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Ergonomics Keeping the Worker on the Job

David Raptosh, MA, OTR/L

Regional Director of WorkStrategies

Job Site Analysis

� WorkRisk Analysis

� WorkTask Analysis

� WorkStation Analysis

Job Site Analysis - Identify Risk

� WorkRisk Analysis

� Analyze Job Functions and

Determine Risk Factors

� Establish a plan of action

� Implement the proposed

recommendation, modification or

reasonable accommodation

� Educate the employee to prevent in

juries and minimize symptoms

� Identify equipment and ergonomic

solutions

Job Site Analysis – Evaluate Job

Functions

� WorkTask Analysis

� Narrative report describing each

essential functions performed

� Physical and postural demands

quantified

� Frequency of each function listed

� Describe how the function is

performed

� List and description of tools used.

� Valuable tool for return to work

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Job Site Analysis – Ergonomics

� WorkStation Analysis

� Analyze computer workstation according to accepted ergonomic principles.

� Make adjustments to existing equipment.

� Educate regarding use of existing equipment.

� Make recommendations for possible equipment modifications

Ergonomics

� A discipline that involves arranging the

environment to fit the person in it.

� Following ergonomic principles helps reduce stress and

eliminate many potential injuries and disorders associated with

the overuse of muscles, bad posture, and repeated tasks.

� This is accomplished by designing tasks, work spaces, controls,

displays, tools, lighting, and equipment to fit the employee’s

physical capabilities and limitations.

» Center for Disease Control

» www.cdc.gov/od/ohs/Ergonomics/ergodef.htm

Ergonomics Benefits / Features

� Reduces lost time from work (Average Carpal Tunnel Syndrome lost work time is 30 days)

� Reduces worker’s compensation costs and claims

� Reduces human errors

� Reduces absenteeism and turnover

� Demonstrates proactive work environment

� Provides primary and preferred method of controlling

Cumulative Trauma Disorders

� Improves employees’ health and safety

� Improves production, quality, and efficiency

� Improves job satisfaction

� Boosts employee morale

Perspectives

Single-segment dynamic coplanar analysis at elbow

of forearm-hand flexion motion.

It doesn’t have to be hard or complicated

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Digital Neuritis

Trigger Finger

Radial Tunnel Syndrome

DeQuervain’s

Disease

Tendonitis

Thoracic Outlet Syndrome

Cervical Strain

Rotator Cuff Tendonitis

Mechanical Back Syndrome

Muscle Strain

Carpal Tunnel Syndrome

Guyon Tunnel Syndrome

Epicondylitis

Sub-Patellar Bursitis

Shin Splints

Plantar Fasciitis

Ligament Sprain

Herniated Disc

Degenerative Disc Disease

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CTDs

� Two main categories

� Tendonitis

• Lateral epicondylitis

• DeQuarvain’s Stenosising Tenosynovitis

• Post Tibials Syndrome

� Nerve compression

• Carpal Tunnel Syndrome

• Cubital Tunnel Syndrome

• Tarsal Tunnel Sydrome

• Radiculopathy

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Carpal Tunnel Syndrome

� Evidence of highly repetitive work alone or combined with other factors and CTS

� Evidence of forceful work and CTS

� Insufficient evidence of awkward postures and CTS

� Evidence of vibration and CTS

� Think for a moment about incidence and cost as related to risk factors and their reduction:

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Neck MSD

� Evidence for causal relationship between highly repetitive work and neck & neck/shoulder MSD

� Repetitive work was those with continuous arm or hand movements which loaded neck & shldr

� Evidence for forceful exertion & neck MSD

� Strong evidence for high levels of static contraction, prolonged static loads or extreme posture & neck/shoulder MSD.

� Insufficient evidence for vibration and neck/shoulder MSD.

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Shoulder MSD

� Evidence for highly repetitive work & shoulder MSD.

