Ergonomics

Ergonomics

Dr. Dalia Galal El Sayed

Dr. Bassem Fouda
Dr. Sarah Sami
Dr. Ahmed A. Al Hady
Lecturers at Surgery Department
Faculty of Physical Therapy
MTI University
University: Modern University for Technology and Information

Faculty: Physical Therapy

Course Specifications
2022- 2023

A. Basic Information

1. Program Title: Physical Therapy

Department Offering the Program (s): …… Department of physical therapy for dermatology
and burn………………………

2. Department Responsible For the Course: …… Department of physical therapy for

dermatology and burn………………….

3. Course Title and Code: Ergonomic (pt4822)

4. Year/ Level: 4th Year/ Level 7

5. Credit Hours/ Units:3

Lecture: 2 H/W Practical: 1 - H/W Clinical: 0 H/W

6. Authorization Date of Course Specification: ……25 – 9 -2021……………..

B. Professional Information

1. Course Aims:
This course aim to:
● Understanding an overall state of knowledge related to ergonomic principles.
● Integrate knowledge and understanding from a limited range of ergonomics domains
to formulate robust and viable solutions to real-world problems.
● Understand and be able to apply a limited range of ergonomics techniques, methods
and approaches, while taking into account practical limitations.
● Critically evaluate the ergonomics research work of others in terms of approach and
methodology
● Take responsibility for their own work, including managing their own time, adhering
to deadlines and targets.
● Understand the issues associated with working in teams and groups, and have
developed team-working.
● Ensure that a product or service will be used by their customers comfortably,
efficiently and safely.
 2. Intended Learning Outcomes From The Course (ILOs):

A. Knowledge and Understanding

On completion of the course the students will be able to:
a.1- Understanding an overall state of knowledge related to ergonomic principles. (A1)
a.2- Integrate knowledge and understanding from a limited range of ergonomics (A2)
a.3-Critically evaluate the ergonomics research work of others in terms of approach and
methodology(A4)

B. Intellectual Skills
On completion of the course the students will be able to:
b.1 - Achieve a creative thinking about their own work, including managing their own time
adhering to deadlines and targets(B1)
b .2- Analyze data of ergonomics using information technology, library and appropriate
techniques.(B5)
b.3-Understand the issues associated with working in teams and groups, and have developed
team-working. (B7)
bI4:- Analyze information from a number of sources of ergonomics in order to gain a coherent
understanding of a clinical case(B9)
C. Professional and Practical Skills
N/A
D. General and Transferable Skills
On completion of the course students should be able to:
d.1- Participate effectively as a member of a team and participate constructively in groups
(D2)
3. Course Content:

No. of Semester Hour (s)

# Topics
Lecture Practical Clinical
1. 1 1 0
Introduction to Ergonomics
- category
2. Biomechanical Background of Ergonomics 1 1 0
- stages
3. Human-Machine System 1 1 0
- types
4. Ergonomics for Posture 1 1 0
- details
5. Ergonomics for Movements 1 1 0
- mechanics
6. Work Related Musculoskeletal Disorder 1 1 0
Assessment and Prevention
- evaluation
 7. Midterm exam 1 1 0
8. Work Related Musculoskeletal Disorder - - 0
Assessment and Prevention
- etiology
9. Work-Related Musculoskeletal Discomfort 1 1 0
in the Neck & Shoulder due to Computer
Use
- robotes
10. P
Common Examples of Lack of Ergonomics 1 1 0
in Computer Workplace
- labs
11. Ergonomic Impact of Spinal Loading 1 1 0
Recovery Positions on Intervertebral Disc
Health & Strategies for Prevention and
Management of Low Back Pain
- Types
12. Information& Operation (Visual, Hearing & 1 1 0
Control)
- details
13. Accommodation through Improved Design – 1 1 0
Practical Situation
- Sensory integration
14. Ergonomics and Assistive Technology 1 1 0
- Common
15. Seats, Seating, and Seat Selection:
Implications for Pressure Ulcers
- Wound healing

4. Teaching and Learning Methods:

4.1- Lectures
4-2 -Practical lessons
4-3 -Case study
4-4 Group Discussion
4-5 Applied Projects
4-6 E- learning

