techniques and yoga therapy.

Phase 3 – Mild discomfort: Management: In this phase, continue with self-stretching exercises, free exercises and begin progressive strengthening exercises followed by relaxation techniques.

Phase 4 – Maintenance phase: Management – This consists of postural maintenance, generalized whole body stretching and strengthening exercises in order to maintain the length and strength of muscle.

Adequate micro and macro breaks should be taken in between work: Do the stretches and strengthening exercise at least thrice a week. If there is any flare up of symptoms in phase 4, stop all the exercises and immediately consult a physiotherapist for further clarification.