Weak Grip Strength Does not Predict Upper Extremity Musculoskeletal Symptoms or Injuries Among New Workers

Purpose Grip strength is often tested during post-offer pre-placement screening for workers in hand-intensive jobs.

The authors' purpose of this study was to evaluate the association between grip strength and upper extremity symptoms, work disability, and upper extremity musculoskeletal disorders (UE MSDs) in a group of workers newly employed in both high and low hand intensive work.

1,107 recently-hired workers completed physical examinations including grip strength measurements. Repeated surveys obtained over 3 years described the presence of upper extremity symptoms, report of physician-diagnosed musculoskeletal disorders (MSDs), and job titles. Baseline measured grip values were used in analytic models as continuous and categorized values to predict upper extremity symptoms, work disability, or UE MSD diagnosis.

Results Twenty-six percent of males and 20 % of females had low baseline hand strength compared to normative data. Multivariate logistic regression analyses showed no consistent associations between grip strength and three health outcomes (UE symptoms, work disability, and MSDs) in this young cohort (mean age 30 years). Past MSD and work type were significant predictors of these outcomes.

Conclusions Physical hand strength testing was not useful for identifying workers at risk for developing UE MSDs, and may be an inappropriate measure for post-offer job screens.

Dale AM, Addison L, Lester J, Kaskutas V, Evanoff B. Weak Grip Strength Does not Predict Upper Extremity Musculoskeletal Symptoms or Injuries Among New Workers. J Occup Rehabil 2014 06;24(2):325-31. 

Somatic dysfunction and fascia’s gliding potential

Somatic dysfunction is defined as “impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic, and neural elements.” (Ward, 2003).

The osteopathic model of somatic dysfunction, that attempts to make sense of such a finding, has been summarized by the acronym STAR (Dowling, 1998).

This includes:
“S” =  sensitivity (abnormal tenderness)
“T” =  tissue texture change such as altered tone, laxity etc.
“A” =  asymmetry (malalignment)
“R” =  range of motion and pliability reduction (e.g. contracture)

The STAR designation offers no diagnosis - only an observation that all may not be well in the tissues being evaluated, demanding further investigation as to causal, aggravating and maintaining features  whether local, global or distant.

Sliding, gliding functions as part of the “R” feature of somatic function and dysfunction!

Chaitow L. Somatic dysfunction and fascia's gliding-potential. J Bodywork Movement Ther 2014 01;18(1):1-3.

Effect of therapeutic infra-red in patients with non-specific low back pain

The authors objective with this study was to investigate the effect of superficial heat by infra-red (IR) in patients with chronic non-specific low back pain (NSLBP).

Ten patients with NSLBP (5 men and 5 women) and disease duration of 21.7 11.50 months participated in this pilot study. Patients had a mean age of 36.40 10.11 years (range Z 25e55). Patients were treated with infra-red (IR) for 10 sessions, each for 15 min, 3 days per week, for a period of 4 weeks.

Outcome measures were the Numerical Rating Scale (NRS), the Functional Rating Index (FRI), the Modified eModified Schober Test (MMST), and the Biering-Sorensen test to assess pain severity, disability, lumbar flexion and extension range of motion (ROM), and back extensor endurance, respectively.

Data were collected at: baseline - study entry (T0); end of 5th treatment session after 2 weeks (T1); and end of the treatment after 4 weeks (T2). The results of the ANOVA demonstrated a statistically significant main effect of IR on all outcomes of pain, function, lumbar flexion-extension ROM, and back extensor endurance.

The treatment effect sizes ranged from large to small. IR was effective in improving pain, function, lumbar ROM, and back extensor endurance in a sample of patients with NSLBP. Treatment effect sizes ranged from large to small indicating clinically relevant improvements primarily in pain and function for patients with NSLBP.

Ansari NN, Naghdi S, Naseri N, Entezary E, Irani S, Jalaie S, et al. Effect of therapeutic infra-red in patients with non-specific low back pain: a pilot study. J Bodywork Movement Ther 2014 01;18(1):75-81. 

Including a range of outcome targets offers a broader view of fibromyalgia treatment outcome: results from a retrospective review of multidisciplinary treatment.

Fibromyalgia is associated with substantial functional disability. Current drug and non-drug treatments result in statistically significant but numerically small improvements in typical numeric measures of pain severity and fibromyalgia impact.

The authors aim with this study was to evaluate additional measures of pain severity and functional outcome that might be affected by fibromyalgia treatment. This retrospective review evaluated outcomes from 274 adults with fibromyalgia who participated in a six-week, multidisciplinary treatment programme.