5. Student Assessment:

# Assessment Method Assessed ILO

5.1- Applied Project
5.1- Theoretical midterm 6th a1-3, b1
5.2- Final term exams 13th a 4,b 2-3,d1
 # Assessment method Semester Weighting
week (%)
1. Research Paper and Mid-Term Exam 4th , 7th 10%
2. Project and Discussion 8Th 30%
3. Final Exam 13th 60%
Total 100%

Any Other Formative Assessment

Non
6. List Of Text Books And References:
Berlaa, M. & Valéria Sousab, A. (2015). Implantation of an ergonomics administration
system in a company: report of an occupational therapist specialist in ergonomics. Work
41 (2012) 2637-2642 DOI: 10.3233/WOR-2012-0655-2637
Hada,M, Yamadam ,D.& Tsuji, T.( 2006) .Equivalent Inertia of Human-Machine Systems
under Constraint Environments. DOI: 10.9746/sicetr1965.42.156
https://www.researchgate.net/publication/228900095
Haque, M.( 2015). Ergonomics, Biomechanics & Musculoskeletal Disorder- A
https://www.researchgate.net/publication/288725523
Kumar, S. (2009) .Ergonomics for Rehabilitation Profession.3rd Edition
Mallick , Z & Asjad ,M.( 2017). A Review of Ergonomic Aspects of Hearing
Impairment of Humans in Different Environments. International Journal of Scientific &
Engineering Research Volume 8, Issue 7, July-2017 ISSN 2229-5518.
http://www.ijser.org.
Minga, Z., Närhi ,M & Siivola,J.(2004). Neck and shoulder pain related to computer use.
Pathophysiology 11 (2004) 51–56. doi:10.1016/j.pathophys.2004.03.001
Owens, S., Gerke, D. & Brismee, J. (2019) Ergonomic Impact of Spinal Loading and
Recovery Positions on Intervertebral Disc Health: Strategies for Prevention and
Management of Low Back Pain. Book Citation Index.
https://www.therapeuticassociates.com/health-wellness/ergonomics/ergonomic-risk-
mitigation-and-prevention/
https://uwaterloo.ca/safety-office/occupational-health-safety/ergonomics/general-
ergonomics-guidelines
7. Facilities Required For Teaching And Learning:

● Appropriate teaching room.

● Academic Library.

Head : Dr .dalia Galal

Course Coordinator: Dr Dalia Galal
Dean: Prof. Dr. Naguib Salem.
Date: 25- 9- 2021
Ergonomics PT4822

Content
Title Page Number
Introduction 1
Biomechanical Background of Ergonomics 10
Human Machine System 13
Ergonomics for Posture 17
Ergonomics for Movements 28
Work Related Musculoskeletal Disorder Assessment and 37
Prevention
Work-Related Musculoskeletal Discomfort in the Neck & 42
Shoulder due to Computer Use
Common Examples of Lack of Ergonomics in Computer 50
Workplace
Ergonomic Impact of Spinal Loading Recovery Positions on 53
Intervertebral Disc Health & Strategies for Prevention and
Management of Low Back Pain
Information& Operation (Visual, Hearing & Control) 58
Accommodation through Improved Design 65
Ergonomics and Assistive Technology 76
Seats, Seating, and Seat Selection: Implications for Pressure 81
Ulcers
Practical Situations and Solutions 87
Ergonomics in Dentistry 92
References 98
Ergonomics PT4822

Introduction

Ergonomics is the science of fitting the job to the person, rather

than requiring the person to conform to the physical parameters of the
job. An Ergonomic Evaluation is a formal, structured process that
assesses many physical and cognitive parameters of the worker, the
workspace, and the job characteristics to determine if the job fits the
worker and to identify ALL risk factors.

What is important about this?

Adapting the job to the worker helps lower risk factors that can
lead to injury, improves productivity, and increases employee morale.
Ergonomics focuses on the work environment, ensuring the demands of
the job match the employee’s physical capabilities. Workplace conditions
may be restructured or modified to reduce stressors that cause
musculoskeletal disorders (MSD’s). The demands of today’s jobs require
an unprecedented amount of attention, diligence, and productivity.
Sometimes work environment safety is overlooked to reach efficiency
goals.

