Work-related musculoskeletal disorders are
increasingly a topic for public concern. The
nature and significance of this group of disorders
are explained from the point of view of
public relations and politics, of medical disciplines,
of health insurance, pension schemes,
accident insurance, ergonomics and epidemiology.
The German term „arbeitsbedingte Erkrankungen“
(disorders caused by work)
is often seen in the context of the causality
principle of occupational diseases, whereas
the international definition of „work-related
diseases“ is wider and would be better expressed
in German as „arbeitsbezogene Erkrankungen“.
The medical diagnosis of the early stages
of musculoskeletal disorders which are relevant
for prevention can only rarely be based
on objective and reliable parameters. Typical
consequences of this situation are the pragmatic
use of the term „syndrome“ instead of
a specific diagnosis and „causal“ reference to
the results of medical diagnostic imaging.
Pain is the most important symptom of
musculoskeletal disorders and determines
the expectations of the affected person and
the medical treatment. Stress-related symptoms
are often not the result of excessive
stress. The occupational physician must differentiate
between functional and structural
causes, between the somatic and the mental.
An association between work-related structural
musculoskeletal disorders and physical
strain is evident in persons doing particularly
heavy work. It is markedly age-dependent.
For preventive and occupational medical
purposes, the assessment of complaints
and symptoms of the locomotor apparatus
from the functional point of view offers advantages
over medical-orthopaedic diagnosis
of structural changes. The recognition of
occupational and non-occupational mental
stress factors as causes of work-related musculoskeletal
disorders is an essential part of
the diagnostic and advisory process.
The standard to be applied is the internationally
accepted research on work-related
musculoskeletal disorders: the epidemiologically
determined incidence of parameters
and their interrelationships must be plausible
from the biomechanical, biological and
psychological points of view.
A concept for prevention should keep
healthy persons healthy under changing
workloads, protect persons subject to particular
stress at work, counter the effects of lack
of exercise in civilized society, optimize work
ergonomically and physiologically, organize
cooperation between medicine, psychology
and technology in the work sciences and put
the results to practical use, and make suggestions
for socio-political decisions on the basis
of reliable results.