Pain and function were evaluated on the first and final treatment visit. Pain was evaluated using an 11-point numerical scale to determine clinically meaningful pain reduction (decrease ≥ 2 points) and from a pain drawing. Function was evaluated by measuring active range of motion (ROM), walking distance and speed, upper extremity exercise repetitions, and self-reports of daily activities.
Numerical rating scores for pain decreased by 10-13% (p < 0.01) and Fibromyalgia Impact Questionnaire (FIQ) scores decreased by 20% (p < 0.001). More substantial improvements were noted when using alternative measures. Clinically meaningful pain relief was achieved by 37% of patients, and the body area affected by pain decreased by 31%. ROM showed significant improvements in straight leg raise and cervical motion, without improvements in lumbar ROM. Daily walking distance increased fourfold and arm exercise repetitions doubled. Despite modest albeit statistically significant improvements in standard measures of pain severity and the FIQ, more substantial pain improvement was noted when utilizing alternative measures of pain and functional improvement.

Alternative symptom assessment measures might be important outcome measures to include in drug and non-drug studies to better understand fibromyalgia treatment effectiveness.

Marcus DA, Bernstein CD, Haq A, Breuer P. Including a range of outcome targets offers a broader view of fibromyalgia treatment outcome: results from a retrospective review of multidisciplinary treatment. Musculoskeletal care 2014 06;12(2):74-81. 

The Impact of Persistent Pain on Working Memory and Learning

The authors by this study reviewed the evidence that persistent pain has the capacity to interrupt and consume working memory resources.

It was argued that individuals with persistent pain essentially operate within a compromised neurocognitive paradigm of limited working memory resources that impairs task performance.

Using cognitive load theory as a theoretical framework, the study investigated if multimedia materials could be used to support individuals with persistent pain. A 2×2 design was used where the first factor was the pain status of the participant (absence vs. presence for more than 6 months), and the second was instructional strategy (written + illustrations vs. written). Fifty-eight full-time teachers from two schools in New South Wales (Australia) were randomly assigned to an instructional strategy to learn about lightning formation.

Participants that identified as experiencing pain for 6 or more months demonstrated clinically low levels of pain, but nevertheless performed significantly worse than pain-free participants on retention and transfer tests. For both pain and pain-free participants, there was a significant benefit in learning from multimedia instruction compared to a written text only strategy.

Smith A, Ayres P. The Impact of Persistent Pain on Working Memory and Learning. Educational Psychology Review 2014 06;26(2):245-264. 

Short- and long-term changes in perceived work ability after interdisciplinary rehabilitation of chronic musculoskeletal disorders.

The authors objective with this study was to  investigate the changes in rehabilitants' perceived work ability after rehabilitation for chronic musculoskeletal disorders with respect to the baseline characteristics.

The study design followed it prospective cohort study based on register and repeated survey data.  Public sector employees in ten towns and five hospital districts were taken in the study.  A total of 854 employees who participated in the rehabilitation programme owing to common chronic musculoskeletal disorders between 1997 and 2009.

Interdisciplinary, biopsychosocial, inpatient rehabilitation programme targeting people of working age with common chronic musculoskeletal disorders. The programme was executed in different rehabilitation centres across the country and funded by the Social Insurance Institution of Finland.

Differences in perceived work ability level before and after rehabilitation was taken. Data were derived from repeated surveys on average 2.1 years before rehabilitation, and 1.5 years (short-term follow-up) and 6.0 years (long-term follow-up) after rehabilitation.

RESULTS: Before the rehabilitation, perceived work ability was 7.13 (SD 1.84) among the rehabilitants and 7.27 (SD 1.72) in the matched reference population. Among rehabilitants, this figure decreased by 0.82 (95% confidence interval -0.98 to -0.67) in the short-term and by 1.26 (95% confidence interval -1.45 to -1.07) in the long-term follow-up. Only slight differences in steepness of this deterioration were observed between subgroups, created based on the participants' baseline characteristics.

Perceived work ability of participants, in an interdisciplinary biopsychosocial rehabilitation programme for common musculoskeletal disorders, deteriorated regardless of any studied pretreatment characteristics. The improvement of work ability may be an unrealistic goal for participants in this type of rehabilitation.

Saltychev M, Laimi K, Pentti J, Kivimäki M, Vahtera J. Short- and long-term changes in perceived work ability after interdisciplinary rehabilitation of chronic musculoskeletal disorders: prospective cohort study among 854 rehabilitants. Clin Rehabil 2014 06;28(6):592-603. 

Impact of the fibromyalgia in the chronic fatigue syndrome

Different studies have showed association of the chronic fatigue syndrome (CFS) with other pathologies, including fibromyalgia (FM).

The author's objective with this study was to analyze whether there are differences in the clinic and in the assessment of fatigue in CFS patients associated or not with FM. A cross-sectional, single-site observational study was undertaken on a consecutive cases of a register of CFS patients at CFS Unit in Vall d'Hebron Hospital, Barcelona, from January 2008 until March 2011. The variables analyzed were FM comorbidity, sleep and fatigue characteristics and cognitive, neurological and autonomic symptoms. Questionnaires of fatigue impact scale, fatigue strength and impact on quality of life SF-36 were evaluated. We included 980 CFS patients (mean age: 48±9 years; 91% women).

