September 2016: Behavior Change and The Pathophysiology of RSI


  • Sysophus2If your organization has experienced any lost time due to existing and new injuries
    over the past 12 months, then you will greatly benefit from reviewing these three
    related topics which many of our clients tell us are vital to address in order to
    significantly reduce injuries in today’s new riskscape:
  • Cumulative Training Disorders; The CTD Before The CTD

  • Behavioral Transformation In Today’s High Tech World

  • The Pathophysiology of Repetitive Strain Injuries (RSI)
Today’s Riskscape Is Not Yesterday’s Riskscape

In fact, office ergonomics risks are evolving and have been evolving steadily over the past decade. Of course, as risks evolve – then risk mitigation countermeasures must also evolve or injuries will most certainly increase.

Today, the biggest problem facing office ergonomics professionals is that when most of the science of office ergonomics was first teased out of the data and put into practice in the 1990’s, back then:

  • Your employees’ exposures were mostly “at the workplace”.

  • They had smaller waists.

  • They ate healthier.

  • They were a younger workforce.

  • They were also more active in their lifestyles.

Today, we now know much more than we did in the 1990’s:

  • Outside of work, people nowadays live on technology more than ever for their personal finances, entertainment, communication, etc…

  • We have to understand the work impact of hours of Facebook, Twitter and playing games after work.

  • We also now know that employees in discomfort are voracious healthcare consumers.

  • We now know that employees taking Statins to lower their cholesterol are more likely to suffer musculoskeletal conditions, joint diseases and injuries.

  • We now know that prolonged sitting leads to serious and very real health problems.
Did You Hear The Claxons Ringing?

Although probably not the case for you, there are many organizations today who endure a recurring cycle starting with a spate of injuries followed by a great focus on injury reduction, a flurry of intense activity, new rounds of online training and assessment and then things quite down – until the next spate of injuries take center stage and the cycle repeats and so on and so on…

In fact, when organizations are experiencing increasing amounts of lost time due to existing and new injuries, they have two primary choices in front of them:

  • More, More, More of The Same… Continue the cycle; sound the alarm and call for new rounds of online training, more consulting, more budget and more assessments and more of everything done before. Legacy-constrained organizations, no matter how well-meaning they are, often repeat history and inadvertently perpetuate cycles.

  • Or, Seek Out Something Different. Do something to arrest and overcome the cycle. Learn from analogous historical challenges society faced and how they were solved and try a slightly different approach delving into the data-rich world of 100 years of Applied Behavioral Analysis and Operant Conditioning.
From Basics To Behaviors

  • WarningSafety professionals can greatly benefit from reviewing today’s regulations in 30 countries covering computer users; which are in effect a form of “Cliff Notes Summarizing 30 Years of Research ” and which identify the behaviors of posture and pacing as prime objectives targeted using adjustable equipment, training, assessment and reinforcement.

Of course office ergonomics is more expansive; however, most regulations address the science-based data-driven core priorities embodied in the government-published Easy Guide For Employers regarding EC Directive 90/270/EEC (European Agency for Safety and Health):

  • Decide Who Is Covered:
         People using a computer an hour or more at a time;
         and use it in this way more or less daily.

  • Train Users:
         Risks, neutral postures, pacing, adjusting equipment;
         Organizing work areas, avoiding reflections and glare, etc…

  • Assess Workstations:
         Broadly self-assess;
         Professionally assess priority cases

  • Provide Adjustable Furniture and Equipment

  • Provide Microbreaks:
         remind users to stretch and change position;
         breaks should be taken before users get tired, rather than to recover;
         short frequent breaks are better than longer, infrequent ones;
         individual control over work patterns is the ideal

  • Provide Vision Testing

  • Tell Employees What You Have Done

For any organizations with employees in California who are therefore under the jurisdiction of California’s Title-8 Ergonomic Regulation, these behaviors of posture and pacing (microbreaks) fall under the topic of Administrative Controls and are the main focus after Engineering Controls such as providing adjustable furniture and equipment, which has been commercially available for at least 20 years now in most marketplaces.

Behavior

Behavior: noun (be-hav-ior): The manner of conducting oneself. Anything that an organism does involving action. The way in which someone or something functions or operates.

  • Employee Behavior After training?The reality is that even in the most perfectly adjusted, laser-goniometer measured office workspace, when the EHS Professional leaves the scene, the employee is left to return to their work, their stresses, their boss’ demands AND their poor ergonomic behaviors which have been developed and hardened over years.

Consider a sobering and illuminating article describing an employee’s perspective on EHS from the San Jose Mercury News: “Of ergonomics and snow cone machines“. The take-away here is not that computer-using employees are slouches or recalcitrant. In fact, they are simply trying to perform their work at the best of their abilities to meet deadlines and objectives and not focused on EH&S and Healthcare Utilization – which is your job and vital for your organization’s financial health more so now than it’s been over the past 20 years.

Primary and Secondary Behaviors

In order to better understand the problem before attempting to solve it, the solution provider needs to understand that practicing good ergonomic behaviors such as neutral postures and pacing are secondary behaviors which are far different than the primary behavior of operating a computer.

Consider your car and safety. The primary behavior required to operate your vehicle includes manipulating the accelerator, the brakes and the steering wheel. Wearing your seat belt, however, is a secondary behavior not essential to performing the task of driving.

