Previous
Exercise-associated muscle cramps (EAMC) remain a significant clinical challenge in elite athletics, often attributed to either electrolyte depletion or altered neuromuscular control. While traditional management focuses on stretching and rehydration, these methods may be insufficient for rapid return to play (RTP) in high-stakes settings with minimal downtime before the next competition. This case report explores the acute application of dry needling (DN) to resolve recurrent EAMC in a 23-year-old National Collegiate Athletic Association (NCAA) Division I basketball athlete. The athlete presented with a severe, involuntary spasm of the right adductor magnus (AM) following a single-leg landing. Initial sideline manual therapy and rehydration provided only transient relief; upon RTP, the athlete sustained a recurrence described as a tenfold increase in intensity, necessitating removal from competition. Within 5 hours of injury, trigger point dry needling (TrP-DN) was administered to the ischiocondylar portion of the AM to facilitate a neuromuscular reset. The intervention resulted in immediate resolution of symptoms and a rapid return to prior performance. The athlete successfully returned to competition the following day, participating in two subsequent games within 48 hours without recurrence or performance deficits. This case demonstrates that DN can serve as a safe and highly effective intervention for the acute management of EAMC, in conjunction with traditional interventions. These findings suggest that directly targeting the motor endplate via DN may more effectively downregulate the neuromuscular hyperexcitability compared to traditional manual stretching and rehydration alone.
Exercise-associated muscle cramps (EAMC) remain a significant clinical challenge in elite athletics, often attributed to either electrolyte depletion or altered neuromuscular control. While traditional management focuses on stretching and rehydration, these methods may be insufficient for rapid return to play (RTP) in high-stakes settings with minimal downtime before the next competition. This case report explores the acute application of dry needling (DN) to resolve recurrent EAMC in a 23-year-old National Collegiate Athletic Association (NCAA) Division I basketball athlete. The athlete presented with a severe, involuntary spasm of the right adductor magnus (AM) following a single-leg landing. Initial sideline manual therapy and rehydration provided only transient relief; upon RTP, the athlete sustained a recurrence described as a tenfold increase in intensity, necessitating removal from competition. Within 5 hours of injury, trigger point dry needling (TrP-DN) was administered to the ischiocondylar portion of the AM to facilitate a neuromuscular reset. The intervention resulted in immediate resolution of symptoms and a rapid return to prior performance. The athlete successfully returned to competition the following day, participating in two subsequent games within 48 hours without recurrence or performance deficits. This case demonstrates that DN can serve as a safe and highly effective intervention for the acute management of EAMC, in conjunction with traditional interventions. These findings suggest that directly targeting the motor endplate via DN may more effectively downregulate the neuromuscular hyperexcitability compared to traditional manual stretching and rehydration alone.
DOI: https://doi.org/10.37349/emd.2026.1007134
Background:
Osteoarthritis (OA) is a degenerative joint disease marked by pain, stiffness, and functional impairment, with inflammation central to its progression. Polyphenol-rich dark fruits, abundant in anthocyanins, possess antioxidant and anti-inflammatory properties that may mitigate OA-related mechanisms. This meta-analysis synthesized evidence from randomized controlled trials (RCTs) evaluating the effects of dark fruit supplementation on clinical symptoms and inflammatory biomarkers in individuals with OA.
Methods:
PubMed, Scopus, Web of Science, and three trial registries (ClinicalTrials.gov, WHO ICTRP, ISRCTN) were searched to September 2025 for RCTs comparing dark fruit supplementation with placebo, usual care, or no intervention. Two reviewers independently screened studies, assessed bias using Cochrane RoB, and evaluated certainty via GRADE (Grades of Recommendation, Assessment, Development and Evaluation). Data were pooled using random-effects models, with Hedges’ g as the standardized mean difference.
Results:
Six RCTs (215 participants; 3–16 weeks) investigating knee OA met inclusion criteria. Pooled analyses showed significant improvements in overall symptom severity (Hedges’ g = –0.31; 95% CI –0.57 to –0.05; P = 0.02), physical function (g = –0.34; 95% CI –0.66 to –0.05; P = 0.02), and interleukin-6 (IL-6, g = –0.40; 95% CI –0.79 to –0.01; P = 0.047). Where reported, compliance was generally high, although adherence and adverse-event reporting were incomplete across trials. Evidence certainty was low, with moderate-to-high risk of bias.
Discussion:
In the available RCT evidence, which was restricted to knee OA, dark fruit supplementation was associated with small short-term improvements in selected OA symptoms and IL-6. However, findings are limited by low certainty of evidence, short intervention durations, incomplete adherence and adverse-event reporting, and the absence of long-term or structural outcomes; therefore, no conclusions can be drawn regarding disease-modifying effects or longer-term tolerability. Larger, high-quality trials are needed to determine whether polyphenol-rich fruits provide clinically meaningful benefits in OA management.
Background:
Osteoarthritis (OA) is a degenerative joint disease marked by pain, stiffness, and functional impairment, with inflammation central to its progression. Polyphenol-rich dark fruits, abundant in anthocyanins, possess antioxidant and anti-inflammatory properties that may mitigate OA-related mechanisms. This meta-analysis synthesized evidence from randomized controlled trials (RCTs) evaluating the effects of dark fruit supplementation on clinical symptoms and inflammatory biomarkers in individuals with OA.
Methods:
PubMed, Scopus, Web of Science, and three trial registries (ClinicalTrials.gov, WHO ICTRP, ISRCTN) were searched to September 2025 for RCTs comparing dark fruit supplementation with placebo, usual care, or no intervention. Two reviewers independently screened studies, assessed bias using Cochrane RoB, and evaluated certainty via GRADE (Grades of Recommendation, Assessment, Development and Evaluation). Data were pooled using random-effects models, with Hedges’ g as the standardized mean difference.
Results:
Six RCTs (215 participants; 3–16 weeks) investigating knee OA met inclusion criteria. Pooled analyses showed significant improvements in overall symptom severity (Hedges’ g = –0.31; 95% CI –0.57 to –0.05; P = 0.02), physical function (g = –0.34; 95% CI –0.66 to –0.05; P = 0.02), and interleukin-6 (IL-6, g = –0.40; 95% CI –0.79 to –0.01; P = 0.047). Where reported, compliance was generally high, although adherence and adverse-event reporting were incomplete across trials. Evidence certainty was low, with moderate-to-high risk of bias.
Discussion:
In the available RCT evidence, which was restricted to knee OA, dark fruit supplementation was associated with small short-term improvements in selected OA symptoms and IL-6. However, findings are limited by low certainty of evidence, short intervention durations, incomplete adherence and adverse-event reporting, and the absence of long-term or structural outcomes; therefore, no conclusions can be drawn regarding disease-modifying effects or longer-term tolerability. Larger, high-quality trials are needed to determine whether polyphenol-rich fruits provide clinically meaningful benefits in OA management.