Fibromyalgia was present in 528 patients (54%). The level of fatigue (P=.001) and pain (P<.001) was higher in FM patients. Patients with CFS and FM had more prevalence of sleep-related phenomena. The percentage of patients and the degree of severity of cognitive symptoms, neurological and autonomic dysfunction was higher in FM patients (P<.001). FM patients scored higher on the fatigue impact scale (P<.001) and showed worse results in the quality of life questionnaire (P<.001). FM co-morbidity worse clinical parameters, fatigue and the perception of quality of life in CFS patients.

Faro M, Sáez-Francàs N, Castro-Marrero J, Aliste L, Collado A, Alegre J. Impact of the fibromyalgia in the chronic fatigue syndrome]. Medicina clínica 2014 Jun 16;142(12):519-525. 

The effects of an 8-week, physiotherapy-led, structured group intervention during the early survivorship phase.

Health and Medicine; Findings from University of Dublin Trinity College Broaden Understanding of Physical Therapy and Rehabilitation Med

According to news reporting out of Dublin, Ireland, by NewsRx editors, research stated, "Strong evidence exists for rehabilitation programmes following a cancer diagnosis, although little is known about their cost. The effects of an 8-week, physiotherapy-led, structured group intervention during the early survivorship phase were evaluated."

Our news journalists obtained a quote from the research from the University of Dublin Trinity College, "Significant changes in quality of life and fatigue, and promising changes in fitness were found. The overall cost for this programme was is an element of 196 per participant, including the salaries of the clinicians, overheads and equipment costs."

According to the news editors, the research concluded: "The modest costs associated with this programme may support more routine 'cancer rehabilitation', although more robust analyses are required."

Health and Medicine; Findings from University of Dublin Trinity College Broaden Understanding of Physical Therapy and Rehabilitation Medicine. Obesity, Fitness & Wellness Week 2014 Jun 14:1390.

Therapies for ataxias.

Ataxia can originate from many genetic defects, but also from nongenetic causes. To be able to provide treatment, the first step is to establish the right diagnosis. Once the cause of the ataxia is defined, some specific treatments may be available.

Ataxia is a movement disorder resulting from the incoordination of movements and inadequate postural control, presented in balance and walking disturbances. It has three subcategories, which are sensory, cerebellar and vestibular ataxia. Some researchers regard frontal ataxia as the 4th category. Mixed ataxia involves symptoms of at least two basic types of ataxia together. Different clinical symptoms, interference of different neurological structures and different diseases play role in the formation of each ataxia type. Since ataxia is resistant to medical treatments, physical treatment applications are of major importance. Physical therapy applications involve proprioceptive training, balance exercises, stabilization techniques regarding the extremity ataxia and vestibular exercises for accomplishing functional improvement and restoration of the ataxic patient. Compensatory applications employ supportive devices.

For example, the nongenetic ataxias that arise from vitamin deficiencies can improve following treatment. In most cases, however, therapies do not cure the disease and are purely symptomatic.

Physiotherapy and occupational therapy are effective in all type of ataxias and often remain the most efficient treatment option for these patients to maximize their quality of life.

Martineau L, Noreau A, Dupré N. Therapies for ataxias. Current treatment options in neurology 2014 07;16(7):300. 

"Better for others than for me": A belief that should shape our efforts to promote participation in falls prevention strategies.

Falls are a common occurrence amongst older adults yet participation in prevention strategies is often poor. Although older adults may perceive a strategy works in general, they may not participate because they feel it will not benefit them personally.

The authors aimed to describe how frequently and why older adults identify falls prevention strategies as being "better for others than for me". A cross-sectional survey with n=394 community-dwelling older adults in Victoria, Australia was undertaken. Participants were provided with detailed descriptions of four evidence-based falls prevention strategies and for each were asked whether they felt that the strategy would be effective in preventing falls for people like them, and then whether they felt that the strategy would be effective for preventing falls for them personally. Follow-up questions asked why they thought the strategy would be more effective for people like them than for them personally where this was the case.

The authors found the "better for others than for me" perception was present for between 25% and 34% of the strategies investigated. Participants commonly said they felt this way because they did not think they were at risk of falls, and because they were doing other activities they thought would provide equivalent benefit.

Strategies to promote participation in evidence-based falls prevention strategies may need to convince older adults that they are at risk of falls and that what activities they are already doing may not provide adequate protection against falls in order to have greater effect.

Haines TP, Day L, Hill KD, Clemson L, Finch C. "Better for others than for me": A belief that should shape our efforts to promote participation in falls prevention strategies. Arch Gerontol Geriatr 2014;59(1):136-144. 

Influence of pressure-relief insoles developed for loaded gait (backpackers and obese people) on plantar pressure distribution and ground reaction forces.

Backpackers and obese subjects were benefited by using pressure relief insoles. One of the insoles better distributed the plantar pressures during the loaded gait. The vertical ground reaction force was decreased when one of the insoles was used. Different materials in the insoles influenced the plantar pressures and forces. Gait biomechanics is different among normal-weight, backpackers and obese subjects.

