Maintaining upper-extremity musculoskeletal health

We've all been there, feeling stiff or sore in our shoulders, neck or arms after a hard day at work. Whether you're working at a desk or laptop all day, stacking shelves, bending over a workbench or lifting and carrying goods, if you're not careful musculoskeletal problems in neck, arms, wrists, elbows or shoulders can all become a problem.

What's more, 'if you're not careful' in this context can sometimes even mean a risk of more severe, long-term and potentially disabling musculoskeletal conditions occurring over the years. These can include carpal tunnel syndrome, repetitive strain injury, tendonitis or even hand-arm vibration ('vibration white finger' as it is also known) from the over-use of power tools.

According to the Health and Safety Executive (HSE), in 2020/21 there were an estimated 470,000 workers affected by work-related musculoskeletal disorders. Most (45%) of these were affecting the upper limb or neck, with the back making up 39% and the lower limbs the remaining 16% of cases.

On top of this, at least three million working days are lost to work-related upper limb disorders a year, with women above the age of 45 at higher risk, the HSE has said.

It has also been estimated that one in four of us will get a 'non-specific' upper limb disorder or arm pain, one in 20 adults will get carpal tunnel syndrome, one in 100 men and one in 50 women tenosynovitis (a tendonitis-like inflammation of the finger sheaf), and one in 75 men and one in 90 women 'tennis elbow', or pain in the elbow.

Furthermore, if you drive there can always be the risk of whiplash neck injuries from an accident or shunt, which may take some time to recover from.

As HSE points out, employers have a duty to protect their employees from the risks of developing upper limb disorders caused by work. These disorders can be caused or made worse by repetitive work, for example on assembly lines, in construction, meat or poultry processing and in work with computers.

Other risk factors can include working in an uncomfortable or awkward position, needing to use sustained or excessive force to do a task, carrying out a task for a long time without suitable rest breaks, a poor working environment, and poor work organisation (for example workload or long hours or demands)

Common symptoms or warning signs can include aches and pains, tenderness, weakness, tingling, numbness, cramp, burning, redness and swelling in your upper limbs, as well as potentially stiffness, pain or reduced movement.

The HSE advises that employers should be carrying out risk assessments, building in breaks to protect from repetitive work and ensuring workstations (especially those with computers or display screen equipment) are appropriate.

Business in the Community also has a good general musculoskeletal health toolkit for employers here.

There is a lot everyone can be doing themselves to look after their musculoskeletal health in these parts of the body.

As this physiotherapy guide from North East London NHS Foundation Trust makes clear, for many upper-extremity musculoskeletal disorders, such as 'frozen' shoulder or general shoulder pain, a combination of painkillers, heat or ice, rest and then gentle exercise to restore or regain mobility can all help.

For tennis elbow, it is a combination of stopping the activity causing the problem, stretching exercises, pain relief and physiotherapy.

For general neck pain or stiffness, the NHS advises taking paracetamol or ibuprofen, general rest using a low, firm pillow, and putting heat or cold packs on your neck. Sitting upright and from time to time rolling your shoulders back gently and bringing your neck back can help, as can making sure you are not keeping your neck in the same position for a long time, for example when sitting at a desk.

It's much the same sort of advice for general wrist pain. Here, the NHS advises rest, an ice pack, paracetamol, stopping activities that are causing the pain (for example typing or using a hand or vibrating tool), wearing a support splint and potentially using a soft pad to support your wrists while typing.

For general elbow and arm pain, again, it's a case of taking down any swelling with a cold compact (perhaps a bag of frozen peas wrapped in a tea towel), painkillers, and raising your arm if it's swollen.

Keeping fit, exercising and ensuring your joints are mobilised are also all going to help, both in terms of strengthening your musculoskeletal system and for improving general health and wellbeing. The key, however of course, is not to overdo it - if you get injured or something is hurting, stop!

What about during the working day? Here, it may be a question of ensuring your workplace is not becoming too sedentary, and that, for example, you are getting up and taking regular breaks.

It can mean regularly stretching or mobilising your neck and shoulders, often with gentle rotation or (for the neck) side to side movements. Be careful, however, especially with the neck and, if in doubt, take advice.

It can mean getting out and active at lunchtimes or building in a more active commute. It can mean making a new year's resolution (even now!) to become more active outside of work.

If you are already in a manual role, it may mean being sensible and managing what you are doing, including repetitive movements or activities that put your upper extremities under pressure.

Employers, too, can help through healthcare provisions. Access to face-to-face or virtual physiotherapy, for example, can be useful, as can offering access to occupational health.

Encouraging workplace yoga or Pilates (again, whether virtual or physical) may also be a good idea and one valued by employees, especially if you have an older workforce.

Finally, don't forget the mental health side of all this. Pain, especially long-term or chronic pain, can have an understandable effect on mood and wellbeing.

Debilitating chronic conditions such as hand-arm vibration or carpal tunnel syndrome are going to bring with them mental as well as physical concerns, including worries about being able to continue in work and what it all means for the future.

To that end, accessing mental health as well as physical health support, whether that be via an employee assistance programme / health and wellbeing helpline or other psychological counselling or cognitive behavioural therapy support, is important.

However, if things get too much, whether physically or mentally, don't just suffer in silence - your employer, alongside the NHS, can often help.

Nic Paton is one of the country's foremost journalists on workplace health, safety and wellbeing, and is editor of Occupational Health & Wellbeing magazine. He also regularly writes on the health and employee benefits and health insurance markets.