DOI: https://doi.org/10.37349/emd.2026.1007133
Causal inference is grounded in contrasts between potential outcomes under alternative interventions. Randomized trials are the reference standard for estimating average causal effects because randomization renders treatment assignment independent of potential outcomes, eradicating confounding by design. However, many clinically important questions in rheumatology cannot feasibly be addressed through randomized experiments due to practical, ethical, or temporal constraints. In such settings, observational data can inform decisions. This paper argues that principles derived from randomized trials should continue to anchor causal reasoning and proposes the target trial framework as a structured approach to strengthen causal inference from observational data. By explicitly specifying the protocol of the hypothetical randomized trial that would answer the question and emulating it using real-world (observational) data, investigators can clarify eligibility criteria, treatment strategies, time zero, outcomes, causal contrasts, and identifying assumptions. By describing how each part of the target trial is emulated in observational data, they increase transparency, clarify the causal estimand, and make assumptions, limitations, and sources of bias explicit. This design-based perspective helps prevent common biases, including immortal time bias, selection of prevalent users, and inappropriate conditioning on post-treatment variables, and aligns reporting with clearly defined causal contrasts and effect measures. Ultimately, credibility of causal inference from observational data depends on whether the assignment mechanism is plausibly reconstructed, design choices are made without access to outcome data, and analyses target explicitly defined causal contrasts under stated assumptions, all of which are explicitly addressed within the target trial emulation framework.
Causal inference is grounded in contrasts between potential outcomes under alternative interventions. Randomized trials are the reference standard for estimating average causal effects because randomization renders treatment assignment independent of potential outcomes, eradicating confounding by design. However, many clinically important questions in rheumatology cannot feasibly be addressed through randomized experiments due to practical, ethical, or temporal constraints. In such settings, observational data can inform decisions. This paper argues that principles derived from randomized trials should continue to anchor causal reasoning and proposes the target trial framework as a structured approach to strengthen causal inference from observational data. By explicitly specifying the protocol of the hypothetical randomized trial that would answer the question and emulating it using real-world (observational) data, investigators can clarify eligibility criteria, treatment strategies, time zero, outcomes, causal contrasts, and identifying assumptions. By describing how each part of the target trial is emulated in observational data, they increase transparency, clarify the causal estimand, and make assumptions, limitations, and sources of bias explicit. This design-based perspective helps prevent common biases, including immortal time bias, selection of prevalent users, and inappropriate conditioning on post-treatment variables, and aligns reporting with clearly defined causal contrasts and effect measures. Ultimately, credibility of causal inference from observational data depends on whether the assignment mechanism is plausibly reconstructed, design choices are made without access to outcome data, and analyses target explicitly defined causal contrasts under stated assumptions, all of which are explicitly addressed within the target trial emulation framework.
DOI: https://doi.org/10.37349/emd.2026.1007132
Fibromyalgia (FM) is a chronic nociplastic pain syndrome characterized by widespread musculoskeletal pain, fatigue, sleep disturbance, cognitive dysfunction, and impaired quality of life. Current management supports a multidisciplinary approach. Horticultural therapy (HT), a structured therapeutic intervention that involves gardening-related activities and interaction with natural environments to achieve specific therapeutic goals, has emerged as a potential adjunctive therapeutic modality. This narrative review summarizes the available evidence related to HT and nature-based interventions in FM. Evidence specific to syndromes of chronic pain has demonstrated the efficacy of HT in increasing pain threshold. Clinical data evaluating patients with FM have shown significant improvements in validated measures of the following: global physical and mental health; depression and anxiety; insomnia; affect, mood state, friendliness, and mindfulness; kinesiophobia and physical activity; cognitive emotional regulation and coping; perceived competence, dominance and self-efficacy; and state of arousal. Proposed mechanisms include stress reduction, sensory stimulation, increased physical activity, autonomic regulation, neurochemical adaptation, and neuroendocrine-immune modulation. The current evidence base is limited by small sample sizes, heterogeneous interventions, limited follow-up, and a scarcity of adequately powered randomized controlled trials (RCTs). Although HT appears safe and may represent a useful adjunct within multidisciplinary FM management, additional high-quality studies are required before definitive conclusions regarding efficacy can be drawn.
Fibromyalgia (FM) is a chronic nociplastic pain syndrome characterized by widespread musculoskeletal pain, fatigue, sleep disturbance, cognitive dysfunction, and impaired quality of life. Current management supports a multidisciplinary approach. Horticultural therapy (HT), a structured therapeutic intervention that involves gardening-related activities and interaction with natural environments to achieve specific therapeutic goals, has emerged as a potential adjunctive therapeutic modality. This narrative review summarizes the available evidence related to HT and nature-based interventions in FM. Evidence specific to syndromes of chronic pain has demonstrated the efficacy of HT in increasing pain threshold. Clinical data evaluating patients with FM have shown significant improvements in validated measures of the following: global physical and mental health; depression and anxiety; insomnia; affect, mood state, friendliness, and mindfulness; kinesiophobia and physical activity; cognitive emotional regulation and coping; perceived competence, dominance and self-efficacy; and state of arousal. Proposed mechanisms include stress reduction, sensory stimulation, increased physical activity, autonomic regulation, neurochemical adaptation, and neuroendocrine-immune modulation. The current evidence base is limited by small sample sizes, heterogeneous interventions, limited follow-up, and a scarcity of adequately powered randomized controlled trials (RCTs). Although HT appears safe and may represent a useful adjunct within multidisciplinary FM management, additional high-quality studies are required before definitive conclusions regarding efficacy can be drawn.
DOI: https://doi.org/10.37349/emd.2026.1007131
This article belongs to the special issue Complementary and Integrative Medicine in Rheumatology: Evidence, Therapies, and Clinical Impact
Aim:
This study aims to develop an automated system for classifying industrial operator movements using motion capture (MoCap) data and a random forest (RF) classifier, with the ultimate goal of supporting ergonomic risk assessment and identifying physically demanding tasks suitable for automation in human–robot collaborative environments.
Methods:
MoCap data were acquired using the Xsens system from nine participants (four men and five women) performing three movement classes: walking, standing, and bending. A labelled dataset was constructed and used to train an RF classifier via a sliding-window approach with statistical and frequency-domain feature extraction. The model was evaluated on a held-out test set (80/20 split) and through leave-one-subject-out cross-validation. The trained classifier was subsequently applied to a real industrial use case at a logistics company. MoCap data were additionally imported into IPS IMMA to generate a human digital twin and perform frame-by-frame Rapid Entire Body Assessment (REBA) trunk position scoring during identified bending movements.
Results:
The RF classifier achieved 98.44% accuracy on the test set, with F1-scores of 0.98, 0.97, and 1.00 for bending, standing, and walking, respectively. Leave-one-subject-out cross-validation consistently exceeded 91% accuracy across all participants. In the industrial use case, bending accounted for 6.7% of the total task time (127.5 s). During bending, the operator spent 45.98% of bending time in REBA trunk position zone 3 (20°–60° flexion) and 28.79% in zone 4 (> 60° flexion).
Conclusions:
The integration of MoCap data with RF-based movement classification and automated REBA trunk position extraction provides an objective, reproducible approach to ergonomic risk assessment in industrial settings. The results demonstrate that bending movements expose operators to elevated musculoskeletal risk, supporting the case for targeted automation of these tasks. This work constitutes a first step toward a broader framework for automated ergonomic evaluation and human–robot collaborative workstation design.
