June 27, 2023 – While in her 60s, Carole E., a retired accounting assistant in Albuquerque, NM, began experiencing neck pain. She found that three of her cervical vertebrae were compressed and her entire spinal canal was narrow.
“The neck problem was treated with surgery to stabilize the discs and prevent them from compressing further, which could have led to paralysis,” said Carole, now 81.
Although the surgery helped Carole’s neck, she continued to have back problems. She developed degenerative disc disease and over the past 3 years has developed severe hip pain, muscle cramps and seizures in her legs, and arthritis in a rotator cuff.
Carole also developed heart disease.
“I always had a heart murmur, but it was very small and weak and I was told not to worry about it,” she said. “But about 3 years ago it became a ‘moderate’ murmur and the cardiologist said we should monitor it and assess it every 6 months.”
The murmur suddenly became “severe” and startled her cardiologist. Carole underwent successful valve replacement surgery a few months ago.
Now, new evidence suggests what happened to Carole and others like her. This suggests that people like Carole, who are at high risk for heart disease, are much more likely to develop muscle and joint disorders (called musculoskeletal disorders).
Common, but not well documented
The study’s lead author, Kurt Hegmann, MD, MPH, professor of family and preventive medicine at the University of Utah and director of the Rocky Mountain Center for Occupational and Environmental Health, explained what prompted the study.
“These injuries are common and affect most people several times in their lifetime,” he said. Up to 5% of the US population suffers from carpal tunnel syndrome, up to 41% suffer from tennis elbow (also called lateral epicondylitis) and up to a third have rotator cuff tears.
These conditions are “painful, lead to disability, may require surgery, and can cause chronic pain,” Hegmann said. “In short, they can harm peopledaily life and pleasure of ple.
But although they are quite common, there is “little scientific data” on their cause, he said. “We designed this study to comprehensively identify the risk factors behind these common problems so that we can help prevent them.”
The researchers studied 9 years of data from 1,224 workers in various employment sectors (manufacturing, healthcare, office jobs and food processing) in three states: Illinois, Utah and Wisconsin.
At the start of the study, participants completed questionnaires about their age, gender, health status (such as diabetes), smoking, hobbies, exercise habits, depression, and job satisfaction. They were also interviewed about symptoms, such as tingling and numbness, and underwent physical exams and nerve conduction studies. Their body mass index (BMI) was calculated using their height and weight, and their blood pressure was measured.
Participants were followed on a monthly basis to monitor changes in symptoms of musculoskeletal disorders. Disorders studied included carpal tunnel syndrome, tennis elbow, golfer’s elbow, and rotator cuff tendonitis.
The researchers then compared the development of these disorders to the risk of cardiovascular disease, using a method derived from the Framingham Heart Study – a frequently used means of testing the risk of developing heart disease over 10 years.
All analyzes were adjusted for factors that may affect results, such as a participant’s BMI or work-related physical exertion.
‘Early warning signal?’
The conclusions were striking. “The risks were up to 17 times, which is as strong as the relationship between lung cancer and smoking; this relationship was so big, it was quite surprising to us,” Hegmann said.
Participants who had a 15% higher risk of heart disease were four times more likely to develop one or more musculoskeletal disorders, compared with people at low risk of heart disease; and their risk of developing four or more musculoskeletal disorders was 17 times higher.
“There is strong corroborating evidence of damage from small blood vessels to injured tissues due to cardiovascular risks, so the data overwhelmingly suggests that cardiovascular risks are the root cause of these injuries,” said Hegman.
On the other hand, people with musculoskeletal disorders “may also reduce their activity level, which could lead to an increased risk of other cardiovascular problems, such as heart attacks.”
Carole says that over the past few years she has become largely sedentary due to physical pain in her hips and legs.
“I started cardiac rehabilitation after my valve replacement, but using stationary bikes hurts my hips and legs and I am in a lot of pain. And machines that also exercise my arms hurt my shoulders,” she said.
She decided to see a pain management specialist who can guide her on how to exercise safely and painlessly.
Hegmann said reducing the risk of cardiovascular disease “will reduce the risk of sustaining one of these common musculoskeletal injuries.”
Conversely, “the more one develops these injuries, the more and more it is critical to work to control the cardiovascular risks of this person”.
In fact, the authors suggest that musculoskeletal disorders could be considered potential “early warning signs” for cardiovascular disease, as they can appear in a person with no apparent heart problems years or even decades before cardiac symptoms do not appear.