Efficacy of Ruta 1M in Musculoskeletal Disorders in Female Garment Factory Workers

Introduction

The Industrial revolution has made garment factories as the largest manufacturing sector in India. Garment factories account for around one fourth of India’s output and two fifth of total export. Karnataka is a major apparel sourcing destination for the global market. Women employees form the major workforce in this industry. There are various occupational diseases found among garment factory workers, thereby emphasising the need for improving the safety at occupation and health care.¹ 

Bengaluru in Karnataka is known as the ‘Garment capital’ of India, with thousands of ready-made garment factories. It is also called as Silicon city and Tech hub, providing direct employment to nearly five lakh people. There has been a boost to textile industries in the state since 2008.²

Studies show that musculoskeletal problems, eye strain, accidents, injuries, skin diseases, respiratory diseases and stress, insomnia, etc. are all common among garment factory workers. Their ill health is influenced by various socioeconomic factors such as poverty, lack of education, poor working conditions, excess working hours, and poor diet.³

Musculoskeletal disorders, often termed as MSDs can affect the muscles, joints, tendons, ligaments and nerves of our body. The commonly affected sites are back, neck, shoulders and upper limbs; lower limbs are affected less often. The symptoms range from discomfort, minor aches and pains, to more serious medical conditions. Although they are seen even in the general population, the frequent and repetitive activity with awkward posture at work places like garment factories increases the risk of MSDs. They may be painful during work or at rest. Most of the works in garment factories require the use of the arms and hands, lower limbs, eyes. Therefore, most MSDs affect these parts and also results in some back problems from repetitive activities.⁴

Musculoskeletal disorders are very difficult to define as per the international classification of disease. These disorders have many names, such as Repetitive motion injuries, Repetitive strain injuries, Occupational cervicobrachial disorders etc. There are three types of injuries: a) Muscle injury, b) Tendon injury, c) Nerve injury. The risk factors include fixed or awkward body positions, continuous and repetitive movements, forceful movements of the hand or wrist and a pace of work that allows insufficient recovery time between movements. ⁵

There are several departments in garment factories consisting of tailors, helpers, checkers, cutters, trimmers, supervisors and those who are working in the ironing section and finishing department. As per the studies, the important morbidities noted here are musculoskeletal disorders, refractive error, skin disorders and respiratory illnesses.

In today’s era, women have diverse roles to play in the society. Often they handle multiple tasks simultaneously Therefore, they are prone for work related diseases which are further complicated by social, psychological issues. Musculoskeletal morbidity is becoming common among middle-aged women (>30 years), particularly among those who had worked for more number of years, worked for longer hours (>10 h/day), and those who were engaged in cutting and sewing. All these are statistically significant.

The homeopathic remedy Ruta Graveolens belongs to the family Rutacea. It contains a number of active compounds such as flavonoids, alkaloids, coumarins and essential oil. Rutin, a flavonoid, is concerned with the action upon the eyes. Alkaloids and coumarins are known for their antispasmodic action. Ruta Graveolens is a very good remedy for pain and soreness in the bones, joints, tendons, and cartilage. Ruta is one of the excellent first aid remedies for sprains, injuries, strain, bruises, bones, pulled ligaments. It is also a good remedy for ankle sprains, soreness in the feet, ankles, Achilles heel, and lower back pain, over strain of ocular muscles.⁶

It is a very good remedy for rheumatism and head pains and neuralgia. It is indicated for formation of deposits or nodes in the periosteum, tendons and the joints, especially wrists. It is used for ill effects of bruises and fractures due to carrying heavy weights. It can be given for lameness after sprains. Lain on parts becomes sore, even in bed. There is a feeling of intense lassitude, weakness & despair.

Modalities Worse: overexertion, injury, sprains, eye strain, cold air, damp, wind, wet, lying, sitting, stooping, ascending, descending steps.

Better: lying on back, warmth, motion, rubbing.⁷

Homeopathic remedy Ruta Graveolens has a special affinity for fibrous tissue, flexor tendons, joints, ankles, wrists, cartilages and periosteum. Eye-strain from close study, sewing, etc. Pain in back or coccyx, as if bruised. Stitches in small of the back worse by sitting, stooping or walking; better by pressure and when lying down. Pain in the feet, ankles with difficulty in stepping. Restless and weak, turns and changes place frequently when lying. Shooting pain from the back, down outside of left thigh, worse from first motion or rising; hamstrings feel shortened. Because of this, the remedy Ruta has been used widely in the clinical practice to treat various musculoskeletal disorders. But the scientific research studies conducted are very few.