The authors aims with this study were to test the effects of two pressure relief insoles developed for backpackers and obese people on the ground reaction forces (GRF) and plantar pressure peaks during gait; and to compare the GRF and plantar pressures among normal-weight, backpackers, and obese participants.

Based on GRF, plantar pressures, and finite element analysis two insoles were manufactured: flat cork-based insole with (i) corkgel in the rearfoot and forefoot (SLS1) and with (ii) poron foam in the great toe and lateral forefoot (SLS2). Gait data were recorded from 21 normal-weight/backpackers and 10 obese participants. The SLS1 did not influence the GRF, but it relieved the pressure peaks for both backpackers and obese participants. In SLS2 the load acceptance GRF peak was lower; however, it did not reduce the plantar pressure peaks. The GRF and plantar pressure gait pattern were different among the normal-weight, backpackers and obese participants.

Peduzzi dC, Abreu S, Pinto V, Santos R, Machado L, Vaz M, et al. Influence of pressure-relief insoles developed for loaded gait (backpackers and obese people) on plantar pressure distribution and ground reaction forces. Appl Ergon 2014 07;45(4):1028-1034. 

Comparison of subjective comfort ratings between anatomically shaped and cylindrical handles

Most authors have provided diameter recommendations for cylindrical handle design in order to increase performance, avoid discomfort, and reduce the risk of cumulative trauma disorders. None of the studies has investigated the importance of determining the correct handle shape on the subjective comfort ratings, which could further improve the handles' ergonomics. Therefore, new methods based on a virtual hand model in its optimal power grasp posture have been developed in order to obtain customized handles with best fits for targeted subjects.

Cylindrical and anatomically shaped handles were evaluated covering ten subjects by means of an extensive subjective comfort questionnaire. The results suggest large impact of the handle shape on the perceived subjective comfort ratings. Anatomically shaped handles were rated as being considerably more comfortable than cylindrical handles for almost all the subjective comfort predictors. They showed that handle shapes based on optimal power grasp postures can improve subjective comfort ratings, thus maximizing performance. Future research should consider real conditions, since the comfort ratings can vary based on the specific task and by the tool selected for the task.

Harih G, Dolsak B. Comparison of subjective comfort ratings between anatomically shaped and cylindrical handles. Appl Ergon 2014 07;45(4):943. 

Task-specific performance effects with different numeric keypad layouts

Two commonly used keypad arrangements are the telephone and calculator layouts. The author's purpose with this study was to determine if entering different types of numeric information was quicker and more accurate with the telephone or the calculator layout on a computer keyboard numeric keypad. Fifty-seven participants saw a 10-digit numeric stimulus to type with a computer number keypad as quickly and as accurately as possible. Stimuli were presented in either a numerical [1,234,567,890] or phone [(123) 456-7890] format.

The results indicated that participants' memory of the layout for the arrangement of keys on a telephone was significantly better than the layout of a calculator. In addition, the results showed that participants were more accurate when entering stimuli using the calculator keypad layout. Critically, participants' response times showed an interaction of stimulus format and keypad layout: participants were specifically slowed when entering numeric stimuli using a telephone keypad layout. Responses made using the middle row of keys were faster and more accurate than responses using the top and bottom row of keys. Implications for keypad design and cell phone usage are also discussed in this paper.

Armand, J. T., Redick, T. S., & Poulsen, J. R. (2014). Task-specific performance effects with different numeric keypad layouts. Applied Ergonomics, 45(4), 917. 

Learning three sets of alarms for the same medical functions: A perspective on the difficulty of learning alarms specified in an international standard.

Three sets of eight alarms supporting eight functions specified in an international medical equipment standard (IEC 60601-1-8) were tested for learnability using non-anaesthetist participants.
One set consisted of the tonal alarms specified in the standard. A second set consisted of a set of abstract alarms randomly selected from a database of abstract alarm sounds held by the authors. A third set of alarms was designed as indirect metaphors of the functions.

The authors in this study presented the participants with the alarms and then asked to identify them across ten blocks of eight trials.

The results indicated a significant difference in learnability across the three sets of alarms. The indirect metaphors were learned significantly better than both other sets of alarms, and the randomly selected abstract alarms were learned significantly better than the alarms specified in the standard. The results suggest therefore that there are more readily learnable possible designs than those proposed in the standard. The use of auditory icons in particular should be given serious consideration as potential alarms for this application.


Edworthy, J., Page, R., Hibbard, A., Kyle, S., Ratnage, P., & Claydon, S. (2014). Learning three sets of alarms for the same medical functions: A perspective on the difficulty of learning alarms specified in an international standard. Applied Ergonomics, 45(5), 1291-1296. 

An investigation of training strategies to improve alarm reactions.

Researchers have suggested that operator training may improve operator reactions; however, researchers have not documented this for alarm reactions.
The authors goal for this research was to train participants to react to alarms using sensor activity patterns.

