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The Musculoskeletal Elf

Is Work Load a Risk Factor for Osteoarthritis of the Hip? A Systematic Review

Heather Gray

A previous blog by one of our industrious Musculoskeletal Elves looked at how osteoarthritis (OA) of the hip or knee affected work participation. This got me thinking about the converse situation – can work be a predisposing factor for the development of OA? We Elves are involved in quite a lot of heavy lifting, particularly around Christmas – would this be something that might cause us problems later on in life? It was then that I stumbled across a very interesting systematic review on the epidemiological evidence for work load as a risk factor for OA of the hip by Sulsky et al (2012) published in PLoS One, an online journal.

Here’s what they did

The review authors conducted comprehensive searches of the scientific literature particularly looking for quantitative estimates of exposure to occupational activities that might increase the risk of hip OA. Only studies with high quality designs and quantitative exposure data were included, as previous reviews have been qualitative, focusing on the authors’ judgment regarding the association between physical work load and hip OA.

Here’s what they found

man lifting box
Long-term exposure to heavy lifting increases risk of hip OA and standing at work might increase the risk of hip OA

Using pre-defined quality criteria, 30 studies were selected for critical evaluation; however, only six of these provided quantitative exposure data. Study results were too heterogeneous to develop pooled risk estimates by specific work activities. However, what they were able to determine was that the weight of evidence favours a graded association between long-term exposure to heavy lifting and risk of hip OA. Long-term exposure to standing at work might also increase the risk of hip OA.

The authors concluded

“There is enough evidence available to identify job-related heavy lifting and standing as hazards, and thus to begin developing recommendations for preventing hip OA by limiting the amount and duration of these activities.”

The Musculoskeletal Elf’s view

picture of the musculoskeletal elf

Certainly the last thing I want to do is look like I am discouraging anyone from working, as I am a firm believer that work is good for you, as evidence clearly indicates on the Health Work Wellbeing website supported by the UK’s Department for Work and Pensions. Furthermore, an Arthritis Care survey in 2005 found that people with osteoarthritis in employment experienced pain less frequently than those out of work. So I put to you some of the authors’ recommendations for OA prevention for your consideration.
Recommendations
  •  Job activities with high physical work load should be minimised to the extent possible.
  • Training and guidelines for appropriate ergonomic approaches to materials handling and other work activities should be made available and implemented.
  • In workplaces where jobs require exposure to high work load, organisations should promote preventive health measures for workers. Programmes should focus on limiting exposure to extended standing, etc.
  • Better work organisation may reduce unnecessary physical work load.
  • Older employees and employees with hip disorders, hip deformity, former injuries or known intrinsic risks for total hip replacement should not be exposed to high physical work load.

Links

Sulsky SI, Carlton L, Bochmann F, Ellegast R, Glitsch U, et al. (2012) Epidemiological Evidence for Work Load as a Risk Factor for Osteoarthritis of the Hip:
A Systematic Review. PLoS ONE 7(2): e31521. doi:10.1371/journal.pone.0031521

Health Work Wellbeing [online] http://www.dwp.gov.uk/health-work-and-well-being/ (accessed 30-8-12)

Arthritis Care [online] http://www.arthritiscare.org.uk/Home (accessed 30-8-12)

How do the recommendations from this review marry up with what you would recommend to your patients? How will this review influence your clinical practice? 

Please send us your comments on this blog and become part of the ever expanding Musculoskeletal Elf community.

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Written by

I am currently the Head of Physiotherapy & Paramedicine at Glasgow Caledonian University and Chair of the Chartered Society of Physiotherapy's Professional Committee. I have worked at the University of Glasgow in several research positions. I am on the Editorial Board of the Journal of Physical Therapy Education. Other work in which I have been involved is as an Educational Consultant with NHS Education for Scotland. Prior to moving into academia I worked in the National Health Service (NHS) in Scotland as a physiotherapist for 11 years.

