From The Ergoweb® Learning Center

Musculoskeletal Disorders – Battling the Big Numbers in the Workplace

Around the world many thousands of professionals go to work each day charged with mitigating the pain of musculoskeletal disorders (MSDs), rehabilitating afflicted workers and grappling with risk factors. In the United States the condition accounts for 35 percent of all lost workdays reported to the Bureau of Labor Statistics (BLS). In search of “the inside line” on the battle to cut the big numbers, The Ergonomics Report(tm) recently interviewed three US ergonomists who work on the front line.

As measured by the Occupational Safety and Health Administration, the healthcare industry has the dubious honor of being the Number One source of MSDs across the nation. And it earns top position in most states, where regionally-important industries occupy places just below. In Washington the timber industry accounts for a significant rate of MSDs.

The View of MSDs from the Front Line

Miriam Wedemeyer, MS OTR/L BCN, sits on the Board of Directors of the American Occupational Therapy Association. The national role provides an almost limitless view of MSD issues. At the day-to-day level, as Director of the Ergonomics Program at Long Beach Memorial Medical Center and Miller Children’s Hospital in California, she is at the heart of the occupation that earned OSHA’s top ranking.

“According to the BLS,” she said, “healthcare workers hold six of the 10 highest risk jobs in the United States – higher risk than construction workers and truck drivers!” These workers suffer low back pain and sciatica, she noted, and have upper-back, neck and shoulder injuries related to pulling a patient up in bed, lifting a patient who is slipping off the bed or arresting a patient’s fall. To her list of high-risk tasks, the California ergonomist added reaching overhead and forcefully pushing or pulling video monitors or electrical plugs and bending low to get heavy food trays out of a cart.

Asked to expand on the particular physical burden for healthcare workers, Stover H. Snook, PhD CPE, described the day-to-day realities of handling patients. You know you are dealing with heavy objects when you are dealing with bodies, said Professor Snook, a nationally prominent ergonomist who teaches a course on lower back pain at Harvard University in Massachusetts. “Sometimes these bodies are pretty non-responsive and it’s just a heavy weight. Sometimes there’s resistance. Patients can get a little resistant or violent.”

Explaining the risk factors, he said nurses are bending over beds very often, or they are trying to pull patients up, or put them on a harness in order to put them in a mechanical device. “There is a lot of manual handling … forward reaching and heavy weights.” These circumstances are particularly evident in nursing homes and rehabilitation care, he added.

The state of Washington places healthcare at the top of its list, but it’s not the only one that contributes high numbers of worker’s compensation claims for MSDs. As a Senior Ergonomist with the Washington State Department of Labor and Industries, Policy and Technical Services, Rick Goggins, LNI, sees them all.

Industries involving the manual handling of materials – lifting, carrying, pushing and pulling – are the ones where they see the most back injuries, he said, listing construction, trucking, warehousing, logging and the manufacture of wood products.

Regionally, the last two on his list generate a disproportionate number of worker’s compensation claims. Explaining the phenomenon, the Washington ergonomist began by crediting Bruce Coulter, CPE, as the source of his information about the timber industry. Goggins described Coulter as “the resident expert on ergonomics for logging, sawmills and wood products manufacturing.” 

In the logging industry, Goggins said, “we actually see more lower extremity MSDs – injuries to the hips, knees and ankles. A lot of the forested land is in mountainous areas, so there’s a lot of walking up and down steep hillsides and over uneven terrain while carrying heavy chainsaws and other pieces of equipment like wire rope.”

Sawmills are different, more of a manufacturing environment, he added. “They’re a fixed industry, the work is indoors and they have a greater ability to make changes to equipment and bring in assistive devices.” The main activities that result in back injury come from handling the lumber manually, he said, which has a lot to do with the type of equipment they have and how the lumber is run through the process.

Surprising Sources for MSDs

Ergonomist Goggins expressed surprise at some categories of occupation associated with MSDs in his state’s worker’s compensation data. He was puzzled when “Services to Buildings and Dwellings” appeared near the top. The high rate of injury made sense, he said, with the realization that janitorial and grounds-keeping work, which are both physically demanding, were included in the services.

