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Working Solutions: PTs & Ergonomics
At businesses and industrial sites across the country, physical
therapists are working with employers to reduce the risk of workplace
injuries and empowering employees to help themselves.
By Eric Ries
| The Guide to Physical Therapist
Practice1 defines ergonomics--from the Greek ergon
(work) and nomoi (natural laws)--as "the relationship among the worker;
the work that is done; the actions, tasks, or activities inherent in
that work; and the environment in which the work is performed."
Ergonomics, the Guide states, "uses scientific and engineering
principles to improve safety, efficiency, and quality of movement
involved in work." |
Scott Ege, PT, MS, vividly recalls the first time he ventured into a
manufacturing plant to see for himself why a patient's back condition
worsened every time the man returned to work. At that time, about a
dozen years ago, Ege (seen on facing page) was a staff PT at an
orthopedic outpatient clinic and had little firsthand knowledge of
industrial settings. He half-expected a Dickensian sweatshop abounding
in obvious perils to his patient's well-being. What he found instead was
a congenial, well-ordered place that was "so clean you could've eaten
off the floor."
Rather than deploring Victorian working conditions, Ege (pronounced
"Eggy") found himself employing the same functional training and
problem-solving skills he was using at the clinic. He ultimately
recommended some "straightforward" modifications to the patient's work
environment: readjusting the height of a chair and table, recommending
that the man place one foot on a stepstool when standing, instigating a
change of footwear, and assigning the man specific on-the-job
exercises.
| APTA and Ergonomics |
| "Ergonomics has been on APTA's radar screen as a niche practice area
for a long time," notes Ken Harwood, PT, PhD, CIE, the Association's
director of practice. "We've done a number of things inside the
profession to increase awareness of ergonomics as a practice area and
outside the profession to emphasize the role of PTs in
ergonomics."
Harwood himself, in fact, represented APTA at a congressional
subcommittee hearing on ergonomics held in July 2001. PTs, Harwood
testified, "play a major role in occupational health and have a strong
interest in the development of health and safety programs that will
accurately assess hazards in the workplace and reduce the risk of
musculoskeletal injuries and illnesses."
APTA chapter representatives in several states have addressed state
legislative hearings, as well, and have appeared before state licensure
boards, "verifying the physical therapist's role in ergonomics," Harwood
notes. "In the governmental and regulatory arena, we've always been
there."
Entering the word "ergonomics" into the search engine at www.apta.org
yields more that 100 entries, including links to numerous articles that
have been published in PT and Physical Therapy. An
entire members-only section on APTA's Web site (click on "Publications")
is devoted to occupational health guidelines; it includes Board
documents on work conditioning and work hardening programs, functional
capacity evaluation, physical therapist management of the acutely
injured worker, the role of the PT in occupational health, work-related
injury/illness prevention and ergonomics, and legal and risk-management
issues.
"A number of courses related to ergonomics have been taught through
APTA, the Orthopaedic Section, the Orthopaedic Section's special
interest group (SIG) on occupational health, and the Hand Section,"
Harwood adds. "These courses have been instrumental in facilitating PTs'
work in this practice area."
The occupational health SIG currently is conducting a practice
analysis of its 600-plus members to determine the specific occupational
health services they offer and the extent of their involvement in
workplaces. "We're trying to more clearly define the practice of
physical therapy in occupational health, to help determine how a
specialization or residency program in occupational health might look if
we were to develop one," says Deborah Lechner, PT, MS, president of the
SIG and steering committee chair of the practice analysis.
"One of the reasons the SIG decided to pursue the practice analysis,
and why we're considering some sort of credentialing for occupational
health PTs," she says, "is that existing certifications in ergonomics
require a great deal of time spent exclusively in that area and many,
many hours in continuing education." Because the practice of physical
therapy in occupational health is much broader than ergonomics
alone--including functional capacity evaluation, work simulation, and
other rehabilitation-related activities, Lechner says, "we'll be looking
toward the possible establishment of a credential that would be more
reasonably obtainable for PTs and would more accurately reflect the
broad scope of what PTs do in occupational health."
|
"It wasn't rocket science," Ege says. "It simply was a matter of getting
his work conditions to better fit him, rather than literally forcing him
to bend to his work." (Not that PTs who make ergonomic modifications
don't sometimes assist rocket scientists. More on that later.)
