Keeping employees on the job through safe and effective care
By Benjamin Henry, MS, ATC
Vol. 24 • Issue 5
Industrial Rehab
An occupational injury can greatly impact the way
industry operates and can be a financial burden for both the employer and employee. The most recent labor injury data for 2011 shows 3.8 million recordable cases for injury and illness. Even though that number has declined every year since 2002, occupational injury accounts for 2.9 million of those cases.1-3
That financial burden only increases when the severity of the injury prevents the employee from returning to work. In 2010 alone, the U.S. Bureau of Labor Statistics reported 1,191,199 cases that involved days away from work due to injury or illness.1,3-4
To fight the biomechanical disadvantage the workforce has, many companies have begun to bring healthcare professionals who specialize in the prevention of musculoskeletal injuries to the team. This has made a major impact in reducing incidence by preventing and treating injury so that the employee stays at and returns to the job safely and effectively. This has brought down the high cost of healthcare and has begun to change a culture within companies to prevent injury from occurring at all.
Many of the costs associated with manufacturing can be attributed to materials, administrative costs, and payroll, but a large expense that cannot be ignored is medical costs. In 2009, employers spent $73.9 billion on workers compensation insurance, a cost that is mandatory in all states but Texas.2,5 Since 2000, workers’ compensation costs have increased 23 percent.5 In addition to those direct costs, injuries can create various other costs, including:
- Wage costs relating to a stop in production;
- Administrative costs due to injury;
- Employee training or costs associated with replacing an injured employee;
- Lost productivity on the job;
- Costs associated with damaged machinery or material.
Musculoskeletal injuries make up the largest percentage of work-related incidents. Specifically, in 2010, employees in all three areas of industry (state sector, government sector and private sector) sustained 474,000 sprains, strains and tears. In addition, 100,730 bruises or contusions occurred on the job.
These work-related injuries can be caused by many different factors. Heavy equipment, repetitive motions, poor body mechanics, or sustained positions can attribute to many cases reported each year, but the most prominent mechanism was due to slips, trips or falls,6 contributing to 294,620 recordable injuries, with the highest incidence of pain occurring in the back (227,730 cases).1,4
Overuse Injuries
Overuse injuries can be due to many internal and external factors. Lack of muscular strength, endurance or range of motion can limit the body from achieving what is necessary for the job. An example of this is the shoulder. While the arm may function properly below 90 degrees of glenohumeral flexion, the increased risk of injury is prominent above 90 degrees, due to impingement of the rotator cuff musculature. By keeping the elbows closer to the body during repetitive tasks, the employee can work in the same location, but keep the humerus below 90 degrees, thus reducing the risk of injury.
Vibration tools such as rivet guns are another potentially hazardous condition. The risk for injury is high due to the repetitive nature of the job, and puts the entire kinetic chain at greater risk. Many tools are designed with the help of an ergonomics team to prevent overuse injuries by using proper grips, lightweight materials or tools that keep the body in efficient positions, as well as ergonomic aids such as anti-vibration gloves or cervical supports to prevent overuse injuries.
Slips, Trips, Falls and Head Bumps
Working in an industrial setting may increase the risk for slips, trips, and falls-the highest mechanism for injury according to 2011 injury reporting. Unfortunately, these injuries account for 15 percent of workplace fatalities.6,7
These injuries can happen due to very common environmental factors such as oil or water on the ground, unstable surfaces such as ladders, uneven surfaces, or material left in walkways. Maintaining ladders and other walking surfaces can greatly reduce the number of slip, trip or fall-related injuries.
The Occupational Health and Safety Administration (OSHA) estimates that over 90 percent of head injuries reported by industrial workers could have been prevented by wearing bump caps or a full hard hat. When fitting properly, a hard hat can reduce the force by 78 percent.8,9
Sprains, Strains, Tears
One of the most preventable occupational injuries is the high number of sprains, strains, and tears. OSHA classifies these as traumatic injuries to muscles, tendons, ligaments and joints caused by sudden wrenching, twisting, stretching, and ripping.17 While these injuries have many different mechanisms, musculoskeletal tissue damage can have long-lasting side effects if left untreated.
The inflammatory response to injury can last much longer than the initial injury, restrict motion and increase overall pain. These injuries can lead to significant time lost from production at work, costing both employers and employees thousands of dollars.
Biomechanical Factors
Movement dysfunctions pose great risk of injury for industry workers. Examination of basic movement patterns is necessary because of the extensive variation in both job demand and physical capacity among industrial employees. Daily repeated stresses contribute to the formation of dysfunctional movement patterns over time.
