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Office Ergonomics:
Preventing Office-Related
         Injuries


    James M. DeCarli, MPH, MPA, CHES
        Research Analyst III/Behavioral Sciences
          Injury & Violence Prevention Program
     Department of Public Health, Los Angeles County
Overview
Background on ergonomics
  Definition
  Statistics
  Regulatory Agencies & Laws
  Types of work-related injuries

Common Anatomical & Associated Risk Factors

6-Steps to Prevention work-related injuries

Steps to take-if you experience work-related injury
At the conclusion of today’s training
         you will be able to:
 Identify at least 3 risk factors
 that contribute to work related
 injuries.

 Perform a self evaluation of your
 own work environment.

 Describe at least 1 change or
 modification that you intend to
 make to your workstation, job or
 work habits.
What is Ergonomics?


          ERGO = Work

    NOMICS = “rules” or “laws”

Ergonomics: Means “the laws of work”
What is Ergonomics?
The science of “designing the job to fit the worker,
rather than forcing the worker to fit the job” (OSHA)

Ergonomic principles are used to improve the “fit”
between the worker and the workplace.

A practical approach to Ergonomics considers the
match between the person, the equipment they use,
the work processes, and the work environment.
Outcome of Ergonomics
        Overall, Ergonomic Interventions:

Makes the job safer by preventing injury and illness

Makes the job easier by adjusting the job to the
worker

Makes the job more pleasant by reducing physical
and mental stress

Saves $$$$
Occupational Injury Statistics
 Ergonomic injuries account
for one-third of all workplace-   600,000 office workers
        related injuries          each year miss at least
                                  one day of work due to
                                  ergonomic injuries (U.S.
                                  Department of Labor (2005)


                                  Cost of ergonomic
                                  injuries to employees,
                                  employers, and society as
                                  a whole: $50 billion
                                  annually (National Research
                                  Council/Institute of Medicine, 2001)
Regulatory Agencies
  Work-Related Injury & Prevention
       Occupational Safety and Health Act of 1970

National Institute for Occupational Safety and
  Health (NIOSH) - U.S. Department of
  Health and Human Services
       Responsible for conducting research and making recommendations for
       the prevention of work-related injury and illness.


Occupational Safety and Health
  Administration (OSHA) in the U.S.
  Department of Labor
     Responsible for developing and enforcing workplace safety and health regulations.
Regulatory Agencies
  Work -Related Injury & Prevention

The State of California Division of
 Occupational Safety and Health
 (DOSH) - referred to as Cal/OSHA
       Responsible for enforcing California laws and regulations
     pertaining to workplace safety and health and for providing
     assistance to employers and workers about workplace safety and
     health issues.
Ergonomic Laws
              (National)
     OSHA Act of 1970, Section 5 (a) (1)

An employer “…shall furnish a place of employment which
is free from recognized hazards that are likely to cause
death or serious physical harm to employees.”
Ergonomic Laws
               (California)
California Code of Regulations, Section 5110
      (Repetitive Motion Injuries, 1997)
  Employers shall establish a program to reduce RMI’s
    Worksite evaluation
    Control of exposures that cause RMI’s through
    engineering and administrative controls.
    Employee training
       RMI exposure
       Symptoms and consequences
       Reporting procedures
       Methods to reduce RMI’s
Ergonomic-Related Injuries
May be called:
 CTD’s (cumulative trauma disorders)
 RSI’s (repetitive stress injuries)
 RMI’s (repetitive motion injuries)

Which are all considered
 MSD’s (musculoskeletal disorders)
 MSD’s can affect muscles, tendons, nerves, joints and
 spinal disks.
Risk Factors and Causes of MSD’s
Repetitive, frequent movements
Excessive force (pinch-grip of hands and fingers)
Awkward Posture - deviation from the “neutral” body position
Static Posture - posture occurs when one position is held for a
prolonged period of time. The muscles will become fatigued from a lack
of blood flow during a static posture
Contact Stress - Caused by repetitive motion that created localized
pressure point such as on finger tip or thumb. This irritates local tissues
and interfere with circulation and nerve function.
Psycho Social - Stress, boredom, clutter, job dissatisfaction and anxiety
can contribute to the possibility of developing a MSD. This stress also
creates increased muscle tension and reduce a person’s awareness of
work technique.
Common Anatomical
     Risks of MSD’s

