Ergonomics

1) Washington Post, March 21, 2001, “President Bush Signs Repeal of Ergonomics Rules, Administration Promises Business-Friendly Workplace Safety Regulations,” written by Mike Allen, Staff Writer:

“President Bush signed his first bill carrying national impact yesterday, repealing workplace safety regulations that he called ‘unduly burdensome and overly broad,’ and sent his administration to work on a business-friendlier substitute that is months or years away.”

President Bush said, “There’s an ergonomics — change in ergonomics regulations that I believe is positive. . .Things are getting done.”

After signing the ergonomics bill, President Bush issued a statement:

“The Safety and health of our nation’s workforce is a priority for my administration,” he wrote. “Together, we will pursue a comprehensive approach to ergonomics that addresses the concerns surrounding the ergonomics rule repealed today.”

“The ergonomics regulations, which were 10 years in the making, would have taken effect in October.”

One study published in the Scandinavian Journal of Work and Environmental Health, 1994;20:417-26, “Job Task and Psychosocial Risk Factors for Work-Related Musculoskeletal Disorders Among Newspaper Employees,” written by Bruce Bernard, M.D.; Steve Sauter, Ph.D.; Lawrence Fine, M.D.; Martin Petersen, Ph.D.; and Thomas Hales, M.D, investigating work related musculoskeletal disorders among newspaper employees found neck symptoms were the most frequently reported. Women tended to have higher rates of tension neck syndrome than men. . .this finding may reflect the concentration of women in jobs involving more risk factors.

“Martha G. Burk, Chair of the National Counsel of Women’s Organizations, an umbrella for 120 groups representing 6 million people, said women suffer many ergonomic injuries from keyboard work and machine cleaning, and called the repeal ‘a slap in the face of women.’”

White House spokesman, Ari Fleisher, said:

“President Bush believes that we can protect the health and safety of workers without passing a regulation that is terribly burdensome to the economy and to the small businesses on which their growth depends.”

ERGONOMICS AND TRUCK DRIVERS

2) Sangyo Eiseigaku Zasshi, 2000, Jan; 42(1):6-16, written by Koda S, Yasuda N., Sugihara Y., Ohara H., Udo H., Otani T., Hisashige A., Ogawa T., Toyama H., Kochi Medical School, Department of Public Health, Japan:

The above-mentioned study was a questionnaire survey which analyzed work-related health problems among truck drivers.

“134 local truck drivers, 199 long-distance truck drivers, and 71 clerical workers were analyzed. . .The prevalence rates of work factors affecting health problems of truck drivers were significantly higher than those of clerical workers in the items on irregular shift work, working environment, working posture, handling heavy materials, job stress due to overloading and working time, and limited time off.

The prevalence rates for subjective symptoms (ringing in the ears, neck pain, and low back pain) and present illnesses (hypertension, ulcers in the digestive tract, back injuries, whiplash injuries and hemorrhoids) among truck driers were significantly higher than those of clerical workers.”

MUSCULOSKELETAL PROBLEMS AND DRIVING IN POLICE OFFICERS

3) Occupational Medicine, Vol. 48, No. 3., pp. 153-160, 1998, “Musculoskeletal Problems and Driving in Police Officers,” written by D. E. Gyi and J. M. Porter, Vehicle Ergonomics Group, Department of Design and Technology, Loughborough University, Leicestershire, United Kingdom:

In the above-mentioned study, the Occupational Health Department of a rural police force in the United Kingdom had concerns with relation to driving and its link to musculoskeletal disorders.

“There are now an increasing number of researchers whose work implicates prolonged exposure to car driving as a risk factor for low back pain.  However, such epidemiological studies examining the relationship between car driving and back pain or other musculoskeletal troubles are difficult to conduct.  Driving as a task involves prolonged sitting, a fixed posture, and vibration, any of which could directly lead to musculoskeletal trouble.  It is likely that symptoms arise from multiple relationships and influences, (Rey, P., 1979).”

