Introduction to Ergonomics

By Dr. Gordon A. Vos Assistant Professor Department of Environmental and Occupational Health TAMUS-HSC-SRPH

Learning Objectives
1. 2. 3.

Introduction to ergonomics. Work Related Musculoskeletal Disorders General Introduction Low Back Pain (LBP)
Describe the problem of low-back pain (e.g. high lifetime prevalence; poor anatomical localization). List the key principles that ergonomists consider when assessing stresses to the low-back (i.e. disc compression, energy expenditure, strength). Match the job analysis tools that ergonomists use to the above principles.

4.

Distal Upper Extremity Disorders (DUEs)

Describe the epidemiological context of work-related distal upper extremity disorders. List the key principles that ergonomists consider when assessing stresses to the DUE. Describe the most common DUE job analysis tools available to ergonomists.

5. 6. 7.

Briefly describe the status of office ergonomics. Explain why participatory approaches in ergonomics is important. Summarize the OSHA initiative on rule-making, including the key programmatic components.

Introduction to Ergonomics

Ergonomics: Definition
The fundamental definition of ergonomics is given as:
the study of work in relation to the physiological and psychological capabilities of people.

The word "Ergonomics" comes from the following two Greek words:
Ergos which means "work" Nomos which means "laws"

Thus, ergonomics is quite literally "the laws of work."

Ergonomics: What is it?

Ergonomics is a broad and multi-disciplinary field of study. The field of ergonomics focuses on fitting jobs and tasks to the worker that must perform them. Ergonomics uses our knowledge of the limitations and capabilities of the human body. Combined with desired job tasks and workplace environments, ergonomics uses this knowledge to create safe, healthful, and functional working environments. These environments help to reduce the occurrence of physical injuries and trauma.

Ergonomics: Main Goals

The overall goals of ergonomics include the following:
Provide a safe and healthful working environment engineered to the capabilities of the human body Decrease worker fatigue and discomfort through the elimination of excess effort Increase efficiency and productivity by reducing worker fatigue

Ergonomics: Main Goals

(continued from previous slide): Improve quality by providing designs that reduce the potential for human error Enhance customer service through improved worker morale Elevate job satisfaction Reduce injuries/illness Reduce costs

Ergonomics: How?
The science of ergonomics has evolved a great deal over the years. Ergonomics utilizes the principles of many different disciplines. These principles have included the study of fields such as engineering, physics, psychology, human physiology and business management. Ergonomists often reach their goals through engineering and workplace designs. Ergonomic designs take into consideration the physiological and psychological capabilities of people.

Ergonomic Design Principles

Design for the Range
This is the main goal of ergonomic designs. Accommodates the range of human capability.

Design for the Extreme

This is used for specific situations, such as clearance in doorways.

Design for the Average

Rarely, if ever recommended.

Ergonomics: Gestalt

Ergonomics: Injuries / Illness

Ergonomic interventions are often used to address injuries and illnesses. Injuries and illness resulting from ergonomic issues are arguably very broad in nature. However, one particular category of injury/illness is often tied very closely to the practice of ergonomics:
Work Related Musculoskeletal Disorders (WMSDs)

Work Related Musculoskeletal Disorders: A General Introduction

Work Related Musculoskeletal Disorders (WMSDs)

Many occupational injuries and illnesses can be attributed to poorly designed job tasks or equipment that lacked application of proper ergonomic principles in their design. These ergonomic related illnesses are commonly referred to as "Work-Related Musculoskeletal Disorders." The term "work-related musculoskeletal disorders" is often abbreviated as "WMSDs".

WMSDs: What are they?

What are WMSDs you may ask? Well, to explain WMSDs properly, let's break the term "WorkRelated Musculoskeletal Disorders" into its components and discuss each.
To start with, musculoskeletal disorders are disorders of the musculoskeletal system. That means that they are related to the muscles, nerves, tendons, ligaments, cartilage, and joints of the body. Typically, musculoskeletal disorders are not sudden "injuries", but are rather "illnesses" that develop gradually over time. This process can take weeks, months, or even years.

