Neck and shoulder injuries – causes and solutions

In 1997, NIOSH (National Institute for Occupational Safety and Health) released a publication called Musculoskeletal Disorders and Workplace Factors, A Critical Review of Epidemiologic Evidence for Work-Related Musculoskeletal Disorders of the Neck, Upper Extremity, and Low Back http://www.cdc.gov/niosh/docs/97-141/pdfs/97-141.pdf . Although this report over 20 years old, the valuable information about what causes work-related injuries remains current.

One of the most interesting parts of the report is the evidence of work-relatedness to injuries.  From the 40 epidemiologic studies they evaluated, NIOSH judged how strong they felt the evidence was that the injury or musculoskeletal disorder (MSD) was caused by the ergonomic risk factor.   Ergonomic risk factors include:  force, repetition, awkward postures, and static postures to name a few.  The categories they used were:

  • Strong Evidence of Work-Relatedness (+++) – a causal relationship
  • Evidence of Work-Relatedness (++) – convincing epidemiologic evidence for a causal relationship
  • Insufficient Evidence of Work-Relatedness (+/0) – could not conclude the presence or absence of a causal relationship
  • Evidence of No Effect of Work Factors (-) – the specific risk factor is not related to MSDs

What they found for the neck and shoulder area was this:

  1. Evidence of Work-Relatedness (++) between highly repetitive work and neck and neck/shoulder MSDs. Repetitive work was defined as activities which involve continuous arm movements which affect the neck/shoulder muscles.
  • So for people who have jobs like painting overhead or lifting to higher levels in a warehouse on a continuous basis, there is evidence that their work causes neck and neck/shoulder injuries.  Even people who keyboard and mouse all day are at risk if their keyboards and mice are too high (activates the trapezius muscle in the neck).
  • Proper use of ladders and the installation of a keyboard and mouse tray would be good ergonomic interventions here.
  1. Evidence of Work-Relatedness (++) between forceful exertion and neck MSDs.  Forceful work was defined as powerful arm or hand movements, which generate loads to the neck/shoulder area.
  • People who do heavy assembly work overhead or construction work would be at risk here.
  • Lowering assembly work levels and rotating jobs in construction should reduce risk.
  1. Strong Evidence of Work-Relatedness (+++) between high levels of static contraction, prolonged static loads, or extreme working postures involving the neck/shoulder muscles and neck and neck/shoulder MSDs.  Static contraction and loads refer to postures being held for a long period of time.  Extreme postures would involve overhead reaching, bending, and squatting usually combined with twisting and reaching beyond comfort levels.
  • People who carry trays of food in banquet halls or move furniture or appliances would be at risk for prolonged static loads.  People who have to work in confined areas with very awkward postures and reach would also be at risk.  And people who keyboard and mouse all day with their shoulders hunched due to their keyboard and mouse being too high would be at risk too.
  • Weight limits on trays, lift assists for furniture and the installation of a keyboard and mouse trays would be helpful here.

In my next several posts, I will be discussing other areas of the body where there is evidence of work-relatedness to various injuries and identifying further jobs where there may be risks.  Ergonomic interventions will be included too.

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Making your job easier

It’s important to have fully adjustable equipment and furniture to ensure your comfort at work.  It’s also important to have good posture, take rest breaks, and vary your work tasks during the day.  These are the cornerstones of good ergonomics.  But what about digging a little deeper into the science of ergonomics to see if you can make your workday more efficient?

Ergonomic consultants perform a task analysis when they conduct basic ergonomic evaluations.  They look at each task the worker performs and identify risks factors that cause ergonomic injury.  If they were asked to take the process a step further with the intent of streamlining inefficiencies, they would use organizational ergonomics and perform a detailed task analysis.  This involves breaking down the tasks into very small tasks and for each one of these, listing the actions, decisions, information, and stimuli that would be required.  They would then take this information and analyse it to come up with new processes for the company to adopt.

