ERGONOMICS & MUSCULOSKELETAL

DISEASES (MSD)
Occupational Health Doctor Course

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 TABLE OF CONTENTS
1. Definition of Ergonomics
2. Objectives of Ergonomics
3. Risk Factors of Ergonomics
4. Effects of Poor Ergonomics
5. Musculoskeletal Disorder (MSD)
6. Preventive and Control Measures

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 1) DEFINITION

Ergon + Nomos = Ergonomics

(work or human) (laws or study) (laws of work)

Ergonomics
 the science of “designing the job to fit the worker
(fitting the workplace or task to the worker), instead of
forcing the worker to fit the job.”

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 WHAT IS ERGONOMICS?
Ergonomics is the scientific discipline concerned with the
fundamental 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 optimize human well-being
and overall system performance.

International Ergonomics Association

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 2) OBJECTIVES
1. Improve safety & health
 Reducing risk factors for musculoskeletal
disorders
 Reduce number & severity of workplace injuries

 Reduce the probability of human error

 Reduce absenteeism

2. Improve job effectiveness

 Increase productivity

 Increase product & service quality

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 2) OBJECTIVES (CONT)
3. Job satisfaction

4. Lowering costs
 use of medical services because of
musculoskeletal disorders
 compensation claims

5. Respond to external & internal pressures

 Policy
 Laws
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 LAWS
• OSHA 94 Section 4: Objective (c):
• To promote an occupational environment for
persons at work which is adapted to their
physiological and psychological needs

• OSHA 94 Section 15: General Duties of

Employers to Employees:
• Duty of every employer and every self-employed to
ensure, so far as practicable, the safety, health and
welfare of all his employees

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 LAWS
• OSHA 1994 (Section 24):General duties of
employees at work
• Take reasonable care for safety and health, co-
operate with employer and comply with instructions
instituted by the employer

• FMA 1967 (Section 12):

• No person shall be employed to lift load so heavy so
as to cause bodily injury to him

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3) RISK FACTORS OF ERGONOMICS

WORKER’S
WORKER’S
CAPACITY
CAPACITY

WORKING TASK
TASK
DEMAND
ENVIRONMENT
DEMAND

3 IMPORTANT ELEMENTS

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 A) WORKER’S CAPACITY
 Physical capability  Psychological factors
 Body size: height,  Personal habits
weight (obesity)  Knowledge
 Fitness and strength
 Experience
 Poor health profile:
Arthritis/DM
 Poor work practices

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 B) WORKING ENVIRONMENT
 Workstation design/layout
 Poor environmental conditions, such as extreme
heat, cold, noise and poor lighting may increase
workers’ chances of developing problems

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 C) TASK DEMANDS

 Depends on the nature of work

 The main ergonomic risk factors:

 Awkward postures

 Repetitive motions

 Forceful exertions

 Local Contact Stress

 Vibration

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 I) AWKWARD POSTURE
• Deviations of body parts from their neutral position
• Posture affects which muscle groups are active
• Awkward postures make tasks more physically
demanding:
o Worsen if tasks also involve repetitive motions or
forceful exertions
• Awkward postures include repeated or prolonged
reaching, twisting, bending, pinch grips, kneeling,
squatting, working overhead and holding of fixed
positions

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 COMMON EXAMPLES OF AWKWARD
POSTURES

Working overhead
Extended wrist Squatting

Kneeling

Reaching
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 II) REPETITIVE MOVEMENTS
• Similar motions or actions/tasks are repeated using
same muscles, tendons, or joints
• amount of repetition are affected by:
o work pace
• high repetitive: if the time to complete such a job was
less than 30 seconds
o recovery time: do not have adequate time to
recover
o amount of variety in tasks
• risk of injury is greater when it also involve awkward
posture or forceful exertions

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 III) FORCEFUL EXERTION
• Force is the amount of muscular effort expended to
perform work
• Tasks that require forceful exertions place higher
loads on the muscles, tendons and joints
• Amount of force exerted when moving or handling
materials depends on :
– Load (shape, weight, dimensions, bulkiness)
– Grip (type, position, friction characteristics)
– Length of time continuous force is applied by muscles
(e.g., the amount of time load/object is held, or handled
without break)
– Number of times the load is handled (per hour/work shift)
– Duration of the task over work shift
– Body posture used
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 IV) LOCAL CONTACT STRESS

