A Pain in the Mask; From “Mask Jaw” to trigger finger, the rise in pandemic-related workplace injuries

When it comes to focusing on workplace wellness amidst the pandemic, many things come to mind. Stress management, social distancing, mask-wearing and working from home when possible. All contribute to keeping workers healthy, both mentally and physically.

What many of us don’t realize however, is that some of these pandemic-dictated wellness measures can create unique problems of their own. Pain and injuries from improper or frequent mask wearing and working from home in less-than-ideal workspaces are on the rise, according to health organizations like the Good Shepherd Rehabilitation Network.

Therapists at the Allentown-based Good Shepherd are treating more cases of “mask jaw,” neck pain, and carpal tunnel syndrome, they say. In addition, as we all increasingly shop online, the warehouse and e-commerce workers tasked with filling our orders are facing their own problems. Back pain, trigger finger and shoulder injuries are all rising among these workers.

“Trigger finger is one of the many things we are seeing.” said Charlie Eberling, regional rehabilitation manager with Good Shepherd.

Trigger finger occurs when a finger gets stuck in a bent position. It is caused by inflammation of the tendon from overuse, he said.

“We see a prominence of overuse injuries in warehouse and ecommerce workers,” Eberling said. “We forget about the human aspect when we place an order; about the people under pressure to fill these orders with increased speed. They do a lot of overhead reaching, a lot of repetitive motions.”

Dr. Jeffrey Zlotnick, a family medicine doctor affiliated with Penn State Health’s St. Joseph campus in Reading, believes that overuse injuries in warehouse workers were common even before the pandemic.

“People working in warehouses like Amazon’s have a high rate of work-related injuries to begin with,” he said. “It’s easy to slip, lift and twist the wrong way. But with the increased use of ecommerce, these injuries are going way up.”

Health care workers and others required to wear a mask all day are seeking relief from aches and pains too, said Catherine Dara, manager of physical therapy at Good Shepherd.

“A lot of people are reporting jaw and facial pain,” she said. “People are calling it ‘mask jaw.”

The number of complaints prompted Good Shepherd to look into it. What they found was that it’s not necessarily the mask that is causing the jaw pain, but what people are doing while wearing it. Actions like jutting the chin out, constantly moving the mask, or readjusting the jaw aren’t natural for the human jaw, Dara said, and can cause misalignment and pain over time.  People tend to “mouth breathe” more when wearing a mask too, she said.

“We aren’t breathing the way we should be,” she said. “It’s causing more tension in the jaw than normal, including an increase in TMJ flare ups.” TMJ, or temporomandibular joint syndrome, she explained, is a disorder of the jaw muscles and nerves caused by the connection between the jawbone and skull. The disorder can lead to pain and discomfort if not treated.

Family medicine physician Zlotnick sees a lot of complaints of skin rashes due to wearing N95 masks among health care workers too, he said. These masks are designed to be tighter than an ordinary face mask for the public.

“The idea is that it creates a heavy filter,” Zlotnick said. “But that tight seal doesn’t allow the skin underneath to breathe, creating pressure ulcers. The skin breaks down over time.”

Zlotnick advises health care workers to wear an unscented emollient crème on their skin under the mask, and to take the mask off and let their skin breather whenever it is safe to do so.

N95 masks also restrict jaw movement, causing jaw pain in some individuals.

When patients with mask-related pain come to Good Shepherd for treatment, the therapist first makes them aware that there is more than one way to fix the problem.

“One of the first things we teach is proper resting position of the jaw,” Dara said. “Lips slightly touching, teeth apart, tongue floating towards the roof of the mouth. Then we explain how to breathe properly in the mask. In through the nose and out through the mouth gently. This alone can help a lot.”

Dara also advises patients to let the mask hang the way it should, not too loose or too tight. And to wear a better fitting mask if needed. Some health care workers find that the specialized N95 masks can be a little too tight, she said.

Gentle jaw stretches are also recommended. “We ask the patient to wiggle their jaw back and forth,” she said, “like shaking out your hand.  We create other specific jaw exercises catered to each patient.”

Workers at home on their laptops aren’t spared from injuries related to overuse either. Carpal Tunnel Syndrome is increasing as workers sit on beds and couches to work, rather than at ergonomically correct desks and chairs, rehabilitation manager Eberling said.

Carpal Tunnel Syndrome is caused by a pinched nerve in the wrist and can cause pain, numbness and tingling. “We advise them to get the best possible work from home conditions, from hands-free Bluetooth keyboards to ergonomically correct chairs. And to step away every so often to stretch, and simply get back to better postural habits.”

Penn State Health’s Zlotnick agrees. “The first thing to ask yourself when working at home is, ‘Do I have a good chair?’ Not paying attention to body mechanics can set you up for pain down the road.”

The good news is that early intervention with physical therapy can provide quick relief to most of these workplace aches and pains. Generally, patients find significant healing within the first two sessions, both Eberling and Dara said.

“Traditionally people wait too long,” Eberling said. “There is lots of “let’s wait and see if it gets better,” and that’s when therapy no longer becomes a viable option, and surgery is needed.”

“PT is good at preventing something from becoming more serious,” he added. “You will start getting numbness and tingling before the carpal tunnel progresses. You can stem off a lot coming to therapy when the injury is still moderate.  The goal is early intervention. That leads to cost savings, better quality of life and faster healing.”