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American Gas Association

White Paper:

Soft Tissue Injury


Prevention & Management
Resource Document

Copyright 2013 American Gas Association, All Rights Reserved


See Notice and Disclaimer on final page.

Soft Tissue Injury Prevention &


Management Resource Document

AGA Safety & Occupational


Health Committee

1.0 Purpose
The purpose of this white paper is to create a non-mandatory resource document to give
American Gas Association (AGA) members a resource to use, if needed, to develop a Soft
Tissue Injury Prevention & Management Program or help to enhance current programs. This
paper does not imply acceptance of any responsibility or liability of any owner/operator to adopt
or follow any aspect of this document; it simply offers guidelines to consider and apply as
appropriate.
2.0 Background
Many AGA Companies have identified Sprains and Strains (Soft Tissue Injuries) as a leading
type of work-related injury. Soft Tissue Injuries also remain the leading category of injury as
reported in the AGA annual report for employee injuries and illnesses.
The intent of the document is to give AGA members a resource to use, if needed, to develop a
Soft Tissue Injury Prevention & Management Program or help to enhance what is currently
done.
This resource document is divided into four areas: 1) Awareness and Education; 2) Job
Assessment and Evaluation; 3) Early Intervention; and 4) Post-Injury Management. The first
two areas provide focus on injury prevention, while the other two areas focus on injury
management.
3.0 Scope
The scope of this document covers the processes relating to the identification, prevention, and
management of soft tissue injuries. This document focuses on the prevention and management of
Soft Tissue Injuries (sprains, strains, musculoskeletal disorders, cumulative trauma, etc.) related
to ergonomic risk factors (ie: workplace design, equipment design, posture, force, repetition,
environmental, and other factors). Injuries resulting from slips, trips, falls, sudden impacts, or
other non-ergonomic hazards are not covered under this resource document. However, the areas
focusing on injury management may be useful for these types of injuries as well.
4.0 Definitions
4.1 Ergonomics
The scientific discipline concerned with the understanding of interactions among humans
and other elements of a system, and the profession that applies theory, principles, data,
and methods to design in order to enhance human well-being and optimize overall system
performance.1

Canadian Standards Association - Z1004-12 Workplace Ergonomics A Management and Implementation Standard, Mississauga, 2012 (pg. 6)

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4.2 Risk
A combination of the likelihood of an injury occurring and the severity of that injury.
4.3 Residual Risk
The risk remaining after a protective measure has been implemented.2
4.4 Soft Tissue Injury
An injury which affects the soft tissues of the body that include muscles, ligaments,
tendons, blood vessels, fibrous tissues, fat, nerves, and joint (synovial) tissues.
5.0 Program Elements
5.1 Planning
5.1.1 Roles and Responsibilities
5.1.1.1 Management
Documentation of the Soft Tissue Injury Prevention & Management Program;
Promotion, implementation, maintenance, and review of the program for continual
improvement;
Provide financial, human, and organizational resources;
Set and measure objectives and targets;
Review performance against the objectives and targets at planned intervals; and
Define roles, assign responsibilities, establish accountability, and appropriate
authority.
5.1.1.2 Workers
Participate in the program;
Provide feedback and perspective;
Follow the documented requirements of the program; and
Support the identification and elimination of ergonomic risk in own work and the
work of others.
5.1.2 Legal and Legislated Requirements
Review and identify required legal and legislated requirements;
Ensure compliance with identified requirements; and
Review requirements regularly to ensure new or modified requirements are
identified.

Canadian Standards Association - Z1004-12 Workplace Ergonomics A Management and Implementation Standard, Mississauga, 2012 (pg. 7)

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5.1.3 Management of Change


Through the use of an effective Management of Change process, identify hazards
and assess risks which result from system changes that have the potential to affect
worker health, well-being, and system performance; and
Ensure effective communication of changes
o Changes may be the result of:
Design of new work processes or operations;
Significant changes to work procedures, organizational structure, staffing,
products, services, or suppliers;
Advancements in knowledge and technology;
New or different legal requirements, collective agreements; or
Other requirements.
5.1.4 Awareness & Education
Provide awareness training in the areas of ergonomic concepts, ergonomics risk
factors, risk factor identification, early warning signs/symptoms, and wellness.
Identify specific training requirements for addressing hazards and risks in each job
classification, which may include:
o Use of tools/equipment;
o Material handling;
o Weather and environmental conditions;
o Office ergonomics; or
o Other areas.
See Appendix for Awareness and Training Activities
5.2 Implementation
5.2.1 Hazard Identification, Risk Assessment and Mitigation
Workers should be encouraged to report all concerns regarding potential ergonomic
hazards.
The process for managing ergonomic risks should include:
o Identifying the root cause of the hazard(s);
o Eliminating the hazard(s) to the extent possible;
o Assessing the level of residual risk; and
o Prioritizing residual risk for further action.
Hazard identification and risk assessment should be performed by a person
knowledgeable in ergonomic principles and the tasks being evaluated. Mitigation
activities should include persons knowledgeable in ergonomic principles and the tasks
being evaluated.
See Appendix for Risk Assessment and Mitigation Activities

