JERROLD J. SCHARNINGHAUSEN, Ph.D.
Workplace Safety Division
Directorate of Assessments and Prevention
U.S. Army Combat Readiness Center
Fort Rucker, Alabama

Noncombat injuries are a major factor impacting Soldier health and readiness. They are the primary cause of outpatient medical visits among active-duty Soldiers, accounting for more than 2 million visits annually. Noncombat musculoskeletal injuries (MSKI), injuries involving the muscles or bones, may account for nearly 60 percent of Soldiers’ limited duty days and 65 percent of Soldier medical non-readiness.

Work-related musculoskeletal disorders (WMSD) are a subset of these injuries, resulting in painful disorders of the muscles, tendons and nerves caused by how a job task is performed. It is also referred to as repetitive motion injury, cumulative trauma injury and overuse syndrome. Carpal tunnel syndrome and tendonitis fall into this category. The good news is WMSDs are preventable through the implementation of an ergonomics program.

There are seven simple steps involved in implementing an ergonomics program:

• Step 1: Identify risk factors
• Step 2: Involve and train leadership and workers
• Step 3: Collect health and medical evidence
• Step 4: Implement your ergonomic program
• Step 5: Evaluate your ergonomic program
• Step 6: Promote worker recovery through health care management and return-to-work
• Step 7: Maintain leader commitment and worker involvement

Incidents of possible WMSDs are either isolated to a particular job/task or widespread, affecting multiple departments. Records of complaints and injuries are often enough to reveal the scope of a WMSD problem. Workplace conditions contribute to physical and psychological stress and can negatively affect the musculoskeletal system. Physical stress comes from the force, repetition and postures required in job tasks. There are neutral postures, awkward postures and static postures. When your muscles and joints are resting and relaxed, you are in the neutral posture. Awkward or unnatural postures require more and more exertion from your muscles, tendons, nerves and bones as movements reach the limits of the range of motion and can lead to WMSDs. Also, if you maintain the same position, even in a neutral posture, for an extended period of time, this can cause additional muscle fatigue and disrupt blood flow. Examples of risk factor conditions include awkward postures, overhead work, twisting and carrying loads, wrist deviations, contact stress, poor shoulder/wrist posture, lifting bulky loads, hand-arm vibration and whole-body vibration.

To identify specific jobs or job tasks that put workers at risk for WMSD problems, supervisors need to examine each job task. A single job setting may present more than one risk factor for WMSDs. Your level of risk for developing WMSDs depends on the intensity, frequency and duration of your work tasks. These requirements may become risk factors for musculoskeletal disorders (MSDs) if your work includes high intensity, frequency or duration.

Use checklists to formally screen job tasks against a list of risk factors. Walk through work facilities and conduct an observational survey. Observe several workers performing the same job task at the same time to record how different workers choose postures and techniques. Interview workers and supervisors, and be sure to only gather data from those who are familiar with the job, task or process you are investigating.

No checklist can fit all situations, so you will need to customize yours for different job tasks or types of work. Consider reaching out to your installation industrial hygiene program office (IHPO) if you need additional assistance. Your IHPO also can contact ergonomic resources at the U.S. Army Public Health Center for a detailed assessment by an ergonomics team. More information on ergonomic standards is available at https://safety.army.mil/ON-DUTY/Workplace/Ergonomics.

Ergonomics training would be beneficial for all workers exposed to conditions that contribute to MSDs. Ergonomics awareness training should be provided to most employees, but it needs to be tailored to the target audience. Consider their education level, literacy level, language and specific job interests. Make any outside instructors aware of unit operations, relevant policies and practices before training begins so it is pertinent to the work performed at the facility.

Determining the scope and characteristics of the problem at your jobsite is done by collecting health and medical evidence of WMSDs. It is essential to follow up on workers whose jobs cause undue physical fatigue, stress or discomfort. If employees report their symptoms early and openly, you can take corrective measures to delay the development of MSDs. In a scenario where workers in a certain department report more MSD problems than workers in other departments, it is best to immediately study possible MSD risk factors in that department.

To implement an ergonomic program, begin by targeting easy-to-implement solutions that have been identified in your earlier analyses. There are five approaches to control WMSD risk factors. Elimination is the most effective way to reduce MSD risk factors in the workplace. The hierarchy of controls, as shown in the graphic below, also includes substitution, engineering controls, administrative controls and personal protective equipment (PPE). In ergonomics, engineering controls (isolating the hazard) leads to substitution (replacing the hazard) and/or elimination (removing the hazard). Administrative controls and PPE are not as likely to reduce or eliminate WMSDs.

Engineering controls are the most effective at reducing WMSD hazards, but may also be the most difficult and expensive to implement. Changing the way you use materials, parts, products and tools can relieve workers from WMSD risks. Engineering controls include mechanical assist devices, fixtures and lighter-weight packaging materials.

Administrative controls are practices and policies that workers must follow until engineering controls become feasible. You can limit exposure to the hazard by reducing the length of workers’ shifts, implementing a job rotation, scheduling more breaks, varying the tasks for individual jobs, or training workers on how to minimize exposure to a hazard, such as stepping and turning instead of twisting during manual handling. PPE, such as knee pads and anti-vibration gloves and grip-gloves, may protect workers from immediate hazards. PPE is inexpensive and used frequently where hazards aren’t under administrative or engineering controls. It is not, however, a permanent solution.

Follow up to ensure the controls you implemented reduce or eliminate the WMSD risk factors. Ensure no new WMSD risk factors were created. New workers need about two weeks to condition their muscles. During the adjustment period, it is not unusual for new hires or workers returning from a long absence to report muscle soreness. Review the job hazard analysis, injury logs, worker compensation costs and the quality of products and services. Workers will not experience the benefits of the ergonomic program immediately, as it can take months for old WMSD symptoms to disappear. The program may need to be modified if new MSD symptoms appear.

Work-related injuries and disabilities are associated with many negative health and social outcomes, including reduced quality of life, job loss, reduced lifetime income, injuries among family caregivers and premature death. MSKI-related, service-connected disabilities account for 44 percent of all U.S. Global War on Terrorism veterans receiving disabilities compensation.

Leadership commitment is crucial to the success of musculoskeletal health awareness training and WMSD interventions. Leadership is responsible for encouraging worker input on real or suspected job hazards, ways to control these hazards, and how best to implement interventions. Leadership should follow the objectives in the unit ergonomics program and keep workers involved with reporting hazards. If properly implemented, these seven steps will allow units to reduce the number and severity of WMSDs.