Aim:
This study aims to develop an automated system for classifying industrial operator movements using motion capture (MoCap) data and a random forest (RF) classifier, with the ultimate goal of supporting ergonomic risk assessment and identifying physically demanding tasks suitable for automation in human–robot collaborative environments.
Methods:
MoCap data were acquired using the Xsens system from nine participants (four men and five women) performing three movement classes: walking, standing, and bending. A labelled dataset was constructed and used to train an RF classifier via a sliding-window approach with statistical and frequency-domain feature extraction. The model was evaluated on a held-out test set (80/20 split) and through leave-one-subject-out cross-validation. The trained classifier was subsequently applied to a real industrial use case at a logistics company. MoCap data were additionally imported into IPS IMMA to generate a human digital twin and perform frame-by-frame Rapid Entire Body Assessment (REBA) trunk position scoring during identified bending movements.
Results:
The RF classifier achieved 98.44% accuracy on the test set, with F1-scores of 0.98, 0.97, and 1.00 for bending, standing, and walking, respectively. Leave-one-subject-out cross-validation consistently exceeded 91% accuracy across all participants. In the industrial use case, bending accounted for 6.7% of the total task time (127.5 s). During bending, the operator spent 45.98% of bending time in REBA trunk position zone 3 (20°–60° flexion) and 28.79% in zone 4 (> 60° flexion).
Conclusions:
The integration of MoCap data with RF-based movement classification and automated REBA trunk position extraction provides an objective, reproducible approach to ergonomic risk assessment in industrial settings. The results demonstrate that bending movements expose operators to elevated musculoskeletal risk, supporting the case for targeted automation of these tasks. This work constitutes a first step toward a broader framework for automated ergonomic evaluation and human–robot collaborative workstation design.
DOI: https://doi.org/10.37349/emd.2026.1007130
This article belongs to the special issue Prevalence and Risk Factors of Work-related Musculoskeletal Disorders
Aim:
To examine whether heart rate variability (HRV) parameters predict work-related musculoskeletal disorder (WMSD) risk profiles in Hong Kong (China) professionals and provide incremental predictive validity beyond self-reported perceived stress.
Methods:
A cross-sectional study recruited 105 full-time office workers from Hong Kong’s financial, legal, healthcare, technology sectors, and other professionals across five corporate sites between December 2025 and February 2026. Participants completed HRV assessment using a photoplethysmography device (5-minute resting protocol plus 1-minute deep breathing protocol), the Perceived Stress Scale-14 (PSS-14), a musculoskeletal pain questionnaire, postural assessment (forward head posture index, thoracic kyphosis angle), and a sedentary behavior inventory. Pearson correlation, hierarchical multiple regression, mediation analysis (PROCESS Model 4), and moderation analysis (PROCESS Model 1) examined associations between HRV parameters, perceived stress, postural variables, and pain outcomes. Statistical significance was set at p < 0.05.
Results:
HRV parameters were significantly negatively correlated with pain intensity (r = –0.31, p < 0.001) and multi-site pain burden (r = –0.38, p < 0.001). Normalized coherence emerged as the strongest HRV predictor of pain severity (β = –0.29, p < 0.001), explaining 11.4% additional variance beyond PSS-14 alone. Forward head posture and thoracic kyphosis statistically mediated the coherence–neck/shoulder pain association. Daily sedentary hours moderated the HRV-pain association, with workers exceeding 8 hours of seated work showing the strongest autonomic–musculoskeletal risk profiles.
Conclusions:
HRV parameters, particularly normalized coherence, are associated with WMSD-relevant pain outcomes in Hong Kong office workers and capture variance not explained by self-reported stress alone. These findings support HRV as a potentially useful objective complement to existing WMSD risk-screening approaches in sedentary professional populations, although longitudinal validation is required before clinical application.
Aim:
To examine whether heart rate variability (HRV) parameters predict work-related musculoskeletal disorder (WMSD) risk profiles in Hong Kong (China) professionals and provide incremental predictive validity beyond self-reported perceived stress.
Methods:
A cross-sectional study recruited 105 full-time office workers from Hong Kong’s financial, legal, healthcare, technology sectors, and other professionals across five corporate sites between December 2025 and February 2026. Participants completed HRV assessment using a photoplethysmography device (5-minute resting protocol plus 1-minute deep breathing protocol), the Perceived Stress Scale-14 (PSS-14), a musculoskeletal pain questionnaire, postural assessment (forward head posture index, thoracic kyphosis angle), and a sedentary behavior inventory. Pearson correlation, hierarchical multiple regression, mediation analysis (PROCESS Model 4), and moderation analysis (PROCESS Model 1) examined associations between HRV parameters, perceived stress, postural variables, and pain outcomes. Statistical significance was set at p < 0.05.
Results:
HRV parameters were significantly negatively correlated with pain intensity (r = –0.31, p < 0.001) and multi-site pain burden (r = –0.38, p < 0.001). Normalized coherence emerged as the strongest HRV predictor of pain severity (β = –0.29, p < 0.001), explaining 11.4% additional variance beyond PSS-14 alone. Forward head posture and thoracic kyphosis statistically mediated the coherence–neck/shoulder pain association. Daily sedentary hours moderated the HRV-pain association, with workers exceeding 8 hours of seated work showing the strongest autonomic–musculoskeletal risk profiles.
Conclusions:
HRV parameters, particularly normalized coherence, are associated with WMSD-relevant pain outcomes in Hong Kong office workers and capture variance not explained by self-reported stress alone. These findings support HRV as a potentially useful objective complement to existing WMSD risk-screening approaches in sedentary professional populations, although longitudinal validation is required before clinical application.
DOI: https://doi.org/10.37349/emd.2026.1007128
This article belongs to the special issue Prevalence and Risk Factors of Work-related Musculoskeletal Disorders
Paediatric orthopaedics is currently witnessing a profound evolution, transitioning from traditional mechanical fixation toward a future defined by biological restoration and digital precision. The dynamic nature of the growing skeleton necessitates a “growth-aware” surgical philosophy to mitigate the lifelong burden on the child. This narrative review synthesises advancements across pivotal domains: advanced 3D imaging, virtual surgical planning, regenerative biotechnology (the “Diamond Concept”), and smart implant design, based on a rigorous analysis of 76 contemporary sources verified against Medline/PubMed databases. Innovations such as the EOS imaging system and AI-driven diagnostics have significantly reduced cumulative radiation exposure and inter-observer variability. The integration of 3D-printed patient-specific instrumentation and robotic assistance has elevated surgical fidelity in complex spinal and pelvic reconstructions. In the biological realm, the synergy of mesenchymal stem cells, BMPs, and bioactive scaffolds is providing solutions for recalcitrant defects. Furthermore, the advent of bioabsorbable magnesium alloys and internal motorized lengthening nails is effectively eliminating the need for secondary surgeries. The convergence of the “Digital Twin” paradigm with regenerative medicine offers a personalised trajectory for paediatric care. By embracing these advancements, clinicians can restore function while rigorously minimising the physical and psychological burden on the developing child.
