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For other articles and previous issues click here. October 7, 2002 The
Comfort Zone What’s New in Ergonomics The proposed ergonomics standards program focuses on preventable work-related injuries—primarily musculoskeletal disorders (MSDs)—that, according to OSHA, affect approximately 1.8 million U.S. workers each year. MSDs, which are primarily caused by overexertion or repetitive motion, account for one-third of all worker’s compensation costs each year due to their lengthy recovery times. Because a large number of women’s jobs require awkward postures, heavy lifting, and repetitive motion, OSHA reports, they suffer 70% of the total carpal tunnel syndrome cases and 62% of all tendonitis cases each year that are acute enough to warrant time off from work. By requiring employers to address problems in the workplace, OSHA hopes to spare an average of 300,000 workers each year from injury, resulting in a potential yearly savings of $9 billion for costs associated with MSDs. The term ergonomics, for many people, conjures images of mysterious new-age treatments, but is actually a science that, among other significant areas, focuses on the health impact of the ever-increasing use of computers and computer workstations in the nation’s workplaces. The problems caused by modern workstations are varied, depending on each individual’s work habits, job responsibilities, and environment, according to Ray Bello, MS, CDE, CIE, ergonomist, physical therapy consultant, and owner of BEST (Back To Employment Safely Trained) Associates, Pelham, N.Y. Bello explains that poorly designed workstations—combined with poor work habits and postures—can potentially result not only in carpal tunnel syndrome and tendonitis, but also in neck and lower back injuries, eye fatigue or soreness, and a number of other upper-extremity injuries. “Static postures are the main cause of the problem,” he says. “For example, we rarely saw carpal tunnel injuries with manual typewriters because typewriter tables were always 26 inches off the floor.” Typists who used them, he adds, were constantly moving, hitting the return bar, pulling paper out, putting paper in, and standing or walking to filing cabinets or to get more paper. “Stretching and movement,” he notes, “were inherent in the job.” Once computer workstations became the standard, however, employees were expected to sit at their terminal without moving. Files are now stored on hard drives, eliminating the standing and walking so important to maintaining blood flow and muscle health. Printers, also, are often located at the workstation, and keyboards have been moved to the desktop, often sitting at a height of 29 to 30 inches. If a keyboard tray is used, the employee usually needs to reach for the mouse, which often remains on the desktop. Monitor height and distance are seldom taken into account, Bello says, and the effects of office lighting are also often ignored. “There may be direct light at the desk, fluorescent light from the ceiling, natural light from the windows, and light from the screen,” he explains, adding that even color combinations on computer screens play a role in eye fatigue and discomfort. “Most people don’t take into consideration how many color combinations there should be, but there is a limit to what the eye can absorb.” With a rapid switch from manual typewriters to computer workstations, corporate safety specialists, industrial hygienists, and human resources personnel noticed an increase in injuries among employees, according to Craig Stewart, vice president of technical services for Kare Products, Boulder, Colo. “Early on, many thought the wrist and shoulder pain people complained about was arthritis,” Stewart explains. “No one had been hurt using manual typewriters, so they didn’t really ‘believe in’ carpal tunnel syndrome.” It took years of research to understand that the reason people who used manual typewriters did not sustain injuries was that traditional offices required more physical activity. Stewart adds that sitting in a static position throughout the day requires muscles to flex and remain taut to hold the body in position—an unnatural activity. “Muscles are not designed for that; they are designed to work like a sponge, contracting and squeezing to get blood and nutrients in and out of the tissue,” he says. Helping employers and employees grasp and accept this concept has been a central challenge faced by ergonomists. “It is difficult to help people understand that these little micromotions—hitting keys thousands of times during the day—has an effect on an isolated muscle group that is not moving enough to get the nutrients it needs.” Working at a computer workstation seems like such an innocent activity that many employees have trouble believing it can result in major injuries. The problem is further exacerbated by Americans’ overall poor cardiovascular fitness and the overwhelming urge to move as little as necessary. “Most people will try to drive their car to the best parking spot at the mall, where they only have to walk 20 or 30 feet to the door,” says James Golden, vice president of sales for Contour Design, Inc., Windham, NH. “We use remote controls for everything,” he says. “Our whole society is designed around the natural migration toward anything that results in less work.” Golden explains that muscles not used will accumulate toxins, which, over time, can result in soft tissue damage, adding that by performing cardiovascular activities and routine stretching exercises, those at risk for MSDs can go a long way toward preventing the costly injuries. And, costly is just the word to describe
the situation. The average cost of a carpal tunnel syndrome case,
for example, is estimated at anywhere from $18,000 to $50,000, depending
on the severity of the injury and healthcare costs in the region
where the employer is located. These estimates include surgery,
physical therapy, replacement of the employee during his or her
recovery time, and lost productivity, but do not include the pain
and suffering of the employee or the impact of decreased confidence
among the workforce, according to Bello. “Once one worker is
affected, you often start to see an epidemic in the company,”
he explains, “when other employees begin to notice and seek
treatment for similar symptoms.” Other no-cost fixes are often overlooked because of the natural human tendency to resist change, according to Stewart, who explains he has encountered resistance toward ergonomic improvements in a number of corporate environments. “We have to deal with the psychology of how adults handle change, which is far different from how children deal with it,” he explains. “Children are steeped in change all day long, constantly learning new things. Adults get set into their own patterns, though. The basic fact that our work habits become a pattern is an essential concept in ergonomics.” In order to effectively deal with ergonomic concerns, it is crucial to help people realize that the positive changes they make in a work environment are likely to pay huge dividends in lower healthcare costs and higher productivity, resulting in a return on even the most meager investment. Health information professionals, including
managers, administrative personnel, coders, and transcriptionists,
often benefit simply from an initial assessment of their workstation
to make sure their desks and chairs are properly adjusted, according
to Stewart. “Their feet should be flat on the ground, and when
they put their hands on the keyboard, their forearms should be straight
and their shoulders relaxed,” he says. Also, when sitting in
front of a computer, the head should be over the shoulders, and
the shoulders over the hips in an upright sitting position, he adds.
