Mitigating Risk for the Leading Cause of Disability

Ask anyone who’s experienced back pain, sciatica, and other common musculoskeletal disorders (MSD), and they’ll tell you it’s a disruptive pain that is difficult to ignore and even more difficult to relieve. If you haven’t experienced MSD-related pain firsthand, you may think it’s generally the result of lifting something heavy or pulling a muscle during strenuous activity. But pain from MSD can seemingly come out of nowhere – even from a minor change in routine activity.  MSD impacts individuals across all professions – from those sitting at a desk for the majority of the day to those working in hospitals, warehouses and manufacturing settings. And if left undiagnosed and untreated, this pain can lead to disabling injury or disease.  

In this article we provide perspective into the prevalence of musculoskeletal disability.  We share insights regarding expertise and tools in the marketplace that have proven beneficial in early identification and treatment of MSD in order to, when possible, prevent the progression of injury and illness before it becomes disabling.  

According to the Spine & Pain Clinics of North America, one out of every two adults in the U.S. is affected by a musculoskeletal disorder in their lifetime.  MSDs are more common than circulatory and respiratory diseases, and treatment costs are relatively higher than the costs to treat other common health conditions².

Consider these facts  that demonstrate the impact of this type of injury and disease on the insured, working population.  

Musculoskeletal disorders:

• are associated with high costs to employers such as absenteeism, lost productivity, and increased health care, disability, and worker’s compensation claims
• come with direct cost of almost $15,000 per MSD; and indirect costs of up to five times that amount³,⁴
• significantly limit mobility and dexterity, often leading to earlier than planned retirement, lower levels of well-being and reduced ability to participate in societal activities
• often lead to disabling conditions, have been increasing and are projected to continue to increase in the coming decades⁵

In addition to the costs associated with lost productivity, assessments and treatments, when pain from MSD is left untreated, individuals often experience continually decreasing range of motion, develop scar tissue, and eventually permanent damage to fibrous tissue.

The CDC defines MSD as injuries or disorders of the muscles, nerves, tendons, joints, cartilage, and spinal discs. Work-related musculoskeletal disorders are defined as conditions in which:

• the work environment and performance of work contribute significantly to the condition; and/or
• the condition is made worse or persists longer due to work conditions⁶

As of April 2020, the top three most common musculoskeletal conditions were²:

• lower back and neck pain such as herniated spinal disc, ligament sprain, muscle or tendon strain, degenerative disc disease, etc.
• trauma such as injuries occurring from workplace injuries, repetitive motion, auto accidents and falls which can lead to bone fracture and soft tissue damage
• arthritis conditions such as osteoarthritis, rheumatoid arthritis, psoriatic arthritis

As we know, the pandemic necessitated a rapid transition to a remote work environment for many  organizations and forced employees from ergonomically-correct office workspaces to make-shift workstations at home. Work environment surveys conducted in 2020 indicated that only 50% of employees were working in a dedicated home office; the other half were working from the bedroom, living room or kitchen.  For at least the first six months of the pandemic, three-quarters of employees were working from a laptop without a separate monitor, and over half were working with a monitor that was too low, causing additional pressure on the discs and joints of the spine as well as an imbalance in the neck.⁸  Given that, for many companies, this sudden shift did not adversely impact employee production and actually saved the company on costly expenses such as rent, the long-term effect is that many employees are now working from home full-time on a permanent basis or in hybrid models.  

While working from home is here to stay, many organizations have a long way to go to solve the problem of ensuring employees have an ergonomically correct work environment.  In addition to unnecessary strain on the back, shoulders and neck for those working with poor posture, the more sedentary workday (one doesn’t even have to stand up to “go to” a meeting) has caused an increase in obesity and a significant decrease in simple daily movement, which is necessary for musculoskeletal health.

In late 2021, the Journal of Occupational and Environmental Medicine published the findings of research⁹ that investigated the effects of a sudden shift to working from home.  The study revealed that, of nine body regions measured for MSD-related pain, four saw pain increase since the onset of the pandemic and the working from home period.  These increases included neck, low back, hip and knee pain.  Low back pain showed a statistically significant increase (P = 0.03) and was the leading reason for doctor visits and sick leave.

The most common methods to diagnose MSDs have been around for decades and are based on subjective assessments. The Oxford Scale, for example, requires the patient to push upper and lower extremities against the examiner’s resistance (usually the examiner’s hand). The examiner then subjectively grades the level of the patient’s strength on a scale of 0 to 5. Other common tests, such as the Timed Up & Go (TUG) Test and the Balance Error Scoring (BESS) Test apply similarly subjective methods to assess an individual’s movement. While these tests provide some insight into the cause of pain, their subjective nature can lead to inaccurate diagnoses and ineffective treatments.  