In Experiment 1, 80 undergraduates monitored a simulated security screen while completing a primary word search task. They received spatial, temporal, single sensor, or no training to respond to alarms of differing reliability levels.

Analyses revealed more appropriate and quicker reactions when participants were trained and when the alarms were reliable.

In Experiment 2, 56 participants practiced time estimation by simple repetition, performance feedback, or performance feedback and temporal subdivision. They then reacted to alarms based on elapsed time between sensor activity and alarm onset.

Surprisingly, results indicated that participants did not benefit differentially from temporal interval training, focusing instead on advertised system reliability. Researchers should replicate these findings with realistic tasks and real-world complex task operators.


Bliss, J. P., & Chancey, E. T. (2014). An investigation of training strategies to improve alarm reactions. Applied Ergonomics, 45(5), 1278-1284. 

The effects of different types of cognitive tasks in conjunction with circadian regulation on heart rate variability and performance parameters.

Every day, humans are exposed to a variety of tasks in the workplace, at home or even in activities of daily living. These tasks all require, to some extent, cognitive processing and activity. In order to perform a task, information from the environment must be perceived, interpreted and an appropriate response elicited (Wickens et al., 1998). The information processing places a certain amount of strain or demand on the resources available to process it (Wickens, 1985; Wickens et al., 1998). Therefore, the extent of this strain needs to be measurable to ensure that cognitive overload and performance impairment does not occur.

This authors aimed with this study to determine to which extent heart rate variability (HRV) is sensitive to changes in different forms of cognitive workload. The second objective was to determine the effects of cognitive tasks on HRV during different times of the day, in conjunction with the variability of performance parameters.

Five tasks were utilized, each at two levels of difficulty in order to ascertain specific cognitive resources. These tasks included a reading task, a decision-making task, a memory task and two forms of modified Fitts tasks. Only one of the modified Fitts tasks, which isolated motor organisation and the spelling error parameter for the difficult reading task showed a time of day effect with respect to performance. With respect to HRV, time domain analysis (rMSSD) and the low frequency (LF) band of a frequency domain analysis showed an overall significant effect of difficulty over all five tasks. The LF band, the high frequency (HF) band, rMSSD and heart rate frequency were sensitive to changes in cognitive workload for the memory task. The LF band was also sensitive to changes in cognitive workload for the modified Fitts task, which isolated motor organisation. The LF-HF ratio was the only HRV parameter that was influenced by the time of day during cognitive task performance.

In conclusion, in some instances, HRV was sensitive to changes in cognitive workload for specific HRV parameters and tasks, with selected HRV variables also being affected by time of day. However, no straightforward assignment of workload to HRV parameters and vice versa can be made yet.

Huysamen, K. C., Göbel, M., & Davy, J. (2013). The effects of different types of cognitive tasks in conjunction with circadian regulation on heart rate variability and performance parameters. Ergonomics SA, 25(1), 52-67. 

Comparisons of Muscular Activity in Males and Females While Walking in Restricted Postures

Increasing numbers of females are entering industrial workplaces. In the mining industry in South Africa, for example, this is partly the result of employment equity laws, which have ruled that by 2009 at least 10% of the workforce must be female (Department of Minerals and Energy, 2004). Differences in factors such as anthropometry and strength are evident between males and females. Males are generally taller and heavier than females, and possess a higher percentage of muscle mass and a lower percentage of body fat compared to females (McArdle et al, 2001). Furthermore, males are seen to possess significantly greater absolute strength than females, while females maintain approximately 50% of the upper body strength of males and 70% of the lower body strength of males (McArdle et al, 2001). Gender is also a factor that influences movement patterns during walking and running, and intrinsic characteristics, including skeletal alignment, muscle strength and anthropometric differences, are likely to contribute to this (Chiu and Wang, 2007). As a result, it is expected that responses to manual tasks are likely to differ between males and females.

The purpose of the authors to do this study was to examine differences in muscular activation between males and females while walking in restricted postures. Restricted postures are evident in various industries, including mining, construction and agriculture. These postures are associated with musculoskeletal disorders and lower back pain. Studies generally focus on a male workforce; however, more females are entering industrial workplaces.

Twelve male and 12 female subjects between the ages of 18 and 25 years participated in the study. Subjects walked on a treadmill at a speed of 3.5 km/h for four minutes under conditions of upright walking, and stooped walking under restrictions at 85% and 70% of stature. Electromyographic activity was measured on seven muscles (trapezius, latissimus dorsi, erector Spinae, rectus femoris, biceps femoris, medial gastrocnemius and tibialus anterior). Ratings of Perceived Exertion (RPE) and Body Discomfort were also obtained. The extent of vertical restriction significantly altered levels of muscle activation. Female subjects had significantly lower levels of activation of the medial gastrocnemius than males. Local RPE was greatest under the lowest restriction, and body discomfort of the neck, lower back and hamstrings was evident during restricted walking. Work place design and interventions should consider these consequences.

