Musculoskeletal Injury Awareness and Prevention

Musculoskeletal Injury Awareness and Prevention. Auto Parts Network.

Housekeeping. Building Orientation Cell Phones Emergency Response Plan Building Muster Station Introduction Instructor Introduction Participant Introduction.

Course Objective. The objective of this course is to inform participants on how to prevent Musculoskeletal Injuries (MSI’s) from occurring in the workplace. This course will provide participants with the knowledge to identify MSI hazards in the workplace and apply appropriate controls that will be effective in preventing or mitigating the risk of a musculoskeletal injury occurring. This training meets the requirements of WorkplaceNL’s Client Service Procedure Manual – 507.00 PRIME Path 2 Employers (OHS Certification) Criteria..

Course Outline. Module 1 : Introduction Module 2 : Legislative Requirements Module 3 : Signs and Symptoms and Reporting Module 4 : MSI Hazards, Risk Factors and Controls Module 5 : Proper Body Mechanics for Manual Handling Module 6 : Workstation Set-up Module 7 : Applying Ergonomics to the Workplace Module 8 : The Role of Exercise in Preventing or Minimizing the Risk of MSI’s Conclusion.

Module 1. Introduction.

[Audio] A musculoskeletal injury (MSI) is an injury or disorder of the muscles, tendons, ligaments, joints, nerves, blood vessels or related soft tissue, including a sprain, strain and inflammation, that may be caused or aggravated by work. They can occur anywhere in the body; but often involve the back, wrist, elbow and/or shoulder. MSIs can result from a single traumatic event, such as lifting a heavy load, or they can develop over time as a result of cumulative damage to a body tissue(s), such as working for prolonged periods at a workstation that is too high. The term MSI is used in Newfoundland and Labrador. Other terms with similar meanings include: Soft-tissue injury (STI) Musculoskeletal disorder (MSD) Work-related musculoskeletal disorder (WMSD) Repetitive strain injury (RSI) Repetitive motion injury (RMI) Occupational overuse syndrome (OOS) Cumulative trauma disorder (CTD) Whatever term is used, they refer to the same types of injuries in the workplace. Though soft tissues can get injured from causes other than poor ergonomics (e.g. transportation accidents, being struck, pinched or compressed by objects, falling on a slippery floor, assaults and violent acts), ergonomics-related hazards are the cause of a large number of these injuries in NL and this training course was designed specifically to address MSI prevention through ergonomics..

[Audio] Ergonomics is a science dedicated to designing jobs, tasks, products, environments, and systems to make them compatible with the needs, abilities and limitations of people. The overarching statement that is often used to describe ergonomics is fitting the job to the person, and not the person to the job. Practicing ergonomics is like saying "I am a human and everything around me must suit me so I am safe and more productive". Poor ergonomics at work or home can negatively affect our health and safety and enjoyment of what we do. Practice good ergonomics to prevent MSIs..

[Audio] In order for people to work effectively, we have to design work according to the physical size and shape of people, and their capabilities in relation to work characteristics. Proper ergonomics considers the shapes and sizes of the workers (height, weight, reach), the physical capabilities of the workers (strength, endurance, ability to move freely) as well as the characteristics of the work (work processes, tools used, work environment, the pace, layout and flow of work). These capabilities and work characteristics will differ from one individual to another. People who design work must break the work down into individual tasks and determine how the job is done and potential stresses that may be placed on the body. MSI hazards are created when the workplace design and work organization fail to meet the worker's physical and mental needs..

[Audio] Generally, MSIs are slowly declining. However, they still account for approximately 70 per cent of all lost-time claims accepted by WorkplaceNL. This translates into approximately $90 million a year in claims costs, due in part to the longer recovery time it takes for a person to be well enough to go back to work. The longer a person is away from work, the more costly the injury becomes for employers and injured workers. Injuries can range from mild discomfort to severe disability. Generally speaking, the more severe the injury, the higher the cost to employers and workers..

Module 2. Legislative Requirements.

[Audio] Trainer to introduce and briefly discuss the learning objectives. Reference occupational health and safety legislation related to MSI prevention Explain the importance of the internal responsibility system Summarize the basic rights of workers Discuss roles of workplace parties in MSI prevention.

