The Value of Early Detection and Treatment of CTDs

  Reprinted from The RSI Network - Issue 36 - Mar'99 

Bonnie Sussman, MEd, PT
Cioffredi & Associates Physical Therapy
Lebanon, New Hampshire
(603) 643-7788

As the incidence of cumulative trauma disorders (CTDs) increases, companies continue to look for ways to prevent these problems or minimize disability and costs when they do occur. Preventive efforts such as minimizing repetition whenever possible, rotating jobs, setting up ergonomically sound workstations, taking stretch breaks, and using assistive devices are becoming more widespread. Although prevention techniques are critical to success, it can sometimes be hard to know how much and where to apply them.

An approach that's gaining in popularity is "post-offer, pre-employment screening" to identify people who are at risk of injury. This process involves physically testing a person's ability to do the job he or she is being hired for prior to starting work. There are many restrictions, though, on just how and when this testing can be conducted. Testing someone's ability to lift 50 pounds is relatively easy, whereas developing an accurate test of someone's ability to type and use a mouse for eight hours a day, or to do repetitive work at a sewing machine or assembly line, is much more difficult.

One shortcoming of such screening is that it won't detect which healthy individuals will develop work-related injuries such as CTDs or back injury. Research tells us that this is difficult to predict. We have only a very limited understanding of why two people can start out healthy and do the same repetitive job, yet one gets injured while the other doesn't. In other words, unless you've already had a problem with your arms and hands, it's hard to tell whether a job involving forceful or repetitive motions is going to cause injury.

An alternative, very effective approach to minimizing CTDs is to arrange for workers who are experiencing early symptoms to be screened at the workplace. We can then identify and modify any job-related factors that are contributing to the problem, and suggest stretching, position changes, icing, or other appropriate activities. The worker can be monitored closely until the problem goes away or until it becomes clear that it warrants further medical attention. That attention would then be obtained promptly, when the problem is still in its early stages.

In the vast majority of cases, problems detected and treated early do not go on to become serious injuries or lost-time cases. They're not allowed to progress too far physiologically. Ergonomic risk factors or the person's work duties are modified before things get out of hand—and the worker appreciates the company's attention and care.

I've found that a combination of prevention, pre-employment screening, and early detection is most effective in helping control injuries and costs. Too many companies miss out on the opportunity offered by a program of early identification and intervention.

The program can be carried out by on-site medical personnel as long as they have sufficient skill in muscle, joint, and nerve evaluations and the company clearly conveys that it truly wants to know about early complaints. For companies without the resources or size to warrant a full-time medical person, regular visits by an occupational health provider who can do a good musculoskeletal screening evaluation, and who gets to know the company, is an excellent option.

For people who do not have access to early screening or intervention at their workplace, the approach should still be the same: seeking out early attention to physical problems, and changing work setups or practices that seem to be causing these problems. I advise workers to inform a supervisor or HR person, and ask to see a company nurse, physical therapist, or other provider, if they're experiencing any of the following:

• a problem area that is obviously painful, swollen, difficult to move, numb, or tingly

• a mild problem that has been coming and going, but now is coming more often or is harder to get rid of

• a problem that is getting progressively worse with time, or has been there consistently (every day) for more than a week or two

• a problem that is persisting and not responding to self-care measures (icing, over-the-counter anti-inflammatory medications, resting the painful area)

• a problem that is beginning to significantly interfere with daily activities—at work, home, or play

Be persistent with supervisors, HR, or managers about anything in your workplace that you think may be causing you pain or injury. In the end, it will be better for them as well as for you if together you figure out a way to eliminate the problem early. Too many times I've been told that a company was aware of a problem for some time but didn't choose to do anything about it until finally someone got injured. Even though some early problems might get better on their own, the smart company (and employee) recognizes the value of detecting and dealing with problems before they blossom. A little attention early on, even if some of it goes to a few people who may have gotten better on their own, is well worth the savings in pain, suffering, and costs if it prevents even one serious case of carpal tunnel syndrome, tendinitis, or thoracic outlet syndrome.

About the Author
Bonnie Sussman has been a physical therapist since 1977, and has been actively involved in the treatment and prevention of work-related injuries for 15 years. She currently works in a private physical therapy practice that consults with companies throughout Vermont and New Hampshire, and she is on the board of the Occupational Health Special Interest Group of the American Physical Therapy Association.

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Last Updated: 11/03/00