Hodgskiss, J., & Zschernack, S. (2013). Comparisons of muscular activity in males and females while walking in restricted postures. Ergonomics SA, 25(1), 39-51. 

A study of ergonomic factors leading to computer vision syndrome among computer users

The invention of computers has transformed and modernized both the work place and the home environment (Blehm et al., 2005). It has been estimated that the number of computer users globally was 670 million in 2007, and rising to 1 billion in 2010 (Izquierdo et al., 2007). With the rate at which the google computing system has grown, the total number of computer users is currently likely to be much higher than 1 billion. According to the National Institute of Occupational Health and Safety (NIOHS), USA, any individual who works with a computer for more than three hours per day is likely to experience symptoms of CVS (Jaschinki-Kruza, 1991; Atenio, 1996). CVS is defined as a complex of eye and vision problems which are experienced during computer use or a task related to the use of a computer (Wimalasundera, 2006; Yan et al, 2008). The symptoms of CVS can be divided broadly into two categories; eye and vision-related symptoms (e.g. dry eyes, watery eyes, irritated and burning eyes, eye strain, eye fatigue, headache, blurred vision and double vision) and posture-related symptoms (e.g. neck, shoulder and back pain) (Verma, 2001, Blehm et al., 2005; Sheedy, 2000; Yan et al., 2008). Other reported symptoms include light and glare discomfort, after-image distortion and colour distortion (Verma, 2001; Sen and Richardson, 2007).

The authors aim of this study was to investigate the ergonomic factors that might lead to computer vision syndrome (CVS) among non-presbyopic computer users in a University staff population. A complete eye examination was performed on each participant before he or she was interviewed using a structured questionnaire probing into demographic status and factors that could lead to CVS.
Eighty seven participants were included in the study. An observation and measurement of the participant's computer workstation was then made in order to identify the risk factors leading to CVS. Data were analysed with descriptive statistics. 72% of participants reported taking breaks after 2 hours while 28% reported taking breaks after every hour of computer use. Eye strain and visual fatigue (89%), headaches (81%), neck and back pains (77%) were the most severe and frequently reported symptoms among the participants. In general, the computer workstations were not economically designed and users were not aware that they were not adhering to ergonomie requirements for computer use.

This suggests the need for awareness campaigns on ergonomic factors that can prevent computer vision syndrome among computer users and early intervention programs for computer users that experience computer vision syndrome.

Mashige, K. P., Rampersad, N., & Oduntan, O. A. (2013). A study of ergonomic factors leading to computer vision syndrome among computer users. Ergonomics SA, 25(1), 3-12.

The effects of posture and cognitive information processing from different sensory modalities on perceived musculoskeletal discomfort and work performance

It appears evident within the literature that many individuals are subjected to a double burden of both physical and mental demands at work (Garson, 2009; Szeto, 2009). Physical work exposures often include having to maintain awkward, static postures for sustained periods of time, which ultimately result in the onset of local muscle fatigue and accompanied symptoms of discomfort (Armstrong et al., 1993). It is suggested that symptoms of discomfort trigger the motivation to recover vital resources, depleted during work, through down-regulation or complete rest (Brandäo and Graeff, 2006).

Various authors, however, have reported that the distraction, offered by concurrent cognitive engagement causes perceptions of discomfort to be over-ridden (or attenuated) (Bushnell et al., 1985; Miron et al., 1989; Hodes et al., 1996; Bushnell et al, 1999; Bantick et al, 2002; Tracey et al., 2002; Seminowicz et al., 2004; Van Damme et al., 2008). Hence, individuals who have jobs that require high levels of concentration are more likely to suffer from long-term musculoskeletal injuries, on account of being unable to receive biofeedback regarding the appropriate timing of rest and recovery (Garson, 2009). In contrast, it has also been reported that intense symptoms of discomfort/pain disrupt cognitive processing, resulting in lowered work performance (Eccleston et al, 1999).
The authors aimed with this research was to investigate the influence of time, awkward posture, and cognitive processing (utilizing different senses; visual and auditory) on measured physical (heart rate (HR), heart rate variability (HRV), electromyography (EMG)), perceptual (body discomfort (BD)) and performance (% error and reading speed) responses.

Results indicated that, apart from the percentage of error incurred, the influence of modality had no significant effect on any of the measured responses, irrespective of time and posture assumed. Exposure to an awkward posture, designed to induce muscular discomfort, had a significant impact on measured HRV during the visual condition. The addition of a stooped posture caused a significant improvement in auditory performance, during the first two minutes. Apart from this unexpected finding, which can be explained by the order of permutation, induced muscular discomfort caused no significant decrements in performance. Performance and HRV remained relatively unaffected by the influence of time. However, perceptions of body discomfort (BD) increased significantly from minute two to four.

Hopley, B., & Mattison, M. (2013). The effects of posture and cognitive information processing from different sensory modalities on perceived musculoskeletal discomfort and work performance. Ergonomics SA, 25(2), 12-21. 

