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

22 Job Risks for School Bus Drivers PROBLEM/HAZARD RISK FACTOR PREVENTIVE ACTION Tennis elbow, tendinitis, shoulder pain Reaching and twisting to open and close manual doors, straining to see in internal and external mirrors and instruments, manual shifting Automatic power doors Adjustable seats and steering wheels Improved placement of controls Better mirror placement Arm rests Automatic transmissions Low back pain, pressure on thighs Non-adjustable drivers seats, bumpy roads Adjustable seats Air cushion seats Carpal tunnel syndrome, hand pain Repetitive and forceful hand movements on manual shifts or manual doors Automatic transmissions Power doors Knee and foot pain Repeatedly depressing clutch and/or brake pedals Automatic transmissions Adjustable seats 20

23 Job Risks for Skilled Trades Workers and Custodians PROBLEM/HAZARD RISK FACTOR PREVENTIVE ACTION Fatigue and muscle soreness in arms and shoulders tendinitis, bursitis, rotator cuff syndrome Working with the elbows elevated or with hands above the shoulder, regularly carrying loads on the shoulder, throwing objects Counterbalance tools Reorient handles Lower the work or raise the worker Micro breaks Elbow, wrist and hand pain tendinitis, tenosynovitis, carpal tunnel syndrome Repeated wrist motions, forcefully extending the hand backward or to the side Use tools that allow work with straight wrist. Raise or lower the work to put your wrist in a neutral position Avoid forcefully gripping or pinch-gripping the tool Micro breaks Loss of feeling in hands, pain on side of the wrist and base of the thumb Palm and finger pressure, repeated wrist motions, rapidly rotating the hand Reduce the gripping force, reduce trigger force, lengthen the tool handle, eliminate single finger triggers Tingling and numbness in hands, followed by whitening of the fingertips Using powered hand tools that cause vibration, cut circulation Counterbalance or lighten tool, reduce the vibration Back pain/strain, disc injury Improper lifting or carrying, bending and twisting, lifting heavy or awkward loads Use safe lifting and carrying procedures, break heavy or bulky loads into smaller, more manageable loads, get help Use mechanical lifting devices 21

24 Job Risks for Food Service Workers PROBLEM/HAZARD RISK FACTOR PREVENTIVE ACTION Low back pain, numbness in legs or feet Bending and stretching to reach across counters, prolonged standing Height-adjustable sinks for dishwashers, tables for servers Reposition supplies, dishes and implements to reduce reaching Rotate positions at both the trayline and dishline on a daily basis, ensuring that rotation from one side of the trayline to the other is included Anti-fatigue mats Back pain/strain, disc injury Improper lifting or carrying, bending and twisting, lifting heavy or awkward bundles or boxes Store food and supplies at work height to reduce bending. Reduce the number of items handled at once to reduce force associated with lifting and pushing Use safe lifting and carrying procedures, break heavy or bulky loads into smaller, more manageable loads, use carts to reduce carrying distances, get help.turn your feet towards work to avoid twisting your back Fatigue and muscle soreness in arms and shoulders tendinitis, bursitis, rotator cuff syndrome Overhead work,elbows elevated with hands above the shoulder Lower dishwasher rinse nozzle to mid-body height to reduce reach Store materials at waist height Elbow, wrist and hand pain tendinitis, tenosynovitis, carpal tunnel syndrome Repeated wrist motions, forcefully extending the hand backward or to the side Use implements that allow work with straight wrist Use automatic can opener. Use shallow ladles to minimize wrist movement Raise or lower the work to put the wrist in a neutral position Consider menu choices to reduce hand actions associated with portioning, such as cutting, spooning and peeling Avoid forcefully gripping or pinch-gripping the tools; flexing your wrists when wrapping or stacking cutlery 22

