Specific Musculoskeletal Disorders

Includes:

Arm and Shoulder Problems

Reaching for equipment can be difficult for people who have limited movement in their arms and hands, back or neck pain, physical disability, or any other condition that makes reaching difficult. Reaching can cause pain, strain, or simply may not be possible due to physical limitations.

The human body is designed to perform various activities by adopting numerous postures throughout the day: however, repetitive reaching or overreaching can also have adverse effects on the healthy body.

Problem to be solved - reaching

This may be an issue associated with shoulder and arm problems (upper limb) or due to lower limb problems resulting in an inability to stand or move around. It is helpful to consider the risk assessment principles to help reduce the difficulties and - if possible - the job and work environment should be redesigned to fit the employee’s abilities considering:

Elimination and substitution: consider completely removing or eliminating the worker’s requirement to reach by job redesign
Minimisation: decrease the frequency of reaching during the day
Engineering: for example use of raised work platforms or step stools
Administration: modification of work systems and practices, e.g. job rotation, good housekeeping, location of products in mid-range
Training/Supervision: ensuring workers operate equipment safely and adopt safe work practices.

Safe work practice recommendations to avoid overreaching and twisting:

place frequently used objects and tools within easy reach and in mid-range of the body
if a person is sitting, it is recommended they stand to reach objects outside of their comfortable reach zone
if a person is standing, a step stool or platform may be required to reach objects outside their comfortable reach zone
locate hand operated controls, switches and levers between elbow and shoulder height of the worker.

Other safe work practice recommendations include:

alternate between work tasks and work postures on a regular basis
perform regular stretches and exercises at work.

There are a number of products, aids and supports to assist people to reach or minimise the risks associated with reaching. When working in jobs where answering the telephone is a large part of the role there are a variety of supports available such as hands-free telephones.

For people with disability, the use of a reacher in the workplace may avoid the need to bend unnecessarily to reach items and therefore reduce the risk of injury. However, it is recommended that items that are used regularly as part of a person’s job role be placed within easy reach to avoid overstretching.

Reachers are usually readily available and relatively inexpensive from shops selling aids and appliances. For example:

References

The Australian Government has come up with a website very similar to askjan where the site can be searched by disability or job requirement. The job requirement section is very helpful and provides clear sensible advice.

Chronic low back pain

There are a number of problems experienced by those suffering from chronic low back pain, and therefore a number of solutions. Difficulties with standing can be helped by the use of perching stools and anti-fatigue matting.

Perching stools are supplied in various forms, with and without backrests and arms. They are usually adjustable in height in order to provide a good fit for the individual.

There are many sources online and they may also be available through occupational therapy services.

Anti-fatigue matting provides a buffer between the floor surface and an individual's body. These mats are available in a variety of sizes and often can be custom made. They are designed to relieve fatigue for individuals who have to stand for prolonged periods.

Anti-fatigue matting is specialised matting made from a range of materials which aims to:

absorb impact from stock or product being dropped on hard floors
provide a non-slip surface
provide anti-fatigue properties whilst allowing for drainage of water or debris
reduce fatigue in the legs, feet and lower back of employees standing for long periods especially on concrete or tiled floors
reduce exposure to cold floor surfaces
specialised nitrile rubber matting provides a spark resistant and non-flammable surface which is suitable for work such as bench based welding.

Anti-fatigue matting can be made from vinyl, wood, PVC tubing, rubber, PVC closed cell foam, carpet, polypropylene, nitrile rubber or marbelised rubber as some examples. Depending on the work environment and purpose, a range of matting products are available as mats or lengths, in standard sizes or custom ordered, available in a range of thicknesses, cut to size and edged if required.

Specific types of anti-fatigue matting are suitable for wet work areas, allowing for drainage and easy washdown. Some are also available in antibacterial format or can be autoclaved.

They can be found, for example, at :

References

Prevention of neck and shoulder strain by reducing bending and twisting movements of the neck

Document holders are designed to hold reading material to encourage better positioning according to the visual and ergonomic needs of the user. If positioned well, document holders may assist in the prevention of neck and shoulder strain by reducing bending and twisting movements of the neck.

