Tag Archives: repetitve stress injury

Good Ergonomics Is Good Economics: Computer Workstations Need Not Be Hazardous to Your Health

Introduction
Two thirds of employees in industrialized countries use a computer on a daily basis. One in five interact with a computer at least 3/4 of the total work-time1. This usage of the technology ushered in an epidemic of work related ailments known as musculoskeletal disorders (MSDs). They are also known as repetitive motion disorder (RMD), repetitive motion injury (RMI), repetitive strain injury (RSI), ergonomic related disorder (ERD) and cumulative trauma disorder (CTD).

Though these disorders may as yet not be household terms, the patent effects of substantial computer use reveal themselves in terms of increased morbidity and declining productivity. In short, in the absence of ergonomic practices, employee efficiency in the American workplace takes a substantial hit.

Chart 1

Chart 1

In fact, according to the United States Bureau of Labor and Statistics (Chart 1), the prevalence rates for these types of disorders increased 1200% from 1982 to 1994 for all standard industry codes; however, those who employed good ergonomic safety management strategies enjoyed a 27% decline through 2000. Even though the rate reached a plateau for office or knowledge workers (computer workers) the wane may have occurred as a result of skewed interventions (e.g., training, workspace design and layout, equipment and accessories, work organization, etc.)2.

In addition, according to the Liberty Mutual Workplace Safety Index, injuries due to repetitive motion disorders from using computers were the #4 cause of work injuries in 2001 and 2002. The bottom line? A $2.8 billion price tag in 2002 for haphazard ergonomics3.

The Good News
According to OSHA, work related musculoskeletal disorders are the most prevalent, most expensive, and most preventable injuries in the American workplace today 4. The Center for Disease Control and Prevention's Injury Control Division reveals that injuries follow the same principles as infectious diseases and are just as predictable and therefore, just as preventable5.

Historical Sketch Of Computer Usage
Twenty years ago, computer workstations typically adjusted easily; however, they were relatively uncomfortable. Over time, they have morphed into rather complex devices with myriad levers and buttons that allow an uneducated user too many options for damage. Position (user may sit or stand), chair interfaces that move in multiple directions, numerous viewing angles of the monitor and fancy keyboard constructions that are split in half and look like accordions supply bells and whistles that may end up delivering harm unless organizations provide training. For those in the know, today's desktop computer were not necessarily designed to cooperate with the body; the user's natural alignment and paths of motion need not become contorted or required to engage in movements that never were designed to become repetitive nor prolonged. Modern fixed computer workstations beg accommodation to the body's motion flow.

Unfortunately, just when we are getting accustomed to our cubicles and other workstation environments, and are making gains in users' ergonomic awareness, some large computer companies have stopped making these computers and amazingly, are forecasting the death of the personal computer. Over the last 10 years, advances in technology have brought us a smorgasbord of new miniaturized devices or gadgets that provide us with faster communication — in essence what amounts to a handheld mobile computer workstation. Ironically, with this enhanced portability comes additional risk exposure for injury, particularly for the hands and neck.

These smaller devices foster awkward postures such as hands twisted into claws, and unnatural neck and shoulder angles — in short, resulting in increased discomfort and less than-efficient performance6. The root cause appears to be poor design — keyboarding areas, pointing devices (mouse) and a monitor-to eye interface that work together to produce a non-accommodating interactive work station. In particular, laptops (notebooks), tablets, I-phones and various PDAs unwittingly draw an unaware user into muscular and skeletal distortions.

Are the gadgets themselves to blame? Arguably, what is most important is the method by which we interact with them: the duration of exposure (how much is too much?), work organization and flow-process stress that occurs at less-than-optimal locations for usage. For example, many users must often conduct business in places such as coffee shops, airport waiting areas, planes, trains, and automobiles — places not designed for anyone to remain effectively postured.

Several primary physical risk and causation factors come into play between the computer user and all computer workstation environments, whether large or small. Three interfaces must be negotiated: the support interface (chair and floor), the manual interface (keyboard and mouse) and the monitor interface (distance from user, luminance, height). In addition to physical risk factors, behavioral variables commonly emerge: individual keyboarding and mousing techniques and style, excessive work pace without a break, prolonged sitting, and awkward forward head and wrist postures complicate the risk. What should be done about this trend?

The Spectrum Of Prevention
Fortunately, there are several easy-to-use methods to implement an effective ergonomics program. Once incorporated, they have prevention potential. A good ergonomics program can minimize computer-related musculoskeletal disorders by utilizing a more proactive and comprehensive approach to the potentially disabling conditions computer users in various workplace settings encounter. The answer lies in numbers.

It has been well documented that an integrated model of ergonomics safety management is critical for developing a healthy, effective workforce provided the company emphasizes a grassroots participatory approach in order to maximize collaboration and communication. The first step is to dedicate an ergonomic team. A successful group should comprise: an ergonomist, risk manager or loss control specialist, health service provider, company management representative (e.g., human resources, CFO, general manager, etc.), and a pre-designated employee ergonomics team trainer (leader)7.