25 Health and Safety Committees Associations should consider forming Health and Safety Committees to monitor conditions in the work environment, negotiate or develop policies to address health and safety language, and meet with supervisors and administrations to have health and safety issues taken seriously.the committee could advocate for: worker training to promote early recognition and quick reporting of injuries/illnesses to the administration. a system for collecting and reviewing injury/illness reports careful check-up of injured workers by medical personnel conservative treatment (ice, massage, splints, medication), instead of early surgery follow-up medical evaluation within a week by specialist familiar with RSIs if condition does not improve conservative return to work, including: > following all work restrictions from doctors > adequate recovery time > real work opportunities on jobs with no risk factors for the worker s injury staffing and adequate facilities, including medical personnel who know about job-related risk factors Administrations must not discourage workers from asking to see a doctor. Actions which discourage injury reports include warnings, write-up or harassment of injured workers, contests based on days-without-injury reports, or discrimination against injured workers. Association representatives who learn of such actions should discuss alternatives and propose correct policies to the administration. 23

26 Your Legal Rights OSHA Standards and Inspections OSHA (part of the U. S. Department of Labor) sets minimum standards governing workplace safety and health conditions. These standards cover machine guarding, materials handling, noise, chemicals, exits, and other hazards, except for ergonomic hazards. To date there is no standard that covers ergonomic hazards. But the Occupational Safety and Health Act does give workers the right to a workplace free from recognized hazards. Dangers not regulated by current standards are still covered by OSHA s general duty clause. If you feel your workplace is unsafe, you can call for an OSHA inspection, and your employer may be required to take corrective action. Ask your local Association or UniServ representative for guidance. Workers Compensation How does the workers compensation system work? In most states, workers compensation laws require employers to carry insurance that pays full medical costs, and usually 2/3 of lost wages, for workers with jobrelated injuries or illnesses.workers compensation laws usually also require rehabilitation services for disabled workers, and death benefits for fatal injuries. It is a no-fault system. This means employers cannot deny benefits by claiming that the injury was caused by the worker. Employers usually also cannot deny benefits because an old injury/illness may have contributed to a new injury. The employer takes an employee as is and usually must pay compensation even if the job aggravates a pre-existing injury or illness or if workers re-injure themselves. What should you do if you develop injuries or illnesses on the job? 1. Tell your supervisor as soon as possible. 2. Get medical attention immediately and document it. 3. Inform your employer in writing about the injury or illness. (NOTE: There are deadlines in each state for giving notice to your employer.) 4. File a claim with the state compensation agency. 5. Ask the state compensation agency for a hearing if the employer or the employer s insurance company refuses or fails to pay workers compensation that the state agency has 24

27 determined you are owed. In complicated occupational illness cases, you may need a lawyer to protect your rights. Who pays for workers compensation? The employer pays all the costs of workers compensation benefits. Sometimes these costs are large even greater than the costs for regular health insurance. Association leaders and health and safety committees can show employers that the best way to reduce workers compensation costs is to become aware of how employee health can be affected by working conditions or equipment. If the administration cooperates, a joint ESP/employer committee can make an ergonomics program into a economic win-win for both the school district and the Association, where the district saves money and the Association improves members job safety and security. Your Association can help Use your state or local Association as a resource for questions about workers compensation. Your Association should have information about your state s compensation laws and benefits, as well as a list of telephone numbers for the nearest workers compensation office, union-friendly lawyers and doctors, and any other related information. 25

28 Resources Internet Resources There are thousands of ergonomics-related websites. NEA cannot vouch for the accuracy or completeness of the sites on this list, but they all have merit, and some are excellent. Those that are essentially ads for consulting services or products are included here if they also include basic information about repetitive stress injuries and/or ergonomic solutions. Ergoweb Ergoweb is an online forum on ergonomics. The site includes Introduction to Ergonomics, Frequently Asked Questions, Ergonomics Glossary, Ergonomics Concepts, Case Studies, and Reference Materials. Case studies describe real life examples in which ergonomics hazards have been addressed. Each case study consists of a task description, ergonomic risk factors, administrative or design solutions, comments, and vendor information. Case studies currently on the site cover school custodians and nutrition services, among other occupations. Ohio Bureau of Workers Compensation This agency has developed Ergonomic Best Practices, a series of industry-specific publications that could help prevent cumulative trauma disorders (CTDs) in your workplace. Ergonomics Best Practices for Public Employers is full of useful information about best practices for, among other worksites, VDT workstations, school buses, and custodial and maintenance work. Canadian Centre for Occupational Health and Safety Among their products and services are the following: > Cold Weather Workers Safety Guide > Food Service Workers Safety Guide > Groundskeepers Safety Guide > Health and Safety Guide for Libraries 26

