Where Does Ergonomics Fit Into Stress Reduction?

Office workers in the United Kingdom say they want to dump their desk jobs.  Business leaders in the United States believe poor workplace morale is hindering staff performance.  And workers themselves report their jobs leave them “overtired and overwhelmed.”  The reason for all of this disdain? Attribute it to workplace stress.

If stress seems like a personal matter, that’s because it is. So why is something that is unique to the individual having such an impact on the workplace? According to experts, it may be the result of a somewhat sketchy economy resulting in worker burnout, job insecurity, spillover from issues in workers’ personal lives, or even too few workers doing too many jobs.  But whatever the cause, the end result is that workers who report chronic stress could be, say some researchers, leaving themselves vulnerable to injury or illness and putting the workplace in a productivity slump.

Stress in itself is a physical and/or emotional response to “stressors” like a tight deadline or a hard-to-meet quota, learning a new task or procedure, or not having a voice in the work or workplace. At times, stress can be perceived as good for a person, acting as a motivator; other times it has the opposite effect, possibly leading to absenteeism, reduced productivity, or even an increased risk of musculoskeletal disorders (MSDs).

Dr. Jason Devereux of the University of Surrey’s Robens Centre for Health Ergonomics is one expert who believes that stress itself plays a large role in the development of work-related MSDs.  Devereux’s theory, backed by a recent research study he conducted, is that workplace MSDs are neither a factor of age, gender, neuroticism or a negative mood; work-related MSDs are, says Devereux, a combination of physical factors associated with the workplace itself, and, oftentimes, the amount of stress and the type of stress a worker is experiencing.

Devereux enlisted 8000 workers for a cross-sectional study, following over 3,100 of the participants for approximately 15 months, to determine what impact stress plays in the development of work-related MSDs.  Participants were asked questions regarding their own physical and psychosocial work factors, demographics, organizational factors, individual traits, attitudes, and well-being factors and stress reactions like perceived job stress, perceived life stress, depression, mental strain, psychosomatic symptoms, and musculoskeletal complaints. A follow-up questionnaire focused on perceived job stress and musculoskeletal complaints only.

Devereux found that workers who reported high levels of stress were four- to five-times more likely to report that they were depressed or mentally strained or that they had headaches, fatigue, stomach problems, trembling hands or a loss of appetite.  They also had a 50 percent greater chance of taking more than five days off work for health reasons.

The study also looked specifically at low back, neck, shoulder, elbow/forearm and hand/wrist pain to determine how various stressful situations or conditions might be exhibited by the body. What Devereux found was that low back complaints, for example, were associated with physical risk factors of lifting and pushing and pulling, and with psychosocial risk factors that included extrinsic effort, intrinsic effort, role conflict and threat of physical harm or injury at work.  In addition to physical risk factors of lifting, sitting at a computer, and bending or twisting the neck, neck complaints were also associated with psychosocial risk factors that included intrinsic effort, job future ambiguity, and verbal abuse and/or confrontations with clients or the general public.  Shoulder complaints were associated with low social support, low reward, job future ambiguity, threat of harm/injury plus physical risk factors like lifting and repetitive arm movements.  Elbow/forearm complaints were associated with physical risk factors that included vibration and repetitive tasks, and psychosocial risk factors including low decision latitude, social support, reward, role conflict, job future ambiguity, and threat of harm or injury. And hand/wrist complaints, associated with similar physical risk factors to elbow/forearm complaints, were also associated with psychosocial risk factors that included intrinsic effort, role ambiguity, and job future ambiguity.

Theories behind why stress may be a risk factor for MSDs and other injuries center around how the body reacts to chronic stress: simply put, stress affects the nervous system, putting the body in a “a constant state of activation,” says the American Psychological Association, and increasing the rate of wear to biological systems, ultimately making a person more susceptible to illness or injury.  Another way the body physically reacts to stress is by releasing certain chemicals, some of which are pro-inflammatory and can lead to tendon inflammation. Others, called corticosteroids, can lead to oedema, or swelling in the joints. This swelling and increased pressure in the joints can then become a risk factor for developing certain physical disorders as well.

Devereux’s research is unique in two ways: one, in dispelling the idea that demographics like age or gender can affect a person’s chances of developing a work-related MSD; and two, by pinpointing how the body reacts to specific stressors. “One of the strengths of this study is that it has investigated a number of different body regions – the lower back, the upper back, the neck, elbows/forearms and hand/wrists,” Devereux told The Ergonomics Report^TM. “This study clearly shows that workers perceptions of what they experience in the workplace in relation to time pressure, interruptions, increasing demands of the job, incompatible requests, or verbal abuse are important for management.”  Why? Because, said Devereux, “workers perceiving their job to be stressful were five times more likely to report poor general health and wellbeing, four times more likely to report depression and four times more likely to report psychosomatic complaints. Workers reporting high perceived job stress were 50 percent more likely to take more than five days off because of health reasons compared to workers reporting low to moderate job stress.”