This model efficiently capitalizes company resources and makes the best use of opportunities for surveillance and behavior change. It has been particularly effective in various organizations where the majority of employees consist of office and biotechnical workers typically tethered to their desktops 4-16 hours; all the while engaging in forceful/repetitive/awkward keyboarding and mousing whether interacting with desktop computers or hand-held devices. This extended risk exposure without appropriate rest cycles invites subsequent unwieldy neck and constrained back postures. The inevitable result? Discomfort at best or an actual recordable MSD at worst.

Nevertheless, these disorders have been shown to respond significantly to surveillance and behavioral change interventions such as job-task-specific ergonomics team training that provides information about strategies to maintain neutral work postures and movements when interacting with computers (Table 1).

Table 1: Team Intervention Recommendations

Have A Seat
  1. While adjusting your chair, make sure that you are sitting on the seatpan.
  2. Maneuver the backrest so it supports the low back curve and the shoulder blades at a 90 -105 degree angle (upright and lever should be located at very back of chair on the right or ratcheting it up and down for the Office Masters).
  3. When keyboarding, recline to 120 degrees for surfing the net or telephoning and decline at 60 – 90 degrees for writing.
  4. Use sit-to-stand options (available now for alternating 30 minutes standing and 30 minutes for sitting).
Watch Your Hands
  1. While keyboarding/mousing, keep your arms, wrists and hands in a neutral work posture, as if playing a piano.
  2. Avoid flexing wrists downward, sideways or extending upwards.
  3. Place hands on lap or armrest when paused or resting.
  4. Wrist rests are to be used when resting only!
Feast Your Eyes
  1. Rest your eyes by placing hands in your lap for 30 seconds while looking away from your screen at another object 20 feet away. Repeat every ten minutes, as you really do deserve a break today … a small one now will give your body a big one later!
Ring A Bell
  1. Consider installing software that reminds you to take short breaks every 10 -15 minutes. While seated, stretch hands, neck and shoulders using helps such as the ForgetMeNot Online Reminders that can be found at the following link www.remedyinteractive.com> (microbreaks).
Stretch Your Day
  1. Get up from your desk or table and walk to the water cooler or perform some simple stretches near your workstation at least once every 50 minutes or so (macrobreaks) that can be found at the following link www.netergonomics.net (wallet-sized stretching cards).
Heads Up
  1. Pay close attention to head posture. Draw an imaginary line so that it begins at the top of your head, extends over your ear to the shoulder, ending at the hip.
  2. Head posture should be maintained suspended, like a puppet, with an imaginary line drawn from the top of head, over the ear, aligned directly over the shoulder and hip as viewed from the side. This avoids forward head posture or craning (for every inch the head moves over the shoulder, the neck bears 30 additional pounds of pressure per square inch … yikes!
No Foot Faults
  1. Plant feet firmly on the floor at a 90-degree angle to the knees.
  2. Avoid resting feet on the pedestals of the chair.
  3. Order a footrest if you are less than 5'2″ or have a medical condition that elicits edema (swelling) in the legs/feet. See www.ergoanywhere.com.
Arms Distance
  1. Place your computer monitor/monitors directly in front of you at an arm's length away or 18 – 28 inches with the top of the screen or tool bar at your eye level.
  2. Tilt the screen back 15 degrees, much like you would hold a book you are reading (unless you use bifocals/trifocals-then lower it slightly).
  3. Make sure you have had an eye exam within the last year.
  4. There are specialized accommodation products for mobile computer laptops, tablets, e-readers and smart phones found at www.ergovue.com that will make life a little easier while on the go!
Make It Happen
  1. Communicate with clients in easy-to-understand messages.
  2. Underscore the benefit to both the worker and the company that employs these practices.
  3. Emphasize the long term effects of increased production, increased efficiency, and improved personal health.
  4. Utilize specific and customized approaches such as the OccuCom Ergonomic Team Training Program package that is available at www.netergonomics.net, which also provides Cal-OSHA and Fed-OSHA compliance.

If your employees are experiencing any discomfort, have them contact their supervisor or designated ergonomics-team leader for a possible ergonomic evaluation of their workstations. Also, these same principles and practices will apply to employees with material-handling tasks of transferring mail, printed materials, folders, bins, etc. in the office area. Any employee whose tasks include lifting should be trained to use correct lifting postures, personal protective equipment, and employ stretching and strengthening recommendations for maintaining neutral work postures, especially in the wrists, shoulders, and low back.

Moreover, as ergonomists, health and safety professionals, human resources personnel, loss control and risk managers, and managers of various workplace settings, we must provide a solution to the question of how much exposure for those workers interacting with various computer devices is too much. Employees who must use a workstation are ever exposed to potential harm through extra strain or forces from the repetitive motions and awkward postures while keyboarding mousing, or staring at a monitor screen for hours on end. Further, we must be on the lookout for the important question in terms of what is good ergonomics vs. voodoo ergonomics. We must be adept at identifying the potential smokescreens of unsuccessful products and advice given to companies with real problems in their workplace. White collar environments are especially at risk for unqualified vendors … be careful out there when selecting an intervention program8.