It’s the exact same in office ergonomics with computer use. The primary behavior is manipulating the computer to produce something, whatever that may be. Secondary behaviors including utilizing neutral postures and pacing while you work on the computer, however, are not essential to operating the computer, until you develop an injury.

Do You Belt?

In the case of secondary behaviors such as seat belt use in automobiles, in the past drivers were left to learn seat belt safety behaviors from driver training courses and periodic reminders such as television commercials and print media notices. It didn’t work and people were unnecessarily getting injured.

  • seatbelt reminderTaking a driver training course, even with some number of periodic reminders afterwards had not changed enough people’s seat belt safety behaviors and so the problem was rethought and Applied Behavioral Analysis was tapped using Operant Conditioning (positive reinforcement) and point-of-use seat belt reminders were placed into automobiles.

The result was a tremendous success which continues to this day. People use their seat belts and their secondary safety behaviors have been successfully improved.

Back in the world of office ergonomics, how can you improve this secondary safety behavior of integrating neutral postures and pacing without a point-of-use operant conditioning tool being used?   It would be far more likely to produce cold fusion in a glass of H2O.

To think otherwise, is tantamount to promoting that seat belt reminders are unnecessary and should be removed from automobiles, including the ones your children operate or are passengers in.

To Break or Microbreak? That Is The Question.

To clinically appreciate microbreaks, one must first understand at least the basics of the pathophysiology of repetitive strain injuries.

We refer to and quote from an excellent paper written by Erin Messier Farnsworth, NP titled: Diagnosis and Management of Repetitive Strain Injury. The clearly written and articulate paper is written for the medical practitioner who will work with patients who have repetitive strain injuries, written because the incidence of such injuries is rapidly accelerating in clinical practices.

Everyone who is even remotely responsible for reducing knowledge-worker injuries should know this white paper well.

Genesis of Repetitive Strain Injuries

“Repetitive strain injury was first identified in the early 1980s, when female office workers who had recently switched from using typewriters to word processors began to develop upper extremity musculoskeletal disorders. The word processors were designed to produce high volumes of work at high speed, and functioned much more quickly and efficiently than typewriters.”

“With these computerized machines, it was not necessary to take the time to manually change paper, push the carriage return or stop to correct a mistake. Workers could, instead, type continuously, without giving their hands and fingers a break from repetitive activity.”

In fact, for over 100 years, people operated typewriters without the epidemic repetitive strain injuries we see today largely due to the fact that they had “microbreaks” which were frequent short breaks during their work when they would interrupt their activity to correct errors and to change the paper in the typewriter. This brief pause was a moment for renewed circulation and re-oxygenation of tissue and allowance of time for the natural cellular process of removal of waste products from tissues.

Pathophysiology

“Since the early 1980s, we have learned a great deal about the mechanism behind repetitive strain injury. Chronic repetition without adequate rest is key in the development of this disorder. Repeatedly performing small rapid movements or tasks causes microscopic tears in tendons and muscles. As a result of these microtears, circulation to the affected area is compromised. Fresh nutrient blood supply is diminished, thereby slowing recovery from the microtrauma.”

“Metabolic byproducts accumulate as a result of microtrauma to the tendons and muscles, initiating an inflammatory response. Inflammation then brings swelling, pain and, ultimately, scar tissue formation. As swelling places pressure on the nerves in tight spaces, pain escalates. Pain inhibits use of the affected extremity, and this leads to weakness. As a result of scar tissue formation, range of motion in the affected extremity is significantly reduced. “

“Poor circulation in the area surrounding the injured tendons decreases synovial fluid. This leads to an increase in friction, force, pressure and inflammation around the tendons and tendon sheaths.”

“In addition to chronic repetition without adequate rest, postural stress plays an integral role in the development of repetitive strain injury. Sitting all day, especially in an awkward body position, results in muscle fatigue. This leads to generalized muscle inflammation and nerve compression throughout the upper extremities. Poor neck and shoulder posture places skeletal bone pressure on the nerve and blood supply to the arms, wrists and hands, thereby diminishing circulation and nerve conduction to these areas.”

Progression

“For most patients, these symptoms often start in a rather benign way. They may not be that noticeable, or it may seem that the symptoms will “just go away.” As the injury progresses, however, these symptoms occur more frequently, become more intense and last for longer periods of time. It is usually at this point, when the symptoms have intensified and have begun to interfere with everyday life, that most patients seek medical evaluation. As a nurse practitioner, it is important to note that serious injury may occur after only a few months. Therefore, early intervention is crucial to patient recovery.”

A Long Read?

Those of you who made it this far will appreciate that you can achieve anything you set out to accomplish – but sometimes circumstances require minor adjustments to be made in order to successfully address shifting parameters in the riskscape.

Our high tech world is evolving and doesn’t even remotely resemble the world of the 1990’s when much of today’s office ergonomics was set in motion. The riskscape has already evolved beyond what anyone could have imagined back then, however, your program can evolve also and meet new needs so you can turn the tide of injuries and lost time.

Don’t have the formal program (or the one that you think you should have) in place yet?

Gadzooks!   What an opportunity you have to either follow other’s footsteps only to arrive at the current problems many organizations are facing today or, unconstrained by the chains of legacy, you can leap over that chronic, painful and costly step.

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