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5.2.2 Ergonomics and Design


Ergonomics should be applied in the earliest stages of design or redesign of a work
system, including workspaces, equipment, layout, facility design, work organization,
and environment. To effectively manage hazards, control risk, enhance human health
and well-being, and optimize system performance, it is essential to ensure ergonomics
is considered in all stages of design. Persons knowledgeable in ergonomic principles
should be involved in these activities.
5.2.2.1 Procurement
Utilize management of change principles to evaluate products, supplies, equipment,
tools, furniture, and raw materials to be procured in order to identify and eliminate
potential hazards or to control risk before they are brought into the workplace.
This can be achieved through:
o Consultation with persons knowledgeable in ergonomics principles;
o Setting ergonomics specifications to be used during procurement that take
physical, cognitive, and work organization demands into consideration;
o Including a user-centered approach in the development of procurement
specifications;
o Ensuring that procured goods conform to established specifications and that
suppliers are made aware of these specifications when required; and
o Facilitating worker participation in the development of specifications and in the
evaluation of procured goods, as appropriate.
5.2.2.2 Modified Process/Equipment/Materials
Utilize management of change principles to evaluate proposed modifications to
existing procedures, equipment, or materials in order to identify and eliminate
potential hazards or to control risk before changes are made.
See Appendix for Design and Procurement Considerations
5.2.3 Pre-Injury Intervention
Establish a process for identifying pre-injury concerns to allow mitigation of these
concerns or hazards present in the work. This process should include:
o Identification methods and opportunities for identifying injury concerns in work
processes which includes early signs and symptoms of injury;
o Elevating concerns methods to elevate worker concerns;
o Intervention methods for providing timely response to concerns on workstation
design issues; and
o Follow up methods to review mitigation effectiveness.
See Appendix for Pre-Injury Intervention Activities
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5.2.4 Post-Injury Management


Following an injury, it is essential to provide appropriate and effective treatment in
order to return a worker to their pre-injury duties or suitable alternative work,
whenever possible. In order to ensure effective rehabilitation of workers and
minimize severity following a soft tissue injury the organization should establish a
process for ensuring:
Identification of Soft Tissue Injuries,
Appropriate First Aid and medical treatment,
Effective and appropriate Modified Work,
Transition to Regular Duties
See Appendix for Post-Injury Intervention Activities
5.3 Monitoring & Evaluation
5.3.1 Evaluation of Preventive and Protective Measures
To ensure that ergonomic changes applied to the workplace have been successful, the
organization should ensure they have a process in place to:
a) Evaluate the effectiveness of the preventive and protective measures
implemented;
b) Identify any newly created hazards resulting from the preventive and protective
measures implemented;
c) Mitigate inadequately controlled or newly created risks;
d) Track actions taken to ensure effective implementation; and
e) Obtain feedback from workers regarding protective measures.
5.4 Continuous Improvement
5.4.1 Management Review
A periodic review of the Soft Tissue Injury Prevention & Management Program
should be conducted to ensure the programs continuing suitability, adequacy and
effectiveness.

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5.4.1.1 Conducting the Review


The Program Review should include the following types of information:
Overall Program Evaluation results which include monitoring and measuring
effectiveness.
Established objectives and targets are being met, examples include:
o Injury reductions
o Effective interventions/Process improvements
o Return to work effectiveness
Feedback from workers;
Communication/feedback from external agencies;
Utilization of trend analysis (data, surveys, corrective action follow-up, etc);
Program documentation adherence and is alignment with organizational goals;
and/or
Resource review for facilitation of the program.

5.4.1.2 Output of the Review


Based on the findings of the Management Review, recommendations should be
developed to address:
Targets and measures;
Program effectiveness;
Resources requirements; and
Continuous improvement.
Resources/References

CSA (Canadian Standards Association)


Z1004-12 Workplace Ergonomics
A Management and Implementation Standard, 2012

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APPENDIX
A.1
Awareness & Training Activities:
1. Principle Based awareness training
Risk factors posture, force, repetitive motion
2. Recognition of Signs and Symptoms
a. Injury development (eg; repetitive strain)
b. Pain and discomfort
3. Wellness Programs
Stretching, exercise, nutrition, physical activity, etc.

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A.2
Risk Assessment and Mitigation Activities
1. Physical Demands Analysis
An assessment of the physical and environmental demands of a job including all
essential and non-essential tasks.
2. Job Hazard Assessments
A comprehensive job hazard safety review which should include ergonomic hazard
review.
3. Field observation and coaching
Observations are an opportunity to hold discussions with workers, identify potential
ergonomic and other risks, and provide immediate feedback.
4. Ergonomics Teams
These teams can be made up of ergonomists, safety specialist, workers, integral
departments, process owners, etc. with the focus of reviewing ergonomic related
workplace hazards and solutions.
5. Other tools
Various ergonomic tools exist for the purpose of reviewing potential ergonomic
hazards in the workplace (ie; REBA, RULA, Snook Tables, Mital et al. Tables, Strain
Index, NIOSH Equations, and other computer based modeling applications). These
tools should be utilized by a person knowledgeable in ergonomic principles.
6. Mitigation of hazards
Hazard mitigation should seek to eliminate the hazard wherever possible.
Options for hazard mitigation may include, load cycle time reductions, exposure
elimination/reduction, workstations improvements, reach and bending reductions,
etc.