A Study of Musculoskeletal Discomforts and Associated Risks among Indian Percussion (Tabla) Players

Musculoskeletal disorders at work are often the prime topic of discussion and research (Yeung et al, 1999). They are widespread in many countries, incurring substantial cost and affecting quality of life. The major contributory risk factors are non-optimal body posture, forceful and repetitive movements, whole body vibration and psychological stress. The risk factors are prevalent in almost all occupations (Punnett and Wegman, 2004). Unlike other professionals, the work of instrumentalist involves playing musical instruments hence work-related musculoskeletal disorders are called playing-related musculoskeletal disorders (PRMDs), which are often disabling (Zaza et al 1998; Bragg 2006). The prevalence of PRMDs in musicians has been found to range from 32% to 87% (Zaza et al, 1998; Storm, 2006).

The Tabla is the most popular percussion instrument used in Indian classical music. Ragothman (2004) reported that Tabla players also suffer from PRMDs. Tabla playing involves repetitive striking movements, force, contact stress and constrained posture for longer period of time which may be the predisposing factors for PRMDs. A study from The University of Pittsburg reported that Indian Tabla players suffer from musculoskeletal discomforts. Among harmonium, sarod and Tabla, Tabla players suffered from the greatest discomfort (http://www.umc.pitt.edu/india3/studv.htmr).

The authors conducted the study to find the most affected areas of discomfort and to identify the major risk factors contributing to playing related musculoskeletal discomforts among Indian Tabla players. Eighty-four professional Tabla players voluntarily participated in the study. The Nordic musculoskeletal questionnaire (NMQ) was administered to identify the susceptible/affected anatomical areas. A questionnaire consisting of eight items on a 10 point likert scale based was administered to identify the risk factors contributing to PRMDs. Results of the NMQ showed that the most commonly affected areas were the lower back (74.15%), right shoulder (67.06%) and neck (67.06%). The internal consistency of the questionnaire was determined by Cronbach's alpha which was found to be acceptable. From the factor analysis results, two factors emerged. Factor one was identified as posture related risk factors while factor two was identified as occupation related risk factors. The risk factors identified in the study were similar when compared to other instrumentalists.


Mishra, W., De, A., Gangopadhyay, S., & Chandra, A. M. (2013). A study of musculoskeletal discomforts and associated risks among indian percussion (tabla) players. Ergonomics SA, 25(2), 2-11. 

Employee health linked to performance of businesses

Employers believe there is a clear link between employee health and organisational performance, a study has suggested - yet nearly twothirds also believe the rising cost of providing healthcare benefits means that current levels of provision will be unsustainable in the future.

A poll by Jelf Employee Benefits found that 93% of employers believe positive health interventions and prevention can influence personal and organisational performance. Yet worryingly, nearly two-thirds (62%) did not believe current healthcare benefits were sustainable over the long term, primarily because of concerns over increasing cost. One of the biggest worries for employers was the cost of managing and providing benefits for an ageing and ailing workforce, rated as a concern by 57% of employers.

"It is important that employers get the right strategy in place to support the structure of their employee benefits by addressing the shortterm costs of premiums and the longer-term healthcare strategies to support both the business and the employee."

Employee health linked to performance of businesses. (2014). Occupational Health, 66(1), 5. 

Ultrasonography in myofascial neck pain

A definitive diagnosis of chronic neck pain (CNP) is sometimes not possible. The authors' aim with this study was to understand the possible role of the deep fasciae in CNP and the utility of the ultrasonography in the diagnosis of myofascial neck pain.  The morphometric and clinical data of 25 healthy subjects and 28 patients with CNP were compared. For all subjects, the active and passive cervical range of motion (ROM) was analyzed and the neck pain disability questionnaire (NDPQ) was administered. The fascial thickness of the sternal ending of the sternocleidomastoid and medial scalene muscles was also analyzed by ultrasonography.  There were significant differences between healthy subjects and patients with CNP in the thickness of the upper side of the sternocleidomastoid fascia and the lower and upper sides of the right scalene fascia both at the end of treatment as during follow-up. A significant decrease in pain and thickness of the fasciae were found. Analysis of the thickness of the sub-layers showed a significant decrease in loose connective tissue, both at the end of treatment and during follow-up.

The data support the hypothesis that the loose connective tissue inside the fasciae may plays a significant role in the pathogenesis of CNP. In particular, the value of 0.15 cm of the SCM fascia was considered as a cut-off value which allows the clinician to make a diagnosis of myofascial disease in a subject with CNP. The variation of thickness of the fascia correlated with the increase in quantity of the loose connective tissue but not with dense connective tissue.

Stecco A, Meneghini A, Stern R, Stecco C, Imamura M. Ultrasonography in myofascial neck pain: randomized clinical trial for diagnosis and follow-up. Surgical and Radiologic Anatomy 2014 04;36(3):243-53. 