WMSDs: What are they?

(continued from previous slide): Musculoskeletal disorders are commonly a result of repeated mechanical stresses on the body. Musculoskeletal disorders can result in losses of mobility and strength. "Work-Related" means that the person's occupation played a role in development of the condition, or made a preexisting condition worse. Note: Many injuries/illness that are referred to as Work Related Musculoskeletal Disorders can also occur without contribution by a persons job. It is entirely possible and plausible that a person may exhibit signs/symptoms of WMSDs which are NONOCCUPATIONAL in origin.

WMSDs: Definition
Therefore, from the individual components of the term "Work-Related Musculoskeletal Disorders," a definition can be given as:
Disorders of the musculoskeletal system that have developed gradually over time, and which can be attributed, either completely or in part, to a person's occupation and related workplace conditions.

WMSDs vs. Acute Injuries

It is critical to understand that WMSDs are not disorders that occur from a single event or accident, but are rather illnesses that have gradually developed from chronic workplace and occupational conditions. Acute injuries, on the other hand, are physical trauma that can be related to a single event and involve an immediate onset of pain.

WMSDs vs. Acute Injuries

Examples of acute injuries include fractures, sprains, and strains. Examples of WMSDs, on the other hand, include:

WMSDs: Tendinitis
Tendinitis is defined as inflammation of a tendon. Tendons are connective tissue that link muscle to bone, and allow for translation of muscular contraction into skeletal movement. Undue physical force and repetitive motions can cause inflammation of the tendons. Tendonitis can occur wherever tendons connect muscle to bone.

WMSDs: Tenosynovitis
Tenosynovitis is defined as inflammation of a tendon sheath. Tendon sheaths provide lubricated pathways in the human body within which tendons can move freely along their designed axis of movement. The sheath minimizes friction and helps to protect the tendon. The sheaths are made of a form of connective tissue. Repetitive motion can cause inflammation of the sheath.

WMSDs: Carpal Tunnel Syndrome

CTS is a clinical diagnosis of compression of the median nerve within the carpal tunnel. The carpal tunnel is a location where several tendons and the median nerve pass through the wrist, connecting to the fingers of the hand. When pressure in the carpal tunnel is increased (possibly due to tendonitis, tenosynovitis, or trauma to the bones of the wrist), pressure is placed upon the median nerve, causing inflammation of the nerve. This can result in symptoms of numbness, tingling or burning in the area of the hand innervated by the median nerve (first 3 fingers).

WMSDs: Epicondylitis
Inflammation of the tendons that anchor the muscles of the forearm to the elbow. Repetitive use of these muscles and tendons, in maneuvers such as grasping, twisting, and gripping, can cause inflammation. Examples: Lateral - Tennis Elbow

Medial - Golfer's Elbow

WMSDs: Prevalence
According to the US Bureau of Labor Statistics, disorders associated with repeated trauma accounted for 66% of all nonfatal occupational illnesses in 1999. In light of the rising compensation and medical costs associated with these often painful and immobilizing injuries/illnesses, increased attention must be given to their control.

WMSDs Prevalence in Industry

Number of Occupational Illnesses Reported
Total Illness Cases
600

Repeated Trauma Cases

Thousands of Cases

500 400 300 200 100 0 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 Year

WMSDs: Reasons for Increase

From the charts on the previous screen, it is evident that there has been an increase in the number of WMSD cases reported annually. In addition, it is obvious that the percentage of all occupational illnesses that are classified as WMSDs has also increased. It is therefore necessary to explore why these increases have occurred. It is likely that due to the complex nature of our modern working environments, and the diversity of jobs and tasks performed in industry, there is no single reason for the increase.

WMSDs: Reasons for Increase

(continued from previous slide): Instead, many different factors have probably combined to contribute to the increase in reported WMSDs. The reasons for increase may include the following: Elevated public awareness of WMSDs and related issues due to: OSHA's efforts to develop and promulgate a workplace ergonomics standard.

