Nicole Matoushek PT MPH CSHE CEES
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Principles of Workplace Injury Prevention
What are Cumulative Trauma Disorders?
Cumulative Trauma Disorders (CTDs) are defined as disorders or diseases of the neuro-musculo-skeletal system due to chronic, or accumulative micro trauma.
How do CTDs develop?
The neuromusculoskeletal tissues work as a system to perform certain functions, including: activities of daily living, recreational activities and work activities. The muscle fibers generate an internal force or contraction, resulting in internal pressures inside the muscle. The force is then transmitted along to the tendons and the skeletal system to move the bones and perform voluntary movement. When bones move, they rotate about an axis, or joint, when this occurs, the joint experiences compressive forces.
When the neuro-musculo-skeletal system experiences stresses and internal forces that overload the tissues, local tissue fatigue can occur. This local tissue fatigue can lead to micro tearing of the tissues, this is also called micro trauma. Micro trauma or wear and tear damage does occur on a daily basis. When micro-trauma continues over a period of time at a rate that exceeds the rate of the body’s ability to repair itself, the damage or trauma accumulates. The accumulation of trauma, over time, results in pain and loss of function. Further damage and trauma can lead to the formation of scar tissue, changes in body or tissue chemistry and even degenerative changes that may also affect motion, strength and function.
What are the Clinical Signs and Symptoms?
When a worker over stresses his or her tissues, and the body is unable to repair itself, the worker begins to experience pain and loss of function as a result of injury to those tissues. Daily activities and even work tasks become difficult and tedious. The worker will complain of and demonstrates the clinical signs and symptoms of CTDs.
Common clinical signs and symptoms of CTDs include:
• Pain
• Swelling.
• Numbness and tingling
• Burning sensation
• Weakness
• Nocturnal pain (pain at night)
These symptoms are the body’s warning signals that there is too much damage followed by too little repair time.
Common CTDs in the Workplace
Due to the nature of work and the relationship between inadequate recovery time and the development of CTD, some injuries or CTDs are observed more frequently in the workplace than others. The most common CTDs include: carpal tunnel syndrome, tendonitis, Tenosynovitis, epicondylitis, bursitis, muscle strain, ligamentous sprain, neck injuries, lower back injuries and lower extremity injuries.
What are Risk Factors?
Common causes or factors, which may contribute to the development of CTDs, are described in terms of risk factors. To prevent CTDs we must modify both ends of the spectrum: reduce the rate and intensity of damage, to in effect reduce tissue fatigue in addition to increasing the rate of tissue repair.
Ergonomic Risk Factors
Some ergonomics risk factors include:
• High repetition
• Forceful exertions
• Awkward postures
• Sustained postures
• Contact Stress
• Noise
• Temperature
• Vibration
• Work organization factors: work rest cycles, shift work
The most important contributing factor to the development of CTDs is the production of local tissue fatigue and micro trauma, as the working tissues are overloaded. Sufficient blood supply is the most important factor in controlling tissue overload and fatigue. By maintaining an adequate supply of oxygen-enriched blood to working tissues, metabolic efficiency can be maintained, thus minimizing the adverse effects of fatigue and preventing excessive micro-trauma.
Principles of Workplace Injury Prevention
The principles of workplace injury prevention are based on the foundation that if we reduce the ergonomic risk factors at the workplace we can effectively reduce worker fatigue and the tissue microtrauma that occurs when the tissues are overloaded and there are insufficient recovery times. Reducing work-related injuries can be accomplished by correctly identifying the ergonomic risk factors that are present and by providing a method for reducing the ergonomic risk or the exposure of the worker to the ergonomic risk factor. The methods for reducing the risk factor or the exposure to the ergonomic risk factor are called control measures. Control measures use the principles of workplace injury prevention to provide suggestions for reducing the ergonomic risk. Injury prevention principles focus on improving blood flow to the local working tissues and reducing the degree of stress on to the working joints and muscles.
Example Injury Prevention Principles
• Reduce High Repetition, this will both reduce tissue stress and allow increased blood flow to the working muscle tissues, thus preventing tissue overload and microtrauma.
• Reduce Forceful exertions, this will both reduce tissue stress and allow increased blood flow to the working muscle tissues, thus preventing tissue overload and microtrauma.
• Reducing Static Work and Static Muscle Contractions, to allow increase blood flow to the working muscle tissues, thus preventing tissue overload and microtrauma.
• Reducing Postural Joint Forces and Awkward Positions: this will both reduce tissue and joint stress while allowing increased blood flow to the working muscle tissues, thus preventing tissue overload and microtrauma.
Control Measures
Injury prevention and reduction is most often made in terms of control measures. Control measures refer to the means or method of work modification that will reduce either the severity of an ergonomic risk factor or will reduce the worker’s exposure to the risk factor. In some cases, more than one control measure or work modification may be used to solve an ergonomic challenge.
Examples of Control Measures
• Change the work products and equipment.
• Job rotation.
• Provide lifting assistance or equipment.
• Reduce the size and weight of product containers.
• Add handles to containers.
• Round sharp edges.
• Provide rest breaks.
• Raise or lower the workstation.
• Implement antifatigue mats.
To prevent workplace injuries, apply the concepts of how the CTDs develop with the ergonomic risk factors to evaluate and propose the appropriate control measures. For example, if a job task involves high repetition; the risk factor is high repetition, the injury prevention principle is to reduce the tissue stress and allow increased blood flow to the working tissues, the control measure will be to reduce the repetition rate or work rate and/or implement more frequent rest breaks. In effect, reducing the tissue stress and allowing a better recovery phase for the working tissues, thus preventing the CTDs from developing.
Summary
Cumulative Trauma Disorders (CTDs) are injuries that may be related to, or are a direct result of work characteristics and performance. CTDs are related to the exposure of an individual to specific ergonomic or work-related risk factors. Since CTDs are injuries that may result from exposure to workplace risk factors, it seems logical that by identifying workplace risk factors and reducing or eliminating them that we can reduce the incidence of, and even prevent CTDs in the workplace.
Nicole Matoushek MPH, PT
[URL=http://www.ergorehabinc.com]www.ergorehabinc.com[/URL]
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Nicole Matoushek, PT, MPH, CSHE, CEES
http://www.ErgoRehabinc.com
http://www.ErgoRehabBlog.com
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