Fig 1. Optimum Sitting Position

Ergonomics PT4822

Biomechanics is the study of body movements and the forces

acting upon the musculoskeletal system. Physical Therapists have
extensive education and experience evaluating the mechanical forces at
work in the human body. Injuries typically occur when biomechanical
forces exceed the biomechanical limitations of soft tissue or bone. When
combined with biomechanical forces, environmental and ergonomic
factors have a cumulative effect on physical health.

Identifying Ergonomic Hazards

Ergonomic hazards refer to workplace conditions that pose risk of

injury to the musculoskeletal system of the worker. Examples of
musculoskeletal injuries include tennis elbow (an inflammation of a
tendon in the elbow) and carpal tunnel syndrome (a condition affecting
the hand and wrist). Ergonomic hazards include repetitive and forceful
movements, vibration, temperature extremes, and awkward postures that
arise from improper work methods and improperly designed
workstations, tools, and equipment.

Ergonomic hazards can occur in many workplace settings and are

not limited to just physically demanding jobs.

Common areas of Concern

• Equipment layout and operation

• Noise

• Temperature

• Workstations (sitting and standing)

• Computer systems

• Lighting
Ergonomics PT4822

Risk Factors (What to look for)

• Significant static loading (awkward posture)

• Continual repetition of movements

• Substantial repeated force

• Environmental Factors

• A pace of work that does not allow sufficient recovery between

movements

• Contact Stress

Ergonomic-related Signs and Symptoms

Identifying early signs and symptoms of Work-related

Musculoskeletal Disorders (WMSDs) can lead to a quicker and more
prompt recovery. Most of the time, catching these early on results in
minimal required medical intervention and the employee will return to
work with full function.

Pain is the most common symptom associated with WMSDs. In

some cases, there may be joint stiffness, muscle tightness, redness, and
swelling of the affected area. Some workers may also experience
sensations of “pins and needles,” numbness, skin color changes, and
decreased sweating of the hands.

WMSDs may progress in stages from mild to severe.

• Early stage: Aching and tiredness of the affected limb occur

during the work shift but disappear at night and during days off
work. No reduction of work performance.

• Intermediate stage: Aching and tiredness occur early in the work

shift and persist at night. Reduced capacity for repetitive work.
Ergonomics PT4822

• Late stage: Aching, fatigue, and weakness persist at rest. Inability

to sleep and perform light duties.

Not everyone goes through these stages in the same way. In fact, it
may be difficult to say exactly when one stage ends and the next begins.
The first pain is a signal that the muscles and tendons should rest and
recover. Otherwise, an injury can become chronic, and sometimes,
irreversible. The earlier people recognize symptoms, the quicker they
should respond to them.

Common Workplace Injuries

• Musculoskeletal injuries (Over exertion, lifting heavy objects,

excessive typing)

• Slip and fall injuries

• Repetitive motion injuries

Early intervention can be critical to reducing lost work time and

preventing repetitive stress disorders. Discomfort should be reported
early to a supervisor to prevent complicated chronic conditions from
developing in the first place. Statistics show that early intervention is the
number one indicator of fast recovery.

Ergonomic Risk Mitigation and Prevention

According to the Bureau of Labor Statistics, the most common

workplace injuries resulting in lost workdays in the United States are
sprains, strains, and tears, with the low back being the most common
body part injured. What can you do to be proactive in preventing
workplace injury? Work smart. If you have an industrial or healthcare
position, know and understand proper lifting techniques, use other people
or devices when lifting amounts over 40-50 pounds, and take necessary
Ergonomics PT4822

breaks to reduce muscle fatigue. If you have a desk job, make sure that
your workstation is set up specifically for you to maintain your spine,
shoulders, elbows, and wrists in the most neutral position possible. Take
micro-breaks of 10-30 seconds every 30 minutes to stretch and reduce
risk of repetitive strain injury. All employees should maintain their health
and fitness outside of the workplace.

Tips

• Get moving – take micro breaks from sustained postures after 20-
30 minutes, perform brief stretching

• Warm up and stretch prior to activities that are repetitive, static, or

prolonged

• Respect pain – change positions or stop painful activity, report

early

• Be aware of workstation environment – understand potential

hazards, assess items BEFORE lifting

Just athletes must prepare for their sport; workers too must be
prepared for their jobs. Consider that most athletes spend several hours
per week training for a one-hour game. Why then does the worker not
prepare for their 8-hour shift? Consider the “worker-athlete.” A worker-
athlete should have flexibility in their arms, legs, and spine in addition to
proper strength and posture needed to perform their necessary work tasks.
Prior to beginning work, take 3-5 minutes to stretch the muscles you will
be using that day.