That encounter was the beginning of Ege's gravitation toward a career
in work-related injury management and prevention. He is now president of
Ege WorkSmart Solutions PC in Cherry Valley, Illinois, which offers
ergonomic evaluation, consultation, and training, as well as injury
prevention education, functional capacity evaluation, and other on-site
services.
Like Ege, Joanette Alpert, PT, MS, CIE (certified industrial
ergonomist), CPE (certified professional ergonomist), hadn't envisioned
a career in industrial and office ergonomics when she began her physical
therapy career. But after exploring a few different practice settings,
she found herself providing ergonomic services at a group of medical
clinics at industrial sites.
"It was just wonderful, working to prevent injuries in healthy people
and helping injured workers stay on the job or get back to the
workplace," she says. "I realized that this was what I wanted to do. I
left that job to start my own consulting firm."
Alpert joined forces with Candice Woodward, PT, CIE, CPE, to form
Woodward, Alpert & Associates Inc in 1994. They advertise their
Santa Ana, California-based business as "a full-service ergonomics
consulting firm" that offers program development, worksite assessment,
customized training programs, and furniture consultation.
There's no question that ergonomics-related injuries, including
musculoskeletal disorders caused by repetitive stress, are a serious
problem for employers. The US Department of Labor reports that in 2002
ergonomics-related injuries accounted for a third of all workplace
injuries involving missed work time, with an average absence of 9 days
per injury.2 Resulting worker injury claims and loss of
productivity are estimated to cost US employers $13 billion to $20
billion per year.3
Many employers--including such big names as LL Bean, Georgia Pacific,
Sun Microsystems, and ConAgra Foods--have reported successful results
from ergonomics programs.4 APTA Director of Practice Ken
Harwood, PT, PhD, CIE, testified before a congressional subcommittee on
ergonomics in 2001,5 when he was associate director of the
program in physical therapy at Columbia University. Representing APTA,
Harwood expressed the Association's "strong support" of federal efforts
to "address the problem of workplace injury" and emphasized physical
therapists' "major role" in occupational health.
Harwood says ergonomics continues to be an area of opportunity for
PTs and points out that APTA "has been active on many levels, supporting
the appropriate role of the physical therapist in this area and making a
variety of resources available to members." (See "APTA and Ergonomics"
at right.)
"The ergonomics field offers huge potential to PTs," agrees Ron
Porter, PT, director of the Back School of Atlanta, which offers
training programs in ergonomic assessment. "PTs are well qualified," he
says, "to help reduce the risk of employees experiencing musculoskeletal
problems and to offer solutions that often can be implemented quickly
and relatively inexpensively." (For more on that, see "Bringing Skills
to the [Work] Table.")
A Fitting Relationship
"Ergonomics is all about body position and how to perform work in the
way that's least stressful to the body, and the assessment of body
position and movement is second nature to PTs," says Deborah Lechner,
PT, MS, president of the APTA Orthopaedic Section's occupational health
special interest group. "Problems that the average worker or supervisor
can't see tend to jump out and scream to us." Lechner, who also is
president of ErgoScience, which markets a research-based functional
capacity evaluation product to health care providers, notes that "PTs
sometimes can make very meaningful changes just by assessing and
reorganizing an individual's workstation."
Susan Isernhagen, PT, a pioneer in the field of work injury
management and prevention programs who founded Isernhagen Work Systems
in 1988, employs what she calls "functional ergonomics" through her
year-old company, Susan Isernhagen Consulting. "What functional
ergonomics does," she says, "is take the best part of what a physical
therapist can do--understand the human body, understand that bodies are
different, understand work methods, understand that work methods are
different, and communicate effectively with people--and sees how all of
that plays into the tools and production methods used on the job."
Isernhagen specializes in "return-to-work ergonomics"-helping injured
workers get back on the job and ensuring that their work environment
does not promote reinjury.