           Eyes

                  Neck
Shoulder


                     Elbow
Back


                         Hand/Wrist
Back-Related MSD’s

Symptoms                        Risks
Muscular
                           Awkward sitting
tension                    position
                           Static position
Low back pain              Prolonged sitting
                           Lumbar not
Reduced range              supported
of motion                  Chair backrest not
                           used
                           Twisting of torso
                           Feet dangling-not
                           flat on floor
Shoulder-Related MSD’s

Symptoms                      Risks
Muscular                 Prolonged Shoulder
                         Abduction (elbows rested
tension
                         outward on arm rest)

Stiffness                Elbows hanging (not
                         using arm rest)

Reduced range            Prolong Raised Shoulder
of motion                Flexion (elbows forward)

                         Prolong Shoulder
                         Hunched position
                         (shoulders up around
                         ears)

                         Static position
Eye-Related MSD’s
Symptoms                          Risks
Sore, tired, itchy,          Improper viewing,
dry, or burning eyes         height, angle, and
Headaches                    distance
                             Improper lighting
Difficulty focusing
between monitor              Glare
and documents                Uninterrupted focus on
                             the screen
Increased
                             Hard copy document
sensitivity to light
                             location
Color fringes/after          Dirty screen
images                       Type of reading glasses
                             Screen contrast between
                             screen and hard copy
                             document
Neck-Related MSD’s
Symptoms                       Risks
                           Twisting head from
                           side to side to read
Muscular                   hard copy documents
tension
                           Head tilted slightly
                           back
Stiffness
                           Neck severely flexed
Reduced range              downward
of motion
Elbow-Related MSD’s

Symptoms                        Risks
Pain                        Elbow or forearm
                            resting for long
                            periods on hard or
Swelling                    sharp work surface,
                            chair armrests, etc.
Stiffness                   Elbow flexed for long
                            period while using
Reduced grip                mouse or keyboard
strength in hand            Forceful Repetitive
                            movements of wrist
                            and arm

                            Forceful Repetitive
                            hand grip
Hand/wrist-Related MSD’s
Symptoms                   Risks
Pain                     Rapid, sustained,
Swelling in joints       or prolonged
Stiffness in joints      keying
Numbness or              Forceful key
burning sensation        strokes or
in the hand or           exertions
fingers                  Prolonged mouse
Reduced grip             use
strength in hand         Wrists bent back
                         (extended) or
                         forward (flexed)
                         for prolong periods
                                   Continued…
Hand/wrist-Related, continued
                         Risks
                      Wrists angled to the
                      side when using
                      side keys
                      Wrists or palms
                      resting for long
                      periods on hard
                      surface
                      Keyboard and
                      mouse not
                      positioned correctly
Types of Musculoskeletal Disorders
            (MSD’s)
     Tendonitis
     Bursitis
     Tennis Elbow
     Trigger finger
     Thoracic Outlet Syndrome
     Carpal Tunnel Syndrome
     Other Types:
        Sprains & Strains
        Neck & Back Injuries
Tendonitis
Inflammation of tendon-thick cord that attaches bone to muscle
Common Office Related Anatomical Location: Elbow & Shoulder
Cause: Repetitive motion
Tendonitis-Shoulder
Bursitis
Inflammation of one of bursa sacks (fluid filled sack-like structures
diminish friction between two moving structures)
Common Office Related Anatomical Location: Elbow & Shoulder
Cause: Repetitive motion & overuse
Bursitis-Shoulder
Tennis Elbow (lateral epicondylitis)
Inflammation of the tendons outside (lateral side) of the elbow
Cause: Repetitive motion of wrists or repetitive gripping
Trigger Finger
  (Stenosing Flexor Tenosynovitis)

Inflammation of A1 pulley
Cause: Repetitive, forceful,
and frequent squeezing or
gripping
Trigger Finger
(Stenosing Flexor Tenosynovitis)
             Cont’d




 NORMAL ANATOMY    ABNORMAL ANATOMY
Thoracic Outlet Syndrome
Compression of the nerves
and blood vessels in the
thoracic outlet (space
between clavicle and first
rib).
Symptoms:
    Pain in shoulders and
    neck
    Numbness in fingers
Cause: Repetitive motion &
poor posture
Carpal Tunnel Syndrome
Carpal Tunnel:

