Fitness professionals strive to help clients enhance their health and reduce the risk of injury; however, they may be missing a large piece of the training puzzle if they aren’t addressing a client’s work-related training needs. While most clients may not be professional athletes, they are in fact “occupational athletes,” meaning they spend 40 or more hours a week on the job. Depending on where they work, they may encounter heavy lifting, awkward positions and repetitive tasks, all of which can lead to work-related musculoskeletal disorders (WMSDs) such as carpal tunnel syndrome, rotator cuff disorders and back injuries. These WMSDs don’t just serve as obstacles to training; they negatively affect quality of life.
In 2012, the Bureau of Labor Statistics reported approximately 388,000 cases of WMSDs that required days off work, a figure that represented 34% of all lost workdays (BLS 2013). It is estimated that employers spend as much as $20 billion per year on workers’ compensation claims directly related to WMSDs and up to five times that amount ($100 billion per year) on indirect costs associated with hiring and training replacement workers. In addition to these monetary effects, WMSDs cause substantial pain and suffering to injured employees, who may no longer be able to work or perform basic activities of daily living (ADL) (OSHA 2014). While WMSDs are a significant and costly health issue, the good news is that most of them are preventable. Fitness professionals can help, and this article explains how.
What Is a Work-Related Musculoskeletal Disorder?
The U.S. Department of Labor defines a WMSD as an injury or disorder of the muscles, nerves, tendons, joints, cartilage or spinal disks. WMSDs do not include disorders caused by slips, trips, falls, motor vehicle accidents or other similar accidents (CDC 2013). One might expect occupations related to transportation, construction and warehousing to have high rates of WMSDs, but surprisingly the highest rate is in the healthcare industry (OSHA 2012). Healthcare workers have very physically demanding jobs. On average, a healthcare worker lifts 1.8 tons of human body weight every shift (Nelson & Baptiste 2004). Patients do not have handles, their weight is not evenly distributed, and they are not always cooperative. Consequently, more than 50% of healthcare workers become injured and experience chronic back pain, and 12% are forced to leave the profession because of disabling back injuries (ANA 2013).
In the United States, back injuries are among the most prevalent and costly WMSDs, representing 41% of all cases (BLS 2013). Additionally, 1 in every 5 accidents reported involves a back injury. It is therefore not surprising that 25% of all workers’ compensation claims involve back injuries and strains (OSHA 2009). The vast majority of these complaints affect the lower back and are caused by manual handling (lifting, carrying, holding, lowering and placing). Poor posture and chronic sitting are also contributory factors.
A WMSD may be caused or exacerbated by exposure to one or more of the following risk factors (OSHA 2000):
- heavy, frequent or awkward lifting (postal, construction,
warehouse or delivery jobs)
- working in awkward (nonneutral) or static positions (lab
work, dentistry, surgery, landscaping, inspection)
- hand-intensive work that requires use of tools and/or repetitive motions (keyboarding, playing a musical instrument,
working an assembly line)
- vibration, both hand (power tools) and whole body (driving
trucks or forklifts)
- contact stress (direct or continuous contact with hard or
sharp objects or surfaces, such as nonrounded desk edges, unpadded tool handles, or standing on concrete or other hard-surface floors)
WMSDs have been increasing in the office setting since the
1990s. Fitness professionals can help their desk-bound clients with these proven strategies:
- Make sure the chair and workstation are set up correctly (see
Figure 1, in the second sidebar). Posture has a significant effect on lumbar-disk
loading (see Figure 2).
- Be aware that sitting, in and of itself, increases intervertebral disk
pressure. This can be minimized by using a chair that allows the person to “lean” back, increasing the hip angle from 90° to 110° (Natchemson & Elfström 1970). In this position, the spine should still be in neutral alignment and be supported by the chair.
- Suggest to clients that they obtain a sit/stand workstation or alternate between sitting and standing to decrease fatigue and discomfort. It is acceptable to use stability balls for short periods of time, but they do not provide adequate support for extended sitting.
- Learn about “tread desks,” which people have recently begun using (Lohr 2012). These workstations allow employees to walk on a treadmill at a slow (~3 mph) pace while working on their computer, talking on the phone, etc. It is a great option if space is available and the company is willing to make the investment.