29 > Office Ergonomics Safety Guide > Warehouse Workers Safety Guide Workers Compensation Board of British Columbia Publications include Preventing Injuries to Dishwashers and Back Talk: An Owner s Manual for Backs. Labor Occupational Health Program, University of California at Berkeley ist-socrates.berkeley.edu/~lohp/ LOHP is a community outreach program at the University of California, Berkeley whose work addresses today s health and safety needs in nearly every industry, from healthcare to agriculture to construction. Among the current projects: > Ergonomics > Human factors > Immigrant workers > Union health and safety skills > Workers compensation > Workplace violence The UCLA Labor Occupational Safety and Health (UCLA-LOSH) Program UCLA-LOSH works with workers, unions, community-based organizations, academics and health professionals to improve environmental health and safety conditions for workers, with a special emphasis on those in Southern California. University of Victoria, British Columbia The University of Victoria has various ergonomic programs and services focusing on the prevention of work-related musculoskeletal injuries. Massachusetts Coalition for Occupational Safety and Health (MassCOSH) MassCOSH brings together workers, unions, community groups, and health, safety and environmental activists to organize and advocate for safe, secure jobs and healthy communities throughout eastern and central Massachusetts. Through 27

30 training, technical assistance and building community/labor alliances, MassCOSH mobilizes its members and develops leaders in the movement to end unsafe work conditions. Sponsors RSI Action ( an all-volunteer organization,that advocates for the health, safety and rights of office workers, focusing on computer-related Repetitive Strain Injuries (RSIs). Computer-Related Repetitive Strain Injury, by Paul Marxhausen eeshop.unl.edu/rsi.html A very brief introduction to computer-related RSI with an extensive list of book references and links to helpful Internet resources, including where to get information about workers compensation and legal help. The CTD Resource Network, Inc. The CTD Resource Network, Inc. (CTDRN) is a nonprofit organization that provides educational material related to the prevention and treatment of cumulative trauma disorders (also known as repetitive stress injuries). The Typing Injury FAQ The Typing Injury FAQ (frequently asked questions) is an educational site, provided by the CTD Resource Network, Inc., containing a wide variety of information about repetitive strain injuries (RSIs), resources for dealing with these ailments, and a broad description of assistive products to reduce injury risk and symptoms. CTDNews CTDNews Workplace Solutions for Repetitive Stress Injuries is aimed at employers. Includes ergonomics tips and solutions to improve workplace safety, prevent employee injuries, and keep workers compensation costs down. American Society of Safety Engineers, Ergo Resources Project ASSE provides links to worldwide ergonomics resources, from governments, to universities, to computer manufacturers. 28

31 Humanics Ergosystems Humanics Ergosystems is a consulting firm with original reports and articles and a wealth of ergonomics resources including workplace ergonomics, ergonomics for children and people with disabilities as well as design of the built environment. Also extensive links to medical research and resources. Government Resources U.S. Department of Labor, Occupational Safety & Health Administration Access to state ergonomics plans and many publications about ergonomic issues, especially RSI issues involving computers. NIOSH (National Institute for Occupational Safety and Health) Among the many resources offered are: > NIOSH Musculoskeletal Documents on CD-ROM: Preventing Work-Related Disorders > NIOSH FACTS: Carpal Tunnel Syndrome, Work-Related Musculoskeletal Disorders > Cumulative Trauma Disorders in the Workplace Bibliography > NIOSH: Elements of Ergonomics Programs. Provides basic information that will be useful for employers, workers, and others in designing effective programs to prevent work-related musculoskeletal disorders. California Division of Occupational Safety and Health (DOSH) This page provides links to several online ergonomics-related publications provided by DOSH. Americans with Disabilities Act (ADA) The ADA prohibits discrimination and ensures equal opportunity for persons with disabilities in employment, State and local government services, public accommodations, commercial facilities, and transportation. Among the publications on the website are ADA Questions and Answers, and lists of information and technical assistance sources. 29