Paediatric orthopaedics is currently witnessing a profound evolution, transitioning from traditional mechanical fixation toward a future defined by biological restoration and digital precision. The dynamic nature of the growing skeleton necessitates a “growth-aware” surgical philosophy to mitigate the lifelong burden on the child. This narrative review synthesises advancements across pivotal domains: advanced 3D imaging, virtual surgical planning, regenerative biotechnology (the “Diamond Concept”), and smart implant design, based on a rigorous analysis of 76 contemporary sources verified against Medline/PubMed databases. Innovations such as the EOS imaging system and AI-driven diagnostics have significantly reduced cumulative radiation exposure and inter-observer variability. The integration of 3D-printed patient-specific instrumentation and robotic assistance has elevated surgical fidelity in complex spinal and pelvic reconstructions. In the biological realm, the synergy of mesenchymal stem cells, BMPs, and bioactive scaffolds is providing solutions for recalcitrant defects. Furthermore, the advent of bioabsorbable magnesium alloys and internal motorized lengthening nails is effectively eliminating the need for secondary surgeries. The convergence of the “Digital Twin” paradigm with regenerative medicine offers a personalised trajectory for paediatric care. By embracing these advancements, clinicians can restore function while rigorously minimising the physical and psychological burden on the developing child.
DOI: https://doi.org/10.37349/emd.2026.1007129
This article belongs to the special issue Innovation in Orthopedics
Aim:
Distal locking during intramedullary nailing remains a technically demanding step. The aim of this study was two-fold: first, to evaluate whether the proposed locking technique reduces radiation exposure and operative duration compared with the conventional free-hand technique across surgeons with different levels of experience; second, to compare its performance with previously published alternative distal locking methods.
Methods:
A retrospective observational study was conducted across three trauma centers in Belgium. A total of 432 patients undergoing intramedullary nailing for long-bone fractures were included. Thirty surgeons (10 junior residents, 10 senior residents, 10 board-certified surgeons) performed distal locking using both the conventional free-hand technique and the proposed method. Radiation exposure and procedure duration were recorded and compared. Results were also compared with published data on alternative distal locking techniques.
Results:
The proposed technique significantly reduced radiation exposure, fluoroscopy time, and procedure duration across all experience levels. Mean radiation dose decreased from 35.47 ± 8.9 to 4.43 ± 1.1 cGy/cm2 (p < 0.0001). Fluoroscopy time decreased from 19.33 ± 6.2 to 11.5 ± 2.0 seconds (p = 0.003). Procedure duration decreased from 9.53 ± 3.1 to 4.23 ± 1.2 minutes (p < 0.0001). The greatest improvement was observed among less experienced surgeons. Compared with published techniques, the method demonstrated non-inferior or superior results in terms of radiation exposure and procedure duration.
Conclusions:
This simple and reproducible technique significantly reduces radiation exposure and operative time compared with the free-hand method. By eliminating the need to obtain a nearly perfectly round fluoroscopic image of the locking hole, the technique relies on hand-eye coordination and cognitive alignment rather than fixed geometric positioning. It requires fewer adjustments and repositioning of the C-arm. Its performance is comparable or superior to alternative techniques. It requires no additional equipment, making it practical for routine trauma practice.
Aim:
Distal locking during intramedullary nailing remains a technically demanding step. The aim of this study was two-fold: first, to evaluate whether the proposed locking technique reduces radiation exposure and operative duration compared with the conventional free-hand technique across surgeons with different levels of experience; second, to compare its performance with previously published alternative distal locking methods.
Methods:
A retrospective observational study was conducted across three trauma centers in Belgium. A total of 432 patients undergoing intramedullary nailing for long-bone fractures were included. Thirty surgeons (10 junior residents, 10 senior residents, 10 board-certified surgeons) performed distal locking using both the conventional free-hand technique and the proposed method. Radiation exposure and procedure duration were recorded and compared. Results were also compared with published data on alternative distal locking techniques.
Results:
The proposed technique significantly reduced radiation exposure, fluoroscopy time, and procedure duration across all experience levels. Mean radiation dose decreased from 35.47 ± 8.9 to 4.43 ± 1.1 cGy/cm2 (p < 0.0001). Fluoroscopy time decreased from 19.33 ± 6.2 to 11.5 ± 2.0 seconds (p = 0.003). Procedure duration decreased from 9.53 ± 3.1 to 4.23 ± 1.2 minutes (p < 0.0001). The greatest improvement was observed among less experienced surgeons. Compared with published techniques, the method demonstrated non-inferior or superior results in terms of radiation exposure and procedure duration.
Conclusions:
This simple and reproducible technique significantly reduces radiation exposure and operative time compared with the free-hand method. By eliminating the need to obtain a nearly perfectly round fluoroscopic image of the locking hole, the technique relies on hand-eye coordination and cognitive alignment rather than fixed geometric positioning. It requires fewer adjustments and repositioning of the C-arm. Its performance is comparable or superior to alternative techniques. It requires no additional equipment, making it practical for routine trauma practice.
DOI: https://doi.org/10.37349/emd.2026.1007127
This article belongs to the special issue Innovation in Orthopedics
Aim:
With technological advancements and altered work environments, it has been thought that the risk of low back injuries would decrease while the risk for upper extremity injuries would increase. This construct has not been investigated, with little information available on possible trade-offs in injury rates across body parts over recent decades. The objective of our work was to perform a time series analysis on low back and upper extremity workplace musculoskeletal disorders through the injury compensation claim system across Canadian provinces from 2000 to 2019.
Methods:
Injury claim data across all Canadian provinces from 2000–2019 were analyzed by grouping injuries based on the nature of injury, body part, and normalized to number of workers in each province.
Results:
Normalized injury claims for both low back and upper extremity injuries have decreased from 2000 to 2015 across Canada (p < 0.001), with faster declines in low back injuries (p < 0.001 to p = 0.0295 depending on nature of injury). Some Canadian provinces have seen a stagnation or slight increase in injuries since 2015. Sprains and strain injuries had the most claims for both the low back (84.8% of all claims) and upper extremity (55.6% of all claims). Tendinitis was the most common specific upper extremity injury (18.2%), followed by epicondylitis (5.3%), carpal tunnel syndrome (3.3%), and rotator cuff injury (3.1%) across all of Canada with the order varying by province.
Conclusions:
This study provides a comprehensive and updated look of the most prevalent musculoskeletal disorders as revealed by compensation data affecting Canadian workers over the last two decades.
Aim:
With technological advancements and altered work environments, it has been thought that the risk of low back injuries would decrease while the risk for upper extremity injuries would increase. This construct has not been investigated, with little information available on possible trade-offs in injury rates across body parts over recent decades. The objective of our work was to perform a time series analysis on low back and upper extremity workplace musculoskeletal disorders through the injury compensation claim system across Canadian provinces from 2000 to 2019.
Methods:
Injury claim data across all Canadian provinces from 2000–2019 were analyzed by grouping injuries based on the nature of injury, body part, and normalized to number of workers in each province.