� Insufficient evidence for Force and shoulder MSD

� Evidence for repeated or sustained shoulder postures

and shoulder MSD

� Insufficient evidence for vibration and MSD

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Elbow MSD

� Insufficient evidence for repetitive work and elbow

MSD

� Evidence for forceful work and elbow MSD

� Insufficient evidence for posture alone and elbow MSD

� Strong evidence for exposure to combination of risk

factors and elbow MSD

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Hand/Wrist Tendonitis

� Evidence of Repetitions and hand/wrist tendonitis.

� Evidence of Force and hand/wrist tendonitis.

� Evidence of Posture and hand/wrist tendonitis.

� Evidence of Vibrations and hand/wrist tendonitis.

� STRONG evidence of combination of risk factors and

hand/wrist tendonitis.

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Hand-Arm Vibration Syndrome

� Strong evidence of high level of hand-arm vibration

and vascular symptoms of hand-arm vibration

syndrome (HAVS) – Shocker!!

� Greater the intensity and duration of vibration, greater

the HAVS incidence risk.

� Greater vibration intensity, greater HAVS severity.

� With increased intensity and duration, quicker onset of

symptoms.

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Low Back Disorders

� Evidence for back disorder and heavy work

� Strong evidence for LB disorder and force

� Evidence for awkward posture and LB disorders

� Strong evidence of whole body vibration and low back

disorder

� Insufficient evidence of LB disorder and static work

posture. (but few studies)

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Overview of Risk Factors and MSDs

Reps Force Posture Vibration

Neck + + ++ No

Shoulder + No + No

Elbow No + No All RF: +++

CTS + + No +

Hand/wrist

tendonitis

+ + + +

All RF: +++

Low Back Not studied ++ Awkward +

Static No

++

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Perspectives

� It Doesn’t Have to be Expensive

Bucket Analogy

Wear & Tear

���� Cumulative

Trauma: Wear

& Tear Exceeds

Healing

Healing

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Activity Factors� Activity Duration

� Repetitive Motions

� Awkward Postures

� High Forces

� Environmental� Vibration

� Cold

� Stress

Duration

� Eight hour day?

� Continuous activity?

� Breaks?

� Overtime?

Repetition Wrist CTDs - Reps & Force

Silverstein 1985

Low Force/

Low Reps

Hi Force/

Low Reps

Low Force/

Hi Reps

Hi Force/

Hi Reps

Odds

Ratio

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Force Awkward Postures

Vibration

Pressure

Points

Pressure

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Temperature Extremes Stressful Conditions

High Compression/Forces Vibration

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What are the Ergonomic Hazard(s) in

this office?Ergonomic Solution

Identify the Ergonomic Hazard(s) in

this office?Is there any Ergonomic Hazard here?

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Lathe Operator

Normal guy

Perfect Lathe Operator

Work in Neutral Postures

� Neck Straight

� Shoulders Relaxed

� Elbows at your side

� Wrists Straight

� Three Curves in the Back

Neutral Postures – Before & After

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Reduce Excessive Force Reduce Repetitions – Before & After

Keep Everything within Easy Reach Work at Proper Heights

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Minimize Fatigue & Static Load Minimize Pressure Points

Provide Clearance Move, Exercise, Stretch

� No one best posture

� Alternate sitting and standing

� Compensate for sustained postures

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10. Maintain a Comfortable

Environment

� Lighting

� Temperature

� Vibration

� Noise

� Stress

Work Environment

When To Recommend a Job Analysis

or an Ergonomic Evaluation

� Client with CTD, especially surgical case

� Recurrent injuries

� Method of injury – routine work activities & symptoms

developed over time

� Multiple injuries from same area of company

Questions?

David Raptosh, MA, OTR/L

Select Physical Therapy / NovaCare Rehabilitation

Regional Director of Work Strategies

2015 Technology Parkway

Mechanicsburg, PA 17050

Phone: 717-580-8749

Email: draptosh@selectmedical.com