ESP REPETITIVE STRESS INJURIES HANDBOOK. Contents

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3 Contents Introduction What Are Repetitive Stress Injuries? What are the risk factors for work-related RSIs? Are RSIs a problem for education support professionals? Types of Repetitive Stress Injuries Hand and Arm Pain Neck and Shoulder Pain Back Pain What You Can Do to Prevent Injuries and Illnesses Avoid Repetitive Work Avoid Awkward and Static Postures Avoid Standing for Long Periods of Time Avoid Bending,Twisting, and Reaching Be Careful How You Lift Reduce the Amount of Force You Use Design Computer Workstations to Fit the User Choose and Use Tools Carefully Keep Workplace Conditions in Mind Job Risks for Clerical and Technical ESP Job Risks for School Bus Drivers Job Risks for Skilled Trades Workers and Custodians Job Risks for Food Service Workers Health and Safety Committees Your Legal Rights OSHA Standards and Inspections Workers Compensation Americans With Disabilities Act (ADA) Resources Internet Resources Glossary

4 The National Education Association is the nation's largest professional employee organization, representing 2.7 million elementary and secondary teachers, higher education faculty, education support professionals, school administrators, retired educators, and students preparing to become teachers. NEA EXECUTIVE COMMITTEE MEMBERS Reg Weaver, President Dennis Van Roekel, Vice President Lily Eskelsen, Secretary-Treasurer Michael (Mike) Billirakis Mark Cebulski Carolyn Crowder Michael Marks Rebecca (Becky) Pringle Marsha Smith EDUCATION SUPPORT PROFESSIONALS QUALITY John I. Wilson, NEA Executive Director Al Perez, Director Lisa Connor, Organizational Specialist Cara Elmore, Organizational Specialist Dominic Padilla, Organizational Specialist Rafael Rivera, Organizational Specialist Agnes Smith, Organizational Specialist Mareena Nephew, Senior Program Assistant Editing and Design: American Labor Education Center No part of this guide may be produced in any form without the permission from NEA Education Support Professionals Quality, except by NEA affiliates or members. Any reproduction of the report material must include the usual credit line and the copyright notice. Address communications to NEA ESP Quality, th Street, N.W.,Washington, DC , directly to Published October

5 Introduction Do you Sit at a desk in front of a computer all day? Drive a bus or operate heavy equipment? Stretch your arms or twist your back to reach your work? Lift or carry materials? Spend most of the day on your feet? Use hand tools? Repeat the same motions over and over? If you answered yes to any of these questions, your work may be harming you. Education support professionals can suffer from hand and wrist disorders, back and neck injuries, and muscle strains due to repetitive motions or awkward work positions. Poorly designed equipment and chairs, forceful exertions, improper lifting and reaching, or vibrating hand tools increase the chances of injury to wrists, arms, back, or shoulders. Doing the same motions over and over, hour after hour, week after week, can make these problems even worse. It s now common knowledge that these problems are a result of repetitive stress injuries (RSIs), also known as cumulative trauma disorders (CTDs). Certain work activities that you do every day can cause tiny injuries to your shoulders, elbows, wrists, hands, fingers, knees, or back. Each trauma alone is so small that you don t know it is happening...until all the small injuries add up and you re in pain. RSIs may take weeks, months, or even years to develop. That s why what you do now is important to your health and your ability to work in the future. 3

6 LOOK AT THE WHOLE PICTURE: Designing a safe workplace involves taking multiple factors into account. The good news is, most of these disorders are preventable. Ergonomics the study of the relationship between work and the worker can be used to make your work fit your body instead of the other way around. When you get in a car, you adjust the seat, mirrors, and steering wheel to drive comfortably and safely. In the same way, your workstation may also take some adjusting to fit you. If you work in a seated position, you may need to raise or lower your chair. Computer operators usually are able to adjust the height of their keyboard, and the angles of their monitor and keyboard as well. If you work in a standing position,you can use anti-fatigue mats, change your posture periodically, or alternately rest one foot on a wooden or concrete block to relieve the pressure of constantly standing. 4

