Professional Documents
Culture Documents
many jobs make the musculoskeletal system This text has compiled a comprehensive
highly vulnerable to a variety of occupational anthropometric database. In different parts of
injuries and illnesses. There are two main the world the workforce is different and diver-
types of musculoskeletal injury: injury associ- sified; therefore, it is important to design the
ated with manual materials handling (MMH) workplace based on the anthropometry of the
and cumulative trauma disorders (CTD). users.
This article, therefore, discusses key issues Tables I and II are anthropometric mea-
such as anthropometry, seat design, work- sures adapted from Pheasant[2] of US and
place principles, manual materials handling, Japanese adults. The 5th percentile male is
and cumulative trauma disorders. These known as the small male, the 50th percentile
important issues need to be understood and male is known as the average male, and the
applied if the objective of the facilities manag- 95th percentile male is known as the large
er is to reduce work-related injuries, improve male. Similarly, the 5th percentile female is
productivity, and improve the quality of life of known as the small female, the 50th percentile
the workers. female is known as the average female, and
the 95th percentile female is known as the
large female. The smallest value of a measure-
Anthropometry
ment is usually associated with the 5th per-
Anthropometry may be defined as the mea- centile female, and the largest value of a mea-
surement of human beings. Factors which surement is usually associated with the 95th
affect anthropometric measurements include percentile male.
gender differences, ethnic differences, growth As an example, the anthropometric mea-
and development, secular trend, ageing, social sures of two populations are presented to
class and occupation, and clothing and per- show the differences in some anthropometric
sonal equipment. measurements. The designer needs to know
Anthropometric surveys have been con- the worker population and then use the
ducted and published on various populations. appropriate anthropometric table in the
These days the most referred source book is design process. If the workers were from both
an international text for the International the US and Japanese populations then it
Labour Office by Jurgens et al.[1] in 1990. would be appropriate to use both these Tables
• Avoid unnatural posture. Bend the handle lines proposed by Mital et al.[9] and Snook
of the tool not the wrist. and Ciriello[10] are industry norms and
• Permit change of posture. should also be used to reduce the risk of
• Maintain a proper sitting posture. MMH injuries.
• Counter-balance tools when possible to
reduce the weight and forces.
Cumulative trauma disorders
• Accommodate the large individual and give
him or her sufficient room. Cumulative trauma disorders (CTDs) are
• Use bins with lips for storage and manual defined as physical injuries which develop
retrieval of small parts instead of boxes. over a period of time as a result of repeated
Incline containers so as to reduce awkward biomechanical or physiological stresses on a
postures of the body. specific body part. CTD is a collective term
• Train the individual to use the workplace for syndromes characterized by discomfort,
facility and equipment properly. impairment, disability, or persistent pain in
joints, muscles, tendons and other soft tis-
sues[11]. Other terms which are also used to
Manual materials handling
describe these disorders include repetitive
Low back injuries, often due to improper trauma injuries (RTI), repetitive strain
manual handling of materials, form the largest injuries (RSI), musculoskeletal disorders
subset of musculoskeletal injuries. The seri- (MSD), and occupational overuse syndrome.
ousness of the lower back injury problem is Since these injuries develop over relatively
reflected in the large number of claims under long periods of time (months or years), it is
the US Worker’s Compensation Act of 1970. difficult to determine how often CTDs occur.
According to Leamon[3], low back pain costs CTDs are generally considered to be work-
Liberty Mutual Insurance Group about US$1 related. In other words, these disorders tend
billion per year, at an average cost of to be more prevalent among working people
US$8,321 per incident. The National Safety than among the general population.
