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Soft-Tissue Injury Prevention: Do We Need to Manage Psychosocial Risks?

Jan 24, 2024
Man sitting on a bed holding his lower back because he is in pain

Soft-tissue injuries are the all-time leading source of lost-time/compensable injuries, according to the Bureau of Labor Statistics and insurer Liberty Mutual.

Yet many safety professionals rely on injury prevention methods that have limited effectiveness because they fail to address the full range of causal factors, particularly psychosocial risks.

Robert Pater, M.A., managing director and founder of MoveSMART, says this is a perfect example of the Einstellung effect. Essentially, the effect defines what happens when prior experience or knowledge interferes with problem-solving.

“We apply previous methods to a seemingly similar problem instead of evaluating the problem on its own terms,” he writes in the June 2022 issue of Professional Safety. “We become unable to consider other solutions when we think we already have one, even though it may not be accurate or optimal.”

In the case of soft-tissue injuries or musculoskeletal disorders (MSDs), this often means safety leaders rely on methods such as:

  • Designing out physical ergonomic risks
  • Restricting at-risk actions
  • Purchasing supposedly safer tools and equipment
  • Creating policies and procedures (e.g., rotation, enlargement, lifting limits) to reduce physical forces

While these methods often generate some improvement, the results eventually plateau and safety leaders see diminishing returns. This is a sure-fire way to get stuck in a “good enough” safety culture, where leaders default to solutions that no longer move the needle toward greater improvement, Pater writes.

Instead, safety professionals should also consider nonphysical or psychosocial contributing risk factors, such as stress (that can directly impinge on risk perception and decision-making), job satisfaction (that can cloud reactions to recommended procedures) and social support (that can sway actions).

Injury Prevention That Considers Psychosocial Risks

Several studies link MSDs to psychosocial factors. While these factors are not the main cause of injury, they are a “significant contributing factor.”

In the study “ Psychologic Factors in Low-Back-Pain Disability,” researchers concluded that “a major factor is a victim’s perception of their own job; do they like it or not?” A four-year physician-driven study also examined a link between back pain and psychosocial factors, most prominently job satisfaction.

More recently, a 2021 review by EU-OSHA provides an overview of 53 published studies that show firm links between soft-tissue injuries and psychological risk factors — their effect combines with and often intensifies the effects of physical risk factors.

However, Pater warns that while the association clearly exists, “it is not possible to identify consistent patterns in those associations.” As a result, it’s not always possible to determine which psychosocial risk factors affect specific MSDs.

Consider the role of stress in soft-tissue injuries. Stress can cause a worker’s attention to narrow and diminish decision-making, which can lead to injury. Reducing stress is a difficult prospect; acceptable stress loads differ from person to person and can have many sources.

However, those variations don’t mean stress can’t be mitigated: Stress often equates to feeling mentally, physically or emotionally out of control, so “any work intervention that offers opportunities for workers to take any additional control of themselves is both stress-reducing and likely soft-tissue injury preventive,” Pater writes. 

This philosophy underscores many of his recommendations for preventing injury and reducing psychosocial risk factors.

11 Proven Strategies for Reducing Soft-Tissue Injury by Redirecting Psychosocial Factors

Informed by more than four decades of experience, Pater says these 11 strategies are key to significant and sustaining injury reductions that consider psychosocial factors.

  1. Use positive motivation to frame personal soft-tissue safety. Instead of focusing discussions of soft-tissue safety methods on injury avoidance, describe – and ideally demonstrate - the benefits, such as greater balance, strength and energy, or getting better at sports and hobbies.
  2. Help workers develop “safety-positive default habits” by applying these methods to off-work activities. Discussing and showing ways ergonomic principles and methods can help employees more easily perform daily at-home activities such as chores and DIY projects will reduce cumulative trauma.
  3. Encourage small changes and avoid overwhelmingly large ones. Continually applied small decisions and actions can lead to greater success with less stress and prevent tension buildup. Language can help: Instead of talking about what caused an injury, identify what contributed to an injury and what small actions a person might take to remain safer.
  4. Incorporate methods to boost self-control of work. Allow workers to personalize their work areas and methods where feasible. This might include sorbothane or foam shoe inserts, padding appropriate surfaces or moving PPE to where it better suits them.
  5. Develop policies and procedures that also reflect psychosocial risk factors. Social support (manager-worker, supervisor-worker, worker-worker) reduces dysfunctional and distracting work stress. Codifying team communication and support pathways aids this support.
  6. Tap the power of discovery. Rather than mandating new ergonomic methods, techniques and tools, empower discovery. (“Does this work for me?” “How can I best adapt this for myself?”) Doing so can reduce pushback, increase control and boost buy-in.
  7. Engage workers in designing, selecting and piloting new tools. According to the EU-OSHA review, “participatory ergonomics approaches bring benefits by raising awareness of ergonomic risks in the workplace and by encouraging and enabling the workforce to assess risks and find solutions through their collaborative efforts.”
  8. Enlist workers as peer agents to improve ergonomic methods. Allowing workers to train, coach and reinforce coworkers about manual materials handling can lead to what Pater terms “eye-popping improvements in MSD reduction."
  9. You don’t have to talk about stress to reduce it. “Stress” is often a loaded term that some prefer to avoid. But any intervention that helps workers feel more in control can help manage stress.
  10. Teach simple methods to alleviate forces from concentrating in vulnerable body areas. Many of these techniques improve physical balance and help reduce unnecessary tension or exertion.
  11. Incorporate mental MSD-prevention skills as well as physical ones. Improving attention control through self-monitoring can greatly reduce negative stress and allow workers to better understand potential risks.

To sustain success in reducing soft-tissue injuries and MSDs, Pater recommends safety professionals monitor both psychosocial and physical contributors and take steps to redirect them where possible.


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