Efficacy of EMLA cream phonophoresis comparison with ultrasound therapy on myofascial pain syndrome of the trapezius

The authors' aim with this study was to investigate whether eutectic mixture of local anesthetics (EMLA) cream phonophoresis superior to conventional US over the trigger points (TPs) in terms of improvements of pain, range of motion and disability in myofascial pain syndrome (MPS).  Fifty patients (42 female, 8 male) diagnosed with MPS were included in the study. Patients were randomly assigned into two treatment groups including phonophoresis (PH) group (n = 25) and ultrasound (US) group (n = 25). PH group received EMLA cream phonophoresis (2.5 % lidocaine, 2.5 % prilocaine); US group received conventional ultrasound therapy over the all active TPs on trapezius muscle for 10 min a day for 15 sessions.

Outcome measures were performed before the treatment course and at the end of a 15-session course of treatment. Student T, Mann-Whitney U, chi-square and Wilcoxon tests were used for statistical analysis.  At the end of the therapy, there was statistically significant decrease in both PH group and US group in terms of number of trigger point (NTP) (p = 0.001, p = 0.029), pain intensity on movement (p = 0.001 vs. 0.002) and right/left cervical lateral ROMs (p = 0.001/p = 0.001, p = 0.009/p = 0.020) relative to baseline. The NTP decrease in PH group was significantly higher than that in US group (1.84 ± 1.46 vs. 0.72 ± 1.45; p = 0.01). Pain intensity at rest (p = 0.001) and NPDI scores (p = 0.001) were statistically improvement in only PH group.

EMLA cream phonophoresis is more effective than conventional ultrasound therapy in terms of pain and associated neck disability, and it seems the complementary treatment option for MPS.

Ustun N, Arslan F, Mansuroglu A, Inanoglu D, Yagiz AE, Guler H, et al. Efficacy of EMLA cream phonophoresis comparison with ultrasound therapy on myofascial pain syndrome of the trapezius: a single-blind, randomized clinical study. Rheumatol Int 2014 04;34(4):453-7.

CHELT therapy in the treatment of chronic insertional Achilles tendinopathy

The application of laser therapy on soft tissue is used for pain relief, anti-inflammation action and biostimulation. The efficiency of High Energy Laser Therapy has not yet been studied on Achilles tendinopathy.  The authors' aim of this study was to evaluate the effectiveness of a flow of Cold air and High Energy Laser Therapy (CHELT) versus Extracorporeal Shock Waves Therapy (ESWT) in the treatment of Achilles tendinopathy.

In this prospective, clinical trial, 60 subjects affected by insertional Achilles tendinopathy were enrolled and randomized to CHELT (30 subjects) or to ESWT (30 subjects). In CHELT group the patients received ten daily sessions of 1,200 J and 12 W of laser therapy (wavelength of 1,084, 810 and 980 nm) added to a flow of cold air at -30 °C.

Both groups of participants performed stretching and eccentric exercises over a 2-month period. The visual analogue scale (VAS), the Ankle-Hindfoot Scale, and the Roles and Maudsley Score were measured before treatment (T0), and at end of the treatment session (T1) and 2 (T2) and 6 months (T3) after treatment during the follow-up examinations.

In both groups, the authors found a statistically significant improvement of the VAS at T1, T2 and T3. It also gave the patient a full functional recovery and greater satisfaction.

Notarnicola A, Maccagnano G, Tafuri S, Forcignanò MI, Panella A, Moretti B. CHELT therapy in the treatment of chronic insertional Achilles tendinopathy. Lasers in Medical Science 2014 05;29(3):1217-25.

Application of ultrasound-guided trigger point injection for myofascial trigger points in the subscapularis and pectoralis muscles to post-mastectomy patients

The authors objective was to investigate the therapeutic effectiveness of ultrasound (US)-guided trigger point injection for myofascial trigger points (MTrPs) in the internal rotator muscles of the shoulder in post-mastectomy patients.This pilot study was a non-controlled, prospective, clinical trial. Nineteen post-mastectomy patients with a diagnosis of at least one active MTrP in the subscapularis and/or pectoralis muscles were included. The authors performed trigger point injections into the subscapularis muscle deep behind the scapula as well as the pectoralis muscle for diagnostic and therapeutic purpose by the newly developed US-guided method.Visual analogue scale and range of motion of the shoulder for external rotation and of abduction showed significant improvement immediately after the first injection and 3 months after the last injection compared with baseline. In post-mastectomy patients with shoulder pain, US-guided trigger point injections of the subscapularis and/or pectoralis muscles are effective for both diagnosis and treatment when the cause of shoulder pain is suspected to originate from active MTrPs in these muscles, particularly, the subscapularis.


Stecco A, Meneghini A, Stern R, Stecco C, Imamura M. Ultrasonography in myofascial neck pain: randomized clinical trial for diagnosis and follow-up. Surgical and Radiologic Anatomy 2014 04;36(3):243-53.