• Pressure points result from body pressing against

hard or sharp surfaces
• Contact stress will irritate local tissues and interfere
with circulation and nerve function
• Certain areas are more susceptible because nerves,
tendons, and blood vessels are close to the skin and
underlying bones:
o sides of the fingers, palms, wrists and forearms,
elbows, knees

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 Tasks that can induce mechanical/contact stress

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 V) VIBRATION
• Vibration are mechanical oscillations produced by
movements of a body about its resting position
• High risk when continuous or high intensity
• Usually causes exposure to hand and arm
• Tools not properly maintained may increase amount
of hand-arm vibration
o Results in fatigue, pain, numbness, tingling, increased
sensitivity to cold, and decreased sensitivity to touch in
affected limb
• Whole-body vibration results from sitting or standing
on work surfaces that vibrate
o can have general discomfort and lower back pain

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 HOW MUCH IS TOO MUCH?

• Still not known

o How many repetitions are too many?
o What degree of awkward posture is harmful?
o What duration of a task is too long?
o How much force is too much?
o What the effects are on individuals from
combinations of these factors?
• contributing factors should be minimized in work
tasks as much as possible to prevent fatigue, pain,
and disability

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 ERGONOMIC FOCUS

The Task
The Tool

The Work
Station and
Environment
The User /Operator

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 4) EFFECTS OF POOR
ERGONOMICS
 Contribute to musculoskeletal disorders
 Work-related musculoskeletal disorders

 Synonyms
 WURLDs: Europe

 Repetitive Strain inuries (RSI): UK

 Cumulative Trauma Disorder: US

 Occupational cervico-brachial disorder:

Scandinavia & Japan
 Occupational Overuse Syndrome: New Zealand

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EFFECTS OF POOR ERGONOMICS

 Can contribute to a number of musculoskeletal

disorders (MSD) including:
 sprains and strains of muscles
 injuries to muscles, ligaments, intervertebral discs and
other structures in the back
 injuries to soft tissues such as nerves, ligaments and
tendons in the wrists, arms and shoulders

 Musculoskeletal disorders occur in two ways:

 Acute Cumulative Trauma Disorder: sudden damage
 Chronic Cumulative Trauma Disorder: gradual wear and
tear
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 5) COMMON TYPE
OF OCCUPATIONAL MSD
Cervical disc prolapse Rotator Outlet
cuff tendinitis
•Muscle Strain •Thoracic Syndrome
•Herniated Disc Frozen Strain
•Cervical shoulder
•Degenerative Disc Disease •Rotator Cuff Tendonitis

Medial epicondylitis
Lateral epicondylitis
•Trigger Finger
•Carpal Tunnel Syndrome
•DeQuervain’s Disease

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 I) CARPAL TUNNEL SYNDROME

• 9 tendons, blood vessels and

median nerve passes through
carpal tunnel in a snug fit

• Awkward posture and repetitive

movements of fingers are
causes irritation and swelling of
tendons in carpal tunnel
leading to impingement of
median nerve

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 I) CARPAL TUNNEL SYNDROME
• Impingement of nerve causes pain
or tingling and numbness

• Worse at night (relieved by hanging

the hand at the edge of the bed)

• More severe, there will be muscle

wasting and loss of function

• Motor deficit typically affects the

thenar muscles and the lateral two
lumbricals
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NIOSH SURVEILLANCE DEFINITION
FOR OCCUPATIONAL CTS
A. One or more of the following symptoms suggestive of CTS
is present (parasthesia, pain or numbness) affecting the
distribution of the median nerve to the hand
B. Objective findings consistent with CTS are present in the
affected hand and wrist EITHER Physical examination
findings (+ve Tinel test, Phalen test) OR Positive nerve
conduction test findings
C. Evidence of occupational causes
1) Frequent repetitive use of the same hand/wrist
2) Regular or sustained tasks requiring awkward postures
of the hand/wrist
3) Regular use of vibrating hand held tools
4) Frequent or prolonged pressure over the wrist or base
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 II) TENDINITIS
• Medial Epicondylitis
o Flexor pronator syndrome or golfer’s elbow
o Caused by overused of finger flexors and
the wrist flexors/pronators.
o Local tenderness over medial epicondyle.