[Audio] In light of the prevalence of MSI injuries in NL, there were specific sections added to the OHS Regulations in 2009 for MSI prevention. Part VI, Occupational Health Requirements, Section 50 – 56 of the provincial OHS regulations require employers to recognize factors in the workplace that may expose workers to a risk of MSI, evaluate this risk and establish controls for workers to implement or follow. OHS committees, WH&S representatives/designate; and workers who show signs or symptoms of MSIs are to be consulted when risk assessments are performed by the employer. Education and training is to be delivered to workers in the controls they are required to use. There are specific sections for seating or standing work, and lifting and handling..

[Audio] Now that we have reviewed some of the applicable legislation we will now turn our attention to the OHS responsibilities in the workplace. The underlying philosophy of OHS legislation in all Canadian jurisdictions is the internal responsibility system, or IRS. The IRS is a culture of health and safety where every individual and job position within an organization - workers, supervisors, employers, OHS committees, WHS representatives/designates – have a role and personal responsibility in OHS. Through the IRS, the OHS Act assigns responsibility to each person in the workplace for creating and maintaining a safe and healthy workplace, to the extent they have the authority and ability to do so. An example to use to illustrate this responsibility can be to compare it to the roles and responsibilities of road safety. Legislators set the rules for using our streets and highways in a safe manner. By setting these rules, this gives them the authority to enforce when the general public does not follow these rules. The general public has the responsibility to follow the rules, and are accountable when these rules are broken..

[Audio] The IRS gives workplace parties roles in OHS, including MSI prevention. The IRS assigns responsibilities and accountabilities to everyone in identifying MSI hazards, evaluating risk and finding ways to eliminate MSI hazards or reduce risk to workers. The roles and responsibilities in MSI prevention are directly related to the IRS. For example, employers and supervisors are responsible to conduct MSI risk assessments in consultation with workers, while workers are responsible to participate in them. Section 50 – 56 of the OHS regulations gives them these responsibilities. A workplace where MSI prevention is at the forefront is a workplace where everyone knows and understands their own, and others' roles and responsibilities. It is the job of the employer to write these in a clear and consistent manner where there is direct connections between roles, and to educate and train workers in these roles. In addition, they must also communicate roles and responsibilities in a manner that is understandable to workers. When everyone is involved in the process for developing and linking roles and responsibilities for MSI prevention, the likelihood of compliance is increased..

[Audio] MSI basics lay the foundation for upcoming learning activities. Handling materials in a warehouse or patients in a healthcare facility, operating harvesting equipment in the woodlands, standing at a manufacturing assembly line, and sitting in an office are all examples of job tasks completed in our province every day. Even though these jobs are all different, the body itself and the way it moves during work is the same. The body is made up of bones, joints, cartilage, ligaments, tendons, muscles, nerves, and various other tissues. Knowing the basic anatomy, or structure, of the body and how the various body tissues become injured will help you understand the cause of MSIs..

[Audio] Signs and symptoms of MSIs range from minor discomfort to severe pain. They may be the result of an acute injury, or appear gradually over time and lead into chronic conditions. General signs and symptoms commonly reported typically occur in any combination, and vary between individuals. Like an alarm system, these signs/symptoms are our body's way of telling us something is wrong, that there is something irritating the body part affected. Typically, there is a gradual onset of MSIs that present as a combination of any of the signs and symptoms listed on the slide. Workers must not ignore these symptoms and hope they go away on their own with no intervention. The likelihood of that happening is low..

Signs of MSI’s. Signs of MSI’s can be seen Decreased range of motion Redness/swelling Loss of normal sensation Decreased grip strength Loss of normal movement Loss of coordination.

Symptoms of MSI’s. Symptoms of MSI’s need to be described Excessive fatigue in the shoulders and neck Tingling, burning, and other pain symptoms Weak grip, cramping of hands Numbness Clumsiness and dropping of objects Hypersensitivity.