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A.3
Design and Procurement Considerations
1. Equipment and Tools to be used,
2. Work activities, maintenance, etc.
3. Force demands (high torque, high pressure, etc.)
4. Posture requirements (reaching, kneeling, bending, twisting, awkward postures)
5. Repetition (cycle times, etc.)
6. Work procedures
7. Job/Physical Demands Analysis

A.4
Pre-Injury Intervention Activities
1. Manager / Process Engineer / Industrial Engineers periodic review of work processes to
address worker concerns
2. Ergonomic Teams - identify concerns through periodic assessments
3. Health / Discomfort Management Teams
a. Ergonomist / Kinesiologist / Physical Therapist / Health Practitioner identify and
address worker concerns through discomfort reporting and process reviews
4. Pre-Hire / Pre-Placement Screening3
a. Assess the abilities of workers prior to hire and/or work assignment
b. Assessment of capabilities in alignment with job demands and worker requirements

This type of activity should be reviewed with the companys Human Resources/Legal department to ensure compliance with all applicable
legal and legislated requirements.

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A.5
Post Injury Management Activities
1. Timely and Appropriate Medical Attention
a. Designated industrial medical providers
b. Nurse/Physical Therapist/Kinesiologist if available
2. Case Management
a. Post injury employee interview & investigation
b. Staff assigned to interact with medical practitioners to closely monitor worker

progress
c. active treatment for pre-existing conditions, employee medical records
d. Worker coaching and retraining
3. Return to Work Program
a. Functional Capacity Evaluation
b. Work hardening programs
c. Kinesiologist/Athletic Trainer/Therapist if available
d. Health and wellness counseling

NOTE: This technical note is a suggested guide only, and the use of these Guidelines or any variation thereof, shall
be at the sole discretion and risk of the user parties. See Notice and Disclaimer on final page.

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NOTICES AND DISCLAIMER:


The American Gas Association (AGA) coordinated the creation of this document. While AGA provides administrative services, it
does not independently test, evaluate, or verify the accuracy or soundness of any statements contained in this document.
This document is based on information that has not been verified or audited. The AGA and its member companies disclaim
liability for any personal injury, property or other damages of any nature whatsoever, whether special, indirect, consequential or
compensatory, directly or indirectly resulting from the publication, use of, or reliance on this document; for any violation of any
federal, state or local regulation with which this document may conflict; or for the infringement of any intellectual property
rights from the use of this document.
The AGA does not take position with respect to the validity of any patent rights asserted in connection with any items which are
mentioned in or are the subject of this document, and the AGA disclaims liability for the infringement of any patent resulting
from the use of or reliance on this document. Users of this document are expressly advised that determination of the validity of
any such patent rights, and the risk of infringement of such rights is entirely their own responsibility.
Efforts have been made to ensure the accuracy and reliability of the data contained herein; however, this document is provided
as is and neither the AGA nor its employees or agents make any representation, warranty or guarantee in connection with this
document, express or implied, including, but not limited to, any warranty that this document will fulfill any particular purpose or
needs of the User and any implied warranties of merchantability, quality, accuracy, or fitness for a particular purpose. Neither
the AGA nor its employees or agents make any warranty as to the results that may be obtained from the use of this document.
Nothing contained in this document should be viewed as an endorsement or disapproval of any particular service provider,
product or methodology.
In issuing and making this document available, neither the AGA nor its member companies are undertaking to render
professional or other services for or on behalf of any person or entity. Nor are they undertaking to perform any duty owed by any
person or entity to someone else. Anyone using this document should rely on his or her own independent judgment or, as
appropriate, seek the advice of a competent professional in determining the exercise of reasonable care in any given
circumstances.
Users of this document should consult applicable federal, state and local laws and regulations. The AGA does not, by the
publication of this document, intend to urge action that is not in compliance with applicable laws, and this document may not be
construed as doing so. Information on the topics covered in this document may be available from other sources, which the User
may wish to consult for additional views or information not covered in this document.
AGA has no power, nor does it undertake, to police or enforce compliance with the contents of this document. Nor does the AGA
list, certify, test, or inspect products, designs, or installations for compliance with this document. Any certification or other
statement of compliance with this document shall not be attributable to the AGA and is solely the responsibility of the certifier or
maker of the statement.
The information contained in this document is not intended as legal advice or as an opinion on specific facts. For information
about these issues, the User should consult the Users employer or seek the advice of a competent professional.
All questions, requests for revisions, or other communications relating to this document should be sent to: American Gas
Association, Attention: AGA Operating Section, 400 N. Capitol St., N.W., Suite 450, Washington, D.C. 20001
Copyright 2013 American Gas Association, All Rights Reserved.

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