   Narrow, C-shaped
   passageway
   Made of tiny bones
   and ligaments
   Tendon and nerves
       Control
       movement to
       fingers
       Pass through the
       carpal tunnel
Symptoms:

                                 Numbness &
                                 tingling in
                                 thumb and first
During repetitive movement:      two fingers.
The Tendon:
   Tendons
                                 Pain increases
       Irritated-causing
   Covered-fluid sheath          during sleep &
            Swelling             after work
   Help glide during
   movement Inflammation
Preventing MSD’s

By applying ergonomic principles to the office setting:

 Risk factors are minimized

 Productivity is increased and

 Workplace quality is improved
Preventing MSD’s
Ergonomic principles: 6-Steps to Preventing MSD’s:
  Adjust workstation to promote a neutral position that fits you and
  makes you feel most comfortable.
  When adjusting your workstation-remember-All of the equipment
  interacts with your body and actions-making one adjustment may
  alter another. Remember:

     THINK-type of adjustment to be made

     ADJUST-make adjustment

     FEEL-your body/if no improvement, then RE-ADJUST
STEP 1. Workstation Area
Organize Desktop -
to keep frequently
used items within
easy, limited reach
Clear any clutter - to
have space when
working
Area under desk –
clear of clutter to
accommodate legs &
allow for stretching
STEP 2. Chair Adjustment-Posture
Hands, wrists, and forearms are straight, in-line,
parallel to the floor.
Head is level, or bent slightly forward, forward facing,
and balanced. Generally it is in-line with the torso.
Shoulders are relaxed, upper arms hang normally at
the side of the body.
Elbows stay in close to the body and bent between 90
and 120 degrees, resting on armrest.
Back is fully supported with lumbar when sitting
vertical or leaning back.
Thighs and hips are supported by well-padded seat,
parallel to the floor.
Knees are about the same height as the hips with feet
slightly forward.
Feet are fully supported by floor or footrest.
STEP 3. Monitor Adjustment
Your eyes should be level with
the top of monitor

Distance between the eyes and
monitor - not less than 20-inches
away or not less than arm length

The monitor should be tilted
upward slightly

Reduce glare from lights or
windows

Have document holder next to
computer monitor
STEP 4. Keyboard/Mouse
KEYBOARD
 The keyboard should be directly in front
 of you.
 Your shoulders should be relaxed and
 your elbows close to your body.
 Your wrists should be straight and in-
 line with your forearms
MOUSE
 Keep mouse close to keyboard
 Alternate hands with which you operate
 the mouse
 Learn to use keyboard short cuts to
 reduce extended use
STEP 5. Workstation Environment

Be aware of, and try to limit:
  Glare from overhead lights, desk lamps, and windows
  Poor air circulation
  Air conditioning vents that "dump" air right on top of
  you
Consider Ergonomic Products to help fit the work
  environment to you
Ergonomically Designed Office
        Equipment
Ergonomically Designed Household
       Tools and Products
STEP 6. Consider New Ergonomic-
     Friendly Work Habits
When working for long periods of time on the
computer, very 20-30minutes take a short 1-
minute routine break:
  Remove eyes from screen (see handout in folder)
  Stretch hands, arms, and back (see handouts in
  folder)
Get regular exercise outside the office. Increase
physical activities (walking, biking, social club) to
help reduce stress
Ergonomic Assessment &
          MSD Symptoms?
What to do if you need an ergonomic assessment or
 begin to experience MSD symptoms:
  Ergonomic Self-Assessment
    http://ergo.human.cornell.edu/cuergotipsintro.html
  MSD Symptoms
    http://www.lapublichealth.org/ivpp/injury_topics/Occupati
    onalInjury/OfficeInjury.htm
    See your Doctor
    Request formal ergonomic assessment (contact IVPP)
       Give “Ergonomic Assessment Request” to your supervisor
       Submit to IVPP
Summary
Remember:
 THINK - type of adjustment to be made
 ADJUST - make adjustment
 FEEL - your body/if no improvement,
 then RE-ADJUST
Summary
              6-Steps to Preventing MSD’s
1.   Keep frequently used items in easy reach & clear clutter
2.   Adjust chair for neutral posture-feet flat on floor,
     appropriate height, arm rests adjusted, lumbar support
3.   Adjust top of monitor to eye level and not closer than
     arms reach
4.   Ensure keyboard is in front of you, located so shoulders
     are relaxed and elbows close to body, and wrists straight in-
     line with forearms. Ensure mouse is next to keyboard
5.   Reduce glare & ensure proper lighting
6.   Take routine 1-minute eye and stretch breaks every 20-30
     minutes of computer work and increase physical activity to
     help reduce job stress
Contact Information




