Mousing elbow? It can be prevented

LaRochelle Greg 2 Posted by Greg LaRochelle

“Hey doc, what do you mean I have tennis elbow?  I don’t even play the game!”

 Tennis elbow or lateral epicondylitis, as clinically described, refers to a condition that results in soreness to the outside of the elbow and forearm, typically to the dominant arm.  Tennis elbow is classified as an overuse injury though the cause can stem from a sudden blow to the elbow or forceful pull of the forearm.  Commonly, micro-tears occur to the extensor forearm muscle tendon near the elbow resulting in pain and discomfort.   Pain is most pronounced when grasping objects with the palm down (pronation), shaking someone’s hand, or turning a door knob.

With a move by many employers to go “paperless”, particularly in healthcare with the implementation of an electronic medical records system, computer mouse use has increased dramatically.  Navigating through software applications with multiple windows, tabs, and dropdown menus has become extremely mouse-click intensive, setting the stage for a repetitive stress injury such as tennis elbow.  

The risk of developing this condition can be caused by the placement of the mouse on a work surface that requires an awkward extended reach.  Additionally, the size and shape of the mouse can be contributing factors depending on the size of the person’s hand as well as overall conditioning of the forearm muscles. 

The good news on tennis elbow is that it’s not permanent if given prompt intervention and opportunity for adequate recovery time.  Here are some tips on avoiding tennis elbow related to computer mouse use.

  1. Position the mouse close to the side of the keyboard with minimal reach.
  2. Increase the mouse pointer motion speed to reduce force exertion.  The mouse properties are accessed through the computer control panel with the pointer options tab and motion (select a pointer speed) the means of adjustment. 
  3. Take a micro-stretch break every half hour.
  4. Alternate mouse location from the favored side of the keyboard to the opposite side (though this takes some adaptation). 
  5. Learn control key shortcuts for the software application.
  6. If tennis elbow has already resulted (from mouse use), replace the conventional mouse with an “in-line” design.  

For more information on controlling ergonomic risk factor exposure, consult the MEMIC Safety Director and lightly click on the Solve your Ergonomic Dilemmas! link.

Reducing Housekeeping Strains May Be Just a Drop in the Bucket

Clark Dan Posted by Dan Clark

 When it comes to housekeeping workers, back and shoulder strains can be significantly decreased by, literally, a drop in the bucket. 

Housekeeping workers often work with wheeled mop buckets that, when full, can weigh 50 pounds or more.  The buckets are easily filled with dispensing systems or a hose from a sink which doesn’t place a huge physical demand on the worker.  However, considerable stress and strain is put on workers when these buckets are emptied after use.  

 Emptying the buckets, typically in a closet with limited space, places significant forces on the shoulder joints and back.  Many housekeeping workers manually lift these buckets to a sink, or other elevated drain, to empty them.  When doing so, these workers are subject to awkward postures, including lifting and twisting.

An inexpensive solution to avoid costly shoulder and back strains is a drop in the bucket.  A small electric submersible pump (priced between $80 and $100), equipped with a short piece of hose, can be set in the bucket that needs to be emptied.  Pumping the water into the sink or drain will eliminate the heavy, manual lift, twist, and awkward posture.

 Be sure that the electric pump is plugged into a ground-fault circuit and that workers are trained on the proper use of the pump.  This practice is so effective in eliminating the unnecessary, heavy lift and twist that some companies have created policies enforcing the use of these pumps by housekeeping workers. 

Is Sitting Good for Your Health?

Allan Brown Posted by Allan Brown

Inactivity (like sitting) has a profound effect on our bodies.  Sitting increases disc pressure by as much as 50% and reduces cardiac output.  It also affects our bodies at the cellular level, changing the production of certain proteins that contribute to our overall wellness. 

Believe it or not, the simple act of getting up and moving around plays a huge role in our overall wellness.  Research done by Marc T. Hamilton, Deborah Hamilton, and Theodore Zderic at the University of Missouri-Columbia, show our bodies are changing because of a decrease in movement throughout the day.  This non-exercise activity (moving around an office) is being greatly reduced in our daily routines because of technology and jobs that involve sitting for an extended period of time.  Our risk of obesity, Type 2 Diabetes, and cardiovascular disease appears to be on the rise because of our sedentary work habits. 

