Both individuals and society experience serious consequences of work disability associated with workrelated musculoskeletal disorders. Shoulder pain is common in overhead workers, often requiring them to seek help from medical professionals. Return to work after shoulder rehabilitation is not always successfull and recurrence of shoulder pain at work can occur when professional activities (again loading the upper limbs) are resumed.
It might be worth to rethink our return to work approach in physical therapy practice starting from experiences of patients themselves.
The aim of the cross sectional survey study of Margot Legein, Lisa Lernout and Eline Rycx (master students physiotherapy education Ghent University) was to investigate self-perceived difficulties in activities at work, participation and psychosocial support in individuals suffering from chronic workrelated shoulder pain.
230 overhead workers suffering from shoulder pain completed the survey (83.4 % women- 16.6% men).
63.5 % of the participants belonged to the elementary occupations category. (ISCO has described elementary occupations as ”simple and routine tasks which mainly require the use of handheld tools and often some physical
effort” (ILO, 2004)). In this category, domestic helpers and domestic cleaners were the majority, with 55 % of the total sample.
What can be learned from this study to take into account in return to work rehab?
- Functional exercises should prepare for the activities experienced as most painfull/loading for the shoulder in your specific patient. Click on the lists below to view which activities were reported by each profession (Yellow= reported by 20-30 participants, Red= reported by >30 participants). Take time to ask the patient to explain his/her job requirements and include the details about equipment used, environment and other relevant items.
2. A large proportion of the population mentioned the influence of stress and fatigue on pain experience during work activities. Advice on activity management at work (variation, duration,…) together with supporting self management to improve general well-being (motivation towards active lifestyle, improve sleep quality, …) might be important to consider in individual patients.
3. Participants often reported that social support at work was insufficient. A high proportion of the investigated population did not report their shoulder injury to their employer and colleagues. In 47.4 % of cases, the employer had been informed of the complaints but in 75,2 % of these cases, the employer did not take the complaints into account. 28.3 % informed their colleagues about their shoulder pain and also here 55.4 % of this group mentioned that colleagues did not support them.
Physiotherapists might open the conversation on this topic. “Shoulder pain is invisible” a lot of patients tell us, reflecting the feeling of incomprehension. It appears to be important to maintain communication with the supervisor during the period of sick leave as well as being ready for the RTW process in advance of the actual return. It also seems to be important to have a flexible work schedule at the beginning of the RTW. Staying connected with colleagues might also contribute to higher motivation to return to work. Reinforce your patient to take the initiative to stay in touch and let go of negative thoughts on what colleagues might think of them/their shoulder pain.
4. Sometimes job requirements are too high for physical capacity of the shoulder. Around 20 % of participents indicated that they could use the assistance of a public employment service to support them to discover new job opportunities. As a physiotherapist we might assist patients in finding their way to the organisation that can assist them.