The Pain Game: Preventing MSDs

What do a pain in the neck, back or shoulder have in common?
Unsafe work behaviors.

What's an ounce of prevention really worth? Not much standing alone. In essence it comes down to equal parts awareness and action in the realms of both safety and health. Awareness without action is simply unused information; action without awareness is simply impulse. Neither is particularly effective without the other.
Similar is the link between safety and health. It has been shown with more and more certainty that safety, the practice of consistent safe behaviors, cannot happen in the workplace without health, the general state of being well. There is a host of reasons for this, but the most important message for anyone involved in safety, especially in the physically demanding utility industry, concerns the bottom line. Individuals who exhibit health-related risk factors do more than chip away at a company's profits via increased absenteeism and healthcare costs. They also jeopardize safety because risk factors inhibit safe behaviors, leading to higher rates of incidents, accidents and injuries.

A Cause of Pain
One group of injuries that demonstrate the close relationship between health and safety are musculoskeletal disorders (MSDs), the often-painful conditions that primarily affect the body's muscles, joints and supporting connective tissue. MSDs, which result in lost time for up to 90 percent of the working population at least once in their career and 30 percent or greater annually, are regularly attributed to the accumulation of many small injuries (microtraumas) over time, which cause mechanical and biological changes in the body's tissue. This is contrary to the belief that most injuries can be attributed to a single event. In fact, it is very common for personnel within the utility industry to show hallmark pain patterns even at rest (see chart). It is generally regarded that mild resting pain (0 - 3) will hurt productivity, whereas moderate resting pain (>3 - 7) will interfere with safety.
Musculoskeletal disorders linked to tissue microtrauma are closely associated with health, lifestyle, psychological and work-related risk factors that accelerate and amplify age-related declines in flexibility, strength and stability. In turn this promotes imbalance and eventual breakdown of the body's tissues, eroding an individual's ability to work efficiently and, of critical importance, safely. Some examples of risks include: poor cardiovascular status, obesity, nicotine use, high personal stress and sustained forceful or awkward postures.

Road to Prevention
What's especially interesting about the role MSD's play in workplace safety is what can happen when the associated risks are identified, analyzed, confronted (awareness) and aggressively attacked (action). There are several avenues that show promise, including engineering controls such as job redesign through ergonomics and exposure controls such as job task rotation. Unfortunately, these controls have not been widely implemented or successful over the long term, due at least in part to the high costs and operational impact they are often associated with, as well as the relatively narrow area of risk they target. That said, however, new strategies are constantly emerging that are both comprehensive in scope and low in cost. These are enabling companies large and small to realize the win-win of increased health and safety.
One company that has successfully implemented such a win-win strategy is Public Service Enterprise Group (PSEG), an integrated generation and energy company serving more than 3.5 million electric and gas customers in New Jersey and with power generation capacity of over 13,000 MW at locations throughout the U.S. At PSEG, a safety culture change has been underway for several years and has yielded substantial results, including a 58 percent drop in the OSHA recordable rate from 1994 to 2003. Even with these impressive results, the health, safety and organizational leadership have not stopped there.
In 2003, PSEG began implementing a program that paid special attention to the link between health and safety through lifestyle and disease management programs that now include a comprehensive injury prevention initiative, a pioneering attack on MSDs and the risks associated with them. Kathy Kostecki, manager of the Integrated Health and Safety Team, and Dr. Ronald Mack, MD, PSEG medical director, have championed the effort by successfully coordinating work between the health, safety and operational leadership. This has facilitated removal of administrative barriers and paved the way for educational initiatives that hit repeatedly at the crux of the problem. This component is then followed closely by personalized health and injury risk management strategies implemented by a team of physical therapists, experts in the treatment/prevention of musculoskeletal-related injuries.
"After an exhaustive analysis of the data, we confronted the facts of the situation: our workforce, similar to the trends nationally, is aging; with the physical work we (and all utilities) do and the health risks we uncovered, the link between health and safety was profound," said Kostecki, who recently returned from a trip to Arizona where she accepted an award from The Institute for Health and Productivity Management for her work at PSEG. "It makes good sense from an organizational and humanistic standpoint, win-win."
Following a review of several injury-management vendors, PSEG chose Pro-Activity Injury Prevention Specialists and its comprehensive prevention strategy that its team of physical therapists and business professionals developed over five years of work with the utility industry. Kostecki states, "Our initiative, Prevention Works, is focused on preventing injury and break-down to the entire body and musculoskeletal system. And Dr. Mack and the medical department believe physical therapists are the medical professionals with the education and the experience to do just that."

Real Life Experience
Whereas physical therapists have traditionally practiced in a clinical setting only, it is becoming clear that skills utilized for treatment are often more powerful in the realm of prevention. Physical therapists are the only professionals in America who are formally trained in diagnosis and conservative treatment of soft tissue disorders of the entire body. In addition, at the core of every licensed physical therapist's training is a deep understanding of human movement and performance and the natural tissue responses to each. This formal knowledge base, coupled with hands-on experience in the field with workers, is a potent combination when the goal is to minimize musculoskeletal disorders.

Showing Initiative
An initiative that emphasizes correction of imbalances of the body's tissues can be a particularly effective means of preventing chronic MSDs. It has been shown that chronic MSDs are the most costly type of non-fatal workplace injuries. Experts in the fields of epidemiology and productivity have determined that 90 percent of the costs can be attributed to the 10 percent of the population considered "chronic." This type of initiative is different than most other prevention efforts in that it makes an important distinction between prevention and treatment efforts that may already exist.
Many prevention efforts are designed to increase awareness, a critical step as mentioned in the beginning of this article. However, this type of broad stroke information campaign often is an exercise in primary prevention, which assumes that the population is currently healthy. This approach falters when mild signs or symptoms exist. What we know, as evidenced in the chart, is that the great majority of utility workers are already having some discomfort in one or multiple body regions. In order to prevent a condition from getting to a chronic level, action must be taken immediately to correct the problem.
Take for example a 40-year-old overhead line worker who describes fatigue and tightness in his lower back after working in a bucket truck and complains that his hands fall asleep when he positions them above his head for long periods. A primary prevention strategy might be to educate this worker on the problem of faulty postures and how they affect his back and shoulders. That said, a roadblock to the correction of this problem comes when we consider the nature of the work itself and how it may be quite unrealistic for anyone performing it to consistently maintain good posture. While an excellent primary prevention strategy to try, it may not always be effective and these relatively mild symptoms could become something far worse. This example screams tissue imbalance, even if there is not an injury per se.
By identifying areas of imbalance such as excessive tightness across the front of this worker's chest, the sides of his neck, back and possibly in his arms, and by educating the worker on exactly how to correct the imbalances (on his own), the potential for a MSD and a safety-related incident are greatly reduced.
A secondary prevention initiative that targets workers who are beginning to show signs and symptoms of musculoskeletal imbalance attempts to correct those imbalances before they become injuries. This benefits everyone. The company wins because a healthy, relatively pain-free workforce is able to stay safe; the individual wins because the pain is self-controlled and he can now focus on the tasks at hand. ip

Michael T. Eisenhart, is a physical therapist and partner with Pro-Activity Injury Prevention Specialists, a New Jersey-based firm dedicated to prevention and safety in the workplace. For the last several years he has worked as a consultant to the utility industry. He can be reached at (908) 730-6640 or This email address is being protected from spambots. You need JavaScript enabled to view it..

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Tuesday, 19 September 2017

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