This is a very involved process that requires much research and analysing, but you can perform a simplified version in your own workplace and enjoy the benefits of a more efficient day.  First off, you would list out all the tasks you do in a day and then take those tasks and break them down further.  Look at these tasks closely.  Is there a lot of repetition in your tasks?  Are there tasks that could be combined?  Do you need to do everything that you are doing?  Can you cut down on the intensity of some tasks?

Here are some examples of how tasks could be changed:

  • Do you write a lot of reports or letters?  Do you find yourself retyping the same sentences or phrases on each report or letter?  If so, make up a skeleton report or letter.  Put the sentences and phrases you use a lot in the skeleton and the next time you go to write a report or letter, use the skeleton and pick and choose which sentences and phrases to use.
  • Take a look at the software you’re using.  Are you aware of all the features it has?  Are you using all the features that would help you?  Do a search on the internet for “cheat sheets” along with the name of your software program.  Aim to master a new feature each day.
  • Make sure you do a quick agenda for every meeting you hold.  List items to be discussed and the time for each.  This will help you stay on track and cut down on wasted time.
  • Are there numbers you can memorize to cut down on time?  For example, a grocery cashier will check out a customer much faster when they have the produce numbers memorized.
  • Plan ahead for what you need.  If you need to go to the printer to retrieve your document, get the mail then too.
  • Keep fully stocked.  If you are a repair person, keep everything you need in your truck and on your tool belt.  If you are a teacher, make sure you have all your supplies stocked at the beginning of the day so you don’t rush around during class time.
  • Do you need to do every task?  Do the trash and recycling cans need to be emptied twice a day?  Could it be done once a day?
  • Does the task have to be as intense as it is?  Are paper copies really necessary or will an email do?  Are three coats of paint necessary or will two do?

Tasks can be modified in any profession and in any capacity.  Only you know your job as well as you do.  Take a good look, identify the things that can be changed, and then sit back and enjoy your efforts.

Ergonomics and business travel

When you travel for work, it is important not to forget about ergonomics.  Computer ergonomics usually worsens during travel, combined with having to transport luggage and other business materials.  Here are some tips to help you stay in ergonomics mode when travelling:

  1. Book an executive hotel room – Many hotels offer hotel rooms with ergonomics in mind.  Booking a hotel room with a desk and an ergonomic office chair will help you avoid uncomfortable postures that put you at risk for injury.
  2. Accessorize your laptop computer – Don’t forget to bring an external keyboard and mouse for your laptop.  Having an external keyboard will allow you to separate the monitor screen from the keyboard decreasing neck and shoulder strain.  Compact sized or roll-up keyboards are great to cut down on space and weight.  And don’t forget to place your laptop on a phonebook or two to raise it to the proper height (top of monitor screen level with the eyes).
  3. Accessorize your phone – The same goes for your smartphone and iPad:  an external keyboard and mouse will leave you feeling much more comfortable while reducing the risk of injury.
  4. Pack smartly – Use two or three small suitcases/bags instead of one large one to distribute the loads.  Make one a back pack and one a rolling suitcase.  Be sure to have padded straps on your back pack and a hip belt to share the load to your hips.  A rolling suitcase that you don’t have to tip to roll will also lessen your load and protect your shoulders.
  5. Be healthy – It is tempting to grab and go when buying food and drinks on the road or in the airport.  But taking a few extra moments to choose healthy food and fill your waterbottle will keep you sharp and focused.  Be sure to carry healthy portable snacks like granola bars and nuts to maintain your blood sugar levels between meals.
  6. Don’t forget posture – Car and plane seats can wreak havoc on your lower back.  Keep the seat upright or tilted back slightly to achieve the most comfortable angle for your back.  Don’t forget to place a small pillow at your lower back to maintain the natural curve of your spine.  When walking with your luggage, keep your back and neck straight with your shoulders back.  Tighten your core muscles when lifting, pushing or pulling your luggage.

Taking extra time to prepare yourself for comfort will go a long way in helping you feel good while traveling and prevent extra fatigue upon return.  Following these tips will give you a happy, productive business trip with no aches and pains to slow you down.