    Ergonomic Resource:
http://www.lapublichealth.org/ivpp

             Email:
        jdecarli@ladhs.org

            Phone:
         (213) 351-7888

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Office Ergonomic Training

  • 1. Office Ergonomics: Preventing Office-Related Injuries James M. DeCarli, MPH, MPA, CHES Research Analyst III/Behavioral Sciences Injury & Violence Prevention Program Department of Public Health, Los Angeles County
  • 2. Overview Background on ergonomics Definition Statistics Regulatory Agencies & Laws Types of work-related injuries Common Anatomical & Associated Risk Factors 6-Steps to Prevention work-related injuries Steps to take-if you experience work-related injury
  • 3. At the conclusion of today’s training you will be able to: Identify at least 3 risk factors that contribute to work related injuries. Perform a self evaluation of your own work environment. Describe at least 1 change or modification that you intend to make to your workstation, job or work habits.
  • 4. What is Ergonomics? ERGO = Work NOMICS = “rules” or “laws” Ergonomics: Means “the laws of work”
  • 5. What is Ergonomics? The science of “designing the job to fit the worker, rather than forcing the worker to fit the job” (OSHA) Ergonomic principles are used to improve the “fit” between the worker and the workplace. A practical approach to Ergonomics considers the match between the person, the equipment they use, the work processes, and the work environment.
  • 6. Outcome of Ergonomics Overall, Ergonomic Interventions: Makes the job safer by preventing injury and illness Makes the job easier by adjusting the job to the worker Makes the job more pleasant by reducing physical and mental stress Saves $$$$
  • 7. Occupational Injury Statistics Ergonomic injuries account for one-third of all workplace- 600,000 office workers related injuries each year miss at least one day of work due to ergonomic injuries (U.S. Department of Labor (2005) Cost of ergonomic injuries to employees, employers, and society as a whole: $50 billion annually (National Research Council/Institute of Medicine, 2001)
  • 8. Regulatory Agencies Work-Related Injury & Prevention Occupational Safety and Health Act of 1970 National Institute for Occupational Safety and Health (NIOSH) - U.S. Department of Health and Human Services Responsible for conducting research and making recommendations for the prevention of work-related injury and illness. Occupational Safety and Health Administration (OSHA) in the U.S. Department of Labor Responsible for developing and enforcing workplace safety and health regulations.
  • 9. Regulatory Agencies Work -Related Injury & Prevention The State of California Division of Occupational Safety and Health (DOSH) - referred to as Cal/OSHA Responsible for enforcing California laws and regulations pertaining to workplace safety and health and for providing assistance to employers and workers about workplace safety and health issues.
  • 10. Ergonomic Laws (National) OSHA Act of 1970, Section 5 (a) (1) An employer “…shall furnish a place of employment which is free from recognized hazards that are likely to cause death or serious physical harm to employees.”
  • 11. Ergonomic Laws (California) California Code of Regulations, Section 5110 (Repetitive Motion Injuries, 1997) Employers shall establish a program to reduce RMI’s Worksite evaluation Control of exposures that cause RMI’s through engineering and administrative controls. Employee training RMI exposure Symptoms and consequences Reporting procedures Methods to reduce RMI’s
  • 12. Ergonomic-Related Injuries May be called: CTD’s (cumulative trauma disorders) RSI’s (repetitive stress injuries) RMI’s (repetitive motion injuries) Which are all considered MSD’s (musculoskeletal disorders) MSD’s can affect muscles, tendons, nerves, joints and spinal disks.