Signs of possible problems include numbness, tingling, or coldness
in the hands, discomfort in the wrist or forearm, or general aches
and pains in any area of the upper body. If adjustments to the workstation
do not result in improvement, the next step may possibly be implementation
of a specially designed mouse or keyboard to prevent further injury. The results have been extremely positive, says Caplan, who explains that many users who suffered from carpal tunnel syndrome and were unable to type have reported they are able to type again. Some are able to type for longer periods of time, with less muscle fatigue, and many have reported increased productivity. “At last year’s meeting of the American Association of Medical Transcriptionists, a woman told us she used to be able to type 1,200 lines a day, but that she couldn’t do that more than one day at a time without resting,” he recalls. “With this keyboard, she says she can type up to 2,400 lines a day, and could do it five days a week if she wanted to.” Increased productivity often translates into increased income, allowing many users to spend more time doing the things they enjoy. Making the switch to an ergonomically
designed keyboard is often a challenge, according to Caplan, but
the results are well worth the time invested. Most keyboards come
with manuals and training programs to enable users to become comfortable
with the tool as soon as possible without compromising productivity
for a lengthy period of time. The problem, however, is that typists
who are not suffering pain or discomfort are not usually willing
to take the time necessary to make the change, Caplan explains.
“We found that if someone is not already injured or feeling
some pain, he or she is often not sufficiently motivated to learn
to use our keyboard, or any ergonomic keyboard for that matter,”
he says. “Initially, any new system will affect your productivity.
If you are an MT [medical transcriptionist], getting paid by the
line, you often can’t afford lower productivity.” If a
person is already injured, however, with decreased productivity,
chances are better that he or she will make the necessary effort
to learn how to use an ergonomically designed keyboard to obtain
the benefits of increased work output and decreased discomfort. Moving the mouse next to the keyboard does not result in an optimal setting, he notes, adding that most people would be better off if they were left handed, because their mouse would be closer to the keyboard in the optimal work zone. “Most people sit all day, putting a strain on the back without realizing it,” he says. “The soft tissue in the back gets taut and prone to injury; you reach for a paper, and suddenly you have a back injury. Poor posture and sitting all day is like a ticking time bomb.” For many health information professionals, an ergonomically designed mouse, which does not solve the problem of reaching for the mouse, may not be enough. Additionally, any time a person reaches for a mouse, it takes away from time he or she could be typing or performing an action on the keyboard. “It is a wasted, nonvalue-added motion,” Golden says. “Every time you do that, you are traveling a foot; so, if you travel two feet to reach a mouse, you take a second or two to do that—time in which you could be doing something else.” When the typist returns to the keyboard, it takes a moment to reorient the fingers, which also slows the process. By incorporating the mouse into the keyboard, however, as with the RollerMouse Station, Contour Design hopes to decrease injuries and increase productivity. In a study of 19 call-center employees who used the RollerMouse, 84% of whom reported upper extremity pain prior to the study, Contour found their solution reduced upper-extremity pain by 47%. “In human terms,” Golden says, “nine out of 19 had shoulder pain before the study. After the study, that number went down to two because they weren’t reaching for the mouse anymore.” Right wrist pain was reduced by 27%, he adds. There are so many products on the market claiming to be ergonomically designed that most professionals have become somewhat skeptical, he continues. “When a product lives up to its reputation, the response from users is so quick and their pain goes away so quickly that they are often dumbfounded.” Golden also sites a study done by Humantech, for Contour Design, in which a 5% increase in productivity was found by using the RollerMouse, compared with a standard mouse. “Further study is underway,” he says, “to validate the pilot study’s preliminary findings.” Assessing
Your Needs The most effective approach to ergonomics
is to be proactive, Stewart adds, explaining that addressing a problem
when it first arises costs far less than the price of medical treatment
for muscle or nerve damage. “It is usually best to make small
adjustments and work your way up to a better posture,” Stewart
continues. “Muscles have memory, so if you are used to sitting
at your desk and slumping forward, your back muscles have been stretched
out and will not be prepared to sit in perfect position.” By
easing your way to a better work posture, it is possible to avoid
the aches and pains associated with muscle stress and fatigue. “People
should be gentle with themselves,” he says, “which sometimes
means making changes in small increments.” |
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