“These police drivers are also deemed to be at particular risk because of the following:

  • They are generally tall males and wear bulky clothing such that seat adjustment may be insufficient to obtain a good posture.
  • They drive fleet cars where the seat and suspension are exposed to excessive wear and tear.
  • They often have to drive in rapid response situations such that they are exposed to fast acceleration and deceleration.
  • Driving is often followed by strenuous physical activity such as lifting and running.
  • They spend most of their eight-hour shift driving or sitting in their vehicle.
  • They often have to take back-seat passengers, such that tall males are unable to take advantage of any seat adjustments that do exist.”

“In a survey of 2,000 U.S. police officers, the number and types of health disorders reported b these officers over a 6-month period were similar to those found in the general public over a 12 month period, (Hurrel, J., 1984).”

The results of the above-mentioned study agree with the findings of other studies that indicate driving a car is a risk factor for the development of low back pain.

4)  Textbook of Pain, 1998, “Prevention of Disability due to Chronic Musculoskeletal Pain,” written by Steven James Linton:

The above-mentioned chapter in the Textbook of Pain, “examines procedures designed for use in health-care settings to prevent disability due to musculoskeletal pain.”

The following statement is made:

“Because musculoskeletal pain is a major source of suffering, health care, and utilization of compensation, there is a definite need for prevention.  However, prevention is not an easy task because disability is related to a developmental process in which multidimensional factors operate over time to produce significant lifestyle changes.  Research on risk factors indicates that although medical and workplace factors are obvious, psychosocial variables are central to the transition from acute to chronic pain.  The early identification of ‘at-risk’ patients is a key to allocating resources and initiating secondary prevention.”

“Unfortunately, we do not yet understand the exact mechanisms that produce musculoskeletal pain.”

ACUTE PAIN

“Acute pain – Pain which is generally defined as pain up to about three weeks is characterized by temporary decreases in activity, reliance on medication, and help-seeking.  It is accompanied by psychological distress; for example, fear, anxiety and worry, in addition to beliefs that pain is controllable through medical and active coping…The patient may have organic findings as well as muscle spasms.

SUBACUTE PAIN

“Subacute pain – Pain which is considered to be between 3 and 12 weeks.  Patients may exhibit altering patterns of increasing and decreasing activity, and withdraw or become reliant on medication.”

PERSISTENT OR CHRONIC PAIN

“Persistent or chronic pain – Pain which is defined as more than 3 months’ duration, activities may have decreased sharply. . .The pain becomes more constant although patients may experience ‘good’ and ‘bad’ periods.”

RECURRENT MUSCULOSKELETAL PAIN

“Musculoskeletal pain is usually recurrent in nature.  While most episodes of back pain remit rather quickly and most people return to work within 6 weeks, (Reid, et al., 1997), the majority of sufferers will experience several episodes of pain during the course of a year, (Frymoyer, 1992; Nachemson, 1992; VonKorff, 1994; Linton & Hallden, 1997).”

50 % OF ACUTE BACK PAIN SUFFERERS HAVE PAIN 6 – 12 MONTHS LATER

“More than 50 percent of patients with acute back pain will experience another episode within a year (Nachemson, 1992), and prospective studies indicate that almost half will still have significant problems 6 – 12 months later, (Philips & Grant, 1991; VonKorff, 1994; Linton & Hallden, 1997).”

MUSCULOSKELETAL PAIN = LEADING CAUSE OF EARLY PENSIONS

“Firstly, a large number of people suffer from musculoskeletal pain, making it a leading health-care problem even though only a minority develop persistent dysfunction.  Musculoskeletal pain is a leading cause of health-care visits, particularly in primary care,  sick absenteeism, and early pensions, (Frymoyer, 1992; Nachemson, 1992; Skovron, 1992).  However, several studies indicate that over 90 percent of those off work with an acute episode of back pain will return within 3 months, (Waddell, 1996;  Reid, et al., 1997).”