  • 13. Risk Factors and Causes of MSD’s Repetitive, frequent movements Excessive force (pinch-grip of hands and fingers) Awkward Posture - deviation from the “neutral” body position Static Posture - posture occurs when one position is held for a prolonged period of time. The muscles will become fatigued from a lack of blood flow during a static posture Contact Stress - Caused by repetitive motion that created localized pressure point such as on finger tip or thumb. This irritates local tissues and interfere with circulation and nerve function. Psycho Social - Stress, boredom, clutter, job dissatisfaction and anxiety can contribute to the possibility of developing a MSD. This stress also creates increased muscle tension and reduce a person’s awareness of work technique.
  • 14. Common Anatomical Risks of MSD’s Eyes Neck Shoulder Elbow Back Hand/Wrist
  • 15. Back-Related MSD’s Symptoms Risks Muscular Awkward sitting tension position Static position Low back pain Prolonged sitting Lumbar not Reduced range supported of motion Chair backrest not used Twisting of torso Feet dangling-not flat on floor
  • 16. Shoulder-Related MSD’s Symptoms Risks Muscular Prolonged Shoulder Abduction (elbows rested tension outward on arm rest) Stiffness Elbows hanging (not using arm rest) Reduced range Prolong Raised Shoulder of motion Flexion (elbows forward) Prolong Shoulder Hunched position (shoulders up around ears) Static position
  • 17. Eye-Related MSD’s Symptoms Risks Sore, tired, itchy, Improper viewing, dry, or burning eyes height, angle, and Headaches distance Improper lighting Difficulty focusing between monitor Glare and documents Uninterrupted focus on the screen Increased Hard copy document sensitivity to light location Color fringes/after Dirty screen images Type of reading glasses Screen contrast between screen and hard copy document
  • 18. Neck-Related MSD’s Symptoms Risks Twisting head from side to side to read Muscular hard copy documents tension Head tilted slightly back Stiffness Neck severely flexed Reduced range downward of motion
  • 19. Elbow-Related MSD’s Symptoms Risks Pain Elbow or forearm resting for long periods on hard or Swelling sharp work surface, chair armrests, etc. Stiffness Elbow flexed for long period while using Reduced grip mouse or keyboard strength in hand Forceful Repetitive movements of wrist and arm Forceful Repetitive hand grip
  • 20. Hand/wrist-Related MSD’s Symptoms Risks Pain Rapid, sustained, Swelling in joints or prolonged Stiffness in joints keying Numbness or Forceful key burning sensation strokes or in the hand or exertions fingers Prolonged mouse Reduced grip use strength in hand Wrists bent back (extended) or forward (flexed) for prolong periods Continued…
  • 21. Hand/wrist-Related, continued Risks Wrists angled to the side when using side keys Wrists or palms resting for long periods on hard surface Keyboard and mouse not positioned correctly
  • 22. Types of Musculoskeletal Disorders (MSD’s) Tendonitis Bursitis Tennis Elbow Trigger finger Thoracic Outlet Syndrome Carpal Tunnel Syndrome Other Types: Sprains & Strains Neck & Back Injuries
  • 23. Tendonitis Inflammation of tendon-thick cord that attaches bone to muscle Common Office Related Anatomical Location: Elbow & Shoulder Cause: Repetitive motion
  • 25. Bursitis Inflammation of one of bursa sacks (fluid filled sack-like structures diminish friction between two moving structures) Common Office Related Anatomical Location: Elbow & Shoulder Cause: Repetitive motion & overuse
  • 27. Tennis Elbow (lateral epicondylitis) Inflammation of the tendons outside (lateral side) of the elbow Cause: Repetitive motion of wrists or repetitive gripping
  • 28. Trigger Finger (Stenosing Flexor Tenosynovitis) Inflammation of A1 pulley Cause: Repetitive, forceful, and frequent squeezing or gripping
  • 29. Trigger Finger (Stenosing Flexor Tenosynovitis) Cont’d NORMAL ANATOMY ABNORMAL ANATOMY
  • 30. Thoracic Outlet Syndrome Compression of the nerves and blood vessels in the thoracic outlet (space between clavicle and first rib). Symptoms: Pain in shoulders and neck Numbness in fingers Cause: Repetitive motion & poor posture
  • 32. Carpal Tunnel: Narrow, C-shaped passageway Made of tiny bones and ligaments Tendon and nerves Control movement to fingers Pass through the carpal tunnel
  • 33.
  • 34. Symptoms: Numbness & tingling in thumb and first During repetitive movement: two fingers. The Tendon: Tendons Pain increases Irritated-causing Covered-fluid sheath during sleep & Swelling after work Help glide during movement Inflammation