Ideally a document holder should be placed between the keyboard and the monitor for optimum positioning. However, where there is insufficient space to achieve this, an upright movable document holder can be positioned next to the screen at the same height and visual distance from the user of the screen.

A-frame or angled document holders can be positioned between the screen and keyboard to support multiple or bulky papers. A-frames need sufficient adjustment to raise, lower and angle documents to accommodate different screen heights and desk depths.

Line guides are simple counter-weighted devices which keep your place on your document. Line guides are invaluable for editing tasks or for wherever you would use your finger to mark a place on the document.

Some document holders have a transparent line guide with magnifying properties to assist people with vision impairment. People with cognitive limitations may also find reading easier through use of a line guide to identify or highlight one line of text at a time.

Document holders are ideally positioned the same distance from your eyes as the computer monitor. This prevents fatigue caused by repeatedly refocusing your eyes. However, if the print on your documents is so small that you cannot see it from that distance, bring the document closer to you rather than bending your neck or straining forward to see the document.

Workplace solutions and adjustments:

In the workplace there are various factors that would assist people with back or neck conditions to better manage their symptoms.

modifying workstation set up to avoid or minimise bending, twisting, reaching or looking down
providing and adjusting ergonomic chair or stool to individual needs
changing work routine to build in regular changes in posture
education in use of correct manual handling techniques
ensuring the workplace and work tasks are set up to minimise repetitive or heavy lifting or the need to access below waist or above shoulder level
if required to stand for long periods, consider the use of anti-fatigue matting or a sit-stand stool to enable postural rotation
consider capacity for staff rotation between physically demanding tasks and lighter tasks as a way of building in breaks without having to stop work
consider the use of lifting or mechanical aids such as trolleys to minimise lifting requirements.

Wrist and hand problems

Problem to be solved - writing

Writing can be a large part of most jobs and can be challenging for people who have difficulties with fine hand use such as holding a pen. Such restrictions may be the result of conditions such as occupational overuse injuries, carpal tunnel syndrome, upper limb amputation, quadriplegia, head trauma such as acquired brain injury or stroke, or neuromuscular diseases like multiple sclerosis.

There are a variety of aids and supports available in the workplace to support people who have writing difficulties.

For people who find it difficult to grip a standard pen due to pain, fatigue, unsteadiness in the hands or reduced grip strength, office supply stores and specialist stores stock a wide range of different shaped pens, pen holders and pen grip attachments.

Some examples of available pens include:

‘V’ shaped pens where one finger goes through the ‘V’ and the ends of the pen rest on the knuckles
pens with a hole in the centre to put finger through
kidney shaped pens
weighted pens to help those with unsteady hands
pens with a wider shaft
fingertip pens
pen holders that allow a gross arm action to write.

Handling medical or dental equipment

Doctors, dentists and other health professionals may be required to handle a variety of handheld tools. Given the precise nature of medical and dental procedures, a high degree of hand stability, dexterity and coordination is usually required. Additionally, these tools often require additional physical demands, such as pushing or pulling, sustained grip or rotation of the wrist.

An employee may find it difficult to lift, carry or handle these items due to decreased grip strength or range of movement. Underlying causes of these restrictions may include pain in the arms and hands, upper limb amputation, quadriplegia or neuromuscular diseases such as multiple sclerosis.

Workplace solutions and adjustments:

There are a variety of tools and aids designed for use in clinical work to assist people with fine motor difficulties including:

https://www.jobaccess.gov.au/employers/employer-toolkit

Additional to the workplace solutions identified above, people with fine motor impairments may also need to incorporate on the job strategies to assist them to perform clinical tasks, these might include:

using tools that are designed to keep the wrist in a neutral position, so that any force applied does not place excess strain on the wrist
using power assisted tools that eliminate the need to apply manual force
pad-up slimmer tool handles to optimise grip size and thus reduce tension in the hand muscles
using tools with non-slip grips, or non-slip gloves
rotating tasks on a regular basis to reduce prolonged or repetitive activity in the hand and wrist
using spring-loaded pins, for tools involved in cutting, to eliminate the need to open tools after each cutting action
considering the use of foot-operated instruments
optimising working position by adjusting the position of the patient relative to you by using adjustable tables and stools
using light weight dental and surgical instruments which place less stress on the muscles, hands and arms.

