Ergonomics:

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ErgonomicsTrain the Trainer

• Daniel Cohen
• Greater Valley Safety Consulting

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Definition

• Webster
• ergonomics (ûr'g?-nom'iks) an applied science
  concerned with designing and arranging things
  people use so that the people and things interact
  most efficiently and safely.
• Literal definition
• Ergon work
• Nomos rules
• The rules of work

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Ergonomics

• Ergonomics the engineering science concerned
  with the physical and psychological relationship
  between machines and the people who use them.
• The practice of adapting products and processes
  to human characteristics and capabilities in
  order to improve peoples well-being and optimize
  productivity.
• Fitting the job to the worker
• We must understand
• What tasks are being performed
• Who is performing the tasks
• What is being used to perform the tasks

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Environmentlighting air qualitytemperaturespace noise                                    Peoplephysical sizework habitsphysical conditionindividual attributes                              Taskstools and equipmentwork pacejob requirements
                                                                                                                    
Psychosocialadministration philosophyemployee responsibilityjob satisfaction stressincentive payquotas Psychosocialadministration philosophyemployee responsibilityjob satisfaction stressincentive payquotas                           Furniturework surfacestechnology/equipmentchairsadjustability Furniturework surfacestechnology/equipmentchairsadjustability
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The Perfect Worker
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Components of a Work Station Fitting all the
pieces together!

• Chair
• Work surface
• Keyboard/Mouse
• Monitor
• Telephone
• Environment
• Accessories

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Chair

• Seat Height
• Able to reach the floor comfortable with both
  feet flat on the floor
• Seat Angle
• Slightly forward tilt
• Seat Depth
• Allow a width of three fingers between calf and
  seat pan
• Backrest Height
• Back support hits the lumbar region
• Backrest Angle
• Allows for 90 - 120 hip flexion
• Armrests
• Must be used correctly or should not be used at
  all

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Adjusting Your Chair - Video

• Watch Video
• Lets give it a try!

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Work Surface

• What can be adjusted?
• Height
• Should be adjusted to the proper chair position.
• Allows for ergonomic positioning.
• Arrangement
• Primary, secondary, reference zone

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Workstation Set-up

• Primary Work Zone
• The distance from elbow to hand
• Able to reach these items without reaching for
  them.
• Secondary Work Zone
• Within arms reach
• Reference Zone
• Outside of arms reach

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Keyboard/Mouse

• For most employees these should be situated in
  the primary work space.
• Arrange directly in front of monitor.
• Demonstrate how to correctly use the mouse and
  keyboard.

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Monitor

• Distance
• Good rule of thumb is approx. an arms length away
  (18-30 in.).
• Height
• Eye level should be at the top 1/3 of monitor.
• Bifocals need to have monitor as low as you
  can.
• Location
• Directly in front of the keyboard.
• Angle
• Approx. 10-20
• Font
• Size
• Clarity/Resolution
• Color Schemes
• Light colored font on dark background.

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Telephone

• Depending on employee, the phone will normally be
  placed either in the primary or secondary work
  space.
• Headsets
• More than 2 hrs of use per day Mandatory?
• Built-up hand set attachments do not do enough.

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Environment Every day nuisances

• Lighting
• Air Quality
• Temperature
• Space
• Noise
• Neighbors
• Fax, Copier, Telephone, etc.

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Accessories

• Document Holders
• Footrests
• Glare Screens

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Assessment Process

1. Gather information.
2. Evaluate how the existing set-up looks.
3. Adjust what is already there.
4. Make your adjustments/recommendations.
5. Follow up/Re-evaluate (2 weeks).
6. If still deficienttry new adjustments and
   consider introducing equipment.
7. TRAIN how to use!
8. Follow up as needed.

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Gather Information

• Interview the employee
• What are your job tasks?
• How often do you do these tasks each day?
• How long have you noticed this pain?
• When does it hurt mostend of day, busier days,
  towards the end of the week, etc.?
• Do you take regular breaks?
• What irritates it the most?
• What specifically hurts?
• What do you think the issue is?
• What do you think will help?
• Observe the employee
• Watch them work for awhile.
• Encourage them to work as they normally would.
• How do they interact with their environment?

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Assessment Process

• Evaluate the existing set-up
• Use checklists if available (initial assessments)
• What is already present and what can we adjust?
• The workstation components
• The process
• The worker
• Look for postural issues and bad habits
• Adjust what is adjustable
• Who will be responsible for making adjustments?
• Make your recommendations
• Document
• Stick only to the facts. What was said, what was
  observed, measurements.
• Name, date, specific report of discomfort,
  observations, recommendations, plan of action,
  and follow up needs.