  • 35. Preventing MSD’s By applying ergonomic principles to the office setting: Risk factors are minimized Productivity is increased and Workplace quality is improved
  • 36. Preventing MSD’s Ergonomic principles: 6-Steps to Preventing MSD’s: Adjust workstation to promote a neutral position that fits you and makes you feel most comfortable. When adjusting your workstation-remember-All of the equipment interacts with your body and actions-making one adjustment may alter another. Remember: THINK-type of adjustment to be made ADJUST-make adjustment FEEL-your body/if no improvement, then RE-ADJUST
  • 37. STEP 1. Workstation Area Organize Desktop - to keep frequently used items within easy, limited reach Clear any clutter - to have space when working Area under desk – clear of clutter to accommodate legs & allow for stretching
  • 38. STEP 2. Chair Adjustment-Posture Hands, wrists, and forearms are straight, in-line, parallel to the floor. Head is level, or bent slightly forward, forward facing, and balanced. Generally it is in-line with the torso. Shoulders are relaxed, upper arms hang normally at the side of the body. Elbows stay in close to the body and bent between 90 and 120 degrees, resting on armrest. Back is fully supported with lumbar when sitting vertical or leaning back. Thighs and hips are supported by well-padded seat, parallel to the floor. Knees are about the same height as the hips with feet slightly forward. Feet are fully supported by floor or footrest.
  • 39. STEP 3. Monitor Adjustment Your eyes should be level with the top of monitor Distance between the eyes and monitor - not less than 20-inches away or not less than arm length The monitor should be tilted upward slightly Reduce glare from lights or windows Have document holder next to computer monitor
  • 40. STEP 4. Keyboard/Mouse KEYBOARD The keyboard should be directly in front of you. Your shoulders should be relaxed and your elbows close to your body. Your wrists should be straight and in- line with your forearms MOUSE Keep mouse close to keyboard Alternate hands with which you operate the mouse Learn to use keyboard short cuts to reduce extended use
  • 41. STEP 5. Workstation Environment Be aware of, and try to limit: Glare from overhead lights, desk lamps, and windows Poor air circulation Air conditioning vents that "dump" air right on top of you Consider Ergonomic Products to help fit the work environment to you
  • 43. Ergonomically Designed Household Tools and Products
  • 44. STEP 6. Consider New Ergonomic- Friendly Work Habits When working for long periods of time on the computer, very 20-30minutes take a short 1- minute routine break: Remove eyes from screen (see handout in folder) Stretch hands, arms, and back (see handouts in folder) Get regular exercise outside the office. Increase physical activities (walking, biking, social club) to help reduce stress
  • 45. Ergonomic Assessment & MSD Symptoms? What to do if you need an ergonomic assessment or begin to experience MSD symptoms: Ergonomic Self-Assessment http://ergo.human.cornell.edu/cuergotipsintro.html MSD Symptoms http://www.lapublichealth.org/ivpp/injury_topics/Occupati onalInjury/OfficeInjury.htm See your Doctor Request formal ergonomic assessment (contact IVPP) Give “Ergonomic Assessment Request” to your supervisor Submit to IVPP
  • 46. Summary Remember: THINK - type of adjustment to be made ADJUST - make adjustment FEEL - your body/if no improvement, then RE-ADJUST
  • 47. Summary 6-Steps to Preventing MSD’s 1. Keep frequently used items in easy reach & clear clutter 2. Adjust chair for neutral posture-feet flat on floor, appropriate height, arm rests adjusted, lumbar support 3. Adjust top of monitor to eye level and not closer than arms reach 4. Ensure keyboard is in front of you, located so shoulders are relaxed and elbows close to body, and wrists straight in- line with forearms. Ensure mouse is next to keyboard 5. Reduce glare & ensure proper lighting 6. Take routine 1-minute eye and stretch breaks every 20-30 minutes of computer work and increase physical activity to help reduce job stress
  • 48. Contact Information Ergonomic Resource: http://www.lapublichealth.org/ivpp Email: jdecarli@ladhs.org Phone: (213) 351-7888