Results:
Normalized injury claims for both low back and upper extremity injuries have decreased from 2000 to 2015 across Canada (p < 0.001), with faster declines in low back injuries (p < 0.001 to p = 0.0295 depending on nature of injury). Some Canadian provinces have seen a stagnation or slight increase in injuries since 2015. Sprains and strain injuries had the most claims for both the low back (84.8% of all claims) and upper extremity (55.6% of all claims). Tendinitis was the most common specific upper extremity injury (18.2%), followed by epicondylitis (5.3%), carpal tunnel syndrome (3.3%), and rotator cuff injury (3.1%) across all of Canada with the order varying by province.
Conclusions:
This study provides a comprehensive and updated look of the most prevalent musculoskeletal disorders as revealed by compensation data affecting Canadian workers over the last two decades.
DOI: https://doi.org/10.37349/emd.2026.1007125
This article belongs to the special issue Prevalence and Risk Factors of Work-related Musculoskeletal Disorders
Precision Spine Care integrates individualized diagnostics and interventions tailored to the unique anatomical and clinical characteristics of each patient. Recent advances in artificial intelligence (AI) and machine learning are addressing these challenges by enabling automated image interpretation, tissue segmentation, quantitative analysis of muscular and fascial features, and longitudinal tracking of structural and functional changes. These AI-driven capabilities support objective assessment, early detection of pathology, personalized rehabilitation planning, and continuous monitoring of treatment response. This approach becomes increasingly complex when incorporating advanced interventional techniques such as ultrasound-guided pain injections and AI tools. AI facilitates automated image interpretation, tissue characterization, and structure recognition, improving efficiency and diagnostic consistency. Augmented reality (AR) and mixed reality (MR) technologies enhance spatial orientation, procedural guidance, and anatomy education, while tele-ultrasound expands access to expert consultation, imaging support, and training in underserved regions. Although ultrasound remains operator dependent and AI outputs require ongoing physician oversight, the integration of ultrasound with AI, AR/MR, and telemedicine represents a significant advancement in spine care. These technologies complement traditional anatomical and clinical approaches, improving diagnostic accuracy, procedural precision, and personalized rehabilitation strategies. As healthcare systems face increasing demand and workforce constraints, technology-assisted ultrasound is positioned to play a pivotal role in advancing spine assessment, education, and comprehensive spine-focused musculoskeletal management. Ultimately, AI, ultrasound, and telemedicine serve to augment, not replace clinicians, enabling precision spine care that is safe, effective, and patient-centered.
Precision Spine Care integrates individualized diagnostics and interventions tailored to the unique anatomical and clinical characteristics of each patient. Recent advances in artificial intelligence (AI) and machine learning are addressing these challenges by enabling automated image interpretation, tissue segmentation, quantitative analysis of muscular and fascial features, and longitudinal tracking of structural and functional changes. These AI-driven capabilities support objective assessment, early detection of pathology, personalized rehabilitation planning, and continuous monitoring of treatment response. This approach becomes increasingly complex when incorporating advanced interventional techniques such as ultrasound-guided pain injections and AI tools. AI facilitates automated image interpretation, tissue characterization, and structure recognition, improving efficiency and diagnostic consistency. Augmented reality (AR) and mixed reality (MR) technologies enhance spatial orientation, procedural guidance, and anatomy education, while tele-ultrasound expands access to expert consultation, imaging support, and training in underserved regions. Although ultrasound remains operator dependent and AI outputs require ongoing physician oversight, the integration of ultrasound with AI, AR/MR, and telemedicine represents a significant advancement in spine care. These technologies complement traditional anatomical and clinical approaches, improving diagnostic accuracy, procedural precision, and personalized rehabilitation strategies. As healthcare systems face increasing demand and workforce constraints, technology-assisted ultrasound is positioned to play a pivotal role in advancing spine assessment, education, and comprehensive spine-focused musculoskeletal management. Ultimately, AI, ultrasound, and telemedicine serve to augment, not replace clinicians, enabling precision spine care that is safe, effective, and patient-centered.
DOI: https://doi.org/10.37349/emd.2026.1007126
This article belongs to the special issue Data-Driven and AI-Based Approaches for Musculoskeletal Disease Monitoring and Rehabilitation
Background:
Pain affected gait performance in patients with non-specific chronic low back pain (NSCLBP) due to protective mechanisms in response to pain. Insufficient evidence demonstrated whether pain altered the walking patterns in NSCLBP. Therefore, this review aimed to compare the walking patterns between individuals with and without NSCLBP.
Methods:
The literature was systematically reviewed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Cochrane, PubMed, Web of Science (WOS), EMBASE, and EBSCOhost were searched for the relevant studies, which were included if they: 1) compared patients with NSCLBP to the healthy controls, 2) evaluated spatiotemporal gait characteristics, 3) were published in English, 4) were peer-reviewed original research articles, and 5) were published since the year of 2000. Two researchers independently assessed the quality of the studies using the modified Downs and Black checklist. Meta-analyses with the random effects model were used, and the standardized mean differences (SMD) and the 95% confidence intervals (CI) were analyzed.
Results:
Out of 822 records, thirteen studies were included in the systematic review, and twelve were incorporated into the meta-analysis. The meta-analysis revealed significant differences between NSCLBP patients and healthy controls in walking speed (SMD = –0.67, 95% CI: –1.08 to –0.25, p = 0.002, I2 = 76%) and step length (SMD = –0.55, 95% CI: –0.94 to –0.17, p = 0.004, I2 = 64%).
Discussion:
Within spatiotemporal gait parameters, patients with NSCLBP show moderately consistent reductions in walking speed and step length relative to healthy controls, which may reflect pain-related protective strategies. These alterations underscore clinically meaningful gait impairments that should be considered in the design of targeted rehabilitation programs. PROSPERO registration number is CRD42023418511.
Background:
Pain affected gait performance in patients with non-specific chronic low back pain (NSCLBP) due to protective mechanisms in response to pain. Insufficient evidence demonstrated whether pain altered the walking patterns in NSCLBP. Therefore, this review aimed to compare the walking patterns between individuals with and without NSCLBP.
Methods:
The literature was systematically reviewed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Cochrane, PubMed, Web of Science (WOS), EMBASE, and EBSCOhost were searched for the relevant studies, which were included if they: 1) compared patients with NSCLBP to the healthy controls, 2) evaluated spatiotemporal gait characteristics, 3) were published in English, 4) were peer-reviewed original research articles, and 5) were published since the year of 2000. Two researchers independently assessed the quality of the studies using the modified Downs and Black checklist. Meta-analyses with the random effects model were used, and the standardized mean differences (SMD) and the 95% confidence intervals (CI) were analyzed.
Results:
Out of 822 records, thirteen studies were included in the systematic review, and twelve were incorporated into the meta-analysis. The meta-analysis revealed significant differences between NSCLBP patients and healthy controls in walking speed (SMD = –0.67, 95% CI: –1.08 to –0.25, p = 0.002, I2 = 76%) and step length (SMD = –0.55, 95% CI: –0.94 to –0.17, p = 0.004, I2 = 64%).
Discussion:
Within spatiotemporal gait parameters, patients with NSCLBP show moderately consistent reductions in walking speed and step length relative to healthy controls, which may reflect pain-related protective strategies. These alterations underscore clinically meaningful gait impairments that should be considered in the design of targeted rehabilitation programs. PROSPERO registration number is CRD42023418511.