A Universal Problem

Work related stress is nothing new, said St. Louis University psychology professor David Munz, Ph.D., who has been working with the topic of workplace stress for over two decades.  “Stress has always been in the workplace,” said Munz, “but now the world is a lot more complex, and stress in workplace can’t be divorced from stress in personal life. The reason [workers are reporting higher levels of stress] isn’t just because of workplace stress, it’s a combination of the two.”

Surprisingly enough, jobs that are considered to be the most stressful don’t correlate to those that are considered the most dangerous or taxing.  A report published in 2001 by the International Labor Organization found that some of the occupations with the highest levels of stress were predictable — miner, police officer, and airline pilot – and some weren’t, like journalist, musician and dentist.  The following list ranks jobs and their associated levels of stress based on a 10-point scale (10 being the highest stress level, compiled by the University of Manchester Institute of Science and Technology):

In the U.K., an estimated 30 percent of all workers report stress associated with their jobs at a loss of 40 million workdays annually; in the U.S., stress-related complaints are expected to cost in excess of $300 billion each year. Noting this trend has caused governments in the U.K. and Australia to make attempts at curbing stress in the workplace through guidelines, recommendations and regulations for employers. In the U.S., NIOSH has stated that “actions to reduce job stress should give top priority to organizational change to improve working conditions,” although no official guidelines for reducing worker stress have been created.

That may be because, as NIOSH implies, stress can’t necessarily be treated simply by making a few universally prescribed changes to the work environment – it may take a combination of efforts to positively impact everyone in the workforce.  The problem is that stress itself is uniquely personal.  “In general, people experience demands on them in different ways, what may be a stressor on one person won’t be on another,” said Munz. “Some [stressors] are felt by just about everyone – downsizing, for example, that’s a major stressor, almost everyone will feel it.  But some people find an excessive workload stressful, and some people are motivated by it. What’s stressful for one person may not be for another person.”

“We’re all more or less susceptible to different types of stressors,” said Dr. Alex Zautra, a researcher at Arizona State University’s department of psychology who has looked at the effect of stress on injuries and specifically MSDs. “We sometimes equate stress to demand, but people like demand and like to achieve.  The real question is ‘are the jobs designed with people in mind’,” Zautra said.

Both Zautra and Munz agree that job insecurity is today’s greatest source of workplace stress, something that may or may not be able to be controlled. What can be controlled is what’s considered to be the underlying cause of workplace stress: an imbalance or mismatch between people and processes.  While companies may employ concepts that help workers cope with stress, addressing the root cause of the imbalance can be more effective in removing the stressors and subsequently the stress.  Noted Michel Aptel and Jean Claude Cnockaert in the European Trade Union Technical Bureau for Health and Safety (TUTB) September 2002 newsletter,

“An impressive number of companies and organizations, particularly in North American and Northern European countries, have introduced programs and measures to help employees cope with stress. Typically, this type of program teaches the individual to deal with stress, rather than addressing the problem at source. This approach may therefore be described as being more reactive than proactive, since it is designed to cure the symptoms of exposure to stress, rather than to prevent stress from occurring. However, evidence is mounting that, although stress management programs focusing on the individual may be effective in the short term, they do not often have a lasting effect.”

Where Ergonomics Fits In

“You have to design workplaces so that they’re suitable for human activity,” said Zautra, who notes that sometimes employers balk at the idea of spending money to cure stress when there’s no true way of knowing if the stress is merely a work-related problem or if it is a spillover from personal issues as well.  But Zautra justifies stress-reducing expenditures this way: “[Stress is] a cost to the organization – it’s tardiness and absenteeism.”  Some companies may also be blind to the fact that stress isn’t just associated with more dangerous lines of work, said Zautra. “ We usually think of stressful jobs like air traffic controllers, but monotonous tasks can be stressful as well.  When you’re doing a lot of work that’s not interesting, your irritability quotient goes up.  That leads to interpersonal stress.”  And that, said Zautra, means that even a mundane desk job can cause a worker to rack up stress.  Research published in early 2004 in Occupational and Environmental Medicine backed up this assertion, finding that workers who deemed their jobs “monotonous” showed an elevated risk of developing shoulder pain.

If a mundane job can cause stress, does that mean stress is all in the worker’s mind? Devereux says his study shows that it’s not. “[The study] results show there is little evidence to support the argument that perceived job stress is due to the individual. Workers who are more emotionally resilient and don’t let past, present or future events upset or worry them may be less susceptible to the mental stressors that they face in the workplace,” he said.  “However, exposure to recognized risk factors in the workplace for developing perceived job stress and feeling overwhelmed were by far the strongest predictor [of stress and injury] in th[e] study.”