PTs, Alpert says, possess a "wonderful combination" of skills for
work in ergonomics. "We have a very strong base in the sciences-anatomy,
physiology, and biomechanics-we work well with people, we tend to have
good verbal and written communication skills, and we work well as a
team," she says, noting that PTs doing ergonomic work sometimes
collaborate with engineering-trained ergonomists to fabricate tools and
modify furniture. "We have a tremendous foundation from which to
draw."
APTA Vision Statement for Physical Therapy 2020
(HOD 06-00-24-35) |
|
Physical therapy, by 2020, will be provided by physical therapists
who are doctors of physical therapy and who may be board-certified
specialists. Consumers will have direct access to physical therapists in
all environments for patient/client management, prevention, and wellness
services. Physical therapists will be practitioners of choice in
clients' health networks and will hold all privileges of autonomous
practice. Physical therapists may be assisted by physical therapist
assistants who are educated and licensed to provide physical
therapist-directed and -supervised components of
interventions.
Guided by integrity, life-long learning, and a commitment to
comprehensive and accessible health programs for all people, physical
therapists and physical therapist assistants will render evidence-based
service throughout the continuum of care and improve quality of life for
society. They will provide culturally sensitive care distinguished by
trust, respect, and an appreciation for individual
differences.
While fully availing themselves of new technologies, as well as basic
and clinical research, physical therapists will continue to provide
direct care. They will maintain active responsibility for the growth of
the physical therapy profession and the health of the people it
serves.
|
Janet Peterson, PT, MA, an ergonomic consultant in Shoreline,
Washington, who also is a member of the APTA Board of Directors,
observes that PT involvement in ergonomics "totally fits in with Vision
2020 [see box at right] because what we're doing in that role is
empowering individuals to be their own problem-solvers and improve the
status of their own health."
In discussing the importance of PT involvement in ergonomics, Porter
quotes Albert Einstein's definition of insanity: "doing the same thing
over and over again but expecting a different result." If injured
workers merely are "sent back to the activity that predisposed them to
the rotator cuff or back injury, or carpal tunnel or what have you,
without evaluating their movements and work station set-up and
recommending changes," Porter observes, "those workers are being sent
back with a high risk of failure--a likelihood of developing the same
symptoms, and of reinjury." PTs, he says, "have the perfect skills set"
to help employees and employers "find ways to reduce risk of
musculoskeletal problems."
The Road to Readiness
When Alpert talks to PT student groups in southern California about
ergonomics, she makes two points: that there are "tons of
opportunities," and that a mixture of class time and face time can help
PTs hone their skills.
In the clinic. "Orthopedic physical therapy is the best
entre into ergonomics, Alpert says, because orthopedic clinics treat the
largest numbers of injured workers. She further advises that PTs
consider working at a facility that has an industrial rehabilitation
program. Work hardening-an individualized treatment program within
industrial rehabilitation that is designed to help return injured
employees to work, "feeds you directly into ergonomics," she says.
"That's how I evolved into it."
In the workplace. "Take advantage of any and all
opportunities to get out into industry and see for yourself how
workplaces are set up-whether through patients, insurance companies,
personal contacts, or perhaps shadowing another PT," Ege advises. Not
only will the PTs who do those things gain firsthand perspectives on
ergonomics that they wouldn't otherwise have, but they'll replace
notions that may be antiquated or stereotypical--such as the untested
image of manufacturing plants that Ege himself once had--with rock-solid
pictures of workplace realities.
In the classroom. "Start taking continuing education
courses in ergonomics, starting within the profession with courses
offered by APTA and by PTs who are doing ergonomics, and then branch out
to the engineering side of the field," Alpert suggests.
Ege's initial self-education in ergonomics and related issues
provides perhaps as good a blueprint as any for the interested PT.
Determined to better understand the workers' compensation system, he
read everything about it he could find from APTA, government, and other
sources. He also took an array of courses on workers' comp offered by
insurance companies, disability agencies, and attorneys' offices. He
attended a variety of seminars and courses on work injury management and
ergonomic analysis--offered, again, by presenters inside and outside of
physical therapy. He took courses on consulting with industry offered by
the Occupational Safety and Health Administration (OSHA) and other
occupational health organizations. In courses taught by Susan Isernhagen
and her husband, Dennis Isernhagen, PT, he "learned foundational
principles regarding functional capacity evaluations, job analysis, job
matching, work conditioning, and pre-work screening programs."