[Audio] Report any signs and symptoms to your supervisor/employer, even if you are not sure what is causing them. Sometimes it is not obvious whether symptoms are related to work. Early treatment may prevent symptoms from worsening, and prevent further damage to soft tissues. Other benefits of early reporting include: Improvements can be made to your job and workstation Hazards that contributed to symptoms can be eliminated Regular activities at home may be continued Claims to WorkplaceNL for medical aid or compensation may be avoided.

Reporting MSI’s. Once a Hazard Report Form has been completed and submitted the hazard will be assessed and recommendations and corrective actions identified. If you notice a MSI hazard that is out of your control to fix, you can report it to your supervisor or a member of the OH&S Committee..

Ways To Report. Pre-Job Hazard Assessment. HAZARD Ass Ope"ing Lift sos.

Employer Responsibility. It is the employer’s responsibility to recognize potential MSI risk factors, evaluate the risk and implement effective controls. Employers are also required to train workers in risk identification and specific control measures..

[Audio] The low back or lumbar spine, is most vulnerable to MSIs. Activities that increase this risk include: Lifting Pushing Pulling Frequent bent or twisted positions Sitting and standing for long periods of time without changing your posture Heavy lifting, even when done with good posture, also increases pressure on your spinal discs and can cause disc damage. Excessively heavy loads can also damage vertebrae (spine bones) by way of fractures. Definition of herniated disc: Occurs when some of the softer 'gel' of the nucleus pushes out through a tear in the exterior of a spinal disc (annulus). A herniated disc that presses against a nearby nerve can cause pain, numbness, or weakness in an arm or leg..

Other Potential Health Effects on the Body. Additional MSI Issues Neck and shoulder pain Repetitive strain injuries (RSIs) Muscular strain and stiffness Circulatory and nerve issues Numbness and tingling Varicose veins Eye and vision strain Headaches Blurred vision Fatigue and reduced productivity Low energy levels Psychological effects Stress and irritability Long-term health impacts Chronic MSI conditions Permanent postural changes.

[Audio] A hazard is any condition, practice or behavior that has the potential to cause harm or loss due to an injury, illness, disease or property damage. We can describe ergonomic (MSI) hazards as physical factors in the environment that may cause harm in the form of a musculoskeletal injury. A risk factor is a condition or variable which increases the chance that an injury may occur . Ergonomic (MSI) risk factors are ways that you perform your work that increases the chance of injury. Ergonomic (MSI) risk factors include work patterns such as repetitive motions, forceful exertions, or sustained or awkward postures. The terms risk and hazard are commonly used interchangeably. Using this logic, we can apply the hazard recognition, evaluation and control process to MSI risk factors. It is the responsibility of the employer to identify the risk factors that may expose workers to MSIs, evaluate the risk to workers, and to implement control measures to eliminate or minimize the risk, all with the involvement of the worker..

[Audio] There may be many tasks placing you at risk of an MSI. The best way to manage the risks is through a systematic process of recognizing and eliminating hazards and evaluating and controlling risk. Hazard recognition, evaluation, and control (REC) is the foundation for an effective OHS program. In order to eliminate workplace hazards (including MSI hazards) and minimize risk, there must be a process for recognizing them, evaluating the risk they pose, and selecting the best method to control them..

[Audio] Risk describes the odds that an MSI hazard will cause harm and takes into account the severity of a potential MSI and the probability of an MSI occurring as a result of exposure to the hazard. Severity refers to the loss most likely to occur when a particular task is performed. The harm experienced by workers resulting from exposure to MSI hazards is often difficult to see by the untrained eye, but is nonetheless significantly affecting the worker. Probability considers how likely it is that a loss will occur when a particular task is performed. Probability usually increases when two or more hazards are present at once. Both the severity and the probability of a hazard or task are ranked independently on a numerical scale. Once values have been assigned to both, they are then multiplied to determine risk (as per the equation shown). Risk can then be used to help set priorities for control. A higher score means higher risk. Severity X Probability = Risk.