The injury risk factors Devereux’s study recognized were as follows:

Ø      Excessive workloads

Ø      Employees who feel overwhelmed by the workload and cannot switch off after work

Ø      Conflict between employees and managers

Ø      Verbal abuse from confrontations with clients or the general public

Ø      Threat of physical harm or injury

Ø      Frequent lifting especially while maintaining an awkward posture

Ø      Vibration from a power tool that makes the hands vibrate

Ø      Repetitive arm movements

Ø      Performing work with a deviated or bent wrist

Ø      Working with the head/neck bent or twisted excessively

Ø      Sitting and using a computer more than half the time

Ø      Seated for 30 minutes or more without a break while carrying out work

Can ergonomics principals be applied to all of these risk factors to reduce their impact or remove them altogether from the workplace?  Yes, says Devereux.  They’re already employed to address physical risk factors like repetition and vibration; now they just need to be applied to the psychosocial ones, too.

“Engineering controls, such as reducing lifting rates and load levels and eliminating the need to work in awkward postures will have little or no influence on the risk of developing work-related stress,” he said, although they will reduce some of the other injury risks Devereux’s study pinpointed.  “But when administrative controls are not in place to reduce exposure to the factors . . . and workers are feeling overwhelmed by the work, the risk of work stress will be significant.”

“For example,” Devereux continued, “working under time pressure and experiencing a number of other issues such as conflict, verbal abuse when performing work in an awkward posture could increase your risk four-fold of developing work-related stress compared to having low levels of exposure to these physical and psychosocial risk factors in the workplace. This is a large increase in risk. The level of exposure to a combination of the psychosocial risk is mainly responsible for the large increases in risk.”

How ergonomics fits in is by redesigning the work and workplace to make it more agreeable for the worker, like by making a tedious and complex task simpler or more enjoyable, asking for worker input on decisions that will affect his or her job, or by addressing administrative controls like taking breaks or vacations, giving the body time to recover from stress, something that Zautra says is needed to reduce the risk of chronic stress.  Without recovery time from recurrent stressors, “the body can’t adapt to [the stressor] and it leads to chronic elevations in stress levels,” said Zautra.  “Most [chronic stress] accumulates by not allowing the body to return to a homeostatic position.”

St. Louis University’s Munz approaches workplace stress from two angles: eliminating the stressors while also teaching workers how to cope with stressful situations.  “One [way to reduce stress] is eliminating it in the workgroup,” said Munz, “eliminating inefficient, ineffective demands on a workgroup — that will eliminate enormous amount of stress.”  It’s not always a big-picture problem that’s causing the stress either, said Munz. “Sometimes it’s the little things that are often causing the most stress. In one big company, the workers were expected to be making sales calls all day so they couldn’t leave their desks. It was causing a tremendous amount of stress for the workers. We went through the stressor reduction process, came up with solution to put up long cord on their headpieces so [the workers] could get up and move around. It was amazing in that [something so small] made a big difference.”

Devereux also looks to multiple efforts for stress prevention including risk analysis, planning, work-directed and worker-directed prevention measures, context-specific solutions, involvement of experienced practitioners using evidence based interventions, worker involvement and sustained prevention and top management support.

A useful approach, he said, is through team involvement coupled with full organizational support. “The objective of the team is to understand what are the real issues, what are the benefits of change, address the barriers to change, consider trial approaches and evaluate them, implement solutions and respond to new challenges,” he said, an approach that mirrors a traditional ergonomics program seeking to reduce injury risk factors. Stress, he said, is not just a problem for one person, but a preventable problem that affects the productivity and the physical well-being of the entire workforce.  Band-aids that simply focus on stress management may not be the answer, but ergonomics initiatives that address the root cause of workplace stress can have a positive effect on productivity, morale and a company’s bottom line.

Most workplaces embrace the responsibility of taking the initiative to reduce the potential of an MSD from a physical aspect of the job, for example by offering ergonomically-designed and appropriate chairs or adjustable workstations for one worker or the entire workforce, reaping the added bonus that almost always accompanies ergonomics — increased productivity and profitability.  So if stress is also deemed to be a true risk factor for developing an MSD, and it also impacts a workforce’s productivity, why shouldn’t a workplace address psychosocial stressors, whenever practical, as well?  If the stressor is a scheduling conflict, for example, can flex-time or job-sharing be implemented to resolve the stressor? If the stressor for an experienced employee is job burnout, can a new duty or responsibility be incorporated into the job or be used to replace a more mundane task? If the stressor for a new parent is being away from his or her child, is telecommuting or on-site child care a possibility? Or, if a job is simply not suited to a worker’s abilities, can that worker be transferred into a different position that matches his or her abilities and interests a little better?

And for dissenters who aren’t willing to address possible psychosocial stressors in the workplace simply because they don’t think stress is a work-related issue, Devereux has just one question — “If taking time off work because of perceived job stress is not a workplace problem then I would be interested to know what is,” he said.

This article originally appeared in The Ergonomics Report™ on 2004-12-08.