DOI: https://doi.org/10.37349/emd.2026.1007124
The popliteus is a thin, flat, triangular muscle that originates from the lateral condyle of the femur and inserts on the posterior surface of the tibia and soleal line. Injury to the popliteus musculotendinous unit is an infrequent cause of posterolateral knee pain. This can result from a traumatic event or as a result of cumulative overload. This report describes posterior knee pain from a popliteal injury that resulted from an unusual low-velocity mechanism while performing a dance movement, which can be easily missed. Clinical and ultrasonographic features that lead to the diagnosis are described. The patient was able to return to dancing after physical rehabilitation and adjustment to dance technique. The report provides an account of popliteus injury through an unusual mechanism and treatment that can aid the clinician in the diagnosis and management of popliteus injury.
The popliteus is a thin, flat, triangular muscle that originates from the lateral condyle of the femur and inserts on the posterior surface of the tibia and soleal line. Injury to the popliteus musculotendinous unit is an infrequent cause of posterolateral knee pain. This can result from a traumatic event or as a result of cumulative overload. This report describes posterior knee pain from a popliteal injury that resulted from an unusual low-velocity mechanism while performing a dance movement, which can be easily missed. Clinical and ultrasonographic features that lead to the diagnosis are described. The patient was able to return to dancing after physical rehabilitation and adjustment to dance technique. The report provides an account of popliteus injury through an unusual mechanism and treatment that can aid the clinician in the diagnosis and management of popliteus injury.
DOI: https://doi.org/10.37349/emd.2026.1007123
Work-related musculoskeletal disorders (WMSDs) are a major occupational health burden, yet early functional alterations are often difficult to capture with symptom-only screening or with predominantly structural imaging. Infrared thermography (IRT) provides a noncontact, nonionizing, physiologically grounded readout of superficial heat exchange that is strongly influenced by microperfusion and autonomic vasomotor control. We conducted an integrative narrative review with traceable study-level compilation to synthesize physiological foundations for thermal-signal interpretation, minimum requirements for acquisition standardization and Quality Control, and occupational applications for screening, risk characterization, and longitudinal monitoring, including multimodal integration. The final included corpus comprised 247 studies spanning diverse designs and contexts, with substantial heterogeneity in devices, regions of interest (ROIs), environmental conditions, thermal metrics, and reporting completeness. Across the evidence, interpretability was consistently dependent on protocol stability and on ROI-based, within-subject metrics [bilateral asymmetry, task-induced temperature difference (ΔT), and recovery dynamics] rather than isolated absolute thresholds. Occupational applications have most often targeted repetitive upper-limb demands, computer-based work, and cold challenge/rewarming paradigms in vibration-exposed populations. We provide an operational checklist aligned with guideline recommendations and propose a pragmatic multimodal workflow integrating IRT with functional measures [surface electromyography (sEMG), strength], structural/perfusion modalities (ultrasonography), and patient-reported outcomes. Future priorities include multicenter harmonization, occupation- and task-specific reference profiles, and prospective validation of decision rules under real-world conditions.
Work-related musculoskeletal disorders (WMSDs) are a major occupational health burden, yet early functional alterations are often difficult to capture with symptom-only screening or with predominantly structural imaging. Infrared thermography (IRT) provides a noncontact, nonionizing, physiologically grounded readout of superficial heat exchange that is strongly influenced by microperfusion and autonomic vasomotor control. We conducted an integrative narrative review with traceable study-level compilation to synthesize physiological foundations for thermal-signal interpretation, minimum requirements for acquisition standardization and Quality Control, and occupational applications for screening, risk characterization, and longitudinal monitoring, including multimodal integration. The final included corpus comprised 247 studies spanning diverse designs and contexts, with substantial heterogeneity in devices, regions of interest (ROIs), environmental conditions, thermal metrics, and reporting completeness. Across the evidence, interpretability was consistently dependent on protocol stability and on ROI-based, within-subject metrics [bilateral asymmetry, task-induced temperature difference (ΔT), and recovery dynamics] rather than isolated absolute thresholds. Occupational applications have most often targeted repetitive upper-limb demands, computer-based work, and cold challenge/rewarming paradigms in vibration-exposed populations. We provide an operational checklist aligned with guideline recommendations and propose a pragmatic multimodal workflow integrating IRT with functional measures [surface electromyography (sEMG), strength], structural/perfusion modalities (ultrasonography), and patient-reported outcomes. Future priorities include multicenter harmonization, occupation- and task-specific reference profiles, and prospective validation of decision rules under real-world conditions.
DOI: https://doi.org/10.37349/emd.2026.1007122
This article belongs to the special issue Prevalence and Risk Factors of Work-related Musculoskeletal Disorders
Interstitial lung disease (ILD) is one of the most important extra-articular manifestations of rheumatoid arthritis (RA) due to its associated significant mortality. The availability of pharmacological treatments capable of slowing its progression, especially when initiated early, makes early diagnosis an essential part of its management. The low sensitivity of chest X-ray or lung function tests to identify RA-ILD in the early stages of the disease, together with the cost, accessibility, and ionizing radiation limitations of high-resolution computed tomography (HRCT), especially when serial screening or follow-up studies are required, has prompted the study of lung ultrasound (LUS) as an additional aid for the screening, diagnosis, and/or follow-up of RA-ILD. Based on the safety, low cost, and accessibility of LUS, and the encouraging results of research into this technique in ILD associated with systemic sclerosis, progress has been made in its validation process with research addressing aspects such as its accuracy, feasibility, and reliability. Negative predictive value and sensitivity values exceeding 80–90% have been reported, suggesting its potential utility. Feasibility has been suggested since LUS scan can be performed in less than 10 minutes, and intra- and inter-observer or examiner reliability shows values in the good to excellent range. However, there are still aspects that require further investigation, such as the standardization of the LUS scanning protocol or the requirements to ensure an effective learning curve before applying the technique in clinical practice. It is necessary to recognize the inherent limitations of LUS and understand that it should be considered a tool to aid in the early identification of patients who require HRCT, which is currently the diagnostic gold standard.
Interstitial lung disease (ILD) is one of the most important extra-articular manifestations of rheumatoid arthritis (RA) due to its associated significant mortality. The availability of pharmacological treatments capable of slowing its progression, especially when initiated early, makes early diagnosis an essential part of its management. The low sensitivity of chest X-ray or lung function tests to identify RA-ILD in the early stages of the disease, together with the cost, accessibility, and ionizing radiation limitations of high-resolution computed tomography (HRCT), especially when serial screening or follow-up studies are required, has prompted the study of lung ultrasound (LUS) as an additional aid for the screening, diagnosis, and/or follow-up of RA-ILD. Based on the safety, low cost, and accessibility of LUS, and the encouraging results of research into this technique in ILD associated with systemic sclerosis, progress has been made in its validation process with research addressing aspects such as its accuracy, feasibility, and reliability. Negative predictive value and sensitivity values exceeding 80–90% have been reported, suggesting its potential utility. Feasibility has been suggested since LUS scan can be performed in less than 10 minutes, and intra- and inter-observer or examiner reliability shows values in the good to excellent range. However, there are still aspects that require further investigation, such as the standardization of the LUS scanning protocol or the requirements to ensure an effective learning curve before applying the technique in clinical practice. It is necessary to recognize the inherent limitations of LUS and understand that it should be considered a tool to aid in the early identification of patients who require HRCT, which is currently the diagnostic gold standard.
