Upper extremity work-related musculoskeletal injuries among chiropractic students at the Durban University of Technology

Abstract

Background: Chiropractic students the world over undergo rigorous training in manual therapy, specifically musculoskeletal manipulation and adjustment. These therapeutic modalities involve the use of the upper extremity to deliver its effects, usually with high velocity and force. This leaves the upper extremity vulnerable to injury, as a result of the repetitive and forceful nature of these manual techniques. Despite this risk, the research available on work-related musculoskeletal injuries of chiropractic students in South Africa is limited. This study aims to determine the prevalence of upper extremity work-related musculoskeletal injuries among chiropractic students at the Durban University of Technology, and selected risk factors associated with work-related musculoskeletal injuries. Method: The study design was a quantitative, descriptive, self-administered questionnaire study that used the total available population. The questionnaire was adapted from a similar study and included the use of a pilot study. The questionnaire had three sections: the first for demographic data, the second was applicable for any new injury to the upper extremity from work-related tasks, and the third was applicable for any old injuries to the upper extremity that were aggravated by work-related tasks. Prevalence was estimated using 95% confidence intervals. Factors associated with injury were assessed at univariate level, using Pearson’s chi-square tests and t-tests, and factors associated at the <0.1 level were selected as independent variables in a multiple logistic regression model to predict risk of injury. The odds ratios and 95% confidence intervals were reported. A stepwise backward selection method, based on likelihood ratios, was used to arrive at a final model consisting only of statistically significant risk factors (p<0.05). Chi-square testing and cross-tabulations were performed on the use of dominant hand and injury. Results: Eighty-six chiropractic students (n=86) were eligible for the study, seventy-seven elected to participate in the study, giving a response rate of 93.9%. The period prevalence of upper extremity work-related musculoskeletal injuries was 59.7% (95% CI 47.93 to 70.57%). The most commonly injured areas were the wrist (60%), shoulder (20%) and hand (17%), with majority of the injuries involving the soft tissue structures: muscle/ tendon strain (42%), ligament sprain (17%) and tendinitis (17%). Most injuries occurred during adjustive procedures (74%) and ischemic compression (19%). None of the demographic variables showed a significant association with prevalence of injury, apart from a moderately non-significant association with year of study (p=0.080). The frequent use of electro-modalities (p=0.073) and temperature therapy (p=0.077) were suggestive of possible associations, however, were not statistically significant. The results showed no significant differences between frequency of adjustments and injury. Despite an absence of statistical significance, a trend was noted showing an increased likelihood of injury when adjusting with the dominant hand. Conclusion: The study findings are consistent with those of similar international and local studies on the chiropractic profession (both academic training and professional), determining a high prevalence of work-related musculoskeletal injuries. The wrist was most commonly injured when performing adjustive procedures with the dominant hand. This study is in response to a call for further investigation and will help in future efforts to develop an injury preventative strategy for chiropractic training institutions.