Stress and Musculoskeletal Disorders: The Psychological Side of MSK
Stress, isolation, and disconnection—three things that the last year has made all too familiar. People have spent the last year watching death counts and unemployment numbers climb, moved from offices and meetings to Zoom calls, and replaced office chairs with kitchen chairs. This, unfortunately, has taken a toll on both the mind and body of your staff.
Stress and Musculoskeletal Issues: Silent, Costly, and High-Risk
Much like a work-related musculoskeletal disorder, stress on the job is one of those things that might not be visible to the naked eye.
Also like an MSK disorder, stress can cripple productivity through absenteeism and presenteeism while exposing workers to increased likelihood of injury through other vectors.
Just as a worker suffering leg pain might compensate for the pain with dangerous technique, a stressed worker may take unsafe steps on the job to meet demands, creating new risks to his or her health.
Unfortunately, the combined impact of two conditions, like a musculoskeletal injury and added emotional stress, can have multiplicative effects. An injured and stressed worker is going to be less productive, cause damage by taking shortcuts, and will spend a greater number of days off work. From a provider perspective, treating a two-pronged battle of musculoskeletal disorder and stress, anxiety or depression is more much complex.
The Link between Mind and Body
Whether it's contributing to an MSK disorder, exacerbating a problem, or creating a challenge in treatment, the mind has a huge impact on the rest of the body, and numerous studies are finding that stress reduction and mental health initiatives can go a long way in reducing risk.
Our minds are tightly linked with our bodies. Going well beyond the simple mechanism in which the brain sends orders to the rest of the body to act, poor mental health can put workers into fight or flight mode, create positive feedback loops that create more stress, and create a variety of other physiological responses to deal with additional stress.
Like depression, stress can cause employees to lose sleep, find themselves isolated and hopeless, and medicate or self medicate. This unfortunately can result in a variety of other issues ranging from lowered sex drive and unhealthy eating habits to chronic back pain.
Before understanding how stress impacts a worker's risk of injury and could even extend the recovery time for MSK treatment, we first must understand the link between psychosocial, psychological, and physiological factors.
According to the Indian Journal of Endocrinology and Metabolism, 'Stress' may be defined as any situation which tends to disturb the equilibrium between a living organism and its environment. In day-to-day life there are many stressful situations such as stress of work pressure, examinations, psychosocial stress and physical stresses due to trauma, surgery and various medical disorders.
Today, people are exposed to more stressful situations than ever. Unfortunately, this leaves us in a constant state of fight or flight mode. With no recourse, the extended state of battle readiness has long-term impacts on our health.
The Stress Response
To understand how stress affects our brains and bodies, we first need to understand how stress works. Think back to the cavemen days. You and your tribe just spotted a wooly mammoth and Problem is? Wooly mammoths are dangerous. Enter the stress response.
Understanding the danger that prehistoric pachyderm presents, your brain tells your body to start working harder. Ranabir and Reetu note that "Reactions to stress are associated with enhanced secretion of a number of hormones including glucocorticoids, catecholamines, growth hormone and prolactin, the effect of which is to increase mobilization of energy sources and adapt the individual to its new circumstance."
Increased heart rate, decreased sensitivity to pain, and reallocation of blood flow from non-essential systems to skeletal muscles are some of the responses as the brain puts your body into fight or flight mode.
Once the danger was removed, blood flow returned to normal in the non-essential systems like digestive, immune, and reproductive system.
Positive and Negative Stress Response
In theory, when the challenge has been resolved, the stress response in the body shuts down. But what happens if the threat didn't go away?
Rather than providing the short-term energy people need to push through a temporary stressor, the brain sees that the initial release of energy didn't do enough to overcome the stimuli.
According to the Canadian Centre for Occupational Safety and Health, workplace stress can create two responses in the body—positive and negative:
Positive Stress Response: A positive stress response is one that is associated with stressors that are surmountable or achievable. They are challenges that we believe we can accomplish and with that comes a general sense of engagement, determination, and interest.
Negative Stress Response: Negative stress responses are associated with challenges that we believe we cannot accomplish. They are associated with feelings such as uncertainty, disinterest, boredom, and anxiety. When discussing the workplace, these negative stresses are linked to the psychosocial factors mentioned above: lack of job control, excessive job demands, low job satisfaction, and lack of social support.
Some stress—especially stress considered achievable—is a good thing. A short-term burst of energy to complete a daily push or beat a deadline can bring out the best in a person. But when the stress becomes insurmountable, the constant release of short-term stress hormones can have a significant impact on the body.
How Stress Increases Risk for Developing Musculoskeletal Disorders
As mentioned earlier, the stress response was great for providing immediate energy for imminent threats. But when assigned to a repetitive task or one in which increased response is unnecessary, the stress response could prove problematic.
The Stress Response and Its Impact on Day-to-Day Tasks
Increased blood pressure, decreased sensitivity to pain, and higher muscle tension are great for taking down a mammoth—but not so much for white- or blue-collar workers. What are some of the ways that a stress response could make for increased risk?
Increased Blood and Fluid Pressure: Aside from the natural risk that comes from constantly elevated blood pressure, the increases could also lead to increased pressure in joints, tendons, ligaments, and nerves.
Reduced Growth and Recovery: When the body is in fight or flight mode, collagen production is reduced. Essential for growth and recovery, this is supposed to return to normal after the stressor is overcome. No reduction in stress, no pivot back to recovery.
Decreased Sensitivity to Pain and Increased Muscle Tension: Possibly the easiest to link to musculoskeletal disorders, the stress response could result in a worker using excessive force during certain activities or movements. With decreased pain sensitivity in response to stress, a worker then fails to register the impact this is having on the body.
Stress and Behavioral Responses
In addition to the physiological response, stress may have an impact on the worker's behaviors. CCOHS notes that this can create even more problems.
"[Behavioral] responses to psychosocial factors are responses taken by a person that they are unaware of, or that they perceive may help them cope with the stresses placed upon them. Unfortunately, in many cases these responses can actually increase their risk of developing MSDs because it causes them to increase their physical and psychological exposure to some MSD risk factors."
Citing a few examples—reacting to pain by altering posture, self-medication, ignoring break and rest time, and working faster or harder—CCOHS highlights the impacts these may have. Changed posture exposes workers to new risks, self-medication could have direct impact on productivity and have side effects, skipped breaks result in reduced recovery, and faster pace provides increased strain; all of this leads to increased risk of injury.
A Bigger Picture: Workplace Health Needs a Holistic Approach
Mental health and ergonomics initiatives each play a significant role in helping workers minimize risk, increase productivity, and stay healthy. Stress can cause a lot of damage—and the risk it presents can have a lasting impact not only on your ability to protect workers, but to get them back to work quickly in the event that they are injured.
As a complete provider of digital health solutions focused on delivering positive outcomes across the spectrum of pain and injury prevention, conservative care, and surgery optimization, we understand that prevention is not only the safest, but also the most cost-effective option.
For years, PeerWell has helped a rapidly growing number of people to recover faster, provided employers and payers with solutions designed to reduce risk and cost, and delivered better outcomes for providers and hospital systems. Our holistic, evidence-based programs meet patients where they are and deliver across the full continuum of care including acute and chronic pain, conservative care, surgery optimization (PreHab) and recovery (PreHab).
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