References

1 Brandt, LP. Neck and shoulder symptoms and disorders among Danish computer workers. Scand J Work Environ Health 2004, 30:399-409.

2 Sherrod, C. Johnson, D. The modulation of upper extremity musculoskeletal disorders in a knowledge worker population with chiropractic care and ergonomics. ACC-RAC Washington, DC. Journal of Chiropractic Education, 58;2007.

3 Liberty Mutual Safety Index of 2002. Liberty Mutual Insurance Company Seminar. 2003.

4 Sherrod, C. The relationship between an ergonomics team training program and the compression of repetitive motion injuries in a bus operator population. ErgoCon Conference Proceedings, 4; 2000.

5 Cotton, P. Preventive medicine extends to injuries, too. Journal of American Medical Association 1990, 263:19-2097.

6 Korkki, P. So many gadgets, so many aches. New York Times. 2011; 12.

7 Sherrod, C. The relationship between an ergonomics team training program and the compression of repetitive motion injuries in a bus operator population. ErgoCon Conference Proceedings, 4; 2000.

8 Chong, I. Prioritize office workstation goals and watch out for voodoo ergonomics. Occupational Health and Safety. 1993, pg. 55-57.

Repetitive Stress Injury Has Become Cumulative Trauma for Employers

According to the medical dictionary, Repetitive Stress Injury (RSI) is defined as an injury that occurs as a result of over or improper use. According to the U.S. Bureau of Labor Statistics, nearly two-thirds of all occupational illnesses reported were caused by exposure to repeated trauma to workers’ upper body (the wrist, elbow or shoulder). While one common example of such an injury is carpal tunnel syndrome, in the workers’ compensation area RSI can also be claimed for shoulder, and back injuries. According to the Occupational Safety and Health Administration (OSHA), repetitive strain injuries are the nation’s most common and costly occupational health problem, affecting hundreds of thousands of American workers and costing more than $20 billion a year in workers’ compensation costs.

In the past, if an injury didn’t result from an accident, there was no workers’ compensation claim. Those days are gone and now it is understood that cumulative trauma injuries and occupational injuries that develop over time are eligible for workers’ compensation. Even if an injury cannot be tied to a single event, workers’ compensation benefits can be claimed.

According to the January 2012 joint publication by WCIR and IAIABC, every state allows workers’ compensation claims for cumulative trauma with the following limited exceptions:

Arkansas — limited to rapid repetitive motion for back or neck and hearing

Hawaii — not in the statue but handling like any other claim

Louisiana — only when considered an occupational disease

Tennessee — with limits to carpal tunnel only if it is arising out of the scope of employment

Virginia — only cumulative hearing loss and carpal tunnel are covered as “ordinary diseases of life” and subject to higher “clear and convincing” evidentiary standards as opposed to the “preponderance of the evidence.”

This widespread acceptance of RSI claims is becoming traumatic in in itself for employers, especially when one considers the requirements by CMS that were established to protect Medicare from future medical expenses for workers’ compensation and general liability claims. With these new mandatory requirements that all workers’ compensation and general liability claims be reported in electronic format, CMS has the mechanism to look back and identify workers’ compensation-related medical care payments made by Medicare. When CMS/Medicare learns (and they will) that it has been paying for workers’ compensation-related medical care it will seek repayment. The insured or employer could pay the future medical cost twice; once to the claimant at settlement and later when Medicare seeks reimbursement of the medical care they paid on behalf of the claimant, i.e. the cumulative effect.

Let’s focus on a key state, California, where this has become a pressing issue. Under California Labor Code Section 5412, the date of injury in cases of occupational diseases or cumulative injuries is that date upon which the employee first suffered disability therefrom and either knew, or in the exercise of reasonable diligence should have known, that such disability was caused by his present or prior employment.

The wording of this statute is proving to be very problematic for employers, as there is no clear-cut timeframe to hold an injured worker accountable to report said injuries. Even more so since cumulative trauma disorders are difficult to diagnose and treat and causation plays an important factor in determining AOE/COE. The magic bullet would be to determine if the injury is AOE/COE or to be able to age the injury. One of the only tools that has been proven effective is the Electrodiagnostic Function Assessment. The EFA is the only FDA-registered device that can age and diagnose this type of injury and its definitive registration allows the monitoring of the necessary frequency response that characterizes a repetitive stress injury. Additionally, it is the only device of its kind that has changed the face of RSI litigation.*

* U.S. District Court, 980 F. Supp, 640, 64-48 (E.D.N.Y., 1997): Geressy v. Digital Equipment Corporation. The EFA changed the face of repetitive stress injury litigation when Judge Weinstein overturned what, at that time, was the largest product liability verdict ever for RSI because of the EFA.