7 Tools, supplies, and parts can be moved closer to you to avoid long reaches. Trays, cleaning supplies, and other materials can often be raised up off the floor to avoid stooping and bending. Hand tools can be modified to avoid awkward arm or hand positions. In many cases the problem isn t the job you re doing or the tool you re using but how you re doing or using it. Overhead reaches, lots of lifting and bending, wrist rotations the things that you usually do without thinking can create a problem. The motion itself may be harmless, but when you do it many times a day, you can hurt yourself. Poorly designed or maintained work environments together with a poorly designed job or workstation can increase the likelihood of repetitive stress injuries or other adverse health effects. Environmental factors such as heat or cold, lack of ventilation, noise, vibration, too much or too little light can worsen ergonomic problems. This handbook is designed to help you recognize workplace stress and hazards and the methods that can be used to correct them. Acting alone, with your co-workers, and with your association representatives, you can apply ergonomics in your workplace. You can customize your job, tools, and workstation, even the way you do your job, to some degree. However, your employer will still have to approve purchases of new equipment or tools, and will usually want to approve any changes in work methods or organization. It s the employer s responsibility to make changes in the workplace that will protect your health and safety. This handbook should help you make the case that the changes are necessary. 5

8 What Are Repetitive Stress Injuries? A repetitive stress injury (RSI) is damage to body tissues muscles, tendons, spinal discs, blood vessels, and nerves caused by repeated physical stresses. RSIs are produced by a gradual build-up of tiny amounts of damage caused by repetitive motions involving the same few tendons or ligaments. Maintaining the same body posture for long periods of time as many jobs require contributes to developing RSIs, because such postures decrease blood supply to the working tissues, making it increasingly difficult for your body to repair itself. Symptoms can range from mild aching to sharp, crippling pain. Symptoms often begin at work, then disappear during periods of rest. As the symptoms get worse, they begin to interfere with your usual work activities and disturb your sleep. Eventually, severe pain, limited mobility, loss of sensation, or muscle weakness make it impossible to perform key job tasks. The first symptoms of injury are weakness of the injured area, trembling, and aches and pains. In an isolated incident, symptoms will disappear. If an RSI is developing, the symptoms will not disappear, even after you have stopped performing the task. At this point, you should see a doctor, or talk to your supervisor about ways to change your workstation or work methods. What are the risk factors for work-related RSIs? > Repetition: doing the same motion hundreds of times each day, never giving 6

9 your body a chance to rest and recover from the stress and strain > Awkward or stressful posture: repeated overhead motions; reaching down and behind your body; extreme bending of the elbow and extreme rotation of the lower arm; lifting, twisting, or bending your back or other parts of your body; holding a fixed position for long time > Forceful movements: using a lot of effort or strength to do the job, even in small movements like pinching your fingers or bending your wrist > Frequent and difficult lifting: in a badly-designed job, even 25-pound loads can cause injuries. Loads over 70 pounds are always dangerous for one person to lift. > Poorly-designed tools: too much vibration; handles that require strong grips or bent wrists or arms; sharp edges > Work organization/job design: the speed at which you work; the workload; job security, and lack of control over work can contribute to the development of RSIs. Additional health symptoms and disorders including anxiousness, irritability, high blood pressure, ulcers, and headaches can be caused by poor work organization or job design. There are also a number of non-work related risk factors, such as inherited conditions, pregnancy, obesity, medication, diseases, overall fitness levels, and others. Are RSIs a problem for education support professionals? Workers in every ESP job category are at risk of developing repetitive stress injuries. > Bus drivers repeatedly open and close manually-operated doors, repeatedly depress clutch and/or brake pedals, operate hand controls forcefully and quickly, and climb and descend bus steps hundreds of times a day. Women drivers bodies especially are stressed when using this equipment, since buses and other vehicles originally were designed by men for men. In addition, the job of safely transporting children is psychologically stressful. > Food service workers repeatedly reach above shoulder level and below knee level, reach across deep counters, twist sideways to reach food items, lift heavy equipment and trays, repeatedly bend hands and wrists when preparing food, and stand for long shifts. > Technical service workers and clerical workers perform repetitive keystroke motions on computers, work with back, shoulders, arms or hands in awkward positions due to improperly fitted work stations, and do continuous work in one position without breaks. 7

