Date: Mon, 12 Dec 1994 12:59:56 -0800 From: Glen Kohler Subject: Computer Safety Article (long!) To: Multiple recipients of list SOREHAND The following article appeared in the October, '94 issue of Occupational Hazards magazine. Among a number of issues I wished to address, I tried to make the point that delays in recognizing and addressing RSI's often leads to further injury: Worker-Oriented Solutions to Office Safety Injury risks in offices appear minimal compared to manufacturing or construction--but even though hard hats are not required, injuries among office workers are increasing faster than all other job categories combined. In the introduction to proposed changes to Title 8 of the California Code of Regulations, Cal-OSHA refers to an "unprecedented increase" in cumulative trauma disorders, ("CTD's," also known as repetitive strain injuries, or RSI's), in the 1980's and 1990's. The agency notes that CTD's increased eightfold between 1982, (22,600 reported cases), and 1990, (185,400 reported cases), up from 21% of all injuries reported in 1982 to 56% in 1990. The proposed changes to Title 8 are largely--though not solely-- concerned with computer users and other desk-bound personnel. Most injuries to office workers occur when isolated body parts are over-used during repetitious routine tasks such as typing, data entry, awkwardly reaching to transfer documents or answer phones, using mechanical time/date stamps, etc. The near-static postures and low overall physical activity that are common among office workers intensify the harmful effects of repetitive tasks. Repetitive strain injuries are molehills that really do grow into mountains.... Pain, numbness, weakness, and restricted range of motion appear "out of nowhere" and get progressively worse until the worker is debilitated, if nothing is done to intervene. Symptoms occur mostly in the upper extremities. (hands and wrists, elbows, shoulders, head and neck) RSI's are usually diagnosed as tendinitis, tenso-synovitis, (inflammation of the fluid-filled sheaths surrounding tendons that cross joints), or nerve- compressions--such as the infamous "carpal-tunnel syndrome," wherein swollen tendons and/or their sheathes exert pressure on nerves. Losses from RSI's are substantial. They include lost time and productivity, the cost of medical services, prescriptions and devices, and restricted work activities for injured and partially disabled workers. All too often a company's most productive workers suffer repetitive strain injuries because they work hard and take fewer breaks. Office workers in every industry get RSI's. Most never imagined it would happen to them and still don't completely understand why it did, because the beginning stages of a repetitive strain injury often seem unrelated to work. A typical RSI patient first becomes aware of odd sensations or pain in hands and wrists at night--not during the day at work. By the time pain is noticeably present throughout the day, so much damage may have occurred that the worker never completely recovers. And, as if the unpredictable and intractable nature of RSI's isn't bad enough, these conditions may get worse when assessment and treatment are delayed. A "conservative" approach to hand or wrist pain often consists of partial immobilization combined with a regime of anti-inflammatory drugs--whereupon the injured worker is sent back to work, even though the condition is not resolved. Physicians say that rest allows affected tendons to heal. Unfortunately, some insurers drag their heels before admitting that a worker has a disabling work- related injury, even a temporary one. A long series of medical evaluations may be ordered. Even mild or moderate tendinitis may become so aggravated that it produces carpal-tunnel syndrome while a worker's claim inches through the red tape. Since virtually all computer users and many other office workers are at risk of RSI's--and since rapid and complete recovery is by no means certain--injury prevention is all-important in office safety. Ed Grossmith, an ergonomist who works for the Quantum Corporation in California's "silicon valley," talks about risk factors: "So many people look at creating a workspace for healthy employees, but employees represent a broad slice of the population. Some of them have previous traumas and illness, or they may not look after themselves from the wellness standpoint. When we try to preclude OSHA-recordable incidents, we have to look at a population some of whom may be pre-disposed to repetitive strain injuries, and bear that in mind by acting to prevent aggravation of their predispositions." A broad spectrum of risk factors are identified as contributors to RSI's. Strategies aimed at preventing these injuries usually cover five areas of concern: 1) Musculo-skeletal efficiency and health. 2) Environmental hazard abatement. 3) Stress reduction and stress management, 4) Visual health. (Lighting, contrast between monitor screen & documents, glare from monitor screens, corrective lens options.) 