[Audio] Most risk matrices have at least three areas: Green (low probability, low severity area) = Low Risk This area indicates the risk of an event is not high or that it is sufficiently controlled. Corrective action is usually not needed. Red (high probability, high severity area) = High Risk This area indicates an event needs control measures to bring the probability or severity down. Yellow (the area in between) = Moderate Risk Any event that falls in this area is usually judged to be one that needs to be monitored, but is controlled as low as reasonably practicable. Essentially it means if we keep the risk at that level, we accept it..

[Audio] When evaluating the severity and probability that an MSI risk factor will cause injury or damage, the magnitude (intensity) of the hazard and the duration and frequency of exposure to the hazard must be considered since these factors will influence the overall risk of MSI. Magnitude of hazard - how awkward, how fast, how much force, how hard is the contact surface? The more awkward the posture, or the greater the magnitude (of force, for example), the greater the risk Duration of exposure - increased duration equals increased risk Frequency of exposure - increased frequency (of the same motion OR the same muscles used) equals increased risk.

[Audio] The selection of controls is based on the method that provides the most protection to workers and the workplace. Elimination – physically remove the hazard. For example: Using material handling equipment rather than have workers lift, lower, or carry materials manually (e.g. a backhoe to replace manual shovelling) Substitution – replace the hazard. For example: Replace a traditional stapler with an electric one that requires less force Engineering controls – make physical changes to the workplace, workstation, work process or tool to improve the 'fit' of the job to the worker. Some examples of engineering controls include: Height-adjustable worktables and platforms to accommodate workers of different heights Suspend heavy tools using tool balancers (spring-loaded support cables) to reduce force Using lifting equipment (e.g., forklift, pallet jack, etc.). Administrative controls – change the way people work. For example: Rotating workers through jobs to decrease the time spent on repetitive tasks Creating safe work practices and safe job procedures Personal protective equipment (PPE) – reduces the severity of exposure to the hazard. It includes articles that can be worn or attached to place a barrier between the worker and the hazard. For example: Vibration-absorbing gloves When implementing hazard controls, the goal is to strive to achieve the highest level of worker protection available..

[Audio] The four most common risk factors that cause MSIs in workplaces include: Awkward postures Sustained postures Forceful exertions Repetitive motions Other not so common MSI hazards include: Local contact stresses Vibrations Insufficient lighting Adverse temperatures.

[Audio] An awkward posture is described as one that requires a body part to move away from its neutral or natural position. Awkward postures force muscles, tendons and ligaments of the body to work harder and awkward back postures place increased pressure on spinal discs. When working, avoid or minimize the number of times you do the following activities: Reach in front of your body or to one side Reach overhead Twist your back Bend your back forward, backward or to one side Bend or twist your wrists Turn or bend your neck Kneel, squat or stoop.

[Audio] Sustained postures refer to holding the body, or a part of the body, in one position for an extended period. Even keeping a neutral posture for an extended period can have negative effects (i.e. neutral sitting or standing). Examples of sustained postures include prolonged or extended periods of: Sitting (regardless if neutral posture is used) Standing (regardless if neutral posture is used) Raising the arms to work at a table that is too high Holding the arms in front of the body to work on a product that is too far away Elevating the arms to perform overhead work Gripping a tool or object Stooping or crouching.

[Audio] Forceful exertions refer to the effort that a muscle or group of muscles must exert to complete a job or task. The more muscular effort required to perform a task, the more stress is placed on body tissues such as muscles, ligaments, joints and intervertebral discs, increasing the risk of an MSI. The handling of loads has the potential to require high amounts of force and increase MSI risk. Manual handling occurs in every work environment. Examples include: Lifting boxes on a packaging line Forcing on a rachet Pushing or pulling carts Squeezing tin cutter pliers to cut sheet metal Manual order picking Loading and unloading trucks Operating a heavy tool above the head Mopping and vacuuming floors Moving trolleys in crammed spaces The back is the most common body part injured from forceful exertions, with the lumbar region, or low back, being most vulnerable..

[Audio] Repetition motions refer to using the same muscles repeatedly. It occurs when the same task is performed over and over, or when different tasks are performed using the same muscles. Without sufficient time for muscles to rest, fatigue develops, causing injury. Examples of repetitive motions include: Working the same station in an assembly plant for long periods Loading or unloading pallets Stamping dozens of papers Climbing stairs Prolonged use of a computer mouse or keyboard Turning socket wrenches Using a knife to repeatedly perform the same cut Using a paint brush for long periods Hours of filing, day after day Sweeping or mopping in custodial work.