For example, many employees place their containment tray containing all of their tools on the floor next to them while they work. Every time a different tool or part is needed, the employee must bend down to select it. Over time, it’s common to observe poor lifting technique due to ankle immobility, hamstring tightness and weak core stability. These are constantly reinforced by poor body mechanics.
When evaluating acquired movement dysfunctions, clinicians should have a basic understanding of the job demands of the employees they are evaluating. This will enable them to correct the dysfunctional movement patterns and relate the corrections to the employee’s job, thereby reinforcing the relevance of the corrective exercise.
When production is the key factor driving business forward, employees’ overtime hours increase. It isn’t uncommon for industrial workers to change their schedule to meet the demands of the job. Overtime and irregular hours increase the amount of overexertion in the workplace-a key mechanism for sprains, strains and tears.6
Using the most up-to-date information from OSHA, each recordable injury without lost work days costs $7,000. If days of work are lost due to that injury, the cost rises to an average of $28,000. If an occupational death occurs due to an accident in the workplace, average expenses ensued is $910,000.10.
Due to the high costs associated with lost work days and expenses due to decreased production, many employers are taking action in the battle against occupational injuries. Companies are beginning to provide educational health and wellness programs, injury prevention programs, ergonomic assessments, nutritional assessments, symptom evaluations and intervention programs, heath risk assessments, pre-employment physicals, and job conditioning programs.
These programs provide resources from athletic trainers, physical therapists, exercise physiologists and registered dieticians. They do much more than decrease the cost of medical expenses. In 2009, Huang et al measured outcomes associated with implementing health and wellness or workplace safety programs. Of the companies providing them, 43 percent saw increased productivity, 7 percent had increased retention of employees, 6 percent had increased job satisfaction, and 28 percent saw reduced costs.11
OSHA estimates that the implementation of injury and illness prevention programs can reduce injuries by 15 to 35 percent for employers who do not currently have a safety and health program. This would potentially save between $9 and $23 billion annually.
In a 2003 study by the National Athletic Trainers’ Association (NATA), of companies who utilized athletic trainers in worksite injury prevention programs, 100 percent reported a positive return on investment (ROI), with more than 80 percent showing an ROI of $3 for every $1 invested.12-14
Many recommendations can be provided to employees in the industrial field to begin reducing costs of injury.
Always wear proper footwear. Avoid rocker-bottom shoes while working on unstable surfaces such as slanted work areas or ladders. Some situations require steel-toe, electrical shock-resistant, or puncture-resistant footwear.15 Shoes should fit properly and be replaced when worn out. The heel should fit comfortably with little to no slippage. Toes should have enough room to wiggle.
Micro-break stretching can reduce fatigue due to sustained positioning. Maintaining proper body mechanics in positions can be difficult due to muscle ache or strain. Sustained positions reduce blood flow and oxygen to muscle tissue. By alternating tasks or positions throughout the day, muscles can recover and perform more efficiently.
Reduce slippery surfaces to prevent slips, trips or falls. Use grip tape or modify walking surfaces to reduce the incidence of these preventable injuries. Clean occupational hazards such as water, oil or hydraulic fluid.7
Create good housekeeping processes throughout the work site. Clean up spills, mark hazards with lights or signs, and use proper cable management devices for hoses and cords. When moving objects, use proper lifting mechanics. If an object is too heavy for one person, be sure to team-lift to prevent back and spine injury.
Hydrate before, during and after work. Keep a water bottle with you at your work station or desk if allowed. Reduce the consumption of drinks that lead to dehydration such as energy drinks or large amounts of caffeine. On warm days, increase your fluid intake.
Maintain a healthy lifestyle. Smoking, obesity and substance abuse can lead to higher risk for injury. The likelihood of an employee developing discomfort while at work can be reduced by improving mood, reducing fatigue, increasing blood flow and reducing stress.
Begin pre-shift warm up programs. Pre-shift warm up programs can increase the temperature of muscles, increase healthy blood flow, and improve muscle coordination. Stretching increases a joint’s ability to move through a greater range of motion, therefore reducing the risk of musculoskeletal injury.16 In addition, balance programs can reduce the risk of falls in the workplace.
Most importantly, seek help when you have pain. Athletic trainers are one example of profesionals who specialize in the prevention of musculoskeletal injuries in the workplace. They are medical professionals trained to assess work-related symptoms and create a plan to prevent them from becoming lost work day injuries.
References are available online at Advance Web
This article was produced in cooperation with the National Athletic Trainers’ Association (NATA), the professional membership association for certified athletic trainers and those who support the athletic training profession. March is National Athletic Training Month, with the theme “Every Body Needs an Athletic Trainer.” For more information visit www.nata.org
Benjamin Henry is assistant head athletic trainer and operations manager at Work-Fit Inc. in Everett, WA.