For example, the researchers compared energy expenditure and found brisk walking 5 days/week or running 35 miles/week produced less energy expenditure and fewer muscle contractions than high non-exercise activity, like standing and walking throughout the day.  Structured exercise does contribute to our overall wellness however non exercise activities like walking, standing and moving during daily activities collectively, contribute more to our overall wellness.  The energy expenditure :

  • "Standing workers”: 1400 kcal/day
  • Shop assistants or homemakers:  2300kcal/day
  • Seated workers with limited movement : 700kcal/day. 

So, what can you do?  Get out of that chair and take stretch break.  Take a walk. Move the printer further from your desk. Consider standing for a portion of the workday.  Walk or bike to work.  Leave your office for lunch and take a walk after you eat.  Do not sit down when you go home.  Take a walk, stay upright against gravity, and increase your non-exercise activity. 

According to public health studies, we are awake on average of 16 hours per day.  How much of that day do spend sitting?  Decrease your hours in the chair and stay vertical.  It is okay to sit and lay down, but save it for after a good day of being upright!


See more with less? Yes!

Allan Brown Posted by Allan Brown

Office environments are usually well lighted, and believe it or not, this poses some problems for the computer operator.  Offices have been around for a long time but the world of computers is relatively new.  Most offices today are equipped with computer workstations, and lots of light from fixtures above.   These overhead lights are left over from the days of paper pushing.   

Today’s office routines pass in front of us electronically.  Less is done on paper and more from our computers.  Viewing a computer in an over-lighted office environment increases the strain on our eyes, necks and shoulders.   The computer is a screen in front of us that contains its own light source.  Adding more ambient light in the room from above or from windows does not make the viewing any easier.  As the ambient light increases the contrast on the computer screen decreases.  The words and images are actually more difficult to see.  A typical response to improve the contrast by the user is to squint or move closer to the screen usually with a forward head posture.  Either of these accommodations will eventually lead to a cumulative trauma disorder (CTD). 

Squinting is accomplished by contracting the muscle around your eyes.  Prolonged contracting can lead to fatigue and achiness around the face and eyes as well as red eye.  Leaning into the computer screen with a forward head posture can increase the forces on the neck and shoulders possibly leading to headaches and neck pain.  In both situations the root cause has not been addressed.  Until the overhead light is reduced the unconscious behaviors of squinting and leaning will continue. 

Reduce the lighting from above.  Look at your screen and have someone turn the overhead lights off and see if this improves the viewing experience.  Shade your eyes from lights from above and see if the screen contrast improves.  Complete darkness is not the solution.  A 3-to-1 relationship has been considered a comfort range for lighting.  In other words, the computer should be 3 times brighter than the room ambient lighting.  Try to balance the lighting to this ratio with shading or filtering the light from above.  Properly balanced light will improve the comfort at your computer work station. 

Of course, paperwork still needs light.  Get a document holder and a small task light to shed light on the paper and anything else below or away from the computer screen.  And, for those of us who hunt and peck at the keyboard, there's an added benefit to having it lighted, too. 

Does my company need a written safety and health program?

Dodge John 
Posted by John Dodge

This week a business owner asked me if he needed a formal safety program. His business employed 10 people and has been successful in preventing workplace injuries for several years. However, he felt some level of uncertainty about his informal safety and health efforts.

Following a brief discussion and a work site tour, it was evident that his organization had elements of a formal safety and health program: An organized workplace, well maintained tools and equipment, elimination of hazardous tasks, and availability of personal protective equipment.

I suspect that many business owners find themselves in a similar situation. They feel that they are doing enough to provide a safe workplace and if they have few injuries, why have a formal program?

I also suspect that some businesses owners feel as if their luck has changed- the informal safety efforts that have worked in the past are no longer working.

If you wonder why you need a formal safety and health program, start by asking these questions:

  1. How do my employees know that I expect them to work safely?
  2. How do I address unsafe work conditions before an accident or near miss?
  3. Does management understand that they are accountable for safe work conditions?
  4. How are employees trained to perform their job?
  5. Do my employees participate in the safety and health process?
  6. Am I compliant with regulatory safety and health requirements?