Ege further notes that "significant resources are available via the
Internet. OSHA has a tremendous amount of resources, for example." (See
"On the Web.") "And Ergo Web is a nice option that offers different
educational tools and products you can buy."
In tandem. "I'm a member of two multi-professional
groups--the Human Factors Ergonomic Society and the Pacific Northwest
Ergonomic Roundtable--that help me expand my knowledge base in
ergonomics by drawing on the insights and experiences of people outside
of physical therapy," says Peterson. The groups bring her into regular
contact, she says, with fellow PTs, occupational therapists, industrial
hygienists, occupational health nurses, certified ergonomists, and
safety experts from large companies. "As physical therapists get more
involved in the ergonomics arena, we'll benefit from more of this kind
of interaction," she says.
It "Rocks"
Brian Dinkelman, PT, MPT, is the coordinator of industrial services
at York Physical Therapy in York, Nebraska, which offers companies a
"comprehensive program" that includes post-hire physical screens,
functional capacity evaluations, ergonomic assessments, and safety
instruction. Much of the satisfaction he gets from his ergonomics work,
he says, is up-close and personal.
"In one case, for example, an employee who was diagnosed with carpal
tunnel syndrome and trigger finger [an irritation of the digital sheath
that surrounds the flexor tendons of the finger] was afraid she was
going to lose work time and wages, be forced to switch to a lower-paying
position, or maybe even be unable to work," Dinkelman says. "I was able
to help her stay on payroll at the same salary. It's great to be able to
see that you can make a difference like that in someone's
life."
Echoing that sentiment is Sue Patenaude, PT, MA, CIE, president of
Patenaude & Associates Inc, an ergonomics consulting firm based in
Morgan Hill, California, with a client list that includes Silicon Valley
aerospace, electronic components, lighting, and pharmaceutical
corporations.
"You can see some horrific things in this line of work," says
Patenaude, who has run ergonomic consulting businesses for 20 years.
"I've seen graphic artists who could barely move their hands, workers
who had terrible back trouble and no clue how to alleviate it. It's hard
to describe how rewarding it is to empower people who have been severely
impacted by pain and lack of functional ability to reclaim their lives
and careers. We've shown rocket scientists how to regain and retain use
of their hands through proper body mechanics and alterations in their
office set-up. They've come back to us almost in tears, so grateful to
be free of pain and back on the job without needing surgery. It's just
one story after another."
"When I'm no longer working," Patenaude says, "I'll be sitting in my
rocking chair thinking about all the fabulous individuals I had the
great privilege of helping to help themselves."
_____________________
Eric Ries is Associate Editor, Manuscripts. He can be
reached at ericries@apta.org.
References
1. Guide to Physical Therapist Practice. Rev 2nd ed.
Alexandria, Va: American Physical Therapy Association; 2003.
2. Bureau of Labor Bureau of Labor Statistics. "Lost-Worktime Injuries
and Illnesses: Characteristics and Resulting Days Away from Work, 2002."
[News release.] Washington, DC: US Department of Labor; March 25,
2004.
3. National Institute for Occupational Safety and Health. A Critical
Review of Epidemiologic Evidence for Work-Related Musculoskeletal
Disorders of the Neck, Upper Extremity, and Low Back. Washington, DC;
1997.
4. Occupational Safety and Health Administration. "Ergonomics Success
Stories." Available at www.osha.gov/SLTC/ergonomics/success_stories.html.
Accessed June 16, 2004.
5. American Physical Therapy Association. "APTA Testifies At Ergonomics
Hearing." Available at www.apta.org/Govt_Affairs/regulatory/OSHA/ergotestimony.
Accessed June 16, 2004.
6. American Physical Therapy Association. APTA Vision Statement for
Physical Therapy 2020. [HOD 06-00-24-35] Available at www.apta.org/About/aptamissiongoals/visionstatement.