32 Printed Material Ergonomics: A Common Sense Activity That Can Save Schools Money. Fleer, Paul; Gauthier-Green, Erin. School Business Affairs; v68 n6, p24-30 ; Jun Describes the use of ergonomics to reduce work-related musculoskeletal disorders such as back pain, tendinitis, and carpal tunnel syndrome that often effect custodians, food service workers, maintenance personnel, and computer users. Describes ergonomics and how to identify ergonomic problems, conduct a job hazard analysis, and develop solutions. Also lists common ergonomic errors in schools. Provides an ergonomic checklist for employees working on computers. National Clearinghouse for Educational Facilities at the National Institute of Building Sciences 1090 Vermont Ave., NW Suite 700, Washington, D.C Toll free: Extensive literature list of school-maintenance-related topics The Ergonomics of School Bus Driving and the Successful Campaign of the Boston School Bus Drivers Union to Redesign Their Buses to Reduce Injuries pha.confex.com/apha/128am/techprogram/paper_14509.htm Susan Moir, Sandra Baldwin-Gonsalves, and Tolle Graham, MassCOSH. Briefly describes The School Bus Design Project, a report that identified 9 specific ergonomic design problems in school buses and proposed solutions. Several of the design solutions proposed by the Committee have been incorporated in specifications for purchase of new buses by the city of Boston. As of September 2000, all full size and half buses in Boston have ergonomically adjustable drivers seats and automatic doors. Dr. Pascarelli s Complete Guide to Repetitive Strain Injury: What You Need to Know About RSI and Carpal Tunnel Syndrome. A 2004 update to his best-selling 1994 book Repetitive Strain Injury: A Computer User s Guide. Emil Pascarelli, M.D., is one of the world s leading experts on repetitive strain injury. List Price: $ Paperback: 272 pages. Publisher:Wiley, June ISBN:

33 It s Not Carpal Tunnel Syndrome, by Suparna Damany and Jack Bellis. Jack Bellis writes, on his website When a physical therapist performed tests on me that my surgeon didn t before or after the operation on my ulnar nerve and my symptoms returned in a few weeks, I decided that someone had to tell the story.with my therapist, Suparna Damany, I ve written a book on the subject, entitled It s Not Carpal Tunnel Syndrome: RSI Theory & Therapy for Computer Professionals. In the book and on this web site is what I learned about RSI, without embellishment or false promises, and with hard details not just accolades from other patients. $19.95 list price. 234 pages ISBN Ergonomically Designed Tools: Selecting the Right Tool for the Job, Industrial Engineering, July 1993, p Ergonomics is the science of optimizing the interaction between the person, the job, and the environment.the primary goal of ergonomics is to create a safe, comfortable workplace that will reduce the potential for cumulative trauma injuries. Although ergonomically correct work stations and tools may cost more initially than others, they are expected to save money in the long run because workers will lose less work time, workers will not file workers compensation claims, and employers will not have to train new employees. The Comfort Zone, by Steve Hirano, School Bus Fleet, December Ironically, occupational injuries are driving school bus drivers out of driving at the very time when there is a national driver shortage. Manual door levers are a major cause of shoulder injury; bumpy roads can cause back problems. Losing driver services represents wasted recruitment and training efforts in addition to expensive workers comp claims. Better Work Environments. Murray, Chris. School Planning and Management; v41 n12, p22-23 ; Dec Looks at equipment, process, and training aspects of backpack vacuum cleaners that facilitate good ergonomics and high productivity levels, focusing on: designing new equipment for bodies and productivity; creating comfortable backpack harnesses; improving the work process via team training; and providing ergonomic training to ensure that backpack vacuums are worn and used properly. 31