5) Personal wellness & fitness. Environmental risk factors are like the twigs that poke holes in a plastic bag filled with leaves. They make holes because they are driven by pressure from the other contents of the bag: poor posture, stress, prior injuries, and sub-standard fitness. Environmental hazard abatement is a good starting point, but more is needed. Musculo-skeletal health is important because "using furniture" really means using the human body. For office workers, this means using the body the wrong way, since it is designed for constant movement using a wide variety of postures. When workers use computers, their bodies are held in un-naturally static positions for hours on end. The best way to counteract the damaging effects of prolonged computer use is through "Ergonomic exercise breaks," which off-set harmful effects from improper use of the body. Promoting musculo-skeletal efficiency among office workers becomes easier and more manageable if a two-pronged approach is adopted. First, "ergonomically" designed furniture permits workers to use good posture and body mechanics. Part two entails training computer users to actually use good posture and body mechanics while they work--and to take the reccommended exercise breaks. Getting workers to substantially change the way they use their bodies is the most challenging aspect of ergonomic safety. One trainer at a National Laboratory recently gave this terse explanation of his approach to ergonomic safety: "And I tell them, they have to be willing to make changes in their lifestyle!" His harsh tone betrayed his displeasure at learning that workers are not compelled by the laws of physics to do any such thing. After all, the way a person uses her or his body is an intensely personal matter--deeply entwined with mental and emotional issues. (Which is why stress contributes to RSI's.) To gain maximum worker compliance, information on posture and body mechanics needs to be delivered persuasively and with finesse. A key point often overlooked is that although a company's interest in safety centers on the bottom line, workers, too, have interests in safety-related health issues--from the slightly different angle known as "quality of life." It is ironic that workers who fail to be galvanized by "vanilla" safety presentations are part of a national reading audience that eagerly buys millions of health and self-help books each year. The fact that they do naturally suggests an alternative to dry, information-based safety programs: equip workers with the knowledge and skills they need to work safely by fulfilling their interest in health and fitness. For example, workers get precisely the skills, awareness, and conditioning, they need for office safety with exercise training to improve posture and body mechanics in exercise systems like Tai Chi Chuan--or Iyengar yoga. This is what programmers call an "elegant solution;" doing more work with fewer instructions. These exercises counteract the negative effects of repetitious movements and static postures while helping workers to reduce stress with complete breathing and relaxation. (Items 1, 3, and 5 on the list of office safety concerns.) Safety presentations with a wellness slant create enthusiasm and motivation among workers that a company has every interest in maintaining. On-going wellness activities featuring fitness professionals in aerobics, body-sculpting, circuit training, Tai Chi, and Yoga, are maintaining this motivation at Chevron, Quantum Corporation, Sun Microsystems, Oracle, Pacific Bell, and many other companies. The future of office safety seems to lie at the crossroads where safety and wellness intersect; reducing injuries and claims by increasing worker health and productivity. END Glen Kohler is a wellness consultant and president of Health Arts wellness services, an ergonomic safety training company in the San Francisco area. For more information contact Health Arts, P O Box 9719, Berkeley, CA 94709; 510/845-8485. * * * * * Sidebar on Training and Exercise Training is the #1 resource for ergonomic safety, according to researchers at the University of California. It should include: How to adjust ergonomically designed office furniture, such as chairs and keyboard wells, and the proper use of personal protective equipment: document holders, glare filters, wrist rests, etc. How to listen to the body. Repetitive strain injuries result from over-work and tension. They can be avoided if workers interrupt their work routines to stretch and move periodically throughout the day. Workers should learn to recognize and heed signals from the body that indicate when to get up and move around. How to exercise with maximum efficiency during a five-minute exercise period: Over-all stretching and conditioning. Lower-body integration for better posture. Breathing & relaxation. Task-specific conditioning. Hand & wrist exercises should be performed while breathing freely, without tension or strain. Stress reduction, which means lowering stress in the short term, and stress management: learning to operate at lower average levels of stress. (The role of stress as a contributor to RSI's is documented in the NIOSH study HETA 89-299-2230, published July, 1992.) Glen Kohler, CMT gkohler@crl.com : Box 9719, Berkeley, CA 94709 Health Arts Wellness Services : 510/845-8485