- Encourage clients to take frequent movement breaks to stretch, walk around, etc.
Most jobs include one or more risk factors for WMSDs. An
ergonomist may be employed to analyze job tasks and implement corrective measures to help diminish or mitigate these risk factors and reduce the development of work-related injuries.
What Is Ergonomics?
Ergonomics is the science of adapting workplace conditions and job demands to the capability of the worker (OSHA 2000). Ergonomics draws on a number of scientific disciplines, including physiology, biomechanics, engineering, psychology, anthropometry, industrial hygiene and kinesiology. The goal of ergonomics is to reduce stress and eliminate injuries and disorders associated with poor posture and repeated tasks. This is accomplished by designing tasks, work spaces, controls, displays, tools, lighting and equipment to fit the employee ́s physical capabilities and limitations. A well-designed ergonomics program can help offset muscle imbalances, lessen muscle fatigue, increase productivity and reduce the number and severity of WMSDs (OSHA 2012).
Many solutions to ergonomic problems in the workplace are simple and inexpensive (OSHA 2000). For example, awkward and uncomfortable positions can be eliminated by
- adjusting the height of working surfaces;
- providing telephone headsets;
- supplying antifatigue mats;
- varying tasks;
- allowing short breaks;
- reducing the weight and size of items workers must lift;
- putting supplies and equipment within easy reach of the worker;
- providing ergonomic chairs or stools; and
- supplying the right tool for the job and the correct handle to fit the worker.
Since the repeal of the Occupational Safety and Health Administration’s ergonomics program standard in 2001, there has been no federal law mandating ergonomics regulation. Currently, California is the only state with an ergonomics standard; the Washington State Ergonomics Standard was repealed in 2003 (Ergoweb 2014). Consequently, companies must typically be convinced of the benefits in order to “buy in.” The most persuasive argument is the direct financial benefit derived from a more efficient and productive staff. Fewer injuries lead to less absenteeism, fewer workers’ compensation claims and longer careers. Employees feel valued when employers pay attention to ergonomics, because they know the company is attempting to make the workplace safer and more comfortable (OROSHA 2007). The benefits of investing in preventive ergonomic measures outweigh the cost of treating injuries, not to mention the loss of productivity and liability issues. For example, the direct cost of treating a lower-back WMSD is approximately $11,000, compared with the $600 preventive cost of purchasing a hydraulic lift (Washington State Department of Labor & Industries 2000).
No single variable has proven to be effective in decreasing the incidence of injuries. Most ergonomics programs focus on
- redesigning employees’ work environment and tasks;
- educating and training employees; and
- providing administrative guidelines.
Let’s look at back pain/injury, since it is a significant problem. Causal factors include lifting, carrying or holding heavy, awkward or odd-shaped items; lifting above the shoulders or below the knees; and rotating the spine while lifting. Figure 3 shows compressive force on the lumbar spine in various lifting positions (Chaffin 1997). According to this graph, holding the weight farther away from the body (20 inches) or bending down to pick something up off the floor places excessive force on the lumbar spine.
Measures that may minimize back injuries include the following:
- When redesigning employees’ work environment and tasks,
- adjust the height at which materials are handled;
- reduce the size and weight of objects lifted; and
- require employees to use mechanical lifting devices
- When educating and training employees,
- train the worker how to sit and lift properly, and with good posture (see Figure 4); and
- stress the importance of physical conditioning (strength, flexibility and core stability training).
- When providing administrative guidelines,
- follow OSHA guidelines for manual handling of materials (OSHA 2002);
- rotate job tasks and/or allow more frequent breaks; and
- assess employees’ strength/fitness levels to make sure they are capable of safely performing the required tasks.
Ergonomics Education and the Fitness Professional
While well-designed products can improve posture and body mechanics, ergonomics has become a buzzword that is frequently used in advertisements and sales pitches. Unfortunately for the consumer, there is no regulation of claims like “ergonomically designed” or “user-friendly” (Day 2014). Consequently, a lot of products declare themselves to be “ergonomic” when they are not. Consumers must evaluate items for ease of use, size/fit, weight and comfort. Fitness professionals can serve as a “bridge” for clients who are seeking out this information, but fitness pros are not ergonomics experts.
