The following article appeared in the October, 1992 issue of Occupational Hazards magazine. The author is a wellness consultant who specializes in the problems of computer users and other office workers. Combating Office Stress with the Martial Arts by Glen Kohler, CMT e-mail: gkohler@crl.com Kambiz Homayounfar is a senior communications engineer at Teknekron Communications Systems, Inc., in Berkeley, CA. Teknekron stays on the leading edge of technology to remain competitive--a strategy that ensures over time and tough deadlines for senior engineers. Kambiz knows about overtime. "My boss is incredible," He exclaimed, "he flies all over the country, works all the time, and expects us to do the same!" Kambiz feels compelled to work ever longer hours. He acknowledges his work routine isn't healthy: "This is killing me," he said. "I don't ever completely relax and I'm not getting any exercise." Kambiz has suffered from low back pain and neck muscle spasms during times of peak workload. For Kambiz, stress has become a way of life. Els Patterson, (not her real name), is a computer programmer. She made $65,000 a year at a major corporation by creating custom applications on mainframe hardware until 1991. That year she felt tingling, burning sensations in both hands as a repetitive strain injury drained away her strength and co-ordination. The diagnosis? Severe tendonitis. Els doesn't know when--or if--she will be able to work again. Job stress and repetitive strain injuries, (R.S.I.'s), are the two fastest-growing sources of worker comp claims. Stress claims increased 700% between 1980 and 1988. In 1990, R.S.I.'s among office workers doubled, while increasing 20% in workers overall. Most comp claims come from high stress work environments. For years, managers and health professionals have used the operative assumption that Job stress is a catalyst for repetitive strain injuries. Recently a N.I.O.S.H. study confirmed this assumption; anxiety about job security and increased work loads from cost- cutting staff reductions directly contribute to the runaway increase in R.S.I.'s. Ergonomics Research In the Ergonomics Laboratory at the University of California at San Francisco (UCSF), Dr. David Remple is an active and voluble proponent of work place health and safety. He collects data on measurable physical traumas like tendonitis ... but precise information on the physiological effects of stress is elusive, and stress studies challenge researchers. "I wish we knew how to better study stress." Dr. Remple remarks, "I think that stress probably plays a role, but it is hard to measure quantitatively." In a telephone interview, Dr. Remple cited a Swedish study that found levels of catecholamines, (metabolic products which indicate stress reactions), increase in workers while they wait for the results of commands they give to a computer. Uncertainty about whether or not they use the right commands creates enough stress to provoke a physical reaction. The results of this experiment and others to come may tell us how stress affects VDT workers. Wladislaw Ellis, M.D., in Berkeley, CA, is a neuro-psychiatric consultant. He points out that, "All chronic diseases (including repetitive strains) seem to be made worse by stress. Ultimately, the common fundamental threat boils down to job evaluation-- internally, (the employee's fear of losing the job), or externally, (by harsh management methods)." Dr. Ellis believes that chronic pain, including pre-clinical repetitive strains, and stress, increase the incidence of injuries that would otherwise be rare in low stress environments. To dramatize the rise in stress claims, Dr. Ellis points to the City of San Francisco, where, he says, 30% of the city workers file stress claims. Repetitive strain injuries have been in the media limelight because of hand and wrist problems experienced by computer users. Actually, R.S.I. cases are more common among manufacturing and assembly line workers, meat and poultry packers, and postal workers than among office workers. R.S.I.'s among office workers deserve attention, however, because injuries in this group are increasing faster than in any other job category. Perhaps surprisingly, office workers also suffer a disproportionate number of traumatic injuries. These injuries are so often overlooked they are virtually unknown. Yet there are more traumatic injuries per office worker than in many overtly hazardous work environments. The California Division of Labor Statistics and Research found that between 1959 and 1978, (the most recent statistics available), 13% of injuries among office workers were in the "struck by or against" category, and resulted from "bodily reaction", a term that means "sudden or awkward motion." The 13% figure for office workers stands out because only 9% of all work injuries--including industrial accidents--occurred because of "bodily reaction" during the same period. Typical injuries in this class are sprains and fractures from falls, bruises and cuts from striking