Repetitive stress injuries happen at work, at home

Repetitive stress injuries are in the spotlight a result of proposed Occupational Safety and Health Administration regulations on ergonomics, according to Libby Green, an occupational therapist at the Work Injury Rehabilitation Center at Cox South.

OSHA's proposed ergonomics regulations would require companies to match workers to their duties, report repetitive stress injuries to OSHA and propose plans to eliminate the cause, Green said.

Eric Weiskopf, a physical therapist at St. John's Outpatient Therapy, said there are many different risk factors that can lead to pain and inflammatory responses, including repetitive motion and exertion, and stressful positioning.

Weiskopf said that injuries caused by factors such as repetitive stress can happen at work or at home.

Carpal tunnel syndrome is one well-known type of repetitive stress disorder, but Green said there are many others.

"Quite frequently, I see shoulder and back injuries, lower back injuries and knee injuries. All of these can be caused by stress or repetitive misuse of those body parts in inappropriate ways," she said.

Weiskopf said the cause and effect of such injuries is not always clear, and sometimes people are surprised because their pain isn't caused by what they think it is. Lateral epicondylitis, commonly known as tennis elbow, is one example.

He said people don't think of tennis elbow as being related to handling and gripping something with their hands, because the pain is felt in the elbow, and that is where, with each overuse, the inflammation occurs.

"The inflammation finally results in pain enough to force a person to stop from the activity that has aggravated it in the first place, like the repetitive gripping," he said.

Both Weiskopf and Green said that repetitive stress injuries don't have to be caused by an actual motion, such as repeated turning of the head. Such injuries can also result from incorrect positioning, as in the case of an employee using a workstation designed to fit someone else.

Weiskopf said a common mistake that can lead to injury in the office environment is incorrect computer setup, in which a person does not directly face her computer monitor.

"What they do is to put their computer to the left or right of their face, resulting in the need to repeatedly turn their head, which can set that person up for neck or upper back pain," he said.

Green added that because workplace injuries don't always involve heavy lifting or heavy exertion, coworkers and supervisors are often confused when someone is diagnosed with an injury caused by repetitive stress on the job.

"They think (the injury) is not valid. But they're overlooking the long-term effect, which wears away at the joints in a way that I describe as using a pencil eraser. You can work away fine for awhile, but when you get to the metal, you're going to have a tear," she said.

Green said some patients' injuries have to be stabilized through surgery before she sees them for therapy, but regardless of surgical intervention, one type of therapy she uses for all patients is work conditioning. Green said work conditioning, or work hardening, focuses on the concept of matching the worker to the work.

She said the patient's ability to do the work required in his job is tested functionally, and the job description is analyzed. The results are matched, and changes are suggested where necessary.

Weiskopf added that when an injury is caused by factors in the workplace, work restrictions can be a common part of the treatment plan. However, he said, that doesn't mean people will have to give up their jobs completely. Sometimes simple and inexpensive changes are all that are needed to correct the problem that led to the injury.

"We've been more frequently using job-site visits in the initial stages of repetitive motion disorders to provide the employee ... and the employer with simple ideas on how to observe work restrictions or the treatment plan, and still allow the person to participate in day-to-day, activities," he said.

Weiskopf said it's also important that the worker, the workplace and the work itself are all addressed during treatment.

Besides treating injuries, Weiskopf and Green agreed it is important to prevent them.

Weiskopf said St. John's physical and occupational therapists have implemented five basic principles in their prevention plans: People need to be open and ready to change home and work environments; they need to be able to identify and change stressful positions on a regular basis; they need to perform repetitive motions in the best possible way; they need to accept that issues that are stressful at work and at home can add to the tension that causes neck and head tension disorders; and employees must first be committed to leading a healthy lifestyle.

Green said a lot of employers are becoming more proactive in the prevention of repetitive stress disorders and injuries. She said many companies are conducting screenings to test job applicants' ability to perform required duties in the jobs they're seeking.

Green said employers are using educational programs to show employees safe techniques for body use and mechanics, such as correct trunk stabilization and correct lifting. And, she said, more companies are encouraging overall physical fitness, which can aid in the prevention of all types of workplace injuries.

"More companies are providing work-out areas or memberships" to health clubs, she said.

"They're also using programs like pre-shift stretches to make employees more aware of their bodies and how staying fit will prevent daily stresses to their bodies," she added.