It’s 5:45AM, and chances are there’s someone heading to work in the cold, feeling their back seize up as their orthopedic shoes slip slightly on the overnight ice, knowing that the ominous electric jolt running down their leg will only worsen throughout the upcoming shift in the area fulfillment center.
It’s 2:15PM, and someone out there is holding their bladder for as long as possible, desperate to stay on top of the grueling productivity metrics bolstered by automation on the floor, focusing on the familiar ache in their shoulder to distract them from the urge to piss their pants at work. Somewhere, someone who just clocked in is already grimacing and rubbing their wrist, their back, their hip, their elbow, their shoulder, their neck, their hands. Demanding quotas and escalating productivity metrics have a very human cost.
In 1983, Isaac Asimov theorized that by now the robotic revolution would dramatically change the way we work, leading us to “a life rich in leisure”. But for many people, this leisurely future has remained a fiction. As Josh Dzieza astutely surmised for The Verge, “The robots are here, they’re working in management, and they’re grinding workers into the ground.” For tech workers trying to keep up with the escalating demands of productivity, the physical wear-and-tear from occupational overuse injuries can lead to a lot more than sore joints.
When an injury at work goes untreated, it can lead to more pain down the road. This phenomenon is called central sensitization. Say there’s an inflammatory musculoskeletal disorder from a motion performed on the job, like carpal tunnel. It’s likely that pushing through such pain would be the preferred stiff-upper-lip solution of your shitty bosses’ dreams, but there are real long-term consequences to having to work injured. According to Dr. Mary Barbe, a professor at Lewis Katz School of Medicine of Temple University, untreated disorders of this nature can create changes in the spinal cord and the brain that lead to chronic pain. This means that even if the nerve in question gets a break from the inflammation caused at work, the central nervous system has already undergone changes that make it overly sensitized to pain.
That’s right: the pain continues beyond the initial injury. If you don’t catch an injury in time and begin the necessary rest and treatment plan, pain can persist long after the source of the harm is ameliorated. In these cases, the chronic pain persists because–very basically–the body has come to expect it and wants to protect itself against it. It is very challenging to treat, as it involves essentially re-programming the brain and spinal cord to function as they did prior to the injury.
Unmitigated overuse injuries are worsened by a lack of an opportunity to heal, which has both localized and systemic effects. Generally speaking, when there’s a small tear in a tendon or muscle, the body is primed and ready to heal it, provided there’s enough rest to get the job done. However, if the injury cannot be adequately repaired due to, say, needing to be at work to pay the fucking bills, the body gets stuck in a repeated injury-repair cycle, leading to a buildup of scar tissue, called fibrosis. Dr. Barbe says that when there isn’t enough time for proper restorative repair, a variety of tendon and muscle disorders can result.
Lateral epicondylitis (also known as tennis elbow), rotator cuff tears, degenerative conditions of the shoulder, lower back injuries due to things like repeated lifting or the constant vibrations of truck driving, these are only a few of the ways that repetitive on-the-job stress impacts the bodies of workers.
“There are a lot of studies that talked about [how] high job demand can increase musculoskeletal disorders,” says Dr. Barbe. High job demand can be both psychological and physical. In the former, pressure to work faster pushes people’s bodies to the limit and stimulates the production of cortisol and other stress-induced hormones; the later refers to the physical nature of the work itself. These situations are often compounded by low job control: work at a reasonable pace, and you might lose your job.
According to Barbe, it has been well-established since 2002 that high psychological job demand and low job control lead to increased musculoskeletal disorders. Not being able to go to the bathroom when you need to, pushing to meet escalating quotas, enduring harassment and hostility in the workplace, all of these things can increase occupational overuse disorders because of psychological strain.
That’s right, your brain is very much involved. It goes both ways: psychological strain can lead to more muscle and joint disorders, but also, a chronic overuse injury can change how your brain works. The systems are not separate. They are talking, and they are trying to fix the problem. With that in mind, here’s how something like that carpal tunnel you got from work can make you feel like shit all over your whole body.
Say you have inflammation in one tissue. “It sends out inflammatory mediators in the bloodstream. It talks to the brain,” says Barbe. Per this molecular chat at the blood-brain barrier, the brain will release cortical steroids to try to decrease the inflammation. But it can get stuck in a loop if there is continued inflammation, causing too much cortisol, which can have major downstream effects on multiple systems. It’s this escalation that leads to trouble.
For many, it’s common to feel pretty okay on Monday, but by the time that Friday shift comes, things are feeling extra rough. The cumulative effect of doing your job with an injury caused by your job grows as the week progresses. “Injury always induces an inflammatory response so that damaged cells can be cleared out and new tissues put down,” says Barbe. “That’s a normal response to normal healing.” Problems happen because without enough time for healing, the effects of inflammation in the injured region will spread to nearby healthy cells. That is, continued inflammation causes the otherwise healthy tissue around it to get inflamed too, adding to the influx of inflammatory signaling molecules in the blood. And those signals are going to talk to the brain.
“One way they get into the brain for a response is diffusion, simple by sheer bulk math of them in the blood,” says Barbe. A second way is by exciting receptors on the blood-brain barrier. These signaling molecules with their urgent messages about inflammation and injury tell the brain that there are problems to attend to. Now. So the brain gears up to respond to it. “Something bad’s happening out in the periphery of your body! Respond, respond, respond!” says Barbe. “So, it could be a virus; it could be a bacteria. But in this case, it’s a repeated injury response from work. But it’s the same response.”
The brain’s response to these kinds of threats results in something called sickness behavior. To simplify, when your brain receives this kind of input about trouble in the body, the brain will act like you have a flu. Normally, Barbe says, this is a good thing, this urge to retreat and go to bed until you feel better. “That’s really what the sickness behavior is supposed to be,” she says. “It’s really the flu response–hunker down, rest, wait until your body heals and you feel better and you can get up.” But unfortunately when this response is prolonged and dysregulated, there can be major issues.
Sickness behavior mean that “the systems start to shut down and slow down so that healing can go into place,” says Barbe. It makes people want to go to bed. Their brain is reading the messages delivered unto it by a stressed system and says damn, we’re sick. That is how an untreated occupational overuse injury can make people feel like shit in a general sense. “Malaise, sadness, fatigue, depression, aggression in some people–the whole shebang.” It’s a full-system response.
“People with low job control, high job demands and a repeated injury response peripherally, they go into overdrive. It’s an overload.” A full-system overload, that is. It’s not just that their backs hurt; it’s affecting their mental health too. “They’re not going to their doctor because they feel bad, or they don’t want to report it because they don’t want to get fired. And then the person gets more sick.”
It’s hard to overstate the effect of untreated, unmitigated occupational musculoskeletal injuries on workers, both physically and mentally. Being chronically injured doesn’t just affect the joints that howl on the clock, it can affect the very way the mind works. It affects the signals your brain sends your body. It affects how you feel. It affects you.