“Secondly, as shown above, musculoskeletal pain is recurrent in nature even though most patients return to work rather quickly after an acute episode.  Although acute sufferers usually feel better and return to work within a few weeks, this does not mean that they have recovered fully or permanently.”

“Thirdly, while up to 85 percent of the population will suffer from musculoskeletal pain, only a small number will account for most of the costs, (Nachemson, 1992; Skovron, 1992; Waddell, 1996).  In general, less than 10 percent of the sufferers may consume up to 75 percent of the resources, (VonKorff, 1994; Reid, et al., 1997).  Thus preventing disability and high-cost cases may result in large economic savings, so that these people constitute a special target for prevention programs.”

MUSCULOSKELETAL PAIN IN SWEDEN & THE NETHERLANDS

“Further, most of the money at this time is spent on compensation, while relatively little is spent on treatment, and almost nothing is invested in prevention.  In Sweden, about 85 percent of the total resources for musculoskeletal pain are spent on compensation as compared to 15 percent for all treatments and drugs, a figure which has remained fairly constant over a 15-year period, (Linton, 1998).”

“Similarly, in The Netherlands, a recent study of all costs due to back pain showed that 93 percent involved compensation and only 7 percent involved treatment, (Van Tulder, et al., 1995).”

PREVENTION NEEDS RESOURCES

“Consequently, until prevention is granted more resources, programs need to be relatively cheap; and this suggests incorporating them into existing practice routines.”

ERGONOMIC RISK FACTORS TO PREVENT

“A host of ergonomic factors, for example, lifting, heavy work, twisting, bending, manual handling, and repetitive work have been found to be associated with musculoskeletal pain, (Pope, et al., 1991; Skovron, 1992).”

“A recent review of some 60 studies revealed a relationship between musculoskeletal pain problems and job demands, control, monotonous work, time pressure, and perceived workload, (Bongers, et al., 1993).”

“If the problem does not remit within 2 – 4 weeks, a formal screening procedure is suggested.”

MAINTENANCE OF LUMBAR LORDOSIS = DECREASED RISK OF LOW BACK PAIN,  ISCHIUM (BUTT BONE) PAIN, & COCCYX (TAIL BONE) PAIN

5)  Spine, Volume 22, Number 21, pp. 2571-2574, 1997, “Lumbar Lordosis, Effects of Sitting and Standing,” written by Michael J. Lord, M.D.; John M. Small, M.D.; Jocylane M. Dinsay, R.N., M.N.; and Robert G. Watkins, M.D., Kerlan-Jobe Orthopedic Clinic, California, U.S.A.:

The objective of the above-mentioned study was to document changes in segmental and total lumbar lordosis (inward curvature of the lumbar spine) between sitting and standing radiographs (x-rays).

“One hundred and nine patients with low back pain underwent radiography in the sitting and standing positions. The patients ranged in age from 21 years to 83 years (mean age, 47 years) and had had no prior lumbar spine fusion or clinical deformity. Seventy men and 39 women took part in the study.”

DECREASED LUMBAR LORDOSIS & LOW BACK PAIN

In their discussion, the authors state the following:

“Keegan (1953) in a study of the relationship between lordosis and sitting, found the most important factor in low back pain with prolonged sitting to be decreased trunk-thigh angle with consequent fattening of the lumbar curve.  Use of a lumbar roll that increases lordosis has been found to decrease low back pain, (Williams, A.M., et al., 1991).”

DECREASED LUMBAR LORDOSIS & BUTT PAIN / TAIL-BONE PAIN

“With decreased lordosis, sitting pressure increases over the ischium (butt bones) and coccyx (tail-bone) with resultant pain, (Drummond, D.S., et al., 1982 and 1985; Smith, R.M., et al., 1992.)