furniture or equipment; even stab wounds from pens and pencils. "Bodily reaction" statistics in offices suggest office workers have less co-ordination and awareness of environmental hazards than workers in other job catagories. Office work deprives workers of opportunities to develop and maintain muscle tone and co-ordination skills that manual workers use and hone daily. Environmental hazards (including stress) must be controlled, but in the end, whether or not an injury occurs depends on each workers's ability to adapt to the work environment. Creating Safer Workers We know how to create a safer work environment: purchase adjustable furniture, permitting workers to use natural postures; proper design and layout of work areas and lighting to reduce strain on muscles and eyes; reduce noise and enhance air quality. The next step is to create safer workplace habits. Dr. Remple at U.C.S.F. ranks training as the number one element in injury prevention. Training should include how to adjust ergonomic furniture, ergonomic exercises, environmental hazard recognition and avoidance, and stress reduction techniques. In the final analysis, the way each worker uses her or his body determines whether or not an injury occurs. "The human body," Dr. Remple tells us, "is built on the hunter-gatherer template. It should be in constant motion that involves the whole body." To achieve what he calls, "Maintaining a better work/rest cycle," Dr. Remple prescribes five minutes of ergonomic exercises and stretching every hour to eliminate repetitive strain injuries. Five minutes is a short span by anybody's watch. If injury prevention success depends in large measure on what takes place during that brief time, then what workers do during ergonomic breaks should not be left to chance. Ergonomic exercises should do at least three things: 1. Move and stretch all major joints and muscle groups. 2. Stimulate complete breathing. 3. Engage the worker's mental attention. The basic goal of ergonomic exercises is to alleviate tension and stress before so much accumulates that clinical strains result. Ergonomic exercise can do more than that. Site-specific program design that accounts for the physical demands of routine tasks and the amount of space around each desk can produce exercise routines that improve body mechanics and hazard recognition and avoidance skills. Better Body Mechanics Body mechanics is the combination of breathing, posture, co- ordination, and awareness. Sedentary work and tasks that only use a small part of the body's capacity diminish body mechanical skills. For instance, most office workers will admit they breathe shallowly. Their blood doesn't get fully oxengenated, which reduces stamina and alertness, which in turn reduces awareness of messages from the nervous system about muscles, tendons, and joints. Muscular tension goes un-noticed and builds to levels that impair joint physiology-- producing stiff, uncomfortable postures. Perpetually tense muscles create high levels of metabolic waste, further impairing joint physiology. A word processor, for example, routinely performs up to 126,000 keystrokes each day, (60 words a minute for seven hours), imposing constant strain on hands, wrists, arms, and shoulders. Shallow breathing and job stress further reduces physiological efficiency in tendons and joints by tensing muscles and reducing circulation--hastening the onset of R.S.I.'s. When we are tense we breathe shallowly, so we don't move much as we work, and the accumulated tension and toxins from tense muscles make us even more tense ... a vicious cycle every office worker knows. Fortunately, this cycle can be broken by exercise. Awareness of messages from the nervous system that come during and immediately after exercise alerts workers to body sensations they have been "tuning out." They can notice and respond to pre-clinical strains before injuries occur. (Dr. Remple at U.C.S.F. lists "knowing how to listen to your body," as a primary goal of injury prevention training.) The movement of the exercises restores joint physiology to more normal functioning. Circulation, (blood oxygen level), picks up, which--combined with deeper breathing, means more awareness--the ability to listen to the body. Tai Chi Chuan At Health Arts we provide a program of ergonomic exercises that work by using the principles found in Tai Chi Chuan, (pronounced "Tie Chee Chwan"), a "soft", school of Chinese martial arts. These exercises readily produce the physical and mental changes workers need for injury prevention and stress reduction, and they are easy to learn and use. Tai Chi improves body mechanics by adjusting breathing, posture, and co-ordination, which results in better awareness. The word "ergonomics" is so often used in association with furniture that it is easy to forget the word refers to the study of how the human body adapts to its environment. Tai Chi Chuan development improves breathing, posture, co-ordination, and awareness. Tai Chi Chuan is actually applied