10 ERGONOMIC FACTS Musculo-skeletal disorders account for 35% of all workplace injuries. Nearly 1.8 million workers each year suffer from ergonomic injuries. It is estimated that 50 cents of every dollar spent on medical costs will be for treating repetitive stress injuries. Workers compensation claims have nearly tripled in the last two decades. An estimated 60% of this increase is attributed to inadequate ergonomic conditions in the workplace. Source: OSHA > Skilled trades workers and custodians are subject to repeated muscle and skeletal stress from vibrating or badly designed tools, improper lifting, overhead work, prolonged kneeling, and bending and twisting. > Health and student services workers and security ESP are less at risk from repetitive motions than from psychological stress. Health workers are subject to occupational hazards such as exposure to diseases and contact with blood and other body fluids. Security staff face psychological stress from dealing with violent student and parent behavior. Working at a stressful job or in a stressful environment can contribute to and exacerbate physical symptoms. 8

11 Types of Repetitive Stress Injuries Most work-related repetitive stress injuries affect the upper part of the body the spinal column, neck, shoulders, arms and hands. Hand and Arm Pain The many bones of the hand and arms are joined together by a combination of ligaments, tendons, and muscles. Because of this delicate combination, your hands, wrists, and arms are easily damaged when stressful movements are repeated frequently over time. Repetitive stress injuries of the hands and arms can be broken down into disorders of the tendons, nerves, and neurovascular (nerves and blood vessels) system. > Tendon disorders: Tendinitis results from overuse or stress on a tendon.wrist and arm tendons often are affected. Symptoms include pain, swelling, and weakness in the hand, elbow, or shoulder. The way to treat this inflammation is to provide time for rest and recovery. > Nerve disorders: Nerve disorders are associated with the repeated exposure to contact stressors, such as sharp edges of tools or work surfaces, or even of adjacent bones, ligaments, or tendons. Perhaps the best known nerve disorder is carpal tunnel syndrome, which results when the median nerve in the wrist is compressed between the tendon and the bone. Carpal tunnel syndrome victims may experience numbness, tingling and pain in the thumb, index, middle finger and inner side of ring finger. Many of these symptoms will first occur away from work, often in bed. If untreated, it can result in progressive loss of strength in the hand and inability to grasp objects. Clerical workers who rest their wrists on the sharp edge of their desk or food service workers who perform repetitious chopping or slicing motions risk developing carpal tunnel syndrome. > Neurovascular disorders: One of the most common neurovascular disorders is thoracic outlet syndrome.this condition produces numbness in the fingers and a weakening of the pulse.the compression of blood vessels results from activities which pull the shoulders 9

12 back and down, such as carrying a heavy pack, and work that requires constant overhead motions, like stacking dishes or supplies. Neck and Shoulder Pain The neck is frequently involved in workrelated discomfort and pain. Prolonged bending of the muscles of the neck is probably the most common cause of discomfort. Clerical workers often experience neck discomfort from bending the neck down to read documents, up to view the computer monitor, or sideways to hold the telephone receiver between the head and the shoulder. Bus drivers report neck pain from craning to see their passengers in the mirror. In addition, psychological stress, which usually increases the muscular tension throughout the body, is particularly critical to the muscles of the neck. Work-related shoulder disorders are often associated with job tasks where the elbow is kept in an elevated position. If your job requires you to keep your hands above your shoulder for significant periods day in and day out, you might develop a condition known as frozen shoulder. manual doors are prone to this condition, which is characterized by a persistent and dull pain in the shoulder region and discomfort in the arms. Back Pain Back injuries occur when people are forced to work for extended periods of time in awkward positions bent over, leaning forward or sideways and when they use poor lifting techniques. Because back injuries are difficult to treat, attention should be directed towards prevention, by designing the job and workplace to fit the worker. Every category of education support professional is at risk of back pain and injury because of their work. Kinds of Back Injuries: Back strains, caused when weak or tense muscles are stretched beyond their limit Back sprains, caused by a partial or complete tear of a back ligament Herniated discs, resulting when stress, strain, or gradual deterioration on a disc causes it to stick out between the vertebrae Ruptured discs, caused when the wall of a disc breaks open Repeated motion of the arm away from the body can lead to a common shoulder disorder known as rotator cuff tendinitis. Bus drivers who repeatedly operate 10