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Sample documentation

• ____ contacted me yesterday after seeing ____., a
  hand therapist at _________ . ____ has been
  having difficulty bilaterally with tendonitis in
  her wrists every since being pregnant. In
  looking at her workstation, I noted that her
  mouse is positioned in a way that causes her to
  reach forward with her shoulder and she is also
  anchoring her wrist down causing her to remain in
  a static wrist extension for prolonged periods of
  time. I moved her mouse so it is at the edged of
  her desk, reducing/eliminating shoulder flexion
  and I placed a piece of dycem underneath her
  mouse pad to eliminate any sliding. I also
  demonstrated the proper way to hold and use the
  mouse so that it involves the entire arm movement
  and keeps her wrist in a neutral position vs.
  anchoring at the wrist. I replaced her split
  keyboard with a regular one because her keyboard
  seemed too large for her. She still needs to
  reach laterally a good distance to get to her
  mouse so I ordered a keyboard with the number pad
  on the left side which will allow her to keep her
  mouse much closer to her side, reducing her
  lateral reach. I will follow up with ____ in one
  week and install the keyboard as soon as it
  arrives. rw

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Assessment Process

• Follow up
• When? Varies depending on the situation.
• Has there been any improvement?
• Have conditions worsened?
• Re-evaluate
• Do you still note some areas of concerns?
• If sois there anything else already present that
  can be adjusted?
• May need to look at introducing some type of
  ergonomic equipment.
• Explain whytrain how to useuse it yourself

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Ergonomic EquipmentGadgets, Gizmos, and Other
Stuff

• Wrist Rests
• Pros
• Maintain neutral wrist positioning
• Reduce weight throughout shoulders
• Softens the surface under the wrists
• Cons
• Promotes anchoring at the wrist
• Contact point on the wrist

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• Keyboard Trays
• Pros
• May adjust the keyboard height and angle to
  custom fit the users needs
• Allows for more posture changes
• Cons
• May decrease knee clearance
• May force longer reaches for other things
• If adjusted incorrectly, may exaggerate problems

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• Alternative ergo Mice/Keyboards
• Pros
• Allows you to use different muscle groups
• Reduce/Eliminate awkward postures of the arms or
  wrists
• Reduce/Eliminate movement at the wrist
• Cons
• Difficulty adapting, leading to reduced
  production
• May be using more/different/smaller muscle groups
• No evidence that trackballs help/hinder

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Do we need an ergo intervention?
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Trouble ShootingWhy do we hurt???

• Poor posture
• Lack of movement
• Frequent micro breaks
• Prolonged poor posture can decrease productivity
  by as much as 50
• Stand to sit ratio of 7030
• 60 second break every hour

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Troubleshooting

• Headaches
• Muscle tension
• Stress
• Irritated/Dry Eyes
• Monitor glare
• Distance of monitor
• Prolonged computer use/Lack of breaks
• Font selection
• Poor vision
• Neck Pain
• Poor head postures
• Monitor height
• Monitor location
• Document viewing
• Arms extended
• Cradling the phone
• Armrests

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Troubleshooting

• Shoulder Pain
• Poor conditioning
• Forward head posture
• Mouse/keyboard too high or off to the side
• Arms extended
• Overhead reaching/lifting
• Overuse/Lack of breaks
• Elbow Pain
• Keyboard too high
• Leaning on elbows
• Repetitive squeezing/pinching
• Striking keys too hard
• Reaching for mouse
• Overuse/Lack of breaks

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Troubleshooting

• Wrist/Forearm Pain
• Keyboard/mouse positioning
• Contact forces
• Striking keys too hard
• Wrist alignment
• Wrist deviation
• Resting on elbows
• Gripping too tight
• Type of mouse
• Overuse/Lack of breaks

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Troubleshooting

• Hand/Finger Pain
• Excessive force on mouse/keyboard
• Holding static positions
• Contact points at wrists
• Type of mouse
• Wrist alignment
• Gripping pen too tightly
• Keyboard/mouse positioning
• Overuse/Lack of breaks

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Troubleshooting

• Upper Back Pain
• Poor conditioning
• Elevated shoulders (armrests)
• Extended arms
• Forward head
• Muscle tension
• Mouse/keyboard is too high/low
• Seating
• Lack of breaks

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Troubleshooting

• Low Back Pain
• Poor posture
• One foot under buttocks
• Arms extended
• Twisting
• Seating
• Feet do not touch floor
• Lack of breaks
• Leg/Feet Pain
• Seating
• Feet dangling
• Seat pan depth
• Posture
• Lack of breaks

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Common Themes??

• Poor Posture
• Failure to take breaks
• We need to continuously stress the importance of
  each employee taking a personal responsibility
  for themselves.

