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13 Articles in Volume 12, Issue #9
PROMPT Challenges PROP’s Petition
PROP Answers Questions Raised About Opioid Label Changes
PROP vs PROMPT: Who Speaks for the Pain Doctor?
PROP’s Petition: PPM’s Editorial Board Weighs in
Assessment of Long-term Outcomes Of Opioid Treatment: How to Set Goals and Objectives
Extracorporeal Shock Wave Therapy: Applications in Pain Medicine—Part One
Neck Pain: Diagnosis And Management
Part Two: Trigeminal Neuralgia: A Closer Look at This Enigmatic and Debilitating Disease
Reducing Musculoskeletal Disorders Through Ergonomics
Risk Evaluation and Mitigation Strategy Compliance
Treating the Opioid-addicted Chronic Pain Patient: The Role of Suboxone
Electromagnetic Devices: A New Partner in Pain Management
Methadone Management in a Patient With Pain and History Of Addiction

Reducing Musculoskeletal Disorders Through Ergonomics

Improving workstation ergonomics may reduce symptoms associated with musculoskeletal disorders.

Musculoskeletal disorders (MSDs) are classified as injuries that affect the joints, muscles, nerves, cartilage, tendons, and discs in the spine, according to the Centers for Disease Control and Prevention.1 Work-related MSDs can be an increasing concern for physicians—both for their patients and their staff. The science of ergonomics is an approach that aims to fit the workplace conditions and requirements to the worker, instead of having the worker adapt to an environment that may foster poor habits and painful conditions, such as carpal tunnel syndrome.2 Work-related MSDs typically include injuries to the shoulders, wrists, elbows, neck, back, and hands.1 Here, Practical Pain Management outlines ergonomic suggestions that can minimize painful stress and strain for your patients.

Risk Factors
According to the US Department of Labor, in 2010, the total number of private sector, state government, and local government cases that reported nonfatal occupational injuries and illnesses involving days away from work due to an MSD was 346,400. The median days away from work for this group, which is often a key measure of injury/illness severity, were 11.3

There are several work-related risk factors that may lead to MSDs. Though certain occupations are more prone to specific risk factors than others, in general, Table 1 outlines the common risk factors for workplace MSDs. The risk for developing an MSD increases in working environments that include multiple risk factors. The degree of risk also varies depending on duration, frequency, and exposure to the behaviors. For physicians who treat patients with MSD pain, it may be beneficial to inquire about the patient’s work environment to see if any repetitive work-related stressors may be risk factors. Signs and symptoms of MSDs can also vary (Table 2) depending on the nature of the occupation.

Workstation Ergonomics
Human beings were not made to sit in a chair for 8 hours per day, yet with the commonplace “desk job,” sitting in front of a computer has become a way of life. However, there are several basic workstation improvements that can be suggested to decrease strain and minimize MSD symptoms, ranging from reorganizing the items on your desk to utilizing ergonomically designed chairs. Figure 1 demonstrates the model ergonomic computer workstation.

Table 1: common Risk Factors for Workplace Musculoskeletal DisordersTable 2: Common Signs and Symptoms of Musculoskeletal Disorders

Before your patients go out and splurge on the ergonomic mesh chair with lumbar support, it’s important to first point out improvements they can make in their workstation setup. When sitting in a chair while working at the computer, your arms should form a 90° angle at the elbow. Chairs with adjustable arm rests or even without arm rests are best so you can avoid pressure on the elbows.

With the keyboard out in front of you, your hands and wrists should be in a neutral position. The keyboard you’re working on should, ideally, be flat on the desk. If the keyboard has little feet underneath that angle the keys, be sure to flip those feet up so the keys can lie flat. Hands and wrists should always be in a straight line. Constantly typing at an angle with bent wrists may lead to the development of carpal tunnel syndrome or tendonitis. Wrist rests that can be placed below the keyboard are useful and help keep your hands and wrists in a straight line and relaxed position. One way to tell whether you’re in a relaxed position is if you move your hands slowly toward the keyboard, you shouldn’t feel any tightness in your neck and back muscles. Also, try to avoid leaning your elbows on the desk, as this is bad for your muscles and nerves. Adjustable keyboards on hinged arms are also available, which may be beneficial for those workstations that aren’t so easily maneuvered.

An adjustable chair and/or work table is your best friend when it comes to preventing leg and lower back pain at your desk. Always try to adjust your station to you, rather than you adjust to your station, in order to maintain relaxed muscles in neutral positions. When sitting in a chair, your feet should be flat and your legs should form a 90° angle at the knee. If the angle is less than 90°, adjust the chair up slightly until your thighs are just lightly supported. You don’t want all of your weight resting on the chair because that causes prolonged pressure on the thighs.

In order to ensure your legs are at that desired 90° angle, using a foot rest may be beneficial in order to keep you feet flat if your chair isn’t adjustable. For women, high-heeled shoes are discouraged, as this would hinder keeping your feet in a flat, neutral position, and put a lot of unnecessary pressure on the body. However, if you must wear heels, it may be best to keep a pair of flat-heeled shoes at your work desk so you can change into them when you expect to be at your desk for long, uninterrupted periods of time.

A back rest for lumbar support can also be beneficial in preventing back strain. Just make sure you’re sitting all the way back in your chair and the back rest supports the lower curve of your spine.

Figure 1. A model ergonomic layout of a computer workstation.Figure 1. A model ergonomic layout of a computer workstation.

Staring down at your desk all day puts unnecessary strain on your neck. You don’t want to have your muscles stretched in one position for too long. To prevent uncomfortable neck strain, first ensure that your computer is set up in the correct position on your desk.

Once your chair and keyboard are adjusted correctly, make sure your computer monitor is at arm’s length in front of you, not too close or far away. Next, ensure the top of the computer screen is at or below eye level. This will minimize neck strain and ensure you’re not tilting your head up or down for extended periods of time. After this adjustment, if you find your monitor is too low, prop it up with a stand or try to adjust it by putting a book or two under the feet of the monitor.

A document holder is another beneficial tool to decrease the strain on your neck. Additionally, glare guards or even eyeglasses may be needed to reduce the glare from the computer screen. It’s important to take deep winks occasionally and allow your eyes to rest so they don’t get fatigued.

In general, it’s important to keep things within easy reach, and plan ahead based on the task you’ll be performing. For example, if you know you’ll be on the phone for a long time, use a Bluetooth headset to avoid neck strain from holding the receiver on your neck.

Any ergonomic adjustment will take time to get used to and feel benefit from. And in the beginning, your patients may notice more of an annoyance in routine disruption, but over time, these recommendations can decrease unnecessary strain on our bodies and minimize MSD symptoms.

Last updated on: November 5, 2012
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