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  • Susan Westlake

    Susan Westlake

    8 years ago
    Hi, I was diagnosed with hip OA about 12 years ago. I never accepted the prognosis - I always knew it was the result of a muscle imbalance caused by years of one sided karate practice. I know the history and onset in detail, but the pros wouldn't listen! Point being that what you do regularly, your body adapts to get better at it. This leads to muscle imbalance which puts you at huge risk of RSI's that 'lock down' the joints and create pain and restriction (as well as abnormal joint wear, which is shown by research to mostly be benign). At this stage a muscle imbalance is very difficult to treat and will typically get an OA diagnosis. It IS treatable though. I would argue that it is IMPOSSIBLE to give a reliable OA diagnosis without first ruling out muscle imbalance. The symptoms produced by muscle imbalance are identical to those that result in hip replacement surgery. Doctors/specialists/physios all insisted I was in denial - it took me a decade, but I finally figured it out, eliminated symptoms and returned to a normal active life. What is more, I wrote a self help book detailing the whole body imbalance that is always (almost always?) present in people with hip OA, and providing self-help on how to treat with corrective exercise. It's a steep learning curve, but the book has been out a year now and reports are positive, with most reporting improvement in symptoms and very many canceling surgery, returning to active life and some complete cures. Par for the course, health pros are snooty and dismissive of anything coming from a lowly 'patient' - this has all been achieved in complete isolation from my little home office - what would be possible with a bit of input and collaboration from 'the experts"? I help people (free of charge) from all around the world via email on a daily basis. Yet I never even get a response when I try to share my story and methods with health pros. Maybe this time will be different? Research is guiding mainstream medicine away from the root cause (root cause in at least many cases) - it's looked at over-simplistic physical therapy approaches and as such it's been shown not to produce good results. Instead of delving deeper it seems that muscle imbalance and corrective exercise has been ruled out as an effective treatment? Let alone complete cure! There are a number of DIY approaches - for example, self MFR / Trigger point treatment that most people that contact me say they get huge benefit from. It's only symptomatic relief, but it gets such good results and makes people feel empowered - for example: "It is good to feel empowered, to be able to relieve the symptoms oneself. I cannot thank you enough, Susan. To be able to walk normally makes me feel euphoric!" ""I am amazed and frankly stunned that no-one of the so called 'health experts' I have visited has ever mentioned it [trigger point self treatment] to me and I had to discover it through the dedicated efforts of someone like you onlinel" "Diary Extract – 30th September 2015 Woke up at 4 am. Pain in thigh. Maybe I was too keen doing exercises yesterday. But no longer do I reach for the Anadin. I am no longer in a state of learned helplessness. I start taking control. I feel for my known trigger points, run through the glutes, the TFL, the IT band, then hit the spot on QL. Eureka. I know I have found it. Massage both sides, relief, followed by deep,restful sleep until 7.30, when I wake up pain free and exulting in the control I now have over my so-called “Osteoarthritis”." Trigger point treatment is perhaps better than pain killers in many cases - it is what largely kept me off pain relief prior to finally unraveling the underlying muscle imbalance. Yet no health industry sources ever seem to mention it? It costs nothing and is completely harmless. Yet toxic drugs are recommended without first trying this? The solution (in many cases, cure) lies in addressing the muscle imbalance. As I say, everyone (hundreds) that have got in touch with me have the same basic imbalance. There are tests to establish it's presence and you can predict accurately what most muscles in the body are doing (lazy, inactive, hypertonic etc). Attempting to address the problem locally is doomed to failure - it needs to be a whole body approach. Primarily it's a core problem. At it's height, I had severe, chronic pain in neck, back, shoulders, feet and hip - all eliminated when the underlying muscle imbalance was addressed. I now lead a highly active life involved in a high level in strenuous sports - 100% symptom free. Although the book was written for people with hip OA I get a lot of reports of it helping with things like sciatica, 'SI Joint Syndrome' and low back pain. Please contact me for more info.