If you don’t have answers to these questions, a written safety and health policy will provide a definite course of action and a schedule of activities. There are various guidance documents available, but most will have these basic program elements:

  1. Management commitment and employee involvement
  2. Worksite analysis
  3. Hazard identification and control
  4. Employee training

To get started, I recommend MEMIC’s Seven Steps to a Safer Workplace guide. This document and other safety support materials are available on MEMIC’s Safety Director website.  You will quickly build a formal safety and health program and will eliminate any uncertainty about the effectiveness and consistency of your future safety efforts.   

The Best 60 Minutes of Aging Workforce Advice

Yesterday, our ergonomist Allan Brown led a webinar about the much-discussed topic of the aging workforce. (A recording of the one-hour webinar is available to MEMIC policyholders on our website.) This demographic reality enters nearly every conversation about the future of workplace safety and about workers’ compensation insurance.

And it should. After all, what’s the fastest growing age range in the work world? Here’s a hint: it’s not the just-out-of-school, first-real-job set. In fact, workers 65 or older now make up about 17% of the total workforce – up from 11% in 1988.

But what does that mean? Well, as Brown points out, physiological changes mean that as we age from our physical peak (in our 20s!), we suffer reductions in strength, endurance, cardiac output, flexibility, hearing and vision. Depressed? Well, hold on. Older workers offer lots of benefits as well. They have better attendance records, tend to be more flexible with time, have a lower turnover rate and bring their life experience to the job.

In general, older workers suffer fewer on-the-job injuries, though that can vary by industry. And, offsetting that fact, is the truth that older workers who do get injured miss more work when recovering. In fact, an injured worker age 65 or older will miss an average of more than 16 days while a worker aged 45-54 would miss about 8 days.

Older workers are nearly twice as likely to suffer an injury due to a slip, trip or fall than any other category of workplace injury. Almost half of all workplace injuries to workers 65 or older are the result of a slip, trip, or fall.

So, what can an employer do? Well, there’s more in the webinar but here are a few important ideas. First, understand the limitations that come with age. Tasks which require significant strength may not be appropriate for older workers. Significant repetitive tasks (due to reductions in endurance) may require more frequent rotation of jobs, or breaks. Beware of noisy environments in which older workers are unable to hear instructions as clearly. Address slip, trip and fall hazards with good lighting, handrails and keeping walkways clear.

For all of us, the alternative to aging is, well, not generally acceptable. Whether you’re an employer or an employee, consider the realities in the workplace. You can take actions and create systems that allow you to gain advantage of the benefits of experienced workers while significantly reducing the risk.

Watch "An Age Old Problem: Addressing Workers' Comp with an Aging Workforce" webinar now.

Is a Sit/Stand Workstation Right for You?

Allan Brown Submitted by Allan Brown

Sit/stand workstations are becoming more popular in the office environment as they allow the user to change position throughout the day.  The primary benefit of a sit/stand station is to reduce worker fatigue through frequent postural change.  Sitting at a conventional office workstation increases the forces on the low back and standing, while reducing these forces, can also place the worker in a prolonged static posture.   While “off-the-shelf” sit/stand stations can be purchased in models that are electric, pneumatic, or manual, simply modifying an existing workstation can achieve the desired benefit.  There are several considerations when creating this type of workstation.

10 steps to a sit/stand workstation

  1. First determine the worker’s neutral standing elbow height.  Have the worker stand comfortably erect and bend their arm at the elbow to 90 degrees.  Measure the distance from the floor to the elbow. 
  2. Measure the worker’s eye height from the floor. 
  3. Measure the thickness of the keyboard.
  4. The worker’s elbow height minus the thickness of the keyboard will be the recommended height of the work surface.   Many cubicle workstations have adjustable height work surfaces with support brackets mounted in partition tracks.  
  5. Ensure there is ample room on the work surface for the mouse and keyboard.
  6. If the worker has normal vision, the top of the monitor screen should be equal to the eye height measurement.
  7. If the worker wears corrective lenses, adjust the screen according to the prescription, i.e., bifocal wearers will need the screen lower than eye height to comfortably view the screen without craning their head back.
  8. A document holder should be included to support documents at the same level as the monitor screen.
  9. For intervals of seated work, provide a chair with enough seat pan height adjustment so as to maintain the worker’s elbow height in the same position as if they were standing.  Typically a drafting stool/chair will provide enough height.
  10. A sturdy box or other platform device should be provided as a foot support to provide lower extremity support while maintaining the thighs parallel to the floor.  The stool/chair should have an adjustable base foot-ring adjusted to the same height as the box.  The box should be positioned approximately 5 inches inward (recessed) from the front edge of the work surface to allow for proper positioning of the chair when the worker is seated.

