Reducing Injury in the Workplace with Exercise and Ergonomics

1. Reducing Injury in the Workplace with Exercise and Ergonomics From the perspective of a physical therapist, Jamie Steier, and a fitness expert, David Sipes.

2. About Jamie Steier Physical Therapist for Summit Health for 19+ years Work Injury Management and Ergonomics Training Starting in 2000 Recertified in Ergonomics by Workwell Systems in 2016 Onsite Ergonomic Intervention Programs Ergonomic and Work Injury Prevention Educational Programs Treatment of Work Related Injuries

3. Common Work Injuries • Tendonitis/Tenosynovitis • Trigger Finger • Carpal Tunnel Syndrome • Sprains and Strains • Cubital Tunnel Syndrome • Rotator Cuff Tears • Knee Meniscus Tears • Low Back Pain

4. Causes of Work Injuries *MANYOF THESE WE CAN CONTROL* Overuse Accidents Poor Posture Faulty Body Mechanics Stressful/Unhealthy Habits Poor Physical Fitness

5. Decreasing Your Risk Exercise Proper Body Mechanics Good Ergonomics Decreasing Stress and Healthy Living

6. About David Sipes • Worked in Fitness field for 14 years • Written several published strength articles • Degree in Exercise Science • Certifications • NSCA CSCS, CPT

7. Exercise

8. The Benefits of Exercise • Exercise • Improves your fitness level and body composition • Combats disease and illness • Improves mental health and decreases stress • Improves sleep patterns • Increases our energy reserves • Decreased risk of disease

9. The Benefits of Exercise • Increased Energy and mood • Candy bar study • Caffeine (energy drinks, coffee, 5 hr energy) • Correct muscle imbalances/posture • Poor posture/imbalances can/does lead to injuries

10. The Benefits of a Prework Warm-Up Exercise Routine Increased joint nutrition Increased blood flow to cold muscles Increased flexibility and range of motion Increased energy Decreased likelihood of injury Increased heart rate and respiration GET YOUR BODY PREPARED TO WORK!!

11. Benefits of a Proper Warm Up • Preps body for exercise/improved performance • Increased blood flow to muscle • Increases temperature of muscle • Increases ability for hemoglobin to release oxygen • Less strain on the heart • 70% of subjects showed abnormal ekg • 90% of those with abnormal ekg was normal after a slow 2 min jog for a warm up

12. Benefits of a Warm Up • Decrease risk of injury • Increases range of motion • More force/lengthening of a muscle is needed to trigger an injury after a proper warm up

13. What is a Proper Warm-Up? • Stretch each muscle • Scapular retraction • Standing quad stretch • Shoulder stretch • Stepping knee hugs • IR/ER • Arm swings • Heel toe rockers

14. Movement Specific Warm-Up • Movement specific exercises • Hip/hinge • Body weight squat • Posture • The take away • A proper warm-up reduces risk of injury

15. Ergonomics The Principles

16. Ergonomics Definition of ergonomics an applied science concerned with designing and arranging things people use so that the people and things interact most efficiently and safely —called also biotechnology, human engineering, human factors

17. Ergonomics What are the goals of ergonomics? • Adapt the work environment to fit the worker • Decrease physical stressors on the body • Improve workflow and efficiency • Decrease the likelihood of potential injuries

18. Ergonomic Stressors • Are there any of these we can modify to • decrease stress on the worker? • Repetition • Duration • Fixed/awkward postures • Vibration • Force • Rotation • Hold duration

19. Decreasing Ergonomic Stress *Repeated movements, excessive force and awkward positioning put more stress on the body and over time may result in permanent and disabling injuries* The ideal situation: low repetition, low force and a neutral position/posture.

20. Decreasing Ergonomic Stress Repetition - performing the same motions over and over. This can lead to overuse, fatigue failure, inflammation in the joints and soft tissues. How can we decrease the stress of repetition? Micro-breaks (exercise breaks), a 7 - 10 sec. stretch in the opposite direction as often as possible. Job rotation, non-repetitive work or work that uses opposite muscles.

21. Decreasing Ergonomic Stress Force - the amount of pressure needed to perform a task. Excess force increases joint pressures causing joint inflammation and place strain on soft tissues. How can we decrease the stress of force? Use mechanical and power assisted devices to eliminate the need for using excessive force to do the work. Engineer lighter loads.

22. Decreasing Ergonomic Stress Posture - the position of the body while performing a task. Variances in joint position can increase the impact that repetition, force and work duration have on the body by increasing the moment arm on the joints. How can we decrease the stress of posture? Avoid awkward postures. Adjust the workstation to fit the worker. Body mechanics education. Reverse awkward postures.

