Physiotherapists continue to treat patients with non-specific arm pain (NSAP) (also known as repetitive strain injury (RSI)). The latest Health and Safety Executive (HSE) figures show that little progress has been made in tackling this problem over the past six years – an unacceptable situation since the condition is largely avoidable.
To prevent NSAP, an understanding of the tasks employees undertake is vital. Only then can the risks be assessed and preventative measures (for those tasks which are avoidable) and control measures (for those which are not) be implemented.
When thinking of NSAP, people often think of computer users. While they are an ‘at risk’ group, HSE statistics indicate that other workgroups are at greater risk of upper limb disorders in general. Process, plant and machine operatives, those in skilled construction and building trades, and health and social welfare professionals, are the top three ‘at risk’ groups. However, it is vital that all groups at risk of upper limb problems are not overlooked.
Risk factors associated with upper limb disorders are forceful movements, repetitive movements, poor posture and exposure to vibration. Work above shoulder height is more demanding on the body and also increases the risk of problems. Forceful movements, particularly where small muscle groups are used, such as those in the hand, are more prone to fatigue. Repetitive movements with short cycle times, particularly around 30 seconds, don’t allow adequate rest and recovery between tasks. Poor posture, resulting in awkward twisting, overreaching, extreme end-of-range movements or where postures are sustained for long periods, also increases the risk of upper limb problems.
Think of maintenance staff crammed into awkward spaces and using poorly designed hand tools, or production line workers continually reaching up above shoulder height and repeating their tasks every few seconds – and yes, they are still out there.
Symptoms of NSAP can range from minor to severe, and can result in minimal to substantial time off work. In the most severe cases, the problem is extremely debilitating. Think of the cost to your employees’ health and to your company. Experience shows that if the problem is not addressed, the symptoms can quickly worsen, further increasing the adverse impact on staff.
When taking a patient’s subjective history, it’s often reported that no workplace risk assessment has been undertaken, or updated if tasks or equipment change. Unfortunately, this situation can occur even when employees have access to OH and the problem only comes to light once staff start to complain of symptoms. Why is that? Perhaps everybody thinks that someone else is doing the assessment, but in reality it’s not happening at all. It is essential that the responsibility for workplace risk assessments is clearly defined and that they are undertaken in practice.
The HSE provides a risk filter for upper limb problems, which can be a good starting point to help practitioners identify if a more detailed assessment is required. The more specific guidance for Display Screen Equipment (DSE) users is covered in the DSE regulations 1992 (revised 2002). A manual handling assessment may also be useful. Other tools to help identify where upper limb problems may occur are the Rapid Upper Limb Assessment (RULA) and the Quick Exposure Check (QEC).
For DSE users, many companies use computer-based assessments as a first step. This is fine provided it helps employees understand the correct way of setting up their workstation in the first place. If people aren’t complaining of pain, they won’t necessarily see any problem with their slumped posture and overreaching for the mouse – a situation seen in physiotherapy clinics all too frequently.
Computer-based assessments should also identify employees at greater risk who can be followed up by occupational health or health and safety professionals. If further help is required after these steps have been undertaken, that can be the time to consult an OH physiotherapist, who can undertake a more detailed ergonomic assessment and make recommendations to reduce risk.
Employers can help their staff stay in work by encouraging early reporting of problems, providing access to early intervention where available, and referral via a GP where it is not, and making appropriate temporary adjustments to duties or hours. Where the problematic task cannot be changed, simple strategies such as the rotation of duties and ensuring staff take regular breaks can reduce the risks of NSAP. These breaks can be formal, such as a lunch break, or achieved via changes of tasks where different postures and the use of different muscle groups are required. The provision of appropriate equipment, such as ergonomic hand tools or computer mice that are a suitable shape and size for the employee’s use, will also help.
OH physiotherapists have specific training related to the management of work-relevant injuries and can provide more detailed guidance on these aspects. Should staff report problems you think may be related to NSAP, early intervention is the key. The sooner somebody is seen, the quicker the problem is likely to be resolved, and the less impact it has on employees’ health and work absence.
A focus on prevention, something that should be at the heart of all occupational health interventions, is the way forward.
by Pauline Cole, physiotherapist, Workplace Health Direct, and member of the Association of Chartered Physiotherapists in Occupational Health and Ergonomics.
Further reading/ links
3. HSE (2002) Upper Limb disorders in the Workplace, HSE books
5. European Agency for Safety and Health at Work (1999), Work-related neck and upper limb musculoskeletal disorders, Office for Official Publications of the European Communities, Luxembourg