Micro Breaks = Macro Benefit

Bill OConnor Posted by Bill O’Connor

Ergonomics is the science of the interaction between people and their work. The ergonomic concerns in the workplace are not limited to computer workstations, assembly operations, or lifting tasks.  Risk factors like excessive force, repetitive tasks, and awkward posture can surely stress the human body to the point where injury occurs. A combination of ergonomic risk factors is the real concern, however.

One of the primary reasons that workers sustain injury involves overload of work without enough recovery time. Whether a worker is performing extremely repetitive tasks, such as assembly or typing, or is exposed to prolonged static tasks, such as sitting or working overhead, the human body will fatigue after period of time.

When fatigue sets in, muscles become stiff and cramped, flexibility decreases significantly, and blood flow to the affected body area is reduced.  The end result is a significant increase of risk of physical injury.

How can you counteract these forces: Do your bodys a favor—take a micro break: 30 – 40 seconds of light movement and stretching (especially for affected body parts) will help keep the muscles limber, squeeze out metabolic waste products from muscles and bring in fresh, nutrient-rich blood to maintain joints with a good range of motion. If you haven’t already, you should consider speaking to the benefits of micro breaks in your Employee Handbook. They may be micro but they do big things!


Put Your Shoulder to the Wheel! On second thought…

LaRochelle Greg 2 Posted by Greg LaRochelle

The expression  "Put your shoulder to the wheel." is an idiom for working hard at something.  Certainly, we don't want to actually place a shoulder against a wheel, especially if it's of the rotating and grinding variety.  Ouch! 

But the message here is more about protecting your shoulder from cumulative trauma than from abrasion.  A little anatomy is in order to fully appreciate the shoulder as a remarkable structure along with its vulnerability.

The shoulder is one of the most sophisticated and complex joints of the body.  It allows us 360-degree range of motion, like the sweep of hands on a clock's face.  Some of us will remember The Who's Pete Townsend wind-milling on the guitar.

It's through the ball and socket attachment of the upper arm bone (humerus) into the shallow "cup" of the scapula that such mobility is afforded. The head of the humerus is reinforced in the socket with ligaments.  Additionally, some 30 muscles provide movement, support, and stability to the shoulder complex. The tapering extension (tendons) of four muscles that raise and lower the arm form the rotator cuff and attach to the humerus.  There is also a fluid-filled sac (bursa) that cushions these tendons from the bony structure (acromion) above. Raising the arm above shoulder level compresses the tendons against the bursa in this subacromial compartment.

Though the structure of the shoulder is unique, its weakness lies in its complexity, coupled with the forces that are applied during arm movement.  Activities performed with the arms outstretched, overhead, and with an object in hand place a significant amount of stress on the shoulder joint. 

Two common shoulder injuries are impingement and rotator cuff tear. Impingement results from the rubbing of the rotator cuff tendons against the bursa and acromion causing pain and inflammation.  Tears to the tendons can result from sudden impact or from chronic wear.  Over time, fraying and tearing of the tendons can result with arm movement impaired due to the pain and inflammation.  Surgery is typical for sudden impact injury resulting in a massive tear and may be warranted for cumulative conditions as well.

To reduce the potential for a cumulative shoulder injury, lift objects close to the body, use stepladders or footstools to avoid overhead work, stretch periodically, and maintain proper conditioning.  If you've already experienced a shoulder injury, these steps will help to ensure that you, in the word of Mr. Townsend, "won't get fooled again!".

Basic Kitchen Ergonomics

Jones Tony Posted by Anthony Jones

This post is meant as a general guide to help anyone who needs information on making commercial or institutional kitchens a safer place to work. As we, all know there is often a dramatic difference between the customer and client sections of a facility and the kitchen area.  

A significant source of injury for kitchen workers -- along with lacerations, burns, slips, trips, and falls --  are back and upper extremity muscle strains, tendonitis, carpal tunnel syndrome and other musculoskeletal injuries.

Recognizing risk factors that contribute to the development of musculoskeletal injuries and developing effective strategies to reduce them has a positive impact on reducing these injuries. The risk factors include forceful exertion, repetitive motion, awkward postures, static postures, and contact stress.