23. Repetition-Force-Posture Triangle stress STRESS! • Decreasing one side of the triangle will decrease the overall stress on the body. FORCE REPETITION POSTURE (Good) FORCE REPETITION POSTURE (Bad)

24. Proper Neutral Posture Open-packed Position (Desirable)•Position with the least amount joint surface congruency•Capsule and support ligaments are lax •Accessory motion or joint play is maximized VS. Close-packed Position (Undesirable)•Position with the most amount of joint congruency•Capsule and supporting ligaments maximally tight•Accessory motion is minimized

25. Neutral Spine Posture https://www.cdc.gov/niosh/mining/UserFiles/works/pdfs/2011-191.pdf SPINAL CURVES Cervical Thoracic  Lumbar 

26. Neutral Posture of Extremities • Degree from neutral position: • 20-30° = minimum fatigue • 60° = 3x faster fatigue • 90°+ = 6x faster fatigue • Grip strength is greater in neutral postures than in awkward postures • Awkward positions produce higher EMG activity in muscles https://www.cdc.gov/niosh/mining/UserFiles/works/pdfs/2011-191.pdf

27. Ergonomics Identifying Risk

28. Identifying Risk = Information Analysis • Look at injury records • Look at the past to predict the future • Discomfort Surveys • Screen your employees for potential problems areas • Safety checklists • Design injury risk tools to identify potential problems • Consider environment, tools/equipment, and work processes

29. Discomfort Survey A questionnaire used to help determine risk level • Ask employees to rate their discomfort from 0-3 in different body parts • Use a body image and have employees indicate where they hurt • Tally the information to identify potential problem areas • Consistent 3’s indicate a definite problem • Consistent 2’s indicate a potential problem • Ask for suggestions on how to make their workstation more comfortable

30. Safety Checklists A series of checklists used to help determine risk • Tools – are they in good condition, balanced, light-weight? Do they subject the employee to vibration, impact, force? Is the employee properly trained to use the tool? • Workstation – is there adequate space? Are mechanical lifts available? Are employees in neutral postures? Is it adjustable? Are employees trained how to properly adjust the workstation? • Work Process– are there wasted steps? Is it repetitious? Is the employee exposed to high amounts of force? Does the employee have all the equipment to perform the duty effectively and efficiently?

31. Safety Checklists A series of checklists used to help determine risk • Environment – Is the lighting adequate? Is there excess noise? How is the air quality? • Equipment – Does the position of the equipment/location of the controls promote neutral posture? Does the employee have to sustain postures while operating the equipment? Is the equipment on a regular maintenance schedule? • Material Handling– is there a lot of force involved? Are objects carried a long distance? Are objects lifted off the floor? Overhead? Are there any sustained holds of force? Is equipment readily available for heavier lifts? Is there any twisting of the spine?

32. Ergonomics Analyzing Risk

33. Risk Analysis Ergonomic Screening Tool • Use a tool that assesses joint positions of the head/neck, shoulders, spine, elbows, wrists/hands, and legs while performing a task. • Any deviation from neutral posture should be noted. • Then, if there are any postural concerns, the tool should assess the force required, the duration, and frequency of the activity. A well-designed tool can indicate the amount of risk to the employee.

34. Risk Analysis How much can a person lift vs. how much should they lift? • NIOSH lifting equation • Washington State Department of Labor and Industries lifting tool • There’s an app for that! • http://lni.wa.gov/safety/SprainsStrains/tools/default.asp

35. Risk Analysis Ergonomic Analysis Worksheet • List the major steps of the activity • Identify ergonomic stressors for each step • Identify if there is any way to decrease that ergonomic stressor • List all possible solutions

36. Industrial Ergonomic Analysis • Risk Identification • Are there previous injuries at this job? • Have the employees fill out a discomfort survey. • Complete safety checklists of the tools, workstation, environment, work process, equipment, and material handling. • Is there a potential problem? Yes or No Risk Analysis • Ergonomic Screening Tool • Assess joint positions and level of risk • Ergonomic Analysis • What are the steps? • What are the ergonomic stressors? • What are some solutions?

37. Computer Workstation Ergonomics

38. Proper Chair Alignment • Seat Height • Feet flat with hips/knees at 90˚ • Cushion • Compresses 1-1.5” and has waterfall edge • Seat Depth/Width • Permits contact with back rest in low back • Inhibits pressure behind the knees • Back Rest • Supports low back curve and promotes a neutral spine • Arm Rests • Elbows resting at side at 90˚ • Width equal to or more than hip breadth

39. Proper Keyboard and Mouse Alignment • Correct Height • Neutral shoulder position with upper arm at side • Elbows at 90˚ • WRISTS STRAIGHT • Wrist Rest • Used ideally only between key strokes • Promotes neutral/straight wrists

40. Proper Monitor Alignment • Focal Distance • Approximately one arm’s length away • Directly in front of operator • Height • Normal vision- top frame of screen level with forehead • Bifocal glasses- 4-5” below normal vision (tip of nose) • 19”+ monitors can be slightly higher

41. Conclusion