13 What You Can Do to Prevent Injuries and Illnesses The first step in preventing RSIs is to take a hard look at your workplace and the way you do your job. You may be able to make changes in the physical set-up of your workstation or the position of your body as you do your work, or both.the following are some suggestions for how to protect yourself. Avoid Awkward and Static Postures A neutral body position is the most comfortable working posture. That s when your shoulders are down and relaxed, your arms are close to your sides, your elbows are bent, and your wrists and hands are straight.when your posture is out of neutral you increase the stress on your joints, muscles, tendons, nerves, and blood vessels. If you work bent over, leaning forward, or with your arms above shoulder height, you re probably keeping your body in one position for a while. These static work activities are very tiring and stress the lower back and shoulders. MODIFY EQUIPMENT: Simple equipment changes can reduce the need to work in awkward positions. 11

14 Move around and change your posture often. Take a micro break.try to split up your work. If you have been bending or kneeling, switch to something else to rest your back and knees. Use the right tool for the job. This can reduce awkward postures. For example, extension poles can be used for cleaning or painting tools so that custodians don t have to reach so far overhead. Organize the work space so that there is enough room to move around and change body position. MODIFY TOOLS: Extension poles can be used for cleaning or painting tools so that custodians don t have to reach so far overhead. Avoid Standing for Long Periods of Time Standing in one position can also put stress on your spine and back muscles. Back and muscle stress on standing jobs can be reduced by the use of: REDESIGN WORK AREA: Reaching like this over deep counters can stress the back, shoulders, and arms. Rubber or plastic anti-fatigue mats. Foot rests, to allow you to shift your weight often. A sit/stand stool and the opportunity to change positions or move around. Rotation to another job. 12

15 Avoid Bending, Twisting, and Reaching Tables, chairs, and countertops should be designed to eliminate frequent bending and extended bending and leaning. Design work tables or counters so that materials are within easy reach. Keep arms and elbows low and close to your body. Reach without stretching and straining. Keep reaches below shoulder level. Avoid stacking materials above shoulder height. Keep your elbows at the height of the work counter. Support your forearms with armrests or other padded surfaces. Have enough room in work area to use your arms while keeping your wrists straight. Be Careful How You Lift Lifting stresses your muscles, tendons, ligaments and spine. The key to proper lifting is to keep the back in its natural position. Here are some steps that will help prevent back injuries: REPOSITION SUPPLIES: Stack materials so that you don t have to lift above shoulder height. Use safe lifting procedures Squat lifts put less stress on your back, but only if you can fit the object between your knees. The best solution is to reduce the size and weight of the load. Never pick up a load unless... > Both feet are firmly on the ground. > The load is no higher than your shoulders. Stand close to load with feet apart. Minimize long reaches. The closer the load to the body, the less pressure it puts on your back. 13