[Audio] While some personal risk factors (such as age) cannot be changed, we must still be aware that limitations exist within each person which may put them at a higher risk of MSI. Personal risk factors include: Age Physical limitations Physical fitness Education, training and experience Attitude.

[Audio] Young workers are still developing and their spine and other joints may be more easily damaged Aging workers may have reduced Range of movement Fitness level Muscle strength With age comes declining Strength Flexibility Reaction time Ability to maintain good posture and balance.

[Audio] In general, males are stronger than females (there are exceptions). Strength varies between individuals. There may be a specific disability or illness that produces physical restrictions, which may increase risk. A history of back disorders may increase risk of future back injuries. Pregnant workers or those having recently given birth may be at increased risk. Hormonal changes affect ligaments and spinal joints become less stable. In pregnancy, the abdomen becomes increasingly larger causing progressive postural problems and reduced agility, coordination and balance. When lifting it becomes more difficult to hold the load close to the spine, which increases muscle effort. Risk factors of particular concern are awkward postures, heavy lifting, repetitive force (e.g. lifting, carrying, pushing, pulling) and limited rest periods. Employers must continue to provide a safe and comfortable workplace..

[Audio] The amount of core muscular endurance, leg strength, and joint mobility (e.g. ankles, knees, hips, shoulders) a worker has will influence body mechanics Excess body weight increases stress on joints and makes it difficult for an individual to get a load close to the spine.

[Audio] Some tasks require specific skills and training; Inadequate education and training in safe lifting and handling principles and techniques increase the likelihood of workers using poor body mechanics and awkward postures.

[Audio] A worker's attitude will influence whether they follow safe work practices and procedures Examples: using proper body mechanics using safe lifting techniques wearing personal protective equipment (e.g. anti-vibration gloves) The mindset that all work-related injuries and illnesses are preventable is necessary to create a stronger safety culture..

[Audio] After each of the MSI risk factors has been evaluated, and priorities have been identified, controls should be put in place to either eliminate the hazards or reduce the risk of MSIs. Effective controls for MSI risk factors are not always elaborate or expensive. Often a simple change in a work process, workstation, or tool is effective. An example is placing a stack of books or paper underneath a computer monitor to raise its height..

[Audio] Each of the factors listed on the slide influence the magnitude of a hazard and the duration and frequency of exposure to the hazards. Workplace design and conditions (e.g. inappropriate working heights and reaches) The way work is organized (e.g. lack of task variety); job demands and control (e.g. in the fishing industry where there are tight deadlines for quotas to be caught and seafood to be processed) Supports in the workplace (e.g. insufficient staffing levels to share the workload) Availability and use of personal protective equipment (e.g. knee pads for kneeling/floor-level work, footwear with shock-absorbing insoles for work on concrete floors, breathable clothing for working in warmer temperatures) A worker's personal health and wellness (e.g. their physical condition, water intake, amount of rest and posture) These factors are explained next..

[Audio] Work organization is the manner in which your work is carried out. Change up your job tasks, set a reasonable pace for work and take regular breaks. This can reduce your MSI risk as well as improve your productivity. Some jobs have periods of peak work demands. This is common in seasonal work; for example, in the fishing industry where there are tight deadlines for quotas to be caught and seafood to be processed. Situations like these may force workers to work faster, or to skip breaks, increasing the rate of fatigue and consequent risk of injury. This is where we can implement controls such as job rotation and work breaks so that production can stay high while still avoiding injury. Job rotation involves workers changing jobs or workstations at certain time intervals so each worker takes on a variety of duties to prevent muscle fatigue..

[Audio] Support in the workplace is important to keep workers happy, healthy and safe. Lack of support in the workplace may increase a worker's risk of developing an MSI..