34 Glossary Acute Trauma an injury such as a bone fracture that has an immediate and easily identified cause. Pain and/or other health effect is also immediate. Artery a blood vessel that carries oxygen-rich blood from the heart to the rest of the body. Arthritis inflammation of a joint (knee, hip, shoulder, fingers are all joints which can become arthritic). Awkward Posture body posture that can increase the risk of Repetitive Stress Injuries. Blood Vessel an artery, vein or capillary through which blood flows, either from the heart to the tissues (arteries) or from the tissues back to the heart (veins). Brain the main part of the nervous system (which also includes the spinal cord and nerves). The brain regulates all of the body s activities. (The brain is the part of the body which when used will save wear and tear on the rest of your body.) Capillary a tiny blood vessel with thin walls. Nutrients and oxygen leave the blood through the walls of capillaries to feed the body s cells. Cardiovascular System the system that circulates blood through the body; includes the heart and blood vessels (arteries, veins, capillaries). Carpal Tunnel Syndrome painful wrist/hand repetitive stress injury in which inflamed tendon squeezes nerve against bone in wrist. Symptoms include tingling and numbness in hand. If not treated, permanent damage, including muscle weakness, can result. Cartilage tissue found between vertebrae and at the ends of bones at the joints. Cartilage can withstand a lot of tension and pressure. Chronic Low Back Pain soreness, fatigue of the low back. Compressive Force pressure that acts to compact or squeeze together parts of the body. Even the body s own weight puts compressive force on the spine. Constriction of Blood Vessels blood vessels can be squeezed, compressed or shrink so that it is hard for the blood to flow through the vessels. Reduced blood flow means less nourishment for the cells past the constriction. 32

35 Contraction (muscle) when a muscle is used, it shortens and thickens (contraction) then relaxes and becomes longer and slimmer. Degenerative Disc Disease breakdown of the discs (which act as shock absorbers) that separate the vertebrae. Disc composed of cartilage with a gellike center, discs separate one vertebrae from the next, and act as shock absorbers to help resist compression of the spine. Dynamic Work involves movement of the muscles. For example, when you hammer, your biceps and triceps are dynamic. (See Static Work.) Energy the capacity to do a certain activity. Some activities, such as carrying, lifting, climbing require a lot of energy. Engineering Control redesigning equipment, tools, work organization and workplaces to reduce workers exposures to factors that cause harm. Epicondylitis inflammation of tendons at the elbow (known as tennis or golfer s elbow). Ergonomics the study of how work, the workplace and the worker all relate to each other.the goal of ergonomics is to fit the work and workplace to the person. External Contact Stress direct pressure from tools and sharp edges on soft tissues (for example, palm of the hand) can damage blood vessels and nerves. Fatigue tiredness that results when there is not enough rest and recovery time for the body to recover from work. Depending upon the activity, the fatigue may be in a muscle or group of muscles (localized muscle fatigue) or the whole body (whole body fatigue). Force Requirements the amount of effort needed to lift, push, pull, hold objects or operate a tool. Hand-Arm Vibration vibration (generally from a hand tool) that goes through the hand, then travels through the rest of the body. Heavy Physical Work work that uses a high level of energy. Lifting, carrying, pushing, pulling, climbing are all examples of heavy physical work. Inflammation the body s reaction to injury. A repair process that produces pain, swelling, redness. Joint the place where two bones meet knee, elbow, fingers, etc. Ligament tough, strong tissue that attaches one bone to the next across a joint. Localized Muscle Fatigue occurs in a specific muscle or muscle group or groups. 33