16 Face load directly. Do not twist your shoulders to reach the load. When gripping the load, arch your lower back inward by pulling AVOID TWISTING: Face the load square to your shoulders rather than twisting to reach it. Twisting puts strain on your lower back. shoulders back and sticking out your chest. Avoid fast, jerky movements. Use safe carrying procedures Another part of lifting is carrying. The best posture for carrying a load is closest to normal standing: Hold the load as close to your body as possible. Objects should have handles or hand-holds. Keep your elbows touching against your sides. Keep the weight of the load evenly balanced. When setting the load down, bend at your knees, keeping your lower back arched. Reduce the amount of lifting you do: Let mechanical devices do the lifting. Use forklifts, jacks, cranes, and carts to lift or carry heavy loads. Lift lighter loads. Lift with a buddy. REDUCE AWKWARD LIFTING AND CARRYING: Objects should have handles or hand-holds. Careful planning and improved layout can help to reduce the amount of carrying and climbing needed and reduce the distance that loads need to be carried. 14

17 Reduce the Amount of Force You Use The more force you use, the more you stress your body and the more you risk fatigue and injury. Forceful movements such as pushing, pulling, tugging, and sliding objects put strain on your lower back. They also stress the muscles, tendons, and joints of your shoulders, arms, upper back, and legs. Use dollies, carts, hand trucks, or bins on wheels designed for pushing instead of pulling. Pulling, which stresses your shoulders and arms, is worse for your body than pushing. When you push, you use your own body weight to advantage. If you re in an awkward posture while pushing or pulling, you need to use more force to move the object. High friction between the object and the surface also increases the force you use. Pushing or pulling an object above shoulder height or below waist height requires a lot of force because the posture is so awkward. The amount of force you apply also can be affected by: The type of grip you use. Gripping with your fingers (pinch grip) is tiring. A fullhand power grip uses the larger muscles of your arm and requires less muscle effort. The position of your hands and arms. If your wrists are bent down, backward or to one side, you will need to use more force to do your work. Cold, slippery handles and gloves. A slippery handle or one with a small diameter is hard to hold, so you tend to grip it more tightly.you also use PUSH, DON T PULL: Use carts on wheels designed for pushing rather than pulling, which stresses your shoulders and arms. 15

18 more force when your hands or fingers are cold. Gloves which are too tight or too loose make you grip more tightly. The length of time you keep your body in one position. The amount of rest your muscles get. If you re tired, you use more force to get your work done. Design Computer Workstations to Fit The User Workstations must consider a worker s ability to comfortably see and handle the work. Chairs with adjustable features and proper back support are essential to prevent injury and improve overall comfort and work performance. It s important that adjustable chairs are easily adjusted by the workers themselves. If someone else has to do the adjustment like a mechanic or supervisor then the chair will probably cause injuries, not prevent them. Force head to lean forward and look down If the chair is too low, it can Raise knees higher than hips and create balance problems Raise elbows away from the body Make wrists bend to the side A good chair should have... Adjustable seat heights (between 16" and 21") A backrest that is adjustable up/down and forward/backward to help support the lower back INSIST ON AN ADJUSTABLE CHAIR: Chairs with adjustable features and proper back support are essential to prevent injury. Chair height Differences in seat height can affect the whole body. If a chair is too high, it can Press thighs against table Press seat against back of the thigh Reduce blood to the feet Make wrists bend up 16

19 Cushioned/contoured seats (15"-17" long and 16"-19" wide) that are padded but firm A five-foot base for maximum stability. Depending on the job, swivel seats that allow workers to turn their whole bodies and reduce twisting of the back Avoid Repetitive Work Every time a muscle works contracts and relaxes the tendons are stretched. Repeated stretching and pulling can cause the tendon to swell and get sore. If the tendons and muscles don t get enough time for rest and recovery, the risk of injury is increased. Repetitive work can also damage nerves and blood vessels if they are squeezed against a hard tool handle or against muscle or bone. Repeated stresses on your back can speed up normal wear and tear. As your muscles get tired from doing the same motion over and over, you exert more effort to do the job. One way to prevent your muscles from getting tired is to rest the muscles doing most of the work. A micro break, in which you use different muscles or pause for even a few seconds, can help.this relieves your muscles more effectively than uninterrupted periods of work with only one or two longer rest breaks. Choose and Use Tools Carefully Use tools or implements that allow you to keep your wrist straight. Consider the requirements of the job as well as the tool. A tool that allows you to keep your wrist straight to do one task may force you to bend your wrist under different conditions. Tools with bent handles can help you keep your wrist straight. Swivels at the connection of a tool and power hose make it easier to manipulate the tool instead of your wrist. Use well-balanced tools. Support handles allow you to support the weight with both hands. Make sure handles and grips are the right size, shape, and material. Use tools with strip triggers and compressible covering. Handles and grips should be oval or round.you should be able to wrap your hand around the handle in a power grip. Handles must be long enough for your hand and all your fingers. Try to avoid tools that: Make you bend or twist your wrist. Are heavy and/or unbalanced. Vibrate. Long-term use of vibrating tools can damage the blood vessels and nerves in your hands and fingers. The risk of injury is increased if you are also exposed to cold. 17

