Fighting the Workplace Blues

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August/September 2003

By C.A. Wolski

Margareta Nordin, Dr Sci, PT, CIE, director of the Occupational and Industrial Orthopaedic Center (OIOC) of Mount Sinai NYU Health, demonstrates ergonomic exercises with a fellow researcher.

Work can be a pain in the neck. Too many people can use this figure of speech literally. In fact, nearly every American worker—no matter their profession—will experience work-related pain sometime in their career, according to Margareta Nordin, Dr Sci, PT, CIE. A research professor and director of the Program of Ergonomics and Biomechanics in the School of Medicine at New York University (NYU), and for the Occupational and Industrial Orthopaedic Center (OIOC), Hospital for Joint Diseases, Mount Sinai NYU Health, Nordin says pain caused by ergonomic problems is among the top causes of worker disability. However, a dedicated group of rehabilitation professionals have made workplace ergonomics and the elimination of the causes of pain their career mission, bringing much-needed help to both workers and their employers.

Pain caused by poor ergonomics consistently ranks first or second on the list of workplace disabilities, Nordin says, adding that about 80% of American workers will have or have had back pain sometime during their working lives, and about 30% currently experience pain. It is a costly problem. “Even though most workers recover from back pain and can return to work pretty fast—between 1 week and 4 weeks—you have a rate of recurrence [of between] 45% and 60%,” she says. “Out of all of these people who have back pain, 6% to 9% become chronically ill—that’s a large percent—and those patients eat up about 80% of all the treatment dollars used for back pain.”

In addition to back and neck pain, carpal tunnel syndrome and knee problems are among the other conditions ergonomists frequently help workers prevent and treat.

Although across the workforce the end result of poor ergonomics—pain—is the same, this pain has a myriad of causes and no single cure.

One Size Does Not Fit All
There are several leading causes for worker pain, including long hours, repetitive tasks, and unsafe work sites. “Other factors are just people cutting corners,” says Stephen Slane, MS, PT, director of industrial rehabilitation, Eagle Physical Therapy, Keystone Rehabilitation System, Pittsburgh. “People are trying to get the job done quickly and sometimes they won’t use the safety equipment that’s available.”

In his work, Slane says one of the biggest problems has been the lack of adequate job descriptions. “What’s really surprising with a lot of the ergonomic analysis assessments is that many companies still have not complied with the 1990 Americans with Disabilities Act (ADA), they still don’t have functional job descriptions,” he says. “Under the ADA, you’re supposed to list the functional activities and the essential job functions, so a lot of the process is actually going in and trying to establish these [descriptions] for them...and looking into problem-prone positions.”

And though many of the causes of pain that Slane ticks off can be objectively measured and documented, Nordin points to a bigger cause that is more elusive—stress. “I think that the most important [problem] right now is the stress level people go through at work, which to some extent is linked to work organization,” she says. “But it is also companies that have reduced the number of employees because of technology, which means that people have more and more to do in less and less time and they have to make decisions faster and faster. If you have poor posture and very repetitive work, plus a very high stress level, there is a threshold where people can’t meet the demands anymore.”

But eliminating stress or coming up with adequate job descriptions may not be the only solution to preventing pain. “To understand what is most bothersome for the patient, you have to understand all the factors that can affect [their health],” says Nordin. “You need to understand the physical plant, the psychosocial stress demands, and the organization of [the company].”

The biggest challenge for the ergonomist is preventing pain, which Nordin says is more difficult than researchers had expected it to be when the OIOC was established 20 years ago. “The primary prevention has not been as effective and as successful as we had hoped, meaning that we had hoped that we could go in and make all the changes in the workplace and thereby eliminate all back pain. This has not happened,” she says. About 70% of OIOC’s work is treatment and 30% preventative.

For the ergonomist, assessing a problem involves much more than seeing a patient in their office. The process can involve going to the site, interviewing the employee, videotaping them at their workstation, and taking physical measurements such as the light level and the size of the workspace using tools like light meters and push/pull gauges. Once this is done, a report with photos and other supporting materials is issued to the employer. “If I say the employer has [to make a change] and if the reader [of the report] is unfamiliar with the work site, or even if the reader has walked past it 10 times a day, but hasn’t looked at it with ergo-nomic eyes, now maybe that picture has different meaning for them,” says Ellen Rader Smith, OTR, CVE, CPE, an ergonomist with ERGO & Rehab Services, Montville, NJ. Whether Rader Smith implements the recommendations in the report has to do with the resources available to the company and how extensive the changes need to be, as sometimes they can be as simple as adjusting a chair.