ergonomics. If a worker averages 25 to 40 minutes a day of Tai Chi based ergonomic exercises, (5 minutes an hour during repetitious tasks), that worker will use better body mechanics because, in effect, s/he is being trained each exercise break. Tai Chi Chuan is performed slowly. People of any age or physical condition can do it safely. It is appropriate for office workers who have been sitting, because you don't have to "warm up". You do it wearing business clothes, at your desk, and the interruption of work is minimal. Kambiz, the engineer at Teknekron, looked into Tai Chi and "Chi Kung", (Chinese yoga), at Health Arts, and began using the exercises to offset stress at work. "I have noticed improvements in my breathing, concentration, and digestion, and I now enjoy a feeling of physical well being." he reported after adding the exercises to his daily routine. Tai Chi Chuan exercises reduce the tendency to "bodily reaction" injuries as well. The weight of the body is shifted from one foot to the other, slowly, during exhalation. This simple exercise improves balance and co-ordination. Many clumsy souls have become immune to tripping and stumbling by practicing weight changes in Tai Chi Chuan. Most of us have a capacity for good co-ordination. To a surprisingly large degree products of stress and tension such as uncertainty and low self-esteem impose a "scrambler signal" over the input and feedback from our nervous system. If these extraneous signals can be damped down we can easily ride a unicycle, juggle, run on top of a fence--or listen to criticism from co-workers or supervisors without losing our temper! Tai Chi Chuan training uses mental concentration on body sensations during slow, gentle exercise to rediscover the natural pathways scrambled by tension, stress, and uncertainty. This is true stress reduction. Some companies have demonstrated that Tai Chi Chuan in the traditional format can play a useful role in corporate wellness. Firms that provide Tai Chi training include a law firm in San Francisco, the City of Los Angeles, the Wellness Center at the Army's Walter Reed Hospital in Bethesda, Maryland, and the Maryland National Bank. Exercises Optimized ergonomic exercises give workers conditioning, skills, and awareness so they can recognize and avoid hazards before injuries occur. A clumsy step can is recovered from; the need for an exercise break is recognized and acted on before the tired wrist develops a strain. Neck and shoulder tension can be eased by stretching and moving before it creates a headache that causes an operator or receptionist to snap at a client. Many companies are slow, however, to recognize and act on the need to deal with stress and R.S.I.'s. These problems may appear nebulous and hard to address. Organizational inertia doesn't accelerate the evaluation process. Stressed out decision makers can have trouble formulating priorities, and may resent an employee who complains about working conditions that everyone at the company shares. What happens when management doesn't encourage ergonomic exercise breaks? Comp claims. Potentially debilitating conditions become aggravated and serious injuries appear. Sadly, many workers are reluctant to admit to having pain. They know that they won't win approval by complaining, and they may be aware that some companies fire workers who have a condition known to result in comp claims. Workers who feel better work better, which means higher productivity. This is a nice common-sense idea, but numbers to support it have been missing--although convincing proof may be available soon. In the N.I.O.S.H. study, it was found that when communications and clerical workers alternated ergonomic breaks with rest periods, productivity increased despite an 8 percent reduction in the length of the work day. When these figures are combined with reduced absenteeism and fewer comp claims, the case for ergonomic exercise breaks is clear. There is another reason to "give workers a break." Rising insurance costs and the soft national economy create a tendency for managers and employees alike to adopt an adversarial approach to their work. Just as sales and management seminars emphasize the need to maintain a positive stance to achieve success, a positive approach to wellness improves relations between management and staff and among front-line workers. In the final analysis, this "employee benefit" may be the most compelling reason of all to implement integrated ergonomic safety programs. END Glen conducts on-site ergonomic safety seminars for companies in the San Francisco Bay Area and elsewhere in North America. You can obtain a copy of his ergonomic safety reference text: The Tao of Ergonomics from the Health Arts address for $9.95. This 40-page, illustrated safety manual contains information on posture, body mechanics, work-station set up, personal protective equipment, and shows ergonomic exercise techniques from Tai Chi Chuan and Chi-kung to alleviate tension and stress and avoid repetitive strain injuries.