WMSDs: Reasons for Increase

(continued from previous slide): Increased media attention to the human suffering associated with WMSDs. This includes national news stories, educational documentaries on television, and legal advertisements for lawyers specializing in occupational illness cases. Increase diversity in the workplace. With greater diversity comes a greater range of worker capabilities. These capabilities may not be accommodated by existing workplace designs.

WMSDs: Reasons for Increase

(continued from previous slide): Change of focus in occupations.
There has been a change in our workplaces away from heavy industry towards specialized services and high technology positions. With increased computerization and automation, there have been decreases in the number and variety of tasks performed by human workers. Likewise, computerization has also increased the pace of work in some industries. In jobs where a worker may once have had several different tasks to perform, he/she is much more likely to be found performing a limited number of tasks over and over with little variation. This increases workers' exposures to musculoskeletal stresses on certain areas of the body, and limits time available for recovery.

WMSDs: Costs
Costs associated with WMSDs have also increased in the recent past. These costs can be broken into two main categories: direct costs and indirect costs. Direct costs associated with WMSDs include the dollars actually spent on providing medical care and indemnity benefits to an injured or ill person. Often these are funds that would have been used for other purposes more inline with workplace goals such as equipment, materials, and other resources.

WMSDs: Costs
(continued from previous slide): Examples of direct costs include: Insurance costs and workers compensation costs (civilian workers only), Medical care for injured/ill workers, Hiring temporary replacement workers to handle the jobs and tasks performed by injured and ill workers, and Costs associated with workplace accommodations needed to return an injured/ill worker to the job. Indirect costs are costs other than those classified as direct costs. They typically include costs associated with retraining, costs associated with lost productivity and efficiency (e.g., resulting in overtime costs), and costs associate with investigating and managing the risks associated with a work site.

WMSDs: Costs
Although difficult to measure, indirect costs can far outweigh the direct costs of WMSD cases. The following picture of an iceberg illustrates the relationship between direct costs and indirect costs with regards to WMSDs. WMSD indirect costs can be anywhere between 2 to 10 times greater than direct costs.

Low Back Pain

( L. B. P. )

Structure of The Back

The back and torso provide the human form with a vertical support structure. The back/torso region contains several components, which include: Vertebrae Discs Ligaments Muscles Spinal cord Foramen

Spinal Structure of The Back

Spinal Structure of The Back

The structure of the vertebral joints is illustrated by these graphics:

LBP: Disc Degeneration

Low Back Pain (LBP)

Low Back Pain (LBP) has long been referred to as a nemesis of medicine and the albatross of industry. Although LPB has been a problem for man as far back as primitive man, most of our understanding of the problem has been developed in the past 50 years. Back related injuries and illnesses accounted for 25% of work related injuries/illnesses in 1999 (US Bureau of Labor Statistics, 2001).

Low Back Pain (LBP)

Lower back pain can occur by direct trauma, a single exertion / over exertion, or potentially as a result of repetitive/cumulative trauma. LBP is an issue involving many schools of research, including: biomechanics, orthopedics, engineering, industrial medicine, industrial hygiene, physical therapy, and law.

LBP: Problems with Assessment

It is difficult to determine the relationship between occupational factors and low back pain because: LBP is not easily defined. Worker absence data is influenced not only by pain but also by physical and psychological work factors, social factors, and the insurance system. Data bias due to healthy worker effect. Exposure is difficult to determine. There is poor relationship between tissue injury and disability. Most studies are case-control studies, and do not indicate causality. Modern epidemiological studies calculate odds ratios for factors of interest by comparing the number of exposed subjects with LBP to the number of nonexposed with LBP. However, only a few LBP studies have used this technique.

LBP: Problems with Assessment

In addition it can be very difficult to address low back pain since there are numerous factors involved in its development, including: Personal (i.e. age and medical) Occupational (job related factors) Non-Occupational (non-job related factors) Not only are the causal factors difficult to identify, but LBP itself is a tenuous problem to define. Many problems that can occur in the low back evidence themselves via the symptom of generalized low back pain.

