Increased computer use creates ergonomic problem
Experts suggest solutions for workers' woes
Carpal tunnel syndrome and tendinitis are just two repetitive motion disorders on the rise among hospital workers whose increasing computer use creates injury-producing ergonomics problems requiring interventions by employee health practitioners.
At the 2,500-employee Providence Alaska Medical Center in Anchorage, Veronica Allmaras, RN, COHN, employee health specialist, has helped develop a procedure for evaluating and reducing ergonomics problems associated with seated work positions.
Allmaras says seated-position ergonomics problems can afflict almost any hospital worker with access to a computer, but that employees in departments such as medical records, admitting, business office, accounting, and purchasing -- whose jobs involve a great deal of data entry -- are most susceptible.
"The problem is that a computer would be plopped on someone's desk, and they would just start using it with no training or adjustments. Before long, they would develop soreness of the soft tissues of the arms, wrists, shoulders, or neck, or back problems from chairs," she explains.
Repetitive strain injuries have varied from mild discomfort to an urgent need for surgery, such as in some cases of carpal tunnel syndrome, she adds.
The hospital formed a task force to address the problem with representatives from employee health, safety, physical therapy, medical records (because of the department's prevalence of reported ergonomics problems), and purchasing.
"Purchasing representation is crucial," Allmaras states. "When we first started doing ergonomic evaluations and recommending acquisition of equipment without purchasing in the loop, people were ordering equipment themselves. It either didn't fit with existing equipment, or it wasn't what they really needed, or it wasn't available. Purchasing has contracts with different vendors, so with their help we were able to standardize a lot of our needs."
Low-budget solutions
Now physical therapists trained in ergonomics assess workstations and determine what new equipment is necessary. New purchases might include adjustable chairs, wrist rests, adjustable keyboard trays, monitor stands, or document holders.
"We try to use existing equipment as much as possible," Allmaras notes. "For example, on an old-fashioned metal desk, we might take out the pencil drawer and raise or lower the desk a few inches to accommodate the height of the person, then replace the drawer with an adjustable keyboard tray. We don't go for renovating an office or spending $5,000 to get a fancy new ergonomic workstation. We try to keep it simple, and by and large it works."
Since implementing the assessment program, the employee health department is receiving many more calls from workers regarding ergonomics problems. "In one way, it measures our success in that people have become more aware of ergonomics issues. It has raised the level of consciousness," Allmaras says.
In addition to self-referrals, problems are identified and handled when employee health receives an ergonomics-related injury report.
After receiving the injury report or phone call, employee health practitioners evaluate the need for a workstation ergonomics assessment through a triage procedure. Workers with more serious problems, especially the need for surgery, get first priority. Employees who expect a potential problem, but who are not injured, are lower on the list.
The physical therapist who performs the evaluation writes a report that is sent to employee health, which then gives a copy each to the employee, the employee's supervisor, and the purchasing department. One copy is kept in the employee's file.
Recommendations include physical changes to the work area, employee training needs, and often a regimen of on-the-job exercises. Allmaras points out that supervisors must accommodate the latter.
"If someone is supposed to stop work every hour and do stretches for five minutes, once the therapist is gone it's up to the supervisor to reinforce that," she says.
Sitting creates postural problems
Allmaras received ergonomics training from a course offered through the University of Michigan's Center for Ergonomics in Ann Arbor. (See Editor's note at end of article.)
Don Chaffin, PhD, director of the center and the Johnson chair professor of ergonomics at the university, says identifying workstation ergo-nomic problems is just the first step in the process of solving them.
The solution lies in focusing on the body postures and static muscle contractions involved in performing job tasks, he says.
"There are special kinds of postural problems associated with sitting for long periods of time," Chaffin explains. "The human body is designed to move around. Any time we constrain the posture for a long period of time, we're going to have aches and pains develop. For some people, that's not just inconvenience but actually can begin a process of inflammation, and later degeneration, of tissue because of prolonged [muscle] loading."
Fortunately, our muscles usually warn us that sustained contractions are severe in both duration and force by becoming painful before any serious inflammatory disorder occurs, Chaffin adds.