Nordin also cautions that just because an item is touted as “ergonomic” does not mean it really is. “Things can look very good, but that does not mean that they’re ergonomically correct,” she says.

Identifying a problem and finding its causes are just the first steps in treating and ultimately eliminating pain.

Treating Workplace Pain
For the last 20 years, Nordin and her multidisciplinary clinical and research, education, and consultation (REC) team at the OIOC have consulted with a wide array of work organizations, from Fortune 500 companies to single proprietorships. The group’s research areas include biomechanics, functional capacity, and the prevention of disability and chronic illness. The latter program has been very successful, with a 92% return-to-work rate and a 25% recurrence rate, says Nordin.

What the group has discovered is that there is no miracle cure for chronic pain caused by poor ergonomics. Instead, treatment, which is aimed at fixing the whole person, is—like the problem—multifaceted. “If the patient doesn’t get better in 2 to 4 weeks, we have to put together a program where the patient gets evaluation by an MD, a pain manager, and a physical therapist, so we can understand the problems they meet at home and work, and they will be able to go back to the lifestyle they had before,” says Nordin. “The new treatment is a combination treatment. The first thing we do is make sure the patient is not using too much medication, and then we put them on an exercise program for 2 hours a day, pain management for about 45 minutes a day, and [provide] education.”

Many times, the solution to workplace pain—no matter the cause—is simply a case of listening to employees. “One of the greatest wealths of knowledge and information you can find in an ergonomic assessment is in sitting down with employees and talking to them to find out what they do to make it easier for them,” says Slane. “Nine out of ten times, they have a solution that is usually relatively inexpensive and easy to implement. Your simplest ideas usually come from your workforce.”

Fundamentally, treatment involves revising jobs so that individuals can function effectively and safely in them, says Slane. “In the United States, we use ergonomics after the injury occurs,” he says. “If you look at classic ergonomics in Europe, it is used more for preventive measures.”

Long-term treatments, which can include stretching, breaks, and better workspaces, are a key in preventing further injury or a recurrence of an injury. “Once an individual has an injury, there is an actual higher potential to have a subsequent injury, so it’s best to prevent anything like that from happening,” says Slane. “If you can prevent an injury from occurring, you’re much better off.”

The key to developing a workable and sustainable treatment and prevention program is showing businesses that it makes sense for their bottom lines.

Selling Ergonomics
When it was formed, the OIOC was based on a Swedish model that emphasized the importance of workers and business collaborating to offer the best health care possible for musculoskeletal injuries and disorders. “The mission of the OIOC is to serve industry and the workforce with clinical educational consulting services in the prevention and treatment of musculoskeletal injuries and disorders,” says Nordin. “So we’re really focusing on working people.

“What we also try to do in the primary prevention part of our work is to make management and unions understand that if they really work together, the results can be amazingly good,” she adds. “Health is non-negotiable, because if you have healthy workers to staff your company, you save a tremendous amount of money.”

Surprisingly, ergonomics has not been a tough sell to companies worried about the bottom line—because it makes good economic sense. “There is a bit of a ‘fashion’ in ergonomics, but the reality that comfort increases with increased ergonomics has paid off in terms of marketing,” says Nordin, adding that all Fortune 500 companies have ergonomics programs.

Rader Smith says that smaller to mid-sized companies have been “wishy-washy” when it comes to ergonomics, sometimes not even considering ergonomics until a workers’ compensation claim has been filed.

Slane’s experience is similar to Nordin’s, but he cautions that bad economic times mean that ergonomics may not be a priority. “When you have an economic climate like this, unfortunately you do tend to see injuries occurring,” he says. “You can look at it from a couple of perspectives. Either the company isn’t doing their job, or the individual isn’t doing theirs, or there is also the old fear of people malingering to get workers’ comp. But in this kind of climate you have to make sure you don’t have injury-prone positions.”

OIOC gets the word out to potential clients, both workers and businesses, through its Web site, public lectures, marketing letters, television and radio appearances, publishing its research findings, and—most directly—one-on-one contact. Of all the tools it uses to market itself, Nordin says, it is the Internet that has made the biggest impact.

In addition to these traditional marketing methods, there has to be a cultural shift in making ergonomics part of the business scene. “I talk with safety professionals, human resource people,” says Rader Smith. “I try to talk with them, but I’m not sure if they’re on the bandwagon for it yet, and it varies with each company.”

In an era of continued downsizing and increasing workload, ergonomics may be part of the price of doing business, but, Slane says, this increasing focus on ergonomics has a broader positive implication. “A lot of it is just getting back to safety,” he says. “That’s what most companies are interested in.”

C.A. Wolski is associate editor of Rehab Management.

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August/September 2003