Ergonomics is a multidisciplinary field that includes environmental, human and engineering-related factors. There are many ways to pursue ergonomics training and education, including through continuing education credits, college courses, and undergraduate or graduate degrees. Only a few institutions offer an undergraduate degree that specializes in ergonomics—most degrees are earned at the master’s and doctoral levels (HFES 2014). Fitness professionals who want to expand their knowledge and skills, but don’t want to pursue a degree, may take courses and online classes at many institutions, including community colleges. OSHA offers online ergonomics certificates ranging from basic 1-hour courses to
30-hour courses that go into greater depth (for more information, see the “Ergonomics Education” sidebar).
Fitness professionals can educate their clients on the following topics:
- occupational WMSDs and ways to reduce risk;
- correct posture (sitting, standing, lifting); and (with the right
- ergonomically sound products.
Fitness professionals may also conduct training seminars for local businesses on topics such as how to have a healthy back, ways to avoid WMSDs, training techniques, nutrition, posture, etc. Finally, with additional training, fitness professionals can learn how to perform task analyses and evaluate workstations.
Training the Occupational Athlete
Work is an activity of daily living for most people. Fitness professionals already have a wealth of knowledge—on topics including physiology, biomechanics, posture and alignment—and can assess job-related stressors and design a program to help their clients mitigate WMSD issues. Below are some ways that fitness professionals can include ergonomics in their training protocols.
Proper Lifting Mechanics
Teach clients to lift and carry in the “power or strike zone,” which is close to the body, between midthigh and midchest height (see Figure 4). This is comparable to the strike zone in baseball, and it is from this zone that the arms and back can lift the most weight with the least amount of effort. When training a client in lifting mechanics, use these guidelines:
When lifting, always use a wide base of support for balance (feet spread apart), maintain a neutral spine, and keep the head and shoulders up. Flex at the hip and knee joint, using the hip and knee extensor muscles to perform the lift. Do not round the spine. Use abdominal bracing, which involves simultaneously contracting the abdominal, lower-back and gluteal muscles to provide additional support. Abdominal bracing has been shown to enhance stability of the spine and lower-back musculature (Vera-Garcia et al. 2007). Based on research from the National Institute for Occupational Safety and Health (NIOSH), OSHA, as well as other organizations, does not recommend the use of back belts among workers who have no history of prior back
injury (CNA 2010).
- First, size up the load. If the load is too heavy or awkward to move safely, get assistance or use a lifting aid, such as a dolly or a forklift.
- Remember that, as a general rule, it is safer to push an object than to pull it. Pulling primarily relies on the arms and back, whereas pushing allows you to get your body weight behind the object and use your legs. Another technique is to slide or “walk” the item rather than lift it.
- Avoid twisting the spine when carrying a load. Pivot with the feet, rather than rotating the spine.
PHYSICAL TRAINING AND CONDITIONING
Many job tasks predispose an individual to muscular imbalances that can increase the risk of developing a WMSD. Fitness professionals who have the necessary skills may perform assessments (muscle strength and endurance, flexibility, core stability and posture) to determine imbalances and design a program to address issues. An in-depth discussion of specific corrective exercises is beyond the scope of this article; however, here are some basic concepts.
Physical activity. Many workers spend most of the day in awkward, static positions. Therefore, one of the best things fitness professionals can do is to get clients up and moving. Taking a 5- to 10-minute break every hour can significantly reduce the risk of developing WMSDs. A pedometer or an activity tracker that monitors physical activity throughout the day is a great tool. It provides feedback, motivation and incentive. Fitness professionals can help their clients set goals and gradually increase their activity, and companies are often willing to invest in a pedometer program.
Flexibility. Many organizations recommend static stretching throughout the day as a way to reduce WMSDs; however, does research support this? A growing body of evidence suggests that, for athletes, traditional static stretching during the warm-up has little, if any, effect on postexercise soreness or risk of injury and may impair strength and power performance (Simic, Sarabon & Markovic 2013). Unfortunately, there is scant research on the effects of stretching in an occupational setting.
A recent review article by da Costa and Vieira (2008) examined seven studies that measured the ability of a stretching program to prevent WMSDs across several industries. The studies provided mixed findings but demonstrated some beneficial effects of stretching in preventing WMSDs. However, the authors expressed concern that stretching might mask employee discomfort and pain, potentially leading to more debilitating injuries. They also reported significant problems with the methodology of the current studies and identified a need for well-designed research.
