Ergonomics and CTDs: the basics.

Ergonomics is a rather new word, first introduced some 30 years ago to refer to the study of workers in their environments. Essentially, the word means "fitting the worker to the job." The field of ergonomics also is young, and many people - employers and employees alike - still know little about it. In the article, "Introduction to Ergonomics" (Forestry, 1992), the authors state that ergonomics consists of two major elements:

* A technical part, concerning the practical aspects of optimizing work places, machines, tools, etc., often called "applied ergonomics," and

* A human part, concerning the description and knowledge of physical and psychological characteristics of man, in terms of measures, reactions, needs, capacities, and limitations.

Accordingly, ergonomics is not a single science, but the application of many scientific disciplines, including anatomy, physiology, medicine, psychology, and economics.

Cumulative Trauma Disorder 

We all have heard of baseball pitchers who develop various disorders in their pitching arms from the effect of forceful, repetitive motions executed with the arm in an awkward position or the long distance runners who suffer numerous lower-limb injuries.

Today, however, athletes aren't the only individuals who suffer on-the-job injuries or illnesses. And it is not just construction workers and those whose jobs require strenuous physical labor. As technology and other innovations invade our offices, a secretary or an accountant can suffer injuries - often without leaving their desks. During the last decade, an occupational illness identified as cumulative trauma disorders CTDs) has been occurring in epidemic proportions. The best known of these potentially disabling injuries is carpal tunnel syndrome, a cumulative, or gradual, injury to the wrist that is caused by repetitive motion (such as that used to work a computer keyboard). In addition, a variety of occupational illnesses/injuries - such as tendinitis, bursitis, and a majority of injuries to the lower back - can be considered CTDs.

By one characterization, CTDs have been called the "plague" of the last 15 years. In fact, according to the U.S. Department of Labor, more than 223,000 of the 368,000 work-related illnesses reported nationwide in 1991 were disorders associated with CTDs. In California, insurance premiums for workers compensation total about $8.5 billion annually, which amounts to one-fourth of the premiums paid for worker compensation nationally, according to the California State Department of Insurance.

Studies reveal that most serious and costly injuries to workers are caused by strains - injuries that occur because employees exceeded the physical limits of their bodies; lifting, lowering, overreaching, pushing, pulling, and carrying products or supplies are the main culprits.

In contrast strains in office personnel occur not from routine lifting of heavy materials but from routine sedentary behavior. Many employees suffer back problems from performing jobs that keep them in one position most of the day, such as sitting at a desk or operating a computer terminal. Others suffer injuries from being sedentary most of the day and then suddenly lifting a box of computer paper or reaching for an object on a high shelf.

The cost of CTD injuries can be quite high. In California, for example, the California Department of Insurance analysis of 1989 claims shows that average workers compensation claims for a "serious" CTD injury costs an insurer or self-insured employer about $20,000. Nationwide, estimates by the National Institute for Occupational Safety and Health indicate that one cumulative trauma injury - carpal tunnel syndrome, affecting the median nerve in the hand - costs $3,500 in benefits and up to $40,000 in medical costs.

In some cases, employers may incur additional costs in the form of civil lines. The Occupational Safety and Health Administration (OSHA) has begun issuing heavy fines for repeated exposure to physical stress. Recently, a Colorado-based luggage manufacturer was fined close to $500,000 for exposing 1,200 employees to excessive ergonomic stress, which resulted in CTDs such as tendinitis, bursitis, ligament strain, and lower back pain.

Parks and Recreation and Ergonomics

Ergonomics can include work site analysis and hazard prevention. All ergonomic measures aim to keep movement well within the full range of body motion, while minimizing the rate of repetition and the application of force. Ergonomics is a discipline that focuses on human capabilities and limitations in the design of jobs, work stations, tools, and equipment. Ergonomics can be used to prevent CTDs.

One of the greatest values of ergonomics - in parks and rec and other work environments - is that it causes people to think and promotes innovation. The workplace and production are seen from a new perspective: soon questions are asked about how a tool or production process can be redesigned to make it more user friendly. Ultimately, this stimulates fresh insights into an old problem.

Work station change is one preventive measure to avoid the kinds of CTDs that have been recognized by the Bureau of Labor Statistics as causing some of the most expensive workers compensation claims. Often, individual work stations for park and recreation personnel are unchanging and designed in ways that contribute to excessive reaching and poor wrist posture. Any such factors, in combination with other stressors, can lead to a repetitive motion injury. High rates of repetition, combined with a poor work station, can lead to a CTD. Repetition is the one "relationship" in all injuries of this type.