LBP: Problems with Assessment

(continued from previous slide): LBP in general refers to the simple presence of pain in the lower back. The pain indicated by the majority of low back disorder patients may have many different sources. However the source of the pain is generally nonspecific, and is often categorized as pain without radiation. The poor anatomical localization of LBP makes it a difficult problem to assess. In addition, there is a very high lifetime prevalence of LBP, 70% in industrialized nations:
Impairment of the back is the most frequent cause of activity limitation in persons under age 64. Between 10%-17% of adults have a back pain episode each year. LBP is the diagnosis in 10% of all chronic health conditions.

LBP: Problems with Assessment

(continued from previous slide): Some of the specific factors thought to have significant impact on the development of LBP are:
Personal Factors:
Age Medical history

Mechanical Factors (both occupational and non-occupational):

Heavy lifting Torso twisting Torso flexion (bending) Duration of exposure to all of the above.

Research is still being conducted into the significance of these factors, and their roles in development of LBP. The lack of information on the exact effect of these risk factors in low back pain development is a major issue in assessing LBP, and developing tools for its prediction.

LBP: Principles of Development

Although LBP can be caused by a variety of factors, there are a few concepts that are fundamental in its evaluation and control:
Mechanical stresses of the spine
Spinal disc compression Spinal shear Spinal torsion Any combination of the above 3 stresses

Energy expenditure
Whole body fatigue

Strength
Individual capability

LBP: Mechanical stresses of the spine

LBP: Mechanical stresses of the spine

LBP: Energy Expenditure

There is NOT any epidemiological evidence of a direct relationship between energy expenditure and LBP. Nonetheless, energy expenditure assessment is used in the control of hazardous jobs that may be associated with LBP due to its relationship to whole body fatigue. When a worker is fatigued, he/she is more likely to make mistakes and become injured. He/she may also be more prone to use improper lifting techniques or poor body mechanics.

LBP: Strength
A workers strength capability determines their willingness and ability to lift certain weights. Strength and lifting ability are observed in a wide spectrum, with some persons capable of lifting more than others. The quantiles (also known as percentiles) of lifting capability are often used when assessing a jobs lifting requirements.

LBP: Lifting Factors and their Criteria (NIOSH)

Mechanical forces on the spine (compressive force)
Energy Expenditure
< 770 lbs (350 Kg)

3.12 Kcal/min (full body work) 2.18 Kcal/min (arm work)

Strength

75% Female population capable 99% Male population capable

LBP: Lifting Factors and Related Tools

Mechanical forces (spinal compression) Energy Expenditure
Strength
2D Biomechanical model 3D Biomechanical model
VO2 max testing Dr. Arun Gargs Model of Metabolic Cost Static strength testing Dynamic strength testing Psychophysical tables NIOSH Lifting Guidelines 2D/3D SSPP

Generalized Tools

Distal Upper Extremity Disorders

( D. U. E. Disorders)

Distal Upper Extremity Disorders: What are They?

The term Distal Upper Extremity Disorders is used to describe symptoms or disorders which occur in the distal upper extremity (the lower arm, usually the hand and wrist area). DUE Disorders is preferred over the term Cumulative Trauma Disorder (CTD) for the following reasons:
Symptoms may or may not be associated with disorders arising from cumulative trauma (they lack diagnostic specificity). CTD lacks anatomical specificity, since it is not limited to the distal upper extremity. The term CTD infers a single specific pathogenetic mechanism: the accumulation of trauma, which may or may not be correct.

Distal Upper Extremity Disorders: What are They?

The distal upper extremity contains several tissues, including skin, subcutaneous tissue, blood vessels, bones, joints, and muscle tendon units. The most common target tissues for DUE disorders associated with work are the muscle-tendon units. Muscle-tendon units are composite structures including:
Muscle Tendon Tendon sheaths Myotendinous junctions Tendon-bone junctions

Distal Upper Extremity Disorders: What are They?