A study was reported in British Journal of Podiatry on Homeopathic remedy Ruta Graveolens for the treatment of pain in plantar fasciitis in 2008. In this randomized double trial, fourteen people suffering from plantar fasciitis were given Ruta Graveolens (30c) or placebo. Those using the Ruta reported a greater level of pain relief when compared to those in the placebo group. Only one study reported its efficacy in computer vision syndrome.⁸ Very few studies were conducted to verify the efficacy of Ruta in musculoskeletal diseases scientifically. 

Since the complaints noted among the female garment factory workers were similar to the symptoms of Ruta (ailments from overuse), this study was chosen to verify the efficacy of this remedy in this specific group of population with a specific potency. Against this background, the study of ‘Efficacy of Ruta 1M in Musculoskeletal disorders in female garment factory workers’ was chosen to determine the efficacy of specific potency in a specific occupational group. Hence the objectives of the study is to assess the extent of workrelated musculoskeletal health problems experienced by female garment factory workers and to identify the efficacy of Ruta 1M in the treatment of MSDs.

Materials and Methods 

Sample details: Women working in garment factories from Mallathalli to Sumanahalli.

Inclusion criteria:

1. Females aged 30-40 years working in sewing and packaging sections.

2. Women above 40 years working in clerical and quality control sections.

3. Musculoskeletal disorders ranging from discomfort, minor aches and pains of neck, back, shoulders, hands, wrist, ankles, and eyes 

Exclusion criteria:

1. More serious medical conditions like osteoarthritis, carpal tunnel syndrome, red flag pathology – recent trauma likely to be associated with significant injury, acute, red, hot, swollen joints

2. Respiratory and skin complaints

Hundred patients were screened. A simple random sample of 30 subjects were selected for the study.

Socio-demographic and occupational health data were collected via interviewer-administered survey 

Each patient was treated for two weeks with Ruta 1M and placebo to evaluate the pain relieving efficacy within a short period of time, based on the duration of action of the remedy. They were attended to once a week, for a period of 6 months. At each time, the pain reduction was assessed with the help of relevant tools.

The screening forms were designed based on the standard ART tool which was modified according to our study after consultation with experts. The task score was computed based on various risk factors like arm movements, repetition, force (ignoring the sides affected), head & neck posture, back posture, arm posture, wrist posture, hand/finger grip, breaks etc. The exposure score was calculated by the formula:

Exposure score = task score x duration multiplier

Note: Duration multiplier is a fixed multiplier used in ART tool to calculate exposure score based on the duration of task by a worker.⁹ 

This exposure score was calculated to assess the risk factors associated with the type of musculoskeletal disorders and to give necessary ergonomic improvement suggestions.

Results

Out of 30 selected subjects, 21 belonged to the sewing section (70%), 9 belonged to the packaging section (30%) (Figure 2, Table 2). Twenty two people belonged to the 30-35 years age group ( 73.3%), 8 people to 35- 40 years age group (26.7%) (Figure 3, Table 3). After the screening, it was found that 60% of the workers complained of headache and eyestrain, 13% complained of neck and shoulder pain, 13% had hand and wrist pain, 7% had lower back pain, and 7% complained of knee pain (Figure 4, Table 4). 

Statistical Analysis 

After the administration of Ruta 1M, the pain reduction in each category was assessed every two weeks and the scores were given based on the improvement experienced by the patient. The data was analysed as follows.

Discussion

The present research work showed that most of the women in garment factories complain of musculoskeletal pain at more than one site. Most of the women complained of headache and eye strain, neck, shoulder, hand & wrist pain, as the exposure was less than 5 years. The lower back pain and knee pain were noted in women in relation to the age and level of exposure (7% each) and the number of such women was less. The study showed the positive results of homeopathic remedy Ruta 1M on musculoskeletal disorders in female garment factory workers, especially for headache & eye strain. There was a subjective pain relief in hand and wrist complaints. Though efficacy of Ruta in musculoskeletal diseases is well known clinically, the scientific studies conducted are very few. This study made us understand the remedy in a better manner according to the research guidelines.

Limitations

The logistic support was inadequate to include a larger sample for the study.

Suggestions

Certain ergonomic changes in workstation such as adequate backrest to prevent lower back pain, frequent short resting periods to prevent headache, eye strain, neck, hand and wrist pain are required where the exposure score was high, for additional benefit. The suggestions for the same were given to the management. 

Conclusion

Overall, the study showed us that Ruta 1M was more efficacious in the treatment of headache and eye strain than in relieving hand, wrist, lower back and knee pain (statistically); though subjectively the patients were feeling better in hand and wrist pain too. However, selection of larger sample size would have given better results in these areas too.