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Upper Extremity Musculoskeletal Disorders

• What are they?
• Soft tissue ailments to the upper extremities,
  most commonly caused by overuse.
• Soft tissue refers to any tissue that connects,
  supports, or surrounds other structures (bones,
  joints) and organs.
• Examples muscles, tendons, cartilage,
  ligaments, nerves, fat cells, blood vessels
• Also referred to as
• CTD (Cumulative Trauma Disorder)
• RSI (Repetitive Stress Injury)
• Overuse Syndrome
• Musculoskeletal Injuries

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Common repetitive-type injuries found in the
office setting

• Lateral Epicondylitis
• Medial Epicondylitis
• Tendonitis
• Carpal Tunnel Syndrome
• Ulnar Nerve Impingement
• DeQuervains Tendonitis
• Shoulder Tendonitis, Bursitis, Impingement
• Rotator Cuff Tear
• Thoracic Outlet Syndrome

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Tendonitis

• Literally means inflammation of the tendon.
• Tendons connect your muscles to your bone.
• Common cause is overuse, when muscles are being
  asked to do higher levels of activity they are
  not accustomed to doing.
• Treatments
• Icing the affected area
• Rest
• Brace protects the tendon
• Anti-inflammatory medication

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Lateral Epicondylitis

• More commonly known as Tennis Elbow
• Pain in the lateral aspect of the elbow where the
  muscles connect to the bone.
• Treatment
• Stop or limit activity
• Anti-inflammatory medication
• Brace may be worn
• Stretching and strengthening.

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Medial Epicondylitis

• Also known as Golfers Elbow
• Similar condition as Lat. Epi., only the pain in
  on the inside of the elbow around the boney
  prominence.
• Treatment is the same as with Lat. Epicondylitis.

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Carpal Tunnel Syndrome

• A disorder in which the median nerve is
  compressed at the wrist
• Causes numbness and tingling. Usually on the
  thumb side fingers.
• Treatment
• Wear brace at night or during activities
• Limit activities that aggravate condition
• Surgical intervention

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Ulnar Nerve Impingement

• Occurs when the Ulnar Nerve becomes compressed
  and cannot function properly
• Numbness and tingling in the ring finger and
  little finger.
• Causes
• Overuse with the elbow in a bent position
• Direct blow to the elbow
• Sleep habits

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DeQuervains Tendonitis

• A condition caused by irritation or swelling of
  the tendons found along the thumb side of the
  wrist.
• Pain over the thumb side of the wrist is the main
  symptom. Usually described as sharp, stabbing
  pain.

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Shoulder Tendonitis, Bursitis, Impingement

• Tendons of the rotator cuff make contact with the
  acromion and they become swollen.
• The swollen tendon can get trapped and pinched
  under the acromion. This is known as an
  impingement.
• Bursitis fluid-filled sacs called bursa become
  inflamed.

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Rotator Cuff Tear

• A tear in the tendon
• Chronic over time, RC tenditis eventually wears
  a hole through the tendon.
• Acute a sudden motion or lift causing a pop in
  the shoulder. Usually experience an immediate
  onset of pain.

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Thoracic Outlet Syndrome

• Your thoracic outlet is the small space between
  your collarbone (clavicle) and your first rib.
• Caused by pressure on the nerves and/or blood
  vessels that pass through the thoracic outlet.
• Symptoms can include pain, numbness, tingling,
  weakness, or coldness in the upper extremity.

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Personal factors/habits

• Posture
• Attitude
• Sleep Postures
• Hobbies/Sports
• Age
• Gender
• Driving
• Psychological Impact
• Obesity/Exercise Fitness
• Smoking
• Personal Habits

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Posture and neutral position gets the first look
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Not so innocent victims
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And so on.
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And so on.
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Modified from Chaffin Anderson
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What was always Mothers Advice???

• Sit up straight!!!
• Guess whatshe was absolutely right!
• Decreases the load on your spine
• Helps the organs of your body function more
  efficiently
• It promotes movement efficiency and endurance and
  contributes to an overall feeling of well-being
• Helps you look confident

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Lifelong misuse of our bodies

• We trick our bodies into thinking we are
  comfortable.
• No longer using our core muscle groups.
• Results in muscles weakening (atrophy)
• May lead to
• Fatigue
• Muscle strain
• Pain
• Dr. Wilfred Barlow, a well known physician, has
  found that misuse is usually a major factor in
  both causing and perpetuating rheumatism,
  backache, arthritis, breathing disorders,
  hypertension, fatigue, gastro-intestinal
  conditions, headaches and certain sexual
  problems.

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What is Proper Posture?