Accessed June 16, 2004.
| Bringing Skills to the (Work) Table
Physical therapists, says Scott Ege, PT, MS, are "uniquely prepared
and trained" to identify, treat, and prevent various ergonomic
injuries.
"PTs offer expertise evaluating and treating work-related MSDs
[musculoskeletal disorders]--both acute and chronic conditions," says
Ege, president of Ege WorkSmart Solutions, PC in Cherry Valley,
Illinois. "We're well-qualified to focus on the particular demands of a
person's work environment, just as we might focus on the challenges an
athlete faces in his or her environment, or the need for a senior
citizen to be more independent at home."
"Where ergonomics comes into play is the job-matching process," Ege
continues. "PTs who work to treat and prevent MSDs assess factors that
may have contributed to the worker's injury-such as exertion of force,
repetition, posture, vibration, and contact stress-and look at job
modifications that will allow that individual to work without pain.
Ergonomics really is a process of addressing the relationship between
the worker's abilities, the physical work demands--force, lifting,
postures, repetition, vibration--and the work environment--chair,
flooring, lighting, temperature, table heights, fixtures, tools. By
addressing all of these components, PTs achieve positive outcomes--such
as injured employees' return to work and reductions in workplace injury
rates."
Ege (working in these photos with employees of Smiths Aerospace in
Loves Park, Illinois), gives an example. "Say a factory worker has neck
and shoulder soreness. He works at a bench, performing various assembly
tasks. I can give him postural education and an appropriate exercise
program, but how might I eliminate possible stressors that may
contribute to his symptoms? I need to look at job factors. Perhaps the
chair back, seat height, or arm rests need to be adjusted. Maybe the
bench's height prevents the worker from getting close enough to it to
perform tasks without straining, so he performs all his tasks with
outstretched arms. Many times an angled work surface promotes a more
upright posture. Perhaps the lighting is poor, or tools need to be
modified. These all are considered ergonomic factors. We, as PTs, are
skilled at 'connecting the dots' as soon as pertinent job factors have
been identified."
"Another modification we commonly see is with tools and hand grip,"
Ege says. "Consider a worker who is experiencing pain in his or her
hands. If we measure the peak grip of a worker at 30 pounds, using a
grip dynamometer, and we measure the grip requirements of that person's
job at 30 pounds, that means he or she must use maximum grip strength
all day to accomplish his or her work--not a good idea. But if the tool
diameter is in question, we can see that it is modified to fit the
worker's optimal grip position and strength. This achieves a better
match between the work and the worker." It may mean an earlier return to
work, with both safety issues and productivity concerns having been
addressed.
The potential benefits to employers of PTs' involvement in ergonomic
solutions is huge--as the experiences of large companies mentioned
elsewhere in this article attest. In Ege's own experience, he says, one
company's annual workers' compensation claims costs shrunk from $250,000
annually to less than $30,000 after he helped the business address
ergonomic issues and implement individualized injury-prevention
strategies. At a hospital in which he was employed, the number of
work-related lost days by nursing staff plummeted from more than 800 to
under 100 in less than a year. Ege played a key role within a team of
occupational health and rehabilitation specialists that established an
effective injury management and prevention process for the
hospital.
Regarding injury prevention, Ege notes, "we could have tried to
increase the strength and flexibility of all the nurses, but they still
would be doing heavy lifting in awkward positions. So, we worked hard to
eliminate the need to lift people by using lifting devices and finding
other ways around the intense physical labor."
When it comes to ergonomic consultation, "What industry wants to
know, succinctly and clearly, in non-medical terminology," says Sue
Patenaude, PT, MA, CIE, is 'What's wrong, and how do I fix it?' That's
what we tell them. It's all analyzed, measured, monitored, and
documented--with illustrative tables and digital photography, but
without excessive text." Patenaude, whose Morgan Hill, California-based
ergonomics consulting firm lists a number of major Silicon Valley
employers among its clients, adds, "We work in all kinds of
environments--chemical-handling to ground maintenance--and we wear the
same safety clothing and replicate the same tasks as the workers. We're
not just standing back with clipboards-we're 'right there' to determine
the problems and offer solutions."
|
PT Magazine - September 2004
| PTmagazine, PTmag, magazine |
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