Council[4] reported that in the USA 400,000 There has been a significant increase in the
workers face disabling back injuries every number of CTD cases reported in the
year. Statistics[5] also show that back injuries USA[12] from 1981 to 1991, as shown in
resulting from manual materials handling Figure 1. Some of the reasons for this increase
(MMH) activities are a major source of lost could include a change in technology, an
time and compensation claims. Morris[6] ageing workforce, decreased physical capaci-
estimated that 28 per cent of the US industrial
population will experience disabling lower
back pain at some time in their lives, with 8
Figure 1 Number of CTDs reported in the USA from 1981
per cent of the total working population being
to 1991
disabled during each year. Lahey[7] stated
that back injuries alone cost industry an
estimated US$14 billion a year. In 1981 the 250
National Institute for Occupational Safety
and Health (NIOSH) published the Work
Practices Guide for Manual Lifting[5]. This 200
Number of cumulative trauma
ties of new workers, lower worker turnover, muscle/tendon unit. Since tendons have
increased awareness, and change in reporting virtually no blood supply, they are incapable
methods. An increase in the number of CTD of self repair and damage becomes incremen-
cases means the associated cost has also tal[16]. The accumulation of minor damage
increased significantly. results in a roughened, nubby tendon which
Putz-Anderson[13] summarizes the rele- may produce friction and irritation of its
vant research in the area of CTDs, where it is sheath. Ultimately, the tendon may become so
emphasized that there are basically four occu- weakened that it ruptures. Without rest or
pational risk factors associated with the devel- sufficient time for tissue to heal, the tendon
opment of CTDs. These are awkward pos- may be permanently damaged[17].
tures, excessive manual force, high rates of
Tendinitis is most likely to occur in areas
manual repetition, and task duration (or
where the tendon is restricted anatomically,
inadequate rest). Static loading has also been
such as in bony channels and tunnels[16].
observed to increase the risk of CTDs[14].
Examples would be the thumb tendons in the
Static loading occurs when muscles are
radial groove at the wrist or in tendons which
required to generate tension without move-
support a joint, such as the rotator cuff of the
ment. Static work is not very efficient and
causes the muscles to fatigue rapidly. Vibra- shoulder.
tion is another variable which has been impli- Tenosynovitis
cated in the development of CTDs. Vibration Tenosynovitis is fairly common in finger and
causes constriction of blood vessels in the wrist tendons or in other areas where the
fingers as well as numbness and swelling of tendon excursion from the synovial sheath is
the hand tissues. This leads to a reduction in long (usually two or more inches). In such
grip strength. Any job which involves one or situations, repetitive motion (gliding) of the
more of these risk factors will have a high
tendon within the sheath may overwhelm the
probability of causing CTDs depending on
lubricating ability of the sheath. This will
the severity of each factor.
ultimately result in an inflammatory reaction
The potential for CTDs’ development
within the tendon sheath[16].
increases when leisure time activities such as
sewing, gardening, and woodworking contin- Bursitis
ue to strain the ligaments and muscles. In Bursae are anti-friction devices found
addition, as the mean age of the working throughout the body where bony
population increases, strength and flexibility prominences are close to the skin surface and
decrements are visible. These are also impor- friction from outside the body or where ten-
tant factors which can contribute to the devel- dons and ligaments may rub against the
opment of CTDs[15]. prominences[16]. In the presence of high
Putz-Anderson[13] outlined several of the degrees of friction, the bursae will oversecrete
common forms of upper extremity CTDs.
lubricating fluids and bursal sacs will become
These can be classified into three major cate-
enlarged and distended. If friction persists,
gories: tendon disorders, neurovascular disor-
the walls of the sac will thicken and become
ders, and nerve disorders.
inflamed.
Tendon disorders Ganglionic cyst
The tendon is a specialized type of connective Caused by the swelling of a tendon sheath
tissue which serves to attach muscle to bone. with synovial fluid, a ganglionic cyst is com-
Tendons are surrounded by sheaths of fibrous mon and is generally related to wrist
tissue in order to protect the tissue from usage[18]. Though rarely causing symptoms
friction in certain areas. The sheath contains a of nerve compression, such a cyst can often be
synovial membrane which facilitates gliding of painful and is usually treated by aspiration or
the tendon during mechanical actions. Minor by surgical removal if the ganglion recurs[18].
disorders of tendons and their sheaths are
very common[13]. Neurovascular disorders
Tendinitis Neurovascular disorders are those CTDs
Tendinitis is inflammation of the tendon which involve both the nerve and adjacent
occurring from repeated action of the blood vessels.