Each component of the muscle-tendon unit is associated with unique physiological and biomechanical properties, and each is associated with unique disorders of manifestations of strain:
Tendinitis Peritendinitis Delayed onset muscular soreness Muscle strains Localized muscle fatigue Stenosing tenosynovitis (i.e. trigger finger)

Distal Upper Extremity Disorders: What are They?

Examples of DUE disorders include: Tendinitis Inflammation of tendons Tenosynovitis Inflammation of tendon sheaths DeQuervains Tenosynovitis, a.k.a. Trigger Finger Carpal Tunnel Syndrome (CTS) Clinical diagnosis of compression of the median nerve as it passes through the anatomical region referred to as the Carpal Tunnel.

DUE: Epidemiological Context

Silverstein et al. Found that the prevalence of CTS was associated with jobs characterized as forceful and repetitive. Repetitiveness seemed to be a stronger factor than forcefulness. Hand wrist posture and vibration were not associated with the prevalence of CTS. Armstrong et al. Found that the prevalence of hand-wrist tendinitis in workers who performed highly repetitive jobs was 29 times greater compared to those who performed jobs low in repetitiveness and forcefulness. Forcefulness was found to be more important. Hand wrist posture and vibration were not associated with the prevalence of CTS.

DUE: Epidemiological Context

(continued from previous slide)

Moore and Garg

Compared exposure factors for jobs associated with upper extremity disorders to jobs without such disorders. Found that intensity of exertion was the major differing factor, estimated as a percentage of maximal strength, and adjusted for wrist posture and speed of work.

DUE: Epidemiological Context

(continued from previous slide) In summary: The primary task variables associated with an increased prevalence or incidence of DUE disorders are: Intensity of exertion (force) Repetition rate Percent of recovery time per cycle Intensity of exertion was the most important task variable in 2 of 3 studies. Most of the morbidity was related to disorders of the muscle-tendon units. One study, focusing on CTS, found repetition more important.

DUE: Epidemiological Context

(continued from previous slide) Wrist posture may not be an independent wrist factor. It may contribute to an increased incidence of DUE disorders when combined with intensity of exertion. The roles of other task variables have not been clearly established epidemiologically. Therefore, once must rely on biomechanical and physiological principles to explain their relationship to DUE disorders, if any.

DUE: Key Principles Ergonomists Consider in Assessment of Stresses

Exertional Theory of DUE Disorders:
The occurrence of most activity related DUE disorders is due to the exertional demands placed on the muscle-tendon units on involved in performing the activity. The theory incorporates principles and relationships derived from biomechanical, physiological, and epidemiological studies. It adopts the principle of dose-response. It also incorporates the concept of exposure versus dose. And it assumes that there is a threshold level of activity below which an increased risk of activity-related DUE disorders either does not exist or is undetectable.

DUE: Common DUE Job Analysis Tools

Rapid Upper Limb Assessment (RULA)
The RULA method was developed by Lynn McAtamney and E. Nigel Corlett, ergonomists at the University of Nottingham in England. RULA is a postural targeting method for estimating the risks of work-related upper limb disorders. A RULA assessment gives a quick and systematic assessment of the postural risks to a worker. The analysis can be conducted before and after an intervention to demonstrate that the intervention has worked to lower the risk of injury. A screening tool to assess external load factors.

DUE: Common DUE Job Analysis Tools

DUE: Common DUE Job Analysis Tools

Strain Index
Developed by J. Steven Moore and Arun Garg Current assessment tool of favor for evaluating stressors relate to development of DUE disorders. Incorporates the exertional theory of DUE disorders. Considers factors such as:
Intensity of Exertion Duration of Exertion Efforts per Minute Hand/wrist posture Speed of work Duration of Task per Day

DUE: Common DUE Job Analysis Tools The Strain Index

Link to SI-USER2.DOC

Office Ergonomics: Status Report

Office Ergonomics
Past Guidelines:
ANSI/HFS 100-1988
Over 13 years old Many of the theories of ergonomics and the biomechanics of office work have evolved over the past decade.

