1. What is Cumulative Trauma Disorder?
2. What causes it?
3. What can I do about it?

WHAT IS CUMULATIVE TRAUMA DISORDER?

Currently there is no universally accepted definition that specifically describes cumulative trauma disorder (CTD). There are a number of definitions, all of which suggest that repetitive use over time leads to microtrauma that occurs to such a degree that it overwhelms and exceeds the adaptive and healing capacity of the body. The literature contains a whole host of terminology describing what is commonly referred to as cumulative trauma disorders including: overuse syndrome, repetitive trauma/microtrauma, repetitive strain injuries, repetitive motion syndrome or injuries and occupational overuse injuries.

Specific diagnoses of upper extremity CTD include bursitis, tendonitis, various nerve entrapment syndromes, (i.e. carpal tunnel syndrome), de Quervains tenosynovitis, epicondylitis, shoulder peritendonitis, and others. Many cases of chronic low back pain, leg (shin splints) and ankle/foot problems (Achilles tendonitis and plantar fasciitis) may be secondary to persistent musculoligamentous strains/sprains and can justifiably be considered cumulative trauma disorders.

There has been some controversy regarding the validity of the various overuse syndromes. What needs to be considered and is so critically important is that in our society, there are many factors that lead to an individual's presentation and perception of being injured and unable to work. Experience suggests that cumulative trauma and repetitive strain do exist. All one has to do to validate the concept of CTD's is look at professional musicians and dancers, two groups of individuals who will often keep working despite discomfort from repetitive motion injuries. The same credibility and dedication to their jobs is present in many other injured workers with CTD as well. The controversy is not whether cumulative trauma disorders exist, but recognizing the importance of all the issues that can lead to this diagnosis and then finding a way to provide adequate treatment.

WHAT CAUSES CUMULATIVE TRAUMA DISORDER?

There are many factors that may lead to overuse syndromes. Computerization of the workplace has been considered a major contributor in the rise of CTD's. Individual, psychosocial and work factors together play a role in the development of these disorders. An individual's body habitus or size including height, weight and body build can influence the CTD. The worker may have a poor body design for the specific job activity. The injured worker may have learned inappropriate adaptation over time to get the job done either to save time and work more quickly, or because he was not taught proper body mechanics or how to perform the task correctly. Furthermore, the individual may be de-conditioned and lack the strength and flexibility to carry out the job task. There are many factors at the work site which can lead to CTD's including repeated, sustained or forceful exertions; excessive intensity or duration; localized mechanical stresses; prolonged constrained posture; extreme joint positioning; low temperatures; vibration; repetitive impact; tool and workplace design; job stress; and work organization. Too often overwhelming emphasis has been placed on productivity without adequate regard for the ergonomics of the work site and the physiologic limitations of the worker.

WHAT CAN I DO ABOUT IT?

Early recognition that a cumulative trauma problem exists is the first step. Aggressive treatment is critical in reducing injury and effecting an early return to work. Immediate acknowledgment by management of a workplace injury, however minor, is of paramount importance in the initial treatment of CTD's. The worker's perception of being injured and the employer's recognition of the reported problem may be more critical than whether there was actually significant tissue damage and the extent of the problem itself. Conservative treatment consists of physical therapy directed toward education about anatomy, the importance of correct posture and proper body mechanics. Biofeedback training may make a profound difference in symptoms. Medication and/or procedural management are often used to minimize symptoms and make therapy more tolerable.

Ergonomic evaluation and modification of the injured workers job station and tasks is of critical importance as all the medical care and physical rehabilitation in the world will be useless if the individual is returned to the same environment that caused the cumulative trauma disorder.

Some people will also develop symptoms of sleep disturbance, fatigue, sadness, decreased appetite, and/or anxiety. If these symptoms have a significant effect on your ability to function, it might be best to consider a coordinated program such as the Health Education for Living with Pain (HELP) Program. This program involves full day, daily participation over many weeks and promotes fitness training, nutrition instruction, biofeedback therapy and counseling by a team of skilled professionals who work together with you and your family. The primary goal is to teach you how to best manage your condition over the long-term. In our experience, this program helps to minimize the impact that this condition has on your ability to accomplish and participate in the activities that are important to you.