"We call that muscle fatigue. Most of the time you're dealing with simple acute muscle fatigue, and the best way to alleviate it is to change the posture -- shift the muscle loading to other muscle groups on a regular basis so the muscles get enough rest to recover metabolically from the contraction," he says.
This can be accomplished by varying job tasks. Workers should get up periodically to file or make copies, or just to move around.
Static muscle contractions often compromise circulation, and data-entry tasks require a worker to be constrained for prolonged periods. Therefore, the worker's chair must distribute loads so as to prevent pressure points on soft body tissues that could become painful after a period of time, Chaffin notes.
An ergonomically well-designed chair must support the user in a posture that reduces forces on various muscles by providing correct back and forearm support and adjusting to the appropriate height. This allows certain muscle groups to relax as much as possible while the worker is performing data-entry tasks.
How do you know if a chair is well-designed ergonomically? It should be adjustable to accommodate people of various sizes who are performing a variety of tasks in a variety of workplaces, Chaffin says. It should also be padded in a way that avoids creating pressure points.
"We cannot say that one particular chair always works," he notes. "The [chair] analysis must consider the task, the workplace, and the individual."
High-frequency repetition of data-entry tasks also presents an ergonomic problem.
"We have exceeded the normal human motion requirements when [work requires] rapid contractions
of very small muscles in the upper extremities on the order of as high as 20,000 or more contractions
in a workday doing data-entry tasks," Chaffin points out. "Under such high-
frequency exertions, many other muscles will also come into play because static contractions are
needed to fix the hand and wrist into a particular posture while keying."
Initiate prevention strategies
The combination of static muscle contractions -- which lead to muscle fatigue and pain -- with the rapid movement of muscles and their tendons can actually irritate the tendons, particularly if the fingers and wrists are in an awkward posture. This increases the risk of tendinitis. In addition, if inflammation occurs around the carpal tunnel area, increased pressure on the median nerve can produce neuropathy, Chaffin says.
Prevention strategies include correcting posture through good workplace layout and chair specification, and keeping frequencies of performing particular tasks at a reasonable level. What is reasonable depends upon the individual, he adds. No specific numbers have been established.
Generally, he suggests training data entry workers to avoid "heavy-fingered" typing. Workers also should avoid awkward wrist postures in favor of more natural, relaxed positions. Work should be paced to allow for five-to-10-minute breaks every hour, during which workers change joint positions and postures.
Barbara Berry, OTR, supervisor of occupational therapy at Nyack (NY) Hospital, says solutions to ergonomic problems associated with seated work positions are multifaceted.
"If you look for a quick fix, you don't always get a good solution," she says.
Teach workers to 'cue' each other
Berry is developing an ergonomics team at the hospital that will use a train-the-trainer approach for performing in-depth worksite ergonomic assessments. She says occupational or physical therapists trained in ergonomics can help hospital workers learn to "cue" each other when they are, for example, assuming bad postures. Employees also can be taught to recognize that fatigue of certain muscle groups in the neck or arms is an early warning of a problem developing.
Using a checklist (see p. 6) to perform ergonomic assessments when setting up a workstation is helpful, but closer investigation may be required if a problem arises, she notes.
"You can set someone up very well at a computer station, but without an ergonomic assessment of how their body moves in relation to that, you're only doing part of it," Berry states. "There are guidelines to the height of the video monitor and to the position of your arms in relationship to the keyboard. There are guidelines for the use of a soft rest on the edge of the table to support the arms, but it's a lot more complex than that. It's more involved than people like to think. One quick fix can create other problems."
For example, adjusting a worker's chair so it will be the appropriate height at a computer doesn't work if the employee then takes the chair to use at a desk that is at a different height, she points out.
[Editor's note: Many good ergonomics training programs exist. Check with a local university or consultant for more information. To find out more about the occupational ergonomics program mentioned in this article, contact the Center for Ergonomics at the University of Michigan in Ann Arbor, (313) 763-2243. Course offerings vary in length and cost and are offered at different locations across the country.] *
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