Ergonomically designed dental and surgical instruments are designed to reduce the risk of wrist and hand injuries during use, by providing instruments with handles that better suit the shape of the individuals hand and the grip required to use them.

Using inappropriately designed tools for prolonged periods of time can lead to wrist and hand injuries. In addition to using ergonomic tools there are a number of practices that can be adopted to reduce the risk of wrist and hand injuries including:

taking regular breaks
using tools with larger handles
using sharp tools to avoid the need for applying extra pressure
using a neutral wrist position where possible as this position provides maximum strength at the wrist.

Consideration should also be given to the grip required to use each tool as this may prove difficult for some individuals with poor grip strength, tremors, weakness, and poor dexterity. Some general grips that relate to use of tools include:

the power grip which holds an object in the palm of the hand using all fingers to grip
the pinch grip which holds an object between the thumb and index finger
the external precision grip which holds an object between the thumb, index and middle finger using the side of the hand for support
the internal precision grip which holds an object across the edge of the middle, ring and little fingers, the tip of the index finger and the thumb.

The size, shape and surface of a grip can also affect how efficient and comfortable a tool is to use. Therefore changing tool design or handle size may result in the tool being easier to use or increase endurance during use.

The following manufacture surgical instruments:

Knee pain and dysfunction

Workplace solutions and adjustments

People suffering from knee injuries may have difficulty with job roles that involve prolonged standing or walking, squatting, crouching, lifting heavy objects, or work that involves weight-bearing and twisting through the lower limbs.

In the workplace there are various factors that would assist people with knee injuries to better manage their symptoms. These include:

ensuring the workplace and work tasks are set up to minimise repetitive or heavy lifting or the need to access below waist level
if required to stand for long periods, consider the use of anti-fatigue matting or a sit-stand stool to enable postural rotation
consider capacity for staff rotation between physically demanding tasks and lighter tasks as a way of building in breaks without having to stop work
education on safe manual handling techniques incorporating tips for those with a knee injury
consider the use of lifting or mechanical aids such as trolleys to minimise lifting requirements
consider task set up to enable people sufficient room for stepping rather than keeping their feet still and twisting.

Lower limb dysfunction

Workplace solutions and adjustments

People with lower limb injuries may have difficulty if working in job roles that involve prolonged standing or walking, squatting, crouching, lifting heavy objects or work that involves weight bearing and twisting through the lower limbs.

In the workplace there are various factors that would therefore assist people with lower limb injuries to better manage their symptoms. These include:

ensuring the workplace and work tasks are set up to minimise repetitive or heavy lifting or the need to squat to access below waist level
if required to stand for long periods, consider the use of anti-fatigue matting or a sit stand stool to enable postural rotation
consider capacity for staff rotation between physically demanding tasks and lighter tasks as a way of building in breaks without having to stop work
education on safe manual handling techniques incorporating tips for those with a lower limb injury
consider the use of lifting or mechanical aids such as trolleys to minimise lifting and carrying requirements
consider task set up to enable people sufficient room for stepping rather than keeping their feet still and twisting.

How to find out about scooters and powered wheelchairs

By using the government funded mobility allowance (part of the Disability Living Allowance) to lease the product, powered products to aid mobility such as cars, scooters and wheelchairs, can be accessed via Motability, an organisation (charity) that provides packages that are worry free as they include insurance, servicing, maintenance etc. as well as providing a new vehicle every three years. There is information on their website regarding choosing a suitable product as well as details about how to apply. www.motability.co.uk

There are other suppliers such as:

Second hand scooters are also available via www.preloved.co.uk, and Googling “mobility scooters” is a good way to start searching.