Recent technology has led to innovative, science-based solutions that can help objectively diagnose and prevent the progression of MSD.

Many cases of MSD-related injuries are preventable - such as those caused by repetitive motion, sitting for long periods of time, regularly lifting heavy items, and poor posture when sitting, walking or lifting. What if we could identify an individual’s probability for injury as well as the type of musculoskeletal injury they are most at risk for?  With this information and a few simple adjustments, we may be able to improve their movement health or an employer could make workplace accommodations before the pain progresses to disability.  

Munich Re North America Life has partnered with Sparta Science to bring this type of risk assessment to our industry, with a focus on reducing the number of MSD-related injuries that lead to claims. Sparta Science has developed a platform that utilizes force plate technology (envision a device the size of a typical weight scale) and predictive machine learning modeling. The technology can be integrated into an employer’s established wellness program and used to record an employee’s risk within seconds. Machine learning provides an objective, science-based assessment with a mobile app that assigns movement recommendations to improve an employee’s movement health and reduce risk.

As revealed by the Journal of Occupational and Environmental Medicine study, without preventive measures, the rate of individuals experiencing MSD-related problems is expected to rise. Based on the factors discussed, it is recommended that employers and carriers consider the following approaches in mitigating disability risk:

• Consider solutions that limit the number of disability claims before they even occur, rather than waiting for a claim to be filed and then working to limit the impact of paying benefits for months or years.
• Track the rate at which covered employees are switching to a work-from-home or hybrid model
  • If working from home, encourage employers to provide means to an ergonomically-correct workstation. (For example: sending an ergonomic workstation consultant to the employee’s home to conduct an assessment.)
  • If hoteling, determine whether workstations in the office is adjustable, and whether each employee knows how to adjust to their ideal seat/desk height.
• Monitor covered occupations that have experienced a shift in duties which may result in new MSD-related injuries - and consider whether shifted employees are being trained properly to avoid injury.
  • Some key industries that have seen a shift in duties include higher level education, traveling nurses/medical care, hospitality industry. 
  • Consider that a shift in duties may result in increased costs to treat new or augmented pain.

MSD is the number one cause of disability and it is on the rise. Continuing to leverage the same subjective assessments and generic treatments applied for decades isn’t the answer. It’s time to take a new approach, apply new technology, and interrupt the trend.  

If you’re interested in MSD claim prevention and learning more about the Munich Re North America Life partnership with Sparta Science, please contact Lynda Turgeon.

References

• ¹U.S. Bureau of Labor Statistics. (2020) Survey of Occupational Injuries and Illnesses Data. Table R70.  https://www.bls.gov/iif/soii-data.htm#dafw
• ²Ghauri, M. (2020, April 3). The Most Common Musculoskeletal Disorders. Spine & Pain Clinics of North America. https://www.sapnamed.com/blog/the-most-common-musculoskeletal-disorders/ 
• ³U.S. Department of Labor. (2022) Occupational Safety and Health Administration. https://www.osha.gov/safetypays/estimator
• ⁴U.S. Bureau of Labor Statistics. (2020) Injuries, Illnesses and Fatalities.  https://www.bls.gov/iif/oshsum.htm
• ⁵World Health Organization. (2021) Musculoskeletal conditions. https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions
• ⁶Centers for Disease Control and Prevention. (2022) Work-Related Musculoskeletal Disorders & Ergonomics. Work-Related Musculoskeletal Disorders & Ergonomics | Workplace Health Strategies by Condition | Workplace Health Promotion | CDC
• ⁷Integrated Benefits Institute. (2022) Health and Productivity Impact of Chronic Conditions, Back Pain. https://ibiweb.org/research-resources/detail/health-and-productivity-impact-of-chronic-conditions-back-pain
• ⁸Cision PR Newswire. (2020) Remote Work to Drive Home Purchase Decisions in the Next Six Months. Remote Work to Drive Home Purchase Decisions in the Next Six Months (prnewswire.com)
• ⁹Guler, Mehmet Akif MD; Guler, Kutay PhD; Guneser Gulec, Meryem MD; Ozdoglar, Elif PhD Working From Home During a Pandemic, Journal of Occupational and Environmental Medicine: September 2021 - Volume 63 - Issue 9 - p 731-741 doi: 10.1097/JOM.0000000000002277