20 Dig into the palm of your hand or the sides of your fingers. Sharp edges or tools that press into the soft tissues of your hand can compress blood vessels and nerves. Compressed blood vessels reduce the supply of blood reaching the tissues. Squeezed nerves can cause numbness and tingling. Need a lot of trigger pressure. Need repetitive triggering and use only one trigger finger. Have finger grooves on the handle. Blow cold exhaust air onto your hands. Keep Workplace Conditions in Mind Good planning, improved work layout, and better work organization can reduce obstacles and slip/trip hazards. Proper storage can reduce the need to lift, move, or reach around objects later on. Planks, sand, gravel, and walkways can be used to reduce the hazards of mud and slippery surfaces for ESP working outside. In cold weather, warm-up exercises may help reduce the risk of muscle strain. When it s hot, heavy physical work can quickly lead to fatigue. Set a comfortable work pace. Short exertions with frequent micro breaks is better than extended work periods with fewer but longer rests. Drink plenty of fluids, especially water. If practical and safe, fans and heaters can be used to moderate extremes in temperature. Be aware of your own level of fitness. The closer the match between your strength and fitness and the physical demands of your job, the better you ll feel. But strength and fitness cannot protect your spine from the cumulative traumas of lifting and other risk factors. 18

21 Job Risks for Clerical and Technical ESP PROBLEM/HAZARD RISK FACTOR PREVENTIVE ACTION Tendinitis, tenosynovitis, carpal tunnel syndrome Wrist flexion or extension, repetitive keying Detachable keyboards that can be moved around to a comfortable position. The keyboard should be relatively flat in relation to the working surface, and the angle should not be more than 15 degrees off horizontal. The mouse should be designed to fit your hand.the mouse should be within easy reach, located at the same height and angle as the keyboard and situated next to the keyboard. Keep your wrists in as neutral a posture as possible. Arm and wrist rests may help you do this. The wrist rests should provide cushioned support and be rounded on the front edge. Muscle soreness, cramping, and fatigue, particularly in shoulders, neck, and back Pressure on thigh, leg fatigue, and numbness in feet Chair too high or too low, poorly designed seat, footrest too low, insufficient back or arm support Adjustable chairs: Seats, backrests, and armrests should be adjustable to fit the individual user. Seats should be at least 16 inches wide and inches deep. They should be padded but firm, and should be tiltable forward and back.the seat height should be raised so that the angle between upper and lower leg is roughly perpendicular (about 90 degrees). Back rest: The back rest should be height-adjustable as well as tiltable, so you can recline backward or forward with adequate support for your lower back. Armrests: Cushioned armrests may be helpful to support your elbows and upper and lower arms and maintain a neutral wrist posture. Foot rest: A foot rest should be provided for operators who cannot securely place their feet on the floor while seated.the foot rest should be adjustable both in height and angle, and have a non-skid surface. Document holder: When you work with hard copy, an adjustable (angle and height) document holder should be provided. Adequate workspace: You need enough tabletop space to be able to move and properly position your keyboard, mouse, monitor, and document holder. Micro-breaks: You should take more frequent, short breaks in addition to the regular scheduled breaks every two hours. 19