Proposed Replacement for ANSI/HFS 100-1988

Draft Exists Current estimated time to completion?

Current Status
ANSI/HFS 100-1988 still provides some beneficial basics, though the revised draft should also be given consideration.

Participatory Ergonomics

Participatory Ergonomics: What is It?

Participatory Ergonomics:
Ergonomists working together with non-experts on a company-wide basis. This involves a methodology of persuasion or cooperation between the ergonomics expert and nonexperts in a workplace, in an attempt to involve persons from several different fields in the ergonomics effort. Basically, participatory ergonomics is a concept of having both employer and employee participation in the implementation of a comprehensive ergonomics program.

Participatory Ergonomics: Why is it Important?

A single ergonomist can not single handedly conceive, implement, and enforce ergonomics in a workplace. Management participation/commitment is required for allocation of resources. Employee participation/commitment is required since they are ultimately capable of either using and benefiting from, or defeating, the ergonomic concepts and controls implemented by a company.

Participatory Ergonomics: Benefits

Efficient utilization and integration of people and information within a company. It allows the building of a framework within a company that utilizes the knowledge, skill and experience of its workers. Considering worker opinions helps in obtaining their cooperation and commitment. Through including the worker in ergonomics: The ergonomist can receive feedback on what the end user thinks about the ergonomic controls The manager can uncover improvements without having to single handedly inspect the entire plant. The worker can make his/her supervisor aware of their interest in their job and their willingness to work. The worker can also implement the concepts learned on the job at the home.

OSHA and Ergonomics

OSHA
Since 1970, government regulation of occupational health and safety matters has largely been delegated to the Occupational Safety and Health Administration (OSHA). OSHA was formed by the passing of the Williams-Steiger Occupational Safety and Health Act in December of 1970. This act, which became effective on April 28, 1971, is commonly referred to as the OSHAct.

OSHA
Under the OSHAct, OSHA is empowered to promulgate safety and health standards, and to enter workplaces to investigate alleged violations of these standards and perform routine inspections. The OSHAct also gives OSHA the right to issue citations and penalties for violations of those standards. By default, all government organizations are excluded from mandatory OSHA compliance. However, according to Executive Order 12196, federal agencies (including the Department of Defense) are required to comply with OSHA provisions.

OSHA: General Duty Clause

A key provision of the OSHAct is commonly referred to as the "General Duty Clause" (GDC). The general duty clause (OSHAct Section 5(a)(1)) states:
"Each employer shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees"

The significance of the GDC is that it authorizes OSHA to cite hazardous conditions that are not covered by a particular OSHA standard. Since there is not a standard on ergonomics, the GDC has historically been used by OSHA inspectors to issue ergonomics related citations, with the first GDC citation on ergonomics being issued in 1979.

OSHA and Ergonomics: The Proposed Ergonomics Standard

Efforts to develop a formal "ergonomics standard" were initiated in 1992, with the release of an advance notice of proposed rulemaking on ergonomic safety and health management. However, it was not until November of 1999 that OSHA published its proposed ergonomics standard.

OSHA and Ergonomics: The Proposed Ergonomics Standard

The proposed OSHA ergonomic standard was very different from most other OSHA standards.
It was different from other standards in that it was not necessarily mandatory for all employers. Although jobs in manufacturing and materials handling were automatically covered, other jobs are exempt from the standard until a WMSD occurs. What this means is that employers can focus their efforts on actual trouble areas in their workplaces, rather than trying to implement large programs affecting their entire operation at once.

OSHA and Ergonomics: The Proposed Ergonomics Standard

Key provisions of the standard, as proposed in November of 1999, included the following: Basic Program Implementation Full Program Implementation Quick Fix Implementation

OSHA and Ergonomics: Current Status

OSHA
Voluntary guidelines being published New ergo-standard in development with projected completion in 2 years

Individual States
WA has state ergo standard Other states are following suit

End of Presentation