“I’ve been a bit surprised to see that bus drivers, both transit and school buses, show up as having a lot of back injuries. I had thought that, without the lifting exposure you see in trucking, back injuries wouldn’t be that prevalent. It may be that static seated posture combined with whole body vibration are enough to result in back injury claims.”

Ergonomics – The Front Line of Prevention

All three ergonomists were asked for their thoughts on prevention of MSDs – on ergonomic interventions that showed promise for reducing the big numbers.

“We’ve made huge inroads into preventing these injuries,” noted the California ergonomist, “but it’s like a lawn with gophers – plug one hole, they dig another.” She concedes that she sees exceptions, but finds nursing personnel difficult to rehabilitate. “They often try to work through it, only reporting an injury when they can’t work any longer.” She described the “‘old school” workers as “proud, tough, and acculturated to sacrifice their own safety for the sake of their patients.” They have strongly resisted taking time to use the patient-handling equipment the hospitals provide, but she sees them “coming around.”

The ergonomic interventions? “For two-and-a-half years we’ve had a Lift Coach dedicated to keeping the equipment conveniently accessible. We continuously train and re-train staff in use of mechanical aids to move patients … (and) we’re always evaluating and bringing on board new devices and modifying the work site.”

Professor Snook described similar ergonomic interventions. He sees mechanized lifting as a significant development, and favors devices that can raise patients to an upright position or weigh or transport them. “Any kind of assist, any mechanical assist is (helpful), whether it be powered or just a mechanical advantage kind of thing.”

Mechanization and automation also figure significantly in Washington’s ergonomics strategy, especially in the state’s vital timber industry. According to Goggins, the logging side of the business ranks high in rates of injury per 100 workers in several injury categories when looking at the overall worker’s compensation statistics, and injuries from falls or being struck or caught are particularly troublesome. “With so many things out in the woods that could kill someone, the industry has been correctly focusing on basic safety issues first before getting into ergonomics.” Nonetheless, ergonomics plays a significant role. It helps reduce the physical demands of the work, he added, and reducing fatigue “should mean fewer accidents as well.”

He dissected a number of logging and sawmill operations to illustrate instances where safety measures and ergonomics to prevent MSDs work in harmony. “Companies that have switched over to mechanized logging, using heavy equipment to fell and transport timber, see far fewer injuries,” he asserts.

His examples of ergonomic answers for some sawmill operations range from tipping the saw slightly to encourage slabs of timber to fall right side up, and a pneumatic device to flip them. He pointed out that eliminating manual flipping saves backs as the slabs weigh up to 300 pounds.

Goggins regards ergonomic measures that incorporate mechanization and automation as a promising direction for industry in general. “Because a good deal of the back injuries are attributable to manual materials handling, processes that address that exposure seem to be the most effective.”

In much of his everyday work at the Department, Goggins works with companies to improve their MSD statistics by helping them focus on which risk factors to address and offering ideas for answers. He credits line-level employees with the most effective solutions. “Once the process is set up and employees have some basic understanding of risk factors and why the process is important, they can be a big help in bringing in solutions.”

He favors engineering controls, such as hoists for lifting or mechanization of a repetitive process. “One of the benefits of bringing in a device to help with lifting, as opposed to an administrative control such as job rotation, is that the engineering control can actually reduce the physical demands of the job, making it easier to bring a worker who has been injured, either on or off the job, back to work.”

The Washington ergonomist wasn’t asked to suggest how the battle against workplace MSDs can be won, but his concluding observation would serve as an apt reply: “I think it’s important to use a systematic process to find problems, implement solutions and then evaluate the solutions to make sure they’re effective. Organizations that do that well tend to have sustaining ergonomics programs with real results in terms of reduced injuries and cost savings.”

Sources: the Bureau of Labor Statistics; Occupational Health and Safety Administration; Miriam Wedemeyer; Stover H. Snook; Rick Goggins; Bruce Coulter

This article originally appeared in The Ergonomics Report™ on 2005-09-21.