DOI: https://doi.org/10.37349/emd.2026.1007121
This article belongs to the special issue Ultrasound as Outcome Measure in Rheumatic Diseases Trials
DOI: https://doi.org/10.37349/emd.2026.1007120
This article belongs to the special issue Innovation in Orthopedics
Paediatric orthopaedics has evolved as a specialized branch of orthopaedics, reflecting the understanding of child development and paediatric musculoskeletal disorders. The push for creative ideas and innovations has expanded its scope and indications to a wide group of musculoskeletal disorders in children. This review discusses some of the most impactful innovations of the late 20th and 21st centuries in the field of paediatric orthopaedic surgery and highlights their relevance in the management of complex problems. It includes their evolution over time, current strengths and challenges, and the scope of further improvement in the future. In addition, it discusses the future perspective and possibilities for similar groundbreaking innovations in the field of paediatric orthopaedics.
Paediatric orthopaedics has evolved as a specialized branch of orthopaedics, reflecting the understanding of child development and paediatric musculoskeletal disorders. The push for creative ideas and innovations has expanded its scope and indications to a wide group of musculoskeletal disorders in children. This review discusses some of the most impactful innovations of the late 20th and 21st centuries in the field of paediatric orthopaedic surgery and highlights their relevance in the management of complex problems. It includes their evolution over time, current strengths and challenges, and the scope of further improvement in the future. In addition, it discusses the future perspective and possibilities for similar groundbreaking innovations in the field of paediatric orthopaedics.
DOI: https://doi.org/10.37349/emd.2026.1007119
This article belongs to the special issue Innovation in Orthopedics
Aim:
Peripheral neuropathy is a frequent but often under-recognized extra-articular manifestation of rheumatoid arthritis (RA), frequently linked to chronic systemic inflammation. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a simple marker of systemic inflammatory burden. This study aimed to investigate the association between NLR and peripheral neuropathy in RA.
Methods:
This cross-sectional study included 230 RA patients. Peripheral neuropathy was identified through clinical evaluation and nerve conduction studies. Demographic and clinical data, serological status, disease activity [28-joint Disease Activity Score (DAS28)], inflammatory markers, and complete blood counts were obtained. NLR was calculated from absolute neutrophil and lymphocyte counts. Multivariable logistic regression was used to identify factors associated with peripheral neuropathy. Discriminatory performance of NLR was evaluated using receiver operating characteristic (ROC) curve analysis.
Results:
Peripheral neuropathy was present in 93 of 230 patients (40.4%). Patients with neuropathy exhibited significantly higher NLR compared with those without neuropathy (median 3.8 vs. 2.3; P < 0.001). In multivariable logistic regression adjusting for age, disease duration, disease activity (DAS28), C-reactive protein (CRP), serological status, and glucocorticoid use, elevated NLR remained independently associated with the presence of peripheral neuropathy [adjusted odds ratio (OR) = 1.92, 95% confidence interval (CI): 1.48–2.49; P < 0.001]. Other factors significantly associated with neuropathy included older age, longer disease duration, higher DAS28, and seropositive status. CRP and glucocorticoid use were not significantly associated with neuropathy in the adjusted model. In the overall cohort, the model including NLR demonstrated significantly improved discrimination for peripheral neuropathy compared with the base model without NLR, with the area under the ROC curve (AUC) increasing from 0.75 (95% CI: 0.69–0.81) to 0.83 (95% CI: 0.77–0.89) after including NLR (P < 0.001).
Conclusions:
Elevated NLR is independently associated with the presence of peripheral neuropathy in RA after adjustment for major confounders, and it demonstrates incremental discriminatory value for distinguishing neuropathy status in RA.
Aim:
Peripheral neuropathy is a frequent but often under-recognized extra-articular manifestation of rheumatoid arthritis (RA), frequently linked to chronic systemic inflammation. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a simple marker of systemic inflammatory burden. This study aimed to investigate the association between NLR and peripheral neuropathy in RA.
Methods:
This cross-sectional study included 230 RA patients. Peripheral neuropathy was identified through clinical evaluation and nerve conduction studies. Demographic and clinical data, serological status, disease activity [28-joint Disease Activity Score (DAS28)], inflammatory markers, and complete blood counts were obtained. NLR was calculated from absolute neutrophil and lymphocyte counts. Multivariable logistic regression was used to identify factors associated with peripheral neuropathy. Discriminatory performance of NLR was evaluated using receiver operating characteristic (ROC) curve analysis.
Results:
Peripheral neuropathy was present in 93 of 230 patients (40.4%). Patients with neuropathy exhibited significantly higher NLR compared with those without neuropathy (median 3.8 vs. 2.3; P < 0.001). In multivariable logistic regression adjusting for age, disease duration, disease activity (DAS28), C-reactive protein (CRP), serological status, and glucocorticoid use, elevated NLR remained independently associated with the presence of peripheral neuropathy [adjusted odds ratio (OR) = 1.92, 95% confidence interval (CI): 1.48–2.49; P < 0.001]. Other factors significantly associated with neuropathy included older age, longer disease duration, higher DAS28, and seropositive status. CRP and glucocorticoid use were not significantly associated with neuropathy in the adjusted model. In the overall cohort, the model including NLR demonstrated significantly improved discrimination for peripheral neuropathy compared with the base model without NLR, with the area under the ROC curve (AUC) increasing from 0.75 (95% CI: 0.69–0.81) to 0.83 (95% CI: 0.77–0.89) after including NLR (P < 0.001).
Conclusions:
Elevated NLR is independently associated with the presence of peripheral neuropathy in RA after adjustment for major confounders, and it demonstrates incremental discriminatory value for distinguishing neuropathy status in RA.
DOI: https://doi.org/10.37349/emd.2026.1007118
Work-related musculoskeletal disorders (WMSDs) are a major global occupational health concern, causing substantial pain, disability, and economic burden. They affect muscles, tendons, nerves, joints, and related structures, arising from or being aggravated by workplace factors. This narrative mini-review synthesizes evidence from targeted searches of peer-reviewed occupational health and ergonomics literature, focusing on epidemiological studies, systematic reviews, and recent advances in risk assessment. The review summarizes current knowledge on the prevalence and risk factors of WMSDs across sectors such as healthcare, manufacturing, construction, transport, and office work, where the lower back, neck, shoulders, and upper limbs are most frequently affected. Physical risk factors include repetitive motion, forceful exertion, awkward postures, prolonged static positions, and vibration exposure, while psychosocial factors such as high job demands, low control, inadequate support, and job dissatisfaction further increase risk. Individual characteristics, including age, gender, body mass index, and genetics, also influence susceptibility and highlight the need for tailored prevention, for example, interventions that accommodate women’s double work burden and age-sensitive strategies that help older workers maintain functional capacity. Advances in biomechanical modeling, wearable sensors, and multifactorial risk assessment now allow more precise exposure quantification and earlier detection of WMSD risk. Effective prevention requires multidisciplinary strategies that combine ergonomic workplace redesign, worker training, organizational policies addressing psychosocial risks, health promotion, and early clinical intervention. By consolidating epidemiological evidence, key risk factors, and prevention approaches from an occupational health perspective, this review supports evidence-informed prevention and underscores that coordinated occupational health policies and participatory workplace practices are essential to achieve sustainable reductions in the global burden of WMSDs.