[Audio] Did you know there is a connection between your own personal health and wellness and MSI prevention? Studies have shown that healthy people are more alert and able to respond more quickly to unexpected events, which make them less likely to become injured. If these workers do become injured, studies show that they generally recover more quickly. Healthy workers are more likely to be more productive and experience less sick time. Take responsibility for your own health, safety and well-being. In addition to using good and safe postures every day, you also need adequate exercise, nutrition, hydration, and rest. All of these activities will enhance your personal health and wellness and reduce your risk of developing MSIs. Movement and exercise Your body was designed to move and be active. Physical activity is essential to good health. There are many benefits to regular exercise, including Improved muscle strength and endurance Increased support to joints and spine Decreased muscle stiffness Improved posture Movement or exercise bouts can be broken up into small increments throughout the day. Even two or three ten-minute sessions is better than nothing. A full thirty minutes or hour is not required to feel the positive benefits of movement on your body. Nutrition Along with exercise, eating a balanced diet of a variety of foods and nutrients will help keep your body strong and fit. A balanced diet also nourishes your body. Your musculoskeletal system requires certain nutrients to function optimally in terms of muscle growth, performance and recovery. Protein - repairs muscle cells and make new ones Zinc - supports bone and muscle growth, boosts your immune system and acts as an anti-inflammatory which helps to repair damaged cells Calcium - supports bone health, including the spine, but is also essential for muscle function and nerve transmission Vitamin D - regulates calcium and promotes calcification of bones Magnesium - maintains normal muscle function, strong bones and a healthy immune system Water Water transports essential vitamins and minerals throughout your body and helps flush toxins and waste products (e.g. lactic acid, uric acid, ammonia) out of your soft tissues. Poor hydration interferes with this transport and flushing ability and results in reduced strength and energy. Even mild dehydration can drain your energy and make you feel tired. Among other benefits, proper water intake: lubricates and cushions your joints and prevents joint stiffness helps maintain resilient ligaments and tendons regulates your body temperature boosts your muscles with energy minimizes fatigue helps you break up prolonged periods of sitting Sleep Sleep helps the body to heal, regenerate, and recover from the day's activities. Insufficient sleep can lead to fatigue, which studies report can lead to impaired judgement and decision making ability, reduced response time (both in speed and thought), and increased tendency for risk-taking, to name a few effects. When tired, people tend to take shortcuts and be less conscious of their postures. Good posture Neutral postures should be practiced and used both inside and outside your workplace. Practice neutral postures in your everyday life so it becomes a habit. That way, when life throws stressful situations at you, you will not need to make a conscious effort to use neutral postures as your body will naturally take you there. When you sit during leisure time, avoid slouching, sitting on your leg, excessively bending your neck when using mobile devices, and shrugging your shoulders to use computer. Sit and stand upright with your back curves maintained (place a cushion behind your back if necessary) and keep your shoulders relaxed at your sides. Lastly, make sure your home computer workstation is set.

[Audio] Manual materials handling includes any way in which workers physically move a load. Examples include lifting, lowering, pushing, pulling, carrying, and holding. In Newfoundland and Labrador, more workers are injured from overexertion in lifting than any other cause. Keep in mind that the best control measure to prevent injury is to eliminate the need for workers to perform manual handling tasks..

[Audio] Planning the move is the first step in any manual material handling task. Planning helps us avoid the unexpected by recognizing physical factors that could lead to an incident or an MSI. The first question in your mind should not be "How do I lift this?". Rather, it should be "Do I need to lift this – is there another way of doing the work?" Assistive devices should be considered first. If you choose to lift or move the load, look for the safest method and develop a plan..

[Audio] Fifty per cent of joint stiffness can be reduced by just two minutes of stretching (McGill and Brown, 1992). Warming up feeds your muscles with oxygen, fuel and nutrients, and prepares your muscles for job demands. Warming up can also enhance muscular balance and coordination, and improve body mechanics. If you perform physically demanding tasks (e.g. manual handling), your warm ups should consist of stretches that involve movement (e.g. squats, lunges, arm swings) rather than stationary stretches (e.g. pulling arm across chest and holding to stretch the shoulder)..

[Audio] Workers need to be trained in the multiple principles of good body mechanics so they are able to select the safest lifting technique for a given task, and to judge whether the task is safe to perform in the first place..