Sharon Taylor’s dog is affecting her health. He’s just a puppy, but at nine months old, he already weighs 90 pounds, and all of it is pure energy.
“I am currently dealing with a rotator cuff strain from walking my dog,” Taylor, a CCPE-certified ergonomist in Edmonton, Alberta, Canada. “He is such a friendly dog that when he sees people he knows, or any other dog, he has to rush off to meet them, with me in tow.”
Taylor admits that the injury only impacts her job moderately. “I mostly do office ergonomic assessments and training. I do notice the aching while typing, filing, lifting and carrying,” she says. So far she’s had to limit the amount of time she spends at a computer to a couple of hours at a time.
Taylor’s situation isn’t unique. Each day, injuries like Taylor’s happen, either on the job or off, that may have been caused, impacted or aggravated by something the worker did during his or her off time. Everyday tasks, like picking up children or cleaning the house, or fun activities like gardening or bowling, even hobbies like playing the guitar or crocheting, can have an impact on the health of the worker on the job. But what can be done about it? That’s a question it seems no one is ready to answer.
According to an insurance company claims representative, each case is reviewed independently to try to determine the cause. Was it work related? Was it recreation related? Usually no one can tell for sure. The employee just knows it hurts to do his or her job.
Cumulative Trauma Disorders or CTDs, a type of musculoskeletal disorder (MSD), are soft-tissue injuries that occur over a period of time due to repeated trauma or exposure to a specific body part. Muscles and joints are stressed, tendons are inflamed, nerves pinched or the flow of blood is restricted.
Pinpointing the exact cause of a CTD can be difficult. The ergonomist, occupational therapist, safety manager, insurance company or whoever is given the task of determining what caused the CTD and how to address the problem, might fish around the workspace, see how the employee performs the job tasks, how things could be changed and then asks the questions about what the employee does on his or her own time.
As a consultant, one of Heather McBride’s clients requests that she do a workplace evaluation whenever an employee complains of an on-the-job discomfort. “We go in and look at the environment,” says McBride, an occupational therapist working with VirtuWell Health. “We have a form that we have them fill out to look at their work tasks, and what things that they may be doing off the job that could potentially contribute to or aggravate the problem.”
As for after-work tasks that McBride sees contributing to work discomfort, McBride says she sees it happen often with any number of activities. One employee who bowled frequently complained of shoulder discomfort. Another worker who played year-round softball reported arm pain. And an assembly line worker who was experiencing discomfort while working with tweezers spent her nights “relaxing” with crochet.
“We look to see if there are other issues outside of work. Even stress levels have a lot to do with it. We have to think about what causes a person to feel like they need to see someone [about their discomfort],” McBride says.
Trying to determine the cause of pain isn’t simple, particularly when insurance claims come into question. “We don’t get to see the other [non-work] environment,” says McBride. “Employers have to do the best they can.”
Dr. David Andrews, Associate Professor of Human Kinetics at the University of Windsor in Ontario, Canada, has been working with a team of students to try to determine to what extent non-occupational activities cause CTDs. “We know that cumulative loading on the low back (spine compression and shear forces, for example) are risk factors for low back pain reporting, at least in industrial tasks. The research group that I am working with is ultimately trying to determine a threshold limit value for cumulative low back loads and one of the issues we are looking at is what are the loads outside of work,” Andrews says.
In one of Andrews’ studies, three female and three male subjects were asked to perform household activities including vacuuming, dish washing, laundry, reading and cooking for a two-hour period. The loads lifted, lowered, pushed and pulled during these activities were documented using a digital force gauge.
The preliminary findings of Andrews’ team’s study indicated to the researchers that significant low back loads do occur outside of work, and that awkward trunk postures, which have been associated with the reporting of back pain in industrial settings, may be attributed to these off-work tasks. Andrews’ group also states that activities outside of work may be one of the reasons why “workplace-related low back disorders continue to exist despite considerable effort to reduce peak loads in the past.”
Then there are the occasions where the activity that may be causing the pain seems unavoidable, where participation in it isn’t a choice. An occupational health representative mentioned that sleeping positions seem to be the root of some of the problems she has seen, particularly when she has a worker complaining about neck and shoulder pain. On another occasion, an employee’s stressful daily commute and the white-knuckle 10-and-2 driving position he took triggered bursitis.
Studies have suggested that young children and the work associated with them might also increase the likelihood that a woman will develop an MSD. In one study of video display unit users, women with young children at home were found to be more likely to develop an MSD than were their male counterparts or their female counterparts without young children. In another study of female sewing machine operators, the ones with children were almost twice as likely as the other women to report chronic shoulder pain. While a recreational basketball player might be able to limit the time spent playing the sport or find an alternative activity, there’s really no way to suggest to a mother that she stop picking up her child.
Sandra Miller, a disability management coordinator and physical therapist, estimates that only about 10 percent of the claims she has seen in her career have been truly non-work related. And in her experience, she believes that most employers “are trying to do the right thing.” The employer makes ergonomic accommodations for the employee; they value their workers.
“Where people miss the boat is in tying the symptoms to the activity. A lot of people are doing the evaluations who don’t understand the epidemiology. They don’t try to trace [the cause of the pain] back. They’re trying to fix it instead of finding out what is causing it,” Miller says.
Finding the cause is the key to determining whose responsibility the injury really is. But when the pain doesn’t show up until the employee is on the job on Monday, regardless of the weekend’s activities that may have triggered the pain, it seems only logical to point the finger at the job itself, unless the worker knows otherwise. Like dog owner Taylor, for example. She’s taking matters into her own hands, limiting her computer time. But mostly she’s working to solve the source of the problem
This article originally appeared in The Ergonomics Report™ on 2003-06-01.