24
Ergonomics in the workplace Facilities
Jeffrey E. Fernandez Volume 13 · Number 4 · April 1995 · 20–27
Thoracic outlet syndrome hard work surfaces and sharp edges on hand
Probably the most common form of neurovas- tools.
cular disorder is the thoracic outlet Although the innervation pattern varies
syndrome[13]. Thoracic outlet syndrome is a slightly, the primary areas affected by the
general term for compression of the nerves median nerve include most of the palmar side
and blood vessels as they pass through the of the hand, the thumb, and all of the fingers
neurovascular bundle between the neck and except the ulnar side of the ring and small
shoulder. fingers. Under normal conditions, there is
Also known as cervicobrachial disorder, smooth movement of the nerve and tendons
thoracic outlet syndrome is generally thought accompanying movements of the wrist. How-
to result from heavy workloads combined with ever, compression of the nerve will result from
repetitive straining or unnatural static posi- flexion and extension movements when the
tioning of the arms[19]. Typical symptoms of boundaries of the tunnel are compromised or
thoracic outlet syndrome include numbness when structures of the tunnel become
and tingling in the fingers and hand, as well as enlarged.
a sensation of the arm “going to sleep”. The Initial complaints of CTS include sensa-
blood pulse at the wrist may also become tions of pain, numbness, and tingling in one
weakened. or both of the hands at night. The symptoms
of CTS may progress until attacks of pain
Vibration syndrome and/or tingling are experienced during the
Sometimes referred to as vibration-induced day. At this point, individuals may complain
white finger, Raynaud’s syndrome, or trau- of a general clumsiness or an inability to grasp
matic vasospastic disease, vibration syndrome and hold objects. A significant reduction in
is characterized by episodes of blanching work-related measures, particularly grip
(whiteness or paleness) of the fingers due to strength, range of motion, and performance
closure of the digital arteries[13]. Due to the time has been demonstrated.
blockage of circulation in the fingers, coldness The exact incidence rate of CTS in indus-
and pain are often associated with vibration try is unknown; however, many industries
syndrome[20]. This condition is caused by now claim that CTS is among their most
the transmission or vibration (varying in disabling and costly medical problems[21].
acceleration, or power, and frequency) from a The average cost of a CTS case has been
tool to the hand. It is believed to be in part a reported to be approximately US$3,500,
vascular disturbance due to changes in the while for the more severe cases, compensation
blood vessel walls and in part a nervous dis- and disability claims may range from
turbance caused by reflex contraction of the US$30,000 to US$60,000[22]. Fernandez et
smooth muscles of the blood vessels. al.[23] stated that the average cost for CTS
cases in a mid-western manufacturing facility
Nerve entrapment disorders ranged from US$15,000 to US$18,000.
Nerve entrapment disorders occur when There are a number of risk factors which
repeated or sustained work activities expose have been associated with the development of
the nerves to pressure from hard, sharp edges CTS. These risk factors can be divided into
of the work surface, tools or nearby structures three broad categories:
such as bones, ligaments, and tendons. (1) systemic conditions;
(2) non-occupational risk factors;
Carpal tunnel syndrome
(3) occupational risk factors as described by
Carpal tunnel syndrome (CTS) is one of the
Turner and Buckle[24].
major forms of cumulative trauma disorders.
Other terminology used to describe CTS The occupational risk factors most frequently
includes occupational neuritis, partial thenar associated with CTS include force, repetitive-
atrophy, and median neuritis. CTS is general- ness, and posture[13]. When a job requires
ly attributed to insult, usually compression, of high levels of force and repetition, more mus-
the median nerve within the wrist. Compres- cle effort is required. This increases the need
sion of the median nerve is, in turn, associated for increased rest periods or recovery time.
with repeated or sustained activities of the Without sufficient recovery time, cumulative
fingers and hands, often combined with the injuries are likely to occur. The amount of
application of force, as well as pressure from time required to perform a task is also thought
25
Ergonomics in the workplace Facilities
Jeffrey E. Fernandez Volume 13 · Number 4 · April 1995 · 20–27
6 Morris, A., “Programme compliance key to preventing 17 Curwin, S. and Stanish, W.D., Tendinitis: Its Etiology
low back injuries”, Occupational Health and Safety, and Treatment, Collamore Press, Lexington, MA,
March 1984, pp. 44-7. 1984.