Early detection, reporting and treatment of musculoskeletal injuries is crucial to control the potential severe effects of this particular class of injury. Injuries treated in the early stages have a better chance of healing properly. Later stage musculoskeletal injuries may not heal completely but effects can be minimized if dealt with properly.

General controls for each of the identified risk factors include:

Forceful Exertions:

  • Good body mechanics can decrease muscle force needed to carry out job tasks, which reduces the risk of developing a musculoskeletal injury.
  • Teach workers to test loads before lifting and to plan routes before lifting and carrying the load. Use good lifting technique for lifting, lowering, and carrying loads.
  • Separate heavier loads into smaller load quantities, or containers. Can heavier bulk items be purchased in smaller load quantities, or containers?
  • Make use of adjunct equipment such as hoists, dollies, or conveyers to reduce the workloads. Install wheels on containers, wherever possible to allow pushing rather than lifting, carrying, or dragging. (Keep the wheels clean and in good working order)
  • Avoid reaching below mid-thigh height, and above shoulder height.
  • Place or store the heaviest items at mid height to make lifting easier, and eliminate lifting heavy items from the floor. Avoid simply placing the heavy items on the floor or bottom shelf.
  • Avoid lifting or carrying items that are slippery, too hot, or unevenly balanced.

Repetitive Motion: Repetitive motion for upper arms, elbows, forearms, and wrists can be defined as more than 10 reps per minute or for shoulders, more than 2.5 reps per minute.

  • Minimize wherever possible repetitive motion to help reduce the worker’s risk of developing a musculoskeletal injury.
  • Use mechanical or automated devices (food processors, potato peeling machines, and electrical mixers)
  • Alternate working positions to avoid overusing any single muscle or muscle group. Alternate hands used to perform simple tasks.
  • Try to combine or eliminate tasks whenever possible. Pace the work when performing repetitive motion tasks.
  • Include job rotation, stretching, frequent rest periods, and task breaks.

Awkward Postures:

  • Move the body closer to the object, or move the object closer to the worker. Do not reach beyond the point of comfort.
  • Wherever possible avoid excessive torso flexion by storing items between knee and shoulder height.
  • Always face the objects you are working on, do not twist and reach behind or to the sides of the body.
  • Work tasks should be adjusted to keep elbows as close to the body as possible.
  • If the work is too high, lower the work, or raise the worker by a platform or footstool.
  • Sit on a stool or chair rather than squatting, kneeling, or bending over while you work.
  • Use tools or hand implements designed to keep wrists straight. For example, grill flippers with bent raised handles.
  • Counter height should be a few centimeters below the worker’s elbow height.
  • Shelf height should not be higher than shoulder height of the shortest worker. If necessary, provide stepstools.
  • Place frequently used items in the most accessible locations. Place frequently used and heavier items 11 to17 inches from the workers. Place infrequently used and lighter items 21 to 25 inches from the workers.
  • Wherever possible, move trip items or obstacles out of the way.

Static Postures:

Static posture can be defined as body positions held without movement for more than 10 seconds.

  • Anti-fatigue matting can provide a softer surface to stand on. Use non-slip surfaces and anti-fatigue mats to prevent slippage. Consider where the matting will be used and purchase the appropriate style and type for the particular applications.
  • Footstools allow workers to raise a foot up, which helps shift body weight and reduces stress on the legs and lower back when standing for long periods.
  • Sit-stand stools can allow workers to alternate sitting and standing positions. Sit-stand stools are most appropriate when the worker does not have to reach too far.
  • Footwear should fit properly and have anti-slip soles. Consider the following:
    • Does the footwear have enough grip?
    • What type of flooring is in the kitchen?
    • Is the footwear durable?
    • Is there adequate ankle protection?
    • What is the kitchen temperature range?
    • What types of hazards exist and type of footwear selected? For example, what about puncture, burn protection, and crush protection?
    • Evaluate the frequency of when the footwear needs replacement. Over time the soles will deteriorate, and the mid-sole will breakdown and lose the cushioning capabilities.

Contact Stress: 

  • Add padding to sharp edges to reduce stress on the hands. For example, knife handles scissors, carts, bins, and countertops.
  • Workers should avoid leaning against sharp edges or metal surfaces. Bevel or round off sharp edges on tables, ledges, and shelves.

Plate fork and knife ergo