In a perfect world, workstations and work demands would be designed to eliminate all WMSD risk factors. However, this is not realistic. Consequently, workers still need to offset the adverse effects of prolonged awkward and static postures. Until there is more definitive information on static stretching in occupational settings, a prudent approach is to include more active/dynamic stretches, or static stretches that are held for a shorter period of time (5–10 seconds).
For example, extended periods of sitting shorten the hip flexor muscles and contribute to “gluteal amnesia,” meaning that activation of the gluteal muscles decreases, which can contribute to lower-back strain. Therefore, it is useful for workers who sit most of the day to periodically perform standing lunges to actively stretch the hip flexor muscles while simultaneously activating (contracting) the gluteals. Range-of-motion stretches for the hands and forearms are also important.
Suggest that clients try the following stretches to avoid developing WMSDs. They can perform them seated or standing, from neutral position, using slow, controlled movement or holding the stretch for 5–10 seconds. Have them repeat the moves two to three times.
- shoulder rolls
- neck stretches: “yes, no, maybe”
- simple spinal rotation
- overhead stretches (back diver, lateral)
- chest stretch, including anterior deltoid and biceps
- fingers, hands and forearms
- lunges (hip flexor stretch) with guteal activation
- standing cat-cow stretch
Strength training. People who have a physically demanding job often balk at the need for additional training. They feel that their job provides all the exercise they need. Unfortunately, that is usually not the case. In actuality, job tasks often contribute to muscle imbalances, which can predispose a person to overuse injuries and WMSDs. One way fitness professionals can overcome that objection is to remind people that they are professional “occupational” athletes, and just like professional “sport” athletes, they need to train for their job so they can perform it safely and effectively. It would be ideal for them to work one-on-one with a fitness professional, but if that is not feasible, then a basic, functional, time-efficient strength training program is indicated. Focus on pushing, pulling, lifting and carrying load, as well as core strength and stability; for example, include dead lifts, push-ups or bench presses, chin-ups or bent-over rows, overhead presses, plank and gluteal bridge.
Practice What You Preach
Fitness professionals also have very physically demanding jobs and are exposed to a number of ergonomic hazards that can increase their risk of developing WMSDs. Merrick & Bracko (2005) examined ergonomic risks for fitness professionals and offered strategies for countering hazards in job tasks. Among the suggestions:
Repetitive stress. Fitness professionals are often required to lift a lot of weight throughout the day, so it is essential to use proper lifting form at all times (even when carrying weights to and from racks). Also, it is best to use light weights when demonstrating exercises; modeling correct form and alignment is more important than impressing clients with strength abilities. Group fitness instructors are at risk for repetitive stress disorders and must listen to their bodies and limit the number and types of classes they teach over the course of a day, week and month.
Awkward or static postures. Performing manual resistance and/ or assisted stretching on a client can result in excessive force or static muscle load. To avoid injury, fitness professionals can use towels or other assistive devices to improve leverage, or can ask another trainer for assistance, particularly with clients who are stronger and larger.
Contact stress. Fitness professionals can be prone to experiencing fatigue from standing, especially on a hard surface
like concrete. Antifatigue matting or properly designed floor systems may help prevent fatigue during continuous standing or exercise instruction.
If a client or coworker is experiencing pain or loss of function, the person should be referred to a medical professional for diagnosis and treatment. This applies to the fitness professional as well.
Offering a Solution
WMSDs are a significant problem, causing approximately 600,000 injuries/illnesses every year (almost two-thirds of them requiring time off work) and costing employers ~$120 billion per year in direct and indirect costs (OSHA 2014). Fitness professionals can have a significant impact on this costly and debilitating problem by understanding and applying basic principles of ergonomics. These include identifying and minimizing job-related risk factors; developing workers’ physical capabilities to enable them to perform jobs safely and effectively (whether they sit at a desk, load and unload packages, or fight fires); and educating clients to be more safety savvy. By recognizing job hazards and implementing simple strategies, fitness professionals can help their clients, as well as themselves, to reduce the risk of WMSDs.
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