• Head, trunk, arms and legs are aligned with one
  another
• Look around, how many people demonstrate good
  posture?

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At what age do you think kids start to develop
poor posture?
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Try breathing with head down and hunched
shoulders compared to head up in proper
alignment. Which gives you better breathing
capacity?
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Attitude of employees

• Interactions with co-workers
• Job Satisfaction
• Unhappy attitude causes discomfort
• Work Culture
• Time Pressures (Stress)
• No time for stretching, breaks, lunch
• Performance Measures

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What are other factors?

• v Posture
• v Attitude
• Sleep Postures
• Hobbies/Sports
• Age
• Gender
• Driving
• Psychological Impact
• Obesity/Exercise Fitness
• Smoking
• Personal Habits

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Things to consider

• Longer work hours (is it really 40 hour work
  weeks?)
• Smaller workstations
• Productivity
• Technology - faxing from desks, emailing, etc.
• Aging Workforce (people working later in life)
• Disabilities
• Obesity (excuse of no time to exercise)
• Sedentary lifestyles (workstations too
  efficient?)

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Other things you can do

• Watch your weight
• Try to maintain an adequate body weight
• Excess weight exaggerates poor postures
• Stop Smoking
• Constricted Blood Vessels
• Reduced Oxygen
• Coughing (mechanical strain)
• Harder to recover from injury and illness

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Key Components to a successful injury prevention
program

• Buy-in from the top down
• Define a purpose/Set goals
• Employee involvement
• Track statistics
• Training
• Have expectations/consequences/accountability
• Be clear and consistent

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Buy-in from the top down

• If your CEO, Director, etc. does not believe in
  establishing a programIT WILL FAIL!
• Need to allocate resources
• Delineate authority

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Define a purpose and set goals

• Ask yourself
• Why are we establishing a program?
• What is it you are trying to achieve?
• Are the employees ready to change?

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Employee involvement

• Involve them in all aspects of the program
• Recognize employees for positive behavior
• Recognize and analyze problem area
• Survey the employees to find hot spots
• Follow through after analyzing the surveys

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Track injury statistics

• This is a good starting point
• Look at your loss runs, claims filed, near miss
  reports
• Are there trends with injuries types, location
  where injuries occur, jobs with most instances?

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Training

• Train all employees on ergonomics, as well as
  your policies for managing injuries.
• Employees must be informed of the expectations
  you have for them.
• Employees must be informed of consequences.

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Expectations/Requirements

• What do you expect/require from your employees?
• 1. Attend training, learn the basic principles of
  ergonomics and apply them to your daily tasks.
• 2. Learn what you can do to decrease your chances
  of being hurt at work.
• 3. Immediately report any signs of discomfort to
  your supervisor.
• 4. Follow through with ergonomic recommendations.

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Employee Responsibilities

• Report any signs of discomfort immediately
• Take breaks
• Be willing to try recommendations
• Do your part to stay healthy
• Muscles that are well toned are less likely to be
  injured recover faster from injury.
• Develop a personal lifelong fitness plan to
  include
• stretching
• strengthening
• endurance

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Expectations/Requirements

• What do you expect/require from your upper level
  management? (Supervisors, managers, directors,
  etc.)
• Conduct initial work station assessments within
  the first week of a new employees start date.
• Document all ergo visits. Include date,
  symptoms, observations and any recommendations
  given.
• Address your employees ergo needs in a timely
  manner.
• Discuss safety/ergonomics regularly at your dept.
  meetings

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Supervisor Responsibilities

• COMMUNICATION!!
• Address employee concerns in a timely manner
• Encourage functional and effective work
  environments
• Learn and use adjustment features
• Organize workflow
• Rotate job tasks

• Promote positive employee, supervisor relations
• Demonstrate self responsibility and healthy
  lifestyles
• Perform a self evaluation and modify workstation,
  job or habits

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Clear and consistent

• Does your work environment reflect what you are
  telling your employees?
• Do you follow the policies when corrective
  actions need to be taken?
• Does everyone fully understand their role and
  responsibilities?

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Other things that can be done

• Know the basic principles and use them throughout
  the day.
• Apply intervention methods at work and at home
• Set the example adjust chair, stretch, take
  breaks, etc.
• Talk ergonomics and safety with employees often

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Before After Look at Ergonomics
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Hands-on

• Well head upstairs at this point to conduct
  assessments of actual workstations.

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Conclusion

• Dont be afraid to try something.
• Communication is key!
• It is no longer acceptable to be hurting while at
  work
• Talk about safety oftenbring your ideas to the
  table
• Ergonomics is not rocket science, once you learn
  the basic principles most of this is common
  sense.