• Lateral Epicondylitis
o Tendinitis of common extensor origin or
tennis elbow
o Repetitive wrist dorsiflexion, repeated
forceful wrist extension e.g. using
screwdriver, grasping a lever or lifting heavy
load
o Local tenderness over lateral epicondyle.

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 iii) De Quervains’s Disease
• Inflammation of the tendon sheath of the thumb
attributed to excessive friction between two thumb
tendons (abductor pollicis longus and extensor
pollicis longus) and their common sheath.
• Caused by repetitive movements of these tendons,
twisting and forceful gripping movements such as: -
o Wringing washcloths, cutting with scissors, sewing or
pinching, stirring food for a long period of time
• Symptoms include:
• –swelling, crepitus, pain at the base of the thumb.

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 IV) TRIGGER FINGER

• Occurs when there is a thickening in the flexing

tendon of the finger/thumb
• Causes
o Highly repetitive or forceful use of the finger or
thumb.
o Aggravated by prolonged, strenuous grasping such
as with power tools, handles with hard or sharp
edges or long hours grasping a steering wheel
• Symptoms
o Soreness at the base of the affected finger
o Painful clicking or snapping when attempting to flex
or extend the affected finger.
o Joint stiffness
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 V) ROTATOR CUFF
TENDINITIS/SYNDROME
• Rotator cuff tendinitis is a condition
in which the tendons of the 4
muscles become inflamed, causing
pain

• Symptoms often occur with

repeated lifting of heavy weights
over the head (e.g., painters,
welders, plate workers, and
slaughterhouse workers)

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 VI) CERVICAL DISC PROLAPSE
• Less common in the neck than in the lower back
• The most common levels for a slipped disc in the neck
are between C5 - C6 and C6 - C7
• Repeated stress/overuse during neck movements, in an
awkward posture, load over the head can lead to
degeneration of the outer layer of the disc.
• If this degeneration is sufficient the nucleus material is
liable to 'prolapse' out of the disc.
• Symptoms:
o Pain in the neck:
• Spread to the shoulders, base of the skull, arm,
hand or fingers
o May develop 'pins and needles' in part of an arm or
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 VI) CERVICAL
DISC PROLAPSE

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 OCCUPATIONAL OR
NON-OCCUPATIONAL?

• No single good method of distinguishing

• Guidelines:
o Symptoms develop after working on the same
job for some weeks/months
o Symptoms disappear after cease working
o Type of job is known to produce the symptoms
o Worker may have underlying cause

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 6) PREVENTIVE & CONTROL
MEASURES
1) Identify Problems
 Look for problems when introduce changes or new
machines at the workplace

 Critically examine tasks if there are indications

 e.g. workers complain of discomfort

 Investigate and analyse the factors contributing to

manual tasks incidents or near misses
 check for patterns such as repeated injuries with one
task.

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 2) ASSESS PROBLEMS
 Examine the task during normal work conditions
 Consider seasonal variations and peak work periods
 Talk to workers doing the task
 Use checklists to analyse risk factors
 Consider risk factors and decide which require
solutions
 Decide which tasks need the most urgent attention

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 3) ERGONOMIC CONTROLS

ENGINEERING WORK PRACTICE ADMINISTRATIVE

• Mechanical • Safe & proper • Scheduling

work techniques/ sufficient rest
aids or tools procedure breaks
• User- • Training • Job rotation
adjustable • Encourage a • Training workers
work stations specific method - risk
of a task factors/signs &
performance to symptoms
reduce exposure /reporting system
to risk • Consider staff’s
pre-morbid when
assigning manual

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 4) EVALUATION AND REVIEW

Long Term
Evaluation Review
Indicators
• Risk factor • Engineering • Incidence rate of
checklist or job control MSDs
analysis method measures or • Productivity or
other innovative quality
• Symptom technologies • Job absenteeism
survey or turnover rate
• Risk • Performance of
assessments, employees at
inspections and work
worker training

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 ISSUES

AGING UNIVERSAL COST

WORKFORCE DESIGN

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