36 Median Nerve an important nerve that goes down the arm from the neck to the thumb, index and middle fingers and near side of ring finger. It is the median nerve that gets squeezed in carpal tunnel syndrome. Muscle Cramp sudden painful contraction of a muscle; usually caused by overuse (without rest), strain, chill. Muscle Force the effort need to move, lift, hold an object or tool or keep a posture without moving much. Musculoskeletal System the skeleton (bones), cartilage, ligaments, tendons and muscles that support us. Nervous System the brain, spinal cord and nerves coordinates all body activities. NIOSH National Institute for Occupational Safety and Health. A government agency that researches workers health and safety issues. Pinch Grip gripping an object between the fingertips. A pinch grip, which uses small muscles of hand requires much more strength than a power grip (see below). Power Grip gripping an object by wrapping the whole hand around it so the thumb and finger tip are touching each other (for example, gripping a hammer). Uses large muscles of arm; has about four times the strength of a pinch grip. Repetitive Stress Injuries (RSIs) disorders of the muscles, tendons, nerves and blood vessels caused by repeated forceful exertions. It can take some time before pain or dysfunction appear. (Also called overuse or Cumulative Trauma Disorder [CTD].) Reynaud s Phenomenon also called white fingers or hand-arm vibration syndrome. Use of vibrating tools (for example, a rotary hammer) constricts blood vessels in hand, preventing tissues in fingertips from getting enough blood, oxygen and nutrients. Fingertips turn white and painful, especially in the cold. Risk Factor (work-related) a part of a job that increases the worker s chance of getting an illness or injury. For musculoskeletal disorders risk factors include forcefulness, awkward postures and repetitive motions. Rotator Cuff Tendinitis Inflammation of a tendon or tendons in the shoulder. Also called Pitcher s Shoulder. Sheath the covering around a tendon. Sometimes it is the sheath and not the tendon that gets inflamed (see tenosynovitis below). Spinal Column the channel made up of vertebrae held together by ligaments and muscles. (See spinal cord below). 34

37 Spinal Cord the cord of nerve tissue that comes from the base of the brain, through the spinal column down the back. Major nerves branch off the spinal cord. Sprain overstretching or tearing of a ligament. Sprains are generally acute traumas (for example, a twisted sprained ankle). Static Work In static work, the worker holds a body position (for example, working bent over) for long periods of time without moving much. Static work is very tiring. (See Dynamic Work.) Strain an injury, usually to the muscle, caused by too much force or overuse. Strip Trigger a trigger that can be used by two or more fingers at a time. Strip triggers are less stressful than single-finger triggers which can cause trigger finger (an inflammation of finger tendon or its covering). Tendinitis inflammation of a tendon. Tennis elbow is tendinitis of the elbow; pitcher s shoulder is tendinitis of the shoulder. Tendon tough, rope-like tissue that usually attaches muscles to bones. Trigger Finger tendinitis or tenosynovitis (see above) of a finger (or fingers or thumb) caused by repeated triggering of a tool or forcefully holding fingers in one position. It becomes hard to straighten finger. Upper Extremity entire area from the neck to the fingertips, including shoulders, arms, elbows and hands. Vein blood vessel that carries blood from the body cells back to the heart to pick up more oxygen. Vertebra one of the 33 bones that form the spinal column. Whole Body Fatigue when physical demands on your body exceed your capacity your heart beats faster, you breathe faster, you feel hot, uncomfortable and may sweat. Whole Body Vibration heavy equipment operators and bus drivers are exposed to this. Over time, the vibration can cause small traumas to the spine. Workload the physical effort needed to do a job. Tenosynovitis inflammation of the sheath (covering) of a tendon.when the sheath is inflamed it becomes difficult for the tendon to move. 35

38 Ergonomics Symptoms Survey Name Date / / Male Female Right-Handed Left-Handed Current Job Title 1. Briefly describe your job duties. Focus on how you use your body. 2. Do you know any other workers who have had any pain or discomfort during the past year which they feel might have been caused or made worse by their work? Yes No 3. Have you had any pain or discomfort during the past year which you feel might have been caused or made worse by your work? Yes No If NO, please stop here. 5. Did this problem begin before or after you began your current job? Before After 6. If you think the problem was caused by a previous job, please describe. ESP Health and safety committees can use this survey to document work-related injuries and illnesses. This type of record can be used to help convince the employer to make necessary changes in work equipment or processes. 4.What part of your job do you think caused your pain or discomfort? 7.Who has given you treatment for this problem? (check each that applies) none self-treatment (aspirin, Tylenol, etc.) school nurse doctor picked by administration doctor I chose myself occupational or physical therapist chiropractor 36