7 Lahey, J.W., “Bearing down on musculoskeletal 18 Birnbaum, J.S., The Musculoskeletal Manual, 2nd ed.,
disorders”, National Safety News, Vol. 129 No. 3, W.B. Saunders, Philadelphia, PA, 1986.
1984, pp. 37-9.
19 Sallstrom, J. and Schmidt, H., “Cervicobrachial
8 National Institute for Occupational Safety and Health, disorders in certain occupations, with special refer-
Revisions in NIOSH Guide to Manual Lifting, paper ence to compression in the thoracic outlet”, American
presented by V. Anderson and T. Waters in Ann Arbor, Journal of Industrial Medicine, Vol. 6, 1985, pp. 45-52.
MI, 1991.
20 Taylor, W., “The vibration syndrome: introduction”, in
9 Mital, A., Nicholson, A. and Ayoub, M.M., A Guide to Taylor, W. (Ed.), The Vibration Syndrome, Academic
Manual Materials Handling, Taylor and Francis,
Press, London, 1974.
London, 1993.
21 Bleeker, M.L., “Carpal tunnel syndrome: a case study.
10 Snook, S.H. and Ciriello, V., “The design of manual
Preventing illness and injury in the workplace”,
handling tasks: revised tables of maximum acceptable
Working Paper No. 15, Office of Technology Assess-
weights and forces”, Ergonomics, Vol. 34, 1991, pp.
ment, US Congress, Washington, DC, 1984.
1197-213.
11 Kroemer, K.H.E., “Cumulative trauma disorders: their 22 Hiltz, R., “Fighting work-related injuries”, National
recognition and ergonomic measures to avoid them”, Underwriter, Vol. 89 No. 13, 1985, p. 15.
Applied Ergonomics, Vol. 20 No. 4, 1989, pp. 274-80. 23 Fernandez, J.E., Marley, R.J. and Young, K.R., “Results
12 US Labor Department, Occupational Injuries and of an ongoing monitoring program for carpal tunnel
Illnesses in the United States by Industry, BLS syndrome”, in Das, B. (Ed.), Advances in Industrial
No. 2424, Washington, DC, 1993. Ergonomics and Safety II, Taylor and Francis, London,
1990, pp. 265-71.
13 Putz-Anderson, V., Cumulative Trauma Disorders: A
Manual for Musculoskeletal Diseases of the Upper 24 Turner, J.P. and Buckle, P.W., “Carpal tunnel syndrome
Limbs, Taylor and Francis, London, 1988. and related risk factors – a review”, in Buckle, P.W.
14 Fernandez, J.E. and Marley, R.J., “Monitoring and (Ed.), Musculoskeletal Disorders at Work, Taylor and
screening tests for carpal tunnel syndrome”, in Francis, London, 1987, pp. 124-32.
Lovesey, E.J. (Ed.), Contemporary Ergonomics 1990, 25 Silverstein, B.A., Fine, L.J. and Armstrong, T.J., “Hand
Taylor and Francis, London, 1990, pp. 63-8. wrist cumulative trauma disorders in industry”, British
15 Chaffin, D.B. and Anderson, G.B.J., Occupational Journal of Industrial Medicine, Vol. 43, 1986, pp. 779-
Biomechanics (2nd ed.), Wiley-Interscience, New York, 84.
NY, 1991. 26 OSHA, Ergonomics Program Management Guidelines
16 Rowe, M.L., Orthopaedic Problems at Work, Perinton for Meatpacking Plants, US Department of Labor,
Press, Fairport, New York, NY, 1985. OSHA 3123, 1990.
27