The following conclusions were made:

“Segmental and total lordosis were significantly different in the sitting and standing postures. Lordosis increased almost 50 percent when the patients moved from the sitting to the standing position. The clinical significance of this data may pertain to:

  1. The known correlation of increased intra-discal pressure with sitting, which may be caused by this decrease in lordosis;
  2. To the benefit of a sitting lumbar support that increases lordosis; and
  3. To the consideration of an appropriate degree of lordosis in fusion of the lumbar spine.”

Forward Bending & Low Back Pain

Forward Bending & Low Back Pain

6.  Spine, Volume 21, Number 1, pp. 71-78, 1996,“Analysis of Lumbar Spine and Hip Motion During Forward Bending in Subjects With and Without a History of Low Back Pain,” written by Marcia A. Esola, M.S., P.T.; Philip W. McClure, M.S., P.T.; G. Kelley Fitzgerald, M.S., P.T.; and Sorin Siegler, Ph.D., U.S.A.:

In this study, a motion analysis system was used to measure the amount and velocity of lumbar spine and hip motion during forward bending.

The authors begin by citing the following previous findings:

EPIDEMIC OF LOW BACK PAIN

“Disorders of the low back have reached epidemic proportions, (DeRosa, C.P., 1992).”

BILLIONS OF $$$ ANNUALLY, LOST WORK TIME & WORKERS’ COMP CLAIMS

“Epidemiologic studies show that billions of dollars are spent annually on the problem of low back pain, which is one of the most commonly-cited problems for lost work time in industry and Workers’ Compensation claims, (Chase, J.A., 1992; Frymoyer, J.W., 1988; and Pope, M.H., et al., 1991).”

FREQUENT FORWARD BENDING & LOW BACK PAIN

“Researchers have shown an association between frequent forward bending and low back pain, (Berquist-Ullman, M., et al., 1977; Magora, A., 1973; Mellin, G., 1986; Punnett, L, et al., 1991; Svensson H.O., et al., 1989; Videman T., et al., 1989).”

SLOUCHING WHILE SEATED / BENDING AT THE WAIST WHILE STANDING

“Prolonged sitting with the lumbar spine in a flexed position (slouching) and flexed standing postures (bending at the waist) are also associated with an increased risk of low back pain, (Anderson, G.B.J., 1991; Berquist-Ullman, M., et al., 1977; Magora, A., 1972; Punnett, L., et al., 1991; Riihimaki, H., et al., 1989).”

OCCUPATIONS INVOLVING REPETITIVE FORWARD BENDING

“Saunders reports that people with herniated inter-vertebral discs often have a history of an activity or occupation involving repetitive forward bending.”

“Nachemson (1981) has shown that inter-vertebral disc pressure increases 20 percent over that measured in standing when forward bending 20 degrees, and increases 100 percent when bending up to 40 degrees.”

INADEQUATE HIP FLEXIBILITY & EXCESSIVE LUMBAR MOTION

“It has been suggested that inadequate hip flexibility coupled with excessive lumbar motion during forward bending results in low back pain, (Biering-Sorenson, F., 1984; Sahramann, S.A., 1993). . .Sahramann (1993) suggests that excessive lumbar mobility leads to tissue overloading, micro-trauma, and ultimately the development of degenerative joint and disc disease. A person may experience low back pain at any stage of this sequence of events.

FORWARD BENDING = RISK FACTOR FOR LOW BACK PAIN

“Forward bending has been clearly recognized as a risk factor for low back pain. Altered movement patterns of the lumbar spine and hips during forward bending may help explain why forward bending is a risk factor for the development of low back pain.”

HAMSTRING STRETCHING HELPFUL 

In the conclusions, the authors state: “The results provide quantitative data to guide clinical assessment of forward bending motion.  Results also suggest that although people with a history of low back pain have amounts of lumbar spine and hip motion during forward bending similar to those of healthy subjects, the pattern of motion is different.  It may be desirable to teach patients with a history of low back pain to use more hip motion during early forward bending, and hamstring stretching may be helpful for encouraging earlier hip motion.”

 

 

 

 

 

 

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