Work-related musculoskeletal disorders (WMSDs) are a major global occupational health concern, causing substantial pain, disability, and economic burden. They affect muscles, tendons, nerves, joints, and related structures, arising from or being aggravated by workplace factors. This narrative mini-review synthesizes evidence from targeted searches of peer-reviewed occupational health and ergonomics literature, focusing on epidemiological studies, systematic reviews, and recent advances in risk assessment. The review summarizes current knowledge on the prevalence and risk factors of WMSDs across sectors such as healthcare, manufacturing, construction, transport, and office work, where the lower back, neck, shoulders, and upper limbs are most frequently affected. Physical risk factors include repetitive motion, forceful exertion, awkward postures, prolonged static positions, and vibration exposure, while psychosocial factors such as high job demands, low control, inadequate support, and job dissatisfaction further increase risk. Individual characteristics, including age, gender, body mass index, and genetics, also influence susceptibility and highlight the need for tailored prevention, for example, interventions that accommodate women’s double work burden and age-sensitive strategies that help older workers maintain functional capacity. Advances in biomechanical modeling, wearable sensors, and multifactorial risk assessment now allow more precise exposure quantification and earlier detection of WMSD risk. Effective prevention requires multidisciplinary strategies that combine ergonomic workplace redesign, worker training, organizational policies addressing psychosocial risks, health promotion, and early clinical intervention. By consolidating epidemiological evidence, key risk factors, and prevention approaches from an occupational health perspective, this review supports evidence-informed prevention and underscores that coordinated occupational health policies and participatory workplace practices are essential to achieve sustainable reductions in the global burden of WMSDs.
DOI: https://doi.org/10.37349/emd.2026.1007117
This article belongs to the special issue Prevalence and Risk Factors of Work-related Musculoskeletal Disorders
Background:
Nurses perform many daily care tasks that expose them to work-related musculoskeletal disorders (WMSDs). Many studies have reported a high prevalence worldwide. Analyses by continent have provided a better understanding of the WMSD occurrence, but none have yet been conducted among African nurses. The aim was to conduct a systematic review analysis with meta-analysis of the overall WMSD prevalence and the prevalence by body area among nurses in Africa.
Methods:
The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) method was used to present the results in the form of a systematic review analysis with meta-analysis. PubMed/Medline, ScienceDirect, Google Scholar, Mendeley, and Science.gov were explored between August 20 and 29, 2025 to identify studies that investigated the overall and body area WMSD prevalence among African nurses of any specialty without a date limit. Studies were included if they were cross sectional survey assessing the WMSD prevalence among nurses of any specialty or department working in Africa. Any study that was not a peer-reviewed cross-sectional survey published in English, that did not involve African nurses, or that did not report, or sufficiently detail data on the prevalence was excluded. The quality of each article included was assessed using the cross-sectional study assessment tool (AXIS). A meta-analysis with quantification of heterogeneity (Cochran’s Q test and I2 statistic) was conducted. Based on these parameters, a fixed or random effects model was selected to estimate the prevalence. Forest plots were used to summarize the overall, neck, upper back, lower back, shoulder, elbow, wrist, hip, knee, and ankle WMSD prevalence.
Results:
Nineteen cross-sectional studies were selected from the 4,305 identified studies, involving 4,670 African nurses from 10 countries. A significant heterogeneity was highlighted between studies (Cochran’s Q test and I2 statistic). Lower back [59.5%, 95% confidence interval (CI): 52.8–66.2%, 4,670 participants], neck (35.4%, 95% CI: 28.0–42.8%, 4,670 participants), and knee (34.4%, 95% CI: 27.2–41.6%, 4,601 participants) were the most exposed areas. The overall WMSD prevalence was pooled at 74.6% (95% CI: 67.0−82.3%, 4,266 nurses).
Discussion:
Comparison of these results with the literature showed that African nurses were less affected than those on other continents. However, the data were highly heterogeneous. Due to the numerous risk factors associated with nursing work, it is necessary to continue research projects and educational activities, as well as the development of health policies aimed at improving quality of life at work, specifically by expanding the investigation using subgroup analysis.
Background:
Nurses perform many daily care tasks that expose them to work-related musculoskeletal disorders (WMSDs). Many studies have reported a high prevalence worldwide. Analyses by continent have provided a better understanding of the WMSD occurrence, but none have yet been conducted among African nurses. The aim was to conduct a systematic review analysis with meta-analysis of the overall WMSD prevalence and the prevalence by body area among nurses in Africa.
Methods:
The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) method was used to present the results in the form of a systematic review analysis with meta-analysis. PubMed/Medline, ScienceDirect, Google Scholar, Mendeley, and Science.gov were explored between August 20 and 29, 2025 to identify studies that investigated the overall and body area WMSD prevalence among African nurses of any specialty without a date limit. Studies were included if they were cross sectional survey assessing the WMSD prevalence among nurses of any specialty or department working in Africa. Any study that was not a peer-reviewed cross-sectional survey published in English, that did not involve African nurses, or that did not report, or sufficiently detail data on the prevalence was excluded. The quality of each article included was assessed using the cross-sectional study assessment tool (AXIS). A meta-analysis with quantification of heterogeneity (Cochran’s Q test and I2 statistic) was conducted. Based on these parameters, a fixed or random effects model was selected to estimate the prevalence. Forest plots were used to summarize the overall, neck, upper back, lower back, shoulder, elbow, wrist, hip, knee, and ankle WMSD prevalence.
Results:
Nineteen cross-sectional studies were selected from the 4,305 identified studies, involving 4,670 African nurses from 10 countries. A significant heterogeneity was highlighted between studies (Cochran’s Q test and I2 statistic). Lower back [59.5%, 95% confidence interval (CI): 52.8–66.2%, 4,670 participants], neck (35.4%, 95% CI: 28.0–42.8%, 4,670 participants), and knee (34.4%, 95% CI: 27.2–41.6%, 4,601 participants) were the most exposed areas. The overall WMSD prevalence was pooled at 74.6% (95% CI: 67.0−82.3%, 4,266 nurses).
Discussion:
Comparison of these results with the literature showed that African nurses were less affected than those on other continents. However, the data were highly heterogeneous. Due to the numerous risk factors associated with nursing work, it is necessary to continue research projects and educational activities, as well as the development of health policies aimed at improving quality of life at work, specifically by expanding the investigation using subgroup analysis.
DOI: https://doi.org/10.37349/emd.2026.1007116
This article belongs to the special issue Prevalence and Risk Factors of Work-related Musculoskeletal Disorders
DOI: https://doi.org/10.37349/emd.2026.1007115
This article belongs to the special issue Biosimilars: State of the Art in the Treatment of Rheumatic Diseases
