The accommodation of seafarers and fishermen who are able to fulfil their duties on board but still experience a degree of difficulty in certain situations is a challenge for the individual seafarer as well as for his supervisor and for the advising physician. In many such situations it should be recognized that the aggravation of pain does not necessarily implicate ongoing progressive tissue damage; i.e. with uncomplicated low back pain, the best treatment is to pursue normal activity including work-activity, while at the same time not misusing the back by for example ongoing bending or extremely heavy lifting or dragging. We are now aware that back exercises benefit many low back patients through strengthening the back and trunk musculature and, in fact, this is the advised treatment for most patients with uncomplicated low back pain. The striving for maintenance of normal use of the back during work should be viewed in this context.

However, while continued work activity is generally advocated with most musculoskeletal disorders this does not necessarily mean that the work must still be carried out in the same manner as usually. Evidently, it is wise to adapt the tasks and the way the work is done so that the seafarer is not bothered more than necessarily. In many situations one can also learn from such adaptation. The seafarer with a musculoskeletal health problem can be viewed as a particularly vulnerable person who should be accommodated according to his limitations, but also as a measuring devise that can indicate collective work-exposures that may be harmful – not only to the vulnerable individual seafarer but to any colleague in risk. Therefore the actions taken for the symptomatic seafarer can turn out to be also beneficial to others by leading to a general improvement of the work-methods or the ergonomic conditions on board.

The overall advice with regard to accommodating on board the seafarer or fisherman with a milder musculoskeletal disorder would be to promote the concept that there is room for everyone, and consequently that all crew members can work safely with due respect to their ailments. Possibly, the main constraint here is the psychological characteristics of seafarers and fishermen, many of whom share the personality of a macho culture with little emphasis on their own wellbeing and more focus on the task. This attitude is likely to expose them unfavourably to excess harmful exposure.

It is a medically important contribution to a person’s recovery to explain that resuming special work-tasks or beginning to work again after sick leave due to a musculoskeletal disorder should in most situations be gradual with regard to time and/or intensity. This is likely to prevent relapses. A controlled process where the sick or injured seafarer is actively involved leads to the best course and outcome.

One should also be cautious with regard to pain reduction by use of analgesic medication with the aim of being able to continue a harmful work. Recent research suggests that non-steroidal anti-inflammatory medication, which is widely applied for many locomotor ailments including tendinopathy may actually hamper the healing of tissue such as tendons. For security reasons, opiates would be contraindicated during work and therefore its use aboard during extended periods of time is discouraged.