Book Review

Musculoskeletal Disorders in the Workplace: Principles and practice

N Engl J Med 1997; 337:1931December 25, 1997

Article

Musculoskeletal Disorders in the Workplace: Principles and practice
Edited by Margareta Nordin, Gunnar B.J. Andersson, and Malcolm H. Pope. 671 pp., illustrated. St. Louis, Mosby, 1997. $119. ISBN: 0-8016-7984-2

Periodically, a textbook genuinely meets a need by filling a void in the literature. Musculoskeletal Disorders in the Workplace is just such a book in that it provides historical insight, discusses the existing and often disparate research from the emerging field of occupational orthopedics, and provides a clear picture of the work that still needs to be done before this new discipline is adequately grounded in science. The editors have done a superb job of integrating the contributions of more than 50 experts in a field that is not yet well defined. All of the 52 chapters are related, the sum total is remarkably comprehensive, and the book provides a structural framework for anyone interested in the big picture. Whether the reader is new to the subject of workplace disorders or an expert in the field, there is considerable information to be gleaned from this book.

The book is also aesthetically pleasing. The quality and size of the print, the organization of the columns, the spacing of tables and figures, and the generous use of subject headings contribute to the reader's understanding and create a visual impact. Each chapter has a table of contents and a summary paragraph that permits rapid reference to a topic and a quick overview. High-quality paper was used, which permits the jotting of notes in the margins, if desired, without reducing the readability of adjacent pages.

The book is laid out in five sections. The first section, entitled “Basic Concepts,” provides a reasonable overview of the problem of workplace injuries, particularly those causing low back pain, and lays the foundation for subsequent chapters. Some of the material in this section seems a bit out of context (e.g., muscle mechanics and basic biomechanics), but it is not overdone. Two important chapters in this section are those on pain and its management and the significance of psychosocial factors. The second section, “Ergonomics,” is excellent, with a wealth of information that is up to date and comprehensive. Topics include the role of posture as a contributor to pain, and factors predisposing workers to injury and pain, such as job demands (physical stressors such as vibration and heavy lifting), the level of worker fitness (musculoskeletal and aerobic), and workplace design. The current standards of the National Institute of Occupational Safety and Health are presented and used to highlight the utility of ergonomic intervention. Also included in this section are chapters on task analysis, materials handling, and factors leading to falls. The third section, “Prevention,” consists of only one chapter, but it provides an overview of the utility of screening programs, lifting belts, fitness programs, and education and training. The lack of space devoted to prevention is a reflection, unfortunately, of the current state of the art, not an oversight. The fourth section, “Clinical Evaluation and Patient Care,” makes up the greater part of the book. It consists of five separate subsections dealing with problems of the lower back, neck, shoulder, and elbow, the wrist and hand, the hip and knee, and the foot and ankle. Each subsection includes discussion of the epidemiology of the problem, biomechanics, clinical evaluation, treatment, and workplace adaptations. The information about biomechanics and clinical evaluation is not unique to the workplace, but the authors do attempt to integrate clinical findings with causes. Most of the clinical evaluation and treatment options, however, are presented from the physician's standpoint, and thus the roles of other health practitioners are not well defined. The final section, on legal aspects, addresses worker's compensation, the Americans with Disabilities Act, and other new laws.

My criticisms are few and are not intended to suggest that the textbook is not useful. Rather, what follows underscores future research needs, since there are large gaps in our current body of knowledge. For example, there are few clear-cut options for treating workplace injuries, particularly for low back pain. By definition, treatment includes preventing a recurrence of the injury. A number of treatment strategies have been tried, such as workplace modification, the use of lifting belts, muscle-strengthening and other exercise programs, and psychosocial intervention, but the efficacy of these strategies is largely unknown because of the dearth of good clinical trials. Although obesity was addressed as a factor possibly associated with workplace injury, a comprehensive ergonomic examination of obese men and women was missing. It is difficult to believe that obese people perform workplace tasks the same way as slender ones. It is also unknown whether those with more body fat in the abdomen are at a greater disadvantage than those with most of their excess weight at the hips and thighs. With approximately 40 percent of the population overweight, it seems appropriate to determine whether workplace modifications are necessary. It is also unclear whether faulty postural habits developed in childhood contribute to a predisposition to workplace injury in adulthood. Perhaps workplace modification should begin in grade school, where children of all sizes are expected to conform to schoolroom furniture.

All in all, this book is very informative, highly readable, and well researched; it is a welcome and timely addition.

Marybeth Brown, Ph.D.
Washington University School of Medicine, St. Louis, MO 63108-2292