Elsewhere, park and recreation maintenance employees use a wide variety of hand and portable power tools that range from a pair of common hand pliers to power saws and powerful hydraulic equipment. Hand tools, especially the air-powered variety, create vibration which is severely damaging to the musculoskeletal and vascular systems. Many park and recreation workers toil in constantly changing environments, which means plenty of lifting, bending, and working in awkward postures. And park and recreation office personnel also are exposed to risk of CTDs. The office environment has been the subject of much recent ergonomics effort. Issues have centered primarily on adjusting the office to the use of computers, but range from design of chairs and lighting to overall work organization.

Task Modification

Dr. David Rempel, an occupational medicine physician, says, that protecting employees from occupational CTDs poses two challenges: identifying work-related risk factors and instituting appropriate modifications of work stations, tools, work organization, and tasks.

Practical approach to job modification, according to Dr. Rempel, should include:

* identification of the occupational risk factors;

* assessment by the employee and employer of the risk factors that can be modified; and

* assessment of the options to modify exposure by changing the work process, using alternative tools, reducing time on a high-risk task through job rotation or transfer, or using protective equipment.

Task Assessment

In seeking out work environments that need attention or revision, a park and recreation task assessment process evaluating all specific elements of a given job - including work-station design and job functions - is necessary. Onsite identification and subsequent evaluation of exposures relative to employees, materials, equipment, work methods, processes, and facilities then are analyzed. The process should include identification of high-risk jobs and opportunities for job redesign and alternatives or modified work possibilities. The park and recreation task assessment also provides opportunities for job requirements to be matched with physical capabilities.

Often, the changes recommended are as simple as adding handles to tools, raising or lowering work surfaces, or rotating job functions. Modifying the work itself also can be cost-effective; a proven link exists between a positive work environment, proper employee selection, and placement and the reduction of cumulative injuries.

Professional services also may be useful in re-examining work processes. Me park and recreation director may need to evaluate the need to bring in an ergonomics consultant to professionally analyze equipment, work flow, and body movements. It is important to try to find a consultant who will help develop reasonable, cost-effective, and relatively non-disruptive solutions. There are numerous ergonomics consultants, however, a professional ergonomist can be verified by contacting the Board of Certification in Professional Ergonomics, Bellevue, Washington, or Human Factors and Ergonomics Society, Santa Monica, California.

Parks and recreation departments have the responsibility to provide a safe and healthful workplace. Department and employee education regarding work practices and work tasks, job/task rotations, breaks, exercise programs, and other components of job activities all can be implemented where workers and employers join forces to address workplace safety and health concerns. When safety becomes an integral part of the department mission, direct and indirect costs of personnel loss through cumulative trauma disorder can be eliminated. As diverse as the symptoms are, the cause of this occupational illness is simple: poor work station design.

When properly used, ergonomic principles can reduce physical stress on employees as they work. Dan MacLeod, author of The Ergonomics Edge: Improving Safety, Quality and Productivity, states, "Understanding the basic principles of ergonomics and applying them systematically should be the objective of any organization. Much of ergonomics is common sense."

The application of ergonomics in park and recreation departments will allow for careful systematic evaluation of equipment, areas, facilities, and personnel and furnish concepts and techniques that can improve workplace efficiencies and enable optimum employee satisfaction and accomplishment of the department's mission.

References

Gilchrist, Timothy. Spring (1994). As profits grow, ergonomics takes the kinks out of today's workplace." Safe Workplace. Vol. 1, Issue 2, pp. 15-19.

Helander, Martin. (1981). Human Factors/Ergonomics for Building and Construction. New York. John Wiley and Sons.

Introduction To Ergonomics in Forestry and Developing Countries. (1992). Forestry paper, No. 100, pp. 1-4.

MacLeod, Dan. (1995). The Ergonomics Edge: Improving Safety, Quality and Productivity. New York: Van Nostrand Reinhold Publishing.

Minter, Stephen G. September (1993). Building safety into construction. Occupational Hazards. Vol. 55, p. 105.

National Institute for Occupational Safety and Health. July (1992). Journal of Commerce. p. 9.

Osborne, David J. (1987). Ergonomics at Work. New York: John Wiley and Sons.

Pheasant, Stephen. (1986). Bodyspace-Qnthropometry, Ergonomics and Design. Philadelphia: Taylor and Francis.

Remple, David, M.D., Robert J. Harrison, M.D., Scott Barnhart, M.D. February (1992). Work related cumulative trauma disorder of the upper extremity. JAMA. 12, Vol 267, No. 6, pp. 838-842

Rigdon, Joan E. September (1992). The wrist watch: how a plant handles occupational hazards with common sense. Wall Street Journal p. 1.

Robinson, Cynthia. Fall (1994). Simple solutions avert cumulative trauma injuries. Safe Workplace. Vol. 2, Issue 2, pp. 7-9.

Sand, Robert H. Summer (1992). OSHA focuses on cumulative trauma disorders. Employee Relations Law Journal Vol. 18n. 1., pp. 161-167.