Work-related musculoskeletal disorders (WMSDs) are a prevalent issue, associated with a complex interaction of occupational risk factors that can be linked to lower quality of work life (QWL). While these relationships are well-established, it remains unclear how age-based differences mediate them, as younger and older workers may respond differently to various workplace hazards. Understanding these age-specific pathways is crucial for developing targeted interventions. This study aimed to investigate the relationships between occupational risk factors, WMSDs, and QWL across different age groups to identify key differences and inform ergonomic practice. A sample of 312 workers, divided into young (under 45 years) and older (45 years and above) groups, was analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM) to test hypotheses linking biomechanical, psychosocial, and organizational risk factors to WMSDs and QWL. Significant differences were observed between age groups. Tight deadlines were associated with occupational stress (OS) only in older workers, whereas WMSDs were significantly associated with lower QWL only among younger workers. Physical job demands and OS were associated with WMSDs in both groups, and OS was related to their QWL. The findings indicate that worker age significantly influences how occupational risks are associated with WMSDs and QWL, and that these associations are not uniform. This study validated a model that examined the relationships among occupational risk factors, WMSDs, and QWL across age groups. The model demonstrated robust psychometric properties, enabling the identification of significant differences between young and older workers.

The immune system protects against invading pathogens and helps maintain homeostasis. Other pivotal roles include the regulation of tissue health through interactions with the nervous system. Understanding how these neuroimmune interactions may go awry in musculoskeletal conditions and how they can be targeted therapeutically may optimise patient care. We conducted a clinically focused narrative review of the role of the immune and nervous systems in musculoskeletal health and conditions such as neck pain, back pain and osteoarthritis and how psychosocial and behavioural factors impact these conditions via interacting with neuroimmune functioning. The interplay between the immune and nervous system is involved in both the physiology and pathology of musculoskeletal tissues, including bone, joint, nerve, muscle and tendon. We describe this at the local tissue, whole nervous system, and systemic (blood) level and how psychosocial and behavioural factors impact immune activity and influence outcomes. We also highlight recent advances in medical imaging and multi-omics that shed new light on the interplay between the immune and nervous systems in musculoskeletal conditions. Advances in understanding these relationships provide promising new treatment avenues for musculoskeletal conditions and important insights into how psychosocial- and behavioural-based therapies such as exercise and cognitive behavioural therapy work and can be optimised to improve outcomes. This review provides clinicians with a foundation in the neuroimmunology of musculoskeletal conditions. It also explores how the immune and nervous systems, and their interplay can be modulated to improve prevention and management strategies.

Non-specific low back pain (NSLBP) is the leading cause of global disability, and self-management is considered a key component of care. However, physiotherapists' approaches to supporting self-management can be improved. To explore how Italian physiotherapists conceptualize and enact self-management support for non-specific low back pain, and to describe perceived barriers and enablers to its implementation in routine practice. An online SurveyMonkey questionnaire was administered in February 2024 to assess Italian physiotherapists' knowledge and experience with self-management strategies for NSLBP. The survey consisted of 15 open-ended questions adapted from a Dutch study. Responses were analysed using inductive thematic analysis. Thirty physiotherapists (21 female, mean age 30.4±8.7 years) participated. Four themes emerged: (1) Therapeutic interaction style: active, passive, or multimodal?; (2) The patient as the main actor; (3) Self-management as more than a single tool; and (4) The physiotherapist's role in the self-management journey. Most participants viewed self-management support as essential and commonly used education as their primary strategy, while recognising its limitations. Although a variety of treatment approaches was reported, many remained grounded in biomechanical reasoning. A majority expressed the need for further knowledge and skills to better support self-management. Most participants recognised the importance of self-management in treating NSLBP but did not fully align with its core principles. Although they emphasised patient-focused, person-centred care, it remains unclear whether these principles are truly applied. Over half indicated a need for additional skills, consistent with broader challenges physiotherapists face in integrating self-management strategies.

Whiplash injury can impair neck muscle function, which is challenging to assess. Diagnostic ultrasound enables evaluation of musculoskeletal function and exercise effectiveness. To evaluate the function of five dorsal neck muscles before and after 12 weeks of neck-specific exercises in individuals with chronic whiplash-associated disorders (WAD), compared with healthy controls. Twenty-five individuals with WAD grades II and III and 25 age- and sex-matched controls participated in this study. The WAD group completed a 12-week neck-specific exercise programme. Outcome measures, collected at baseline in both groups and post-intervention in the WAD group, included neck muscle deformation (shortening and/or elongation) assessed by ultrasonography with speckle tracking analyses, neck disability (NDI; Neck Disability Index), neck pain (VAS; Visual Analogue Scale), and neck muscle fatigue (Borg CR-10). There was a significant difference in neck muscle deformation at baseline, with higher deformation in the WAD group compared with controls (F [1,214]=14.7, P<0.001). There was no significant difference in deformation between the groups after three months of neck-specific exercises in WAD compared with control baseline data F [1,200]=0.1, P=0.965), indicating restoration towards normal muscle function in the WAD group. The WAD group also improved in disability (NDI; mean 9.8, SD 8.4, P<0.001), neck pain (VAS; mean 12.1, SD 24.7, p=0.036), and fatigue (Borg CR-10; median 1.0, IQR; 0.5-2.5, P=0.019). The study indicates normalisation of dorsal neck muscle function in individuals with WAD after a neck-specific exercise programme.