How to improve your workstation setup

Faulty computer habits can have painful consequences. Sitting too

long at the computer without moving around or changing positions can
Ergonomics PT4822

result in repetitive motion disorders and muscle strain. Physical therapists

recommend that you keep your feet flat on the floor, sit up straight, keep
eyes level with the screen, and take mandatory breaks at least every 20
minutes to avoid muscle fatigue.

Tips for a proper workstation setup

• Keep your feet on the ground – Ensure the feet are flat on the
ground or resting on a footrest when seated
• Sit up straight – Engage the core and sit upright with majority of
the weight resting on the buttocks and feet
• Make sure your eyes are level with the screen – A good rule of
thumb is to make sure the top of the head is parallel with the top of
the computer screen
• Keep your forearms parallel – Keep forearms parallel to the floor
and elbows at a 90-degree position
• Make sure your shoulder blades are settled – Your body should be
relaxed
• Use correct mouse positioning – Place computer mouse near the
keyboard to avoid reaching
• Rest your eyes – Look away from the computer screen as often as
possible and focus on distant objects to allow your eyes to rest
• Take a break – Try to get up from the computer at least every 20
minutes
• Stretch and move – Perform stretches, such as head turns, shoulder
rolls, and marching in place while seated
• Watch for problems – Pay attention to early warning signs such as
headaches, fatigue, muscle pain, or cramping. Make adjustments
early to prevent injuries.
Ergonomics PT4822

Practical
General Ergonomics Guidelines

Musculoskeletal disorders (MSD) in the workplace are commonly caused

by repetitive or awkward movements. Below are some basic tips for
identifying ergonomic risks. Look for these characteristics of work
that may be causing concerns in your workplace.

• Frequent bending or twisting of the back or neck.

• Heavy, awkward or repetitive lifting, pushing or pulling.
• Tasks requiring lifting either below the knees or above the
shoulder.
• Static postures - spending long periods without movement of a
particular body part. This could include sitting, standing, bending,
crouching, etc.
• Working with arms above shoulder height, elbows away from the
body, or reaching behind the body.
• Repetitive or prolonged grasping and holding of objects, gripping
with the wrist or elbow in an awkward position, or repetitive
bending or twisting of the wrists or elbows.
• Frequent exposure to whole-body or hand-arm vibration that has
not been controlled.
• Work surfaces that require elevation of the shoulders or stooping of
the back for long periods.
• Contact stress, where force is concentrated on a small area of the
body.
• Using any part of the body, especially your hand, as a hammer or
mallet.
• Inadequate or excessive light or glare.
Ergonomics PT4822

Often, low-cost simple solutions can be used to correct these risk

factors, like re-arranging storage shelves, changing the height of work
surfaces, or re-organizing tasks to reduce unnecessary manual material
handling. The most effective ergonomic solutions involve both the
workers and supervisors.

There are 3 main risk factors that can contribute to MSD’s in

material handling tasks. They are:

(1) Force

• Refers to the amount of effort made by the muscles and the amount
of pressure on a body part.
• All work tasks require some level of force, however if the required
force is higher than the capability of the muscle, it can damage
muscles or associated tendons, ligaments, and joints.
• Injury can occur from a single action that requires a very high level
of force or more commonly, occurs due to moderate to high forces
generated over long duration, and is more likely when the body is
in an awkward posture.

(2) Fixed or awkward postures

• Is the position of the joints of the body during an activity.
• “Neutral posture” is when the joints are working near the middle of
their normal range of motion.
• MSD injuries can occur when the joint is not in “neutral posture”,
when the joint moves toward the end of the normal range of
motion.
Ergonomics PT4822

• The more awkward the posture, the more strain on the joints,
ligaments, discs (in the spine) and muscles, and the higher the risk
of injury.
• A "fixed posture" refers to staying in the same position for a long
period of time, and injuries occur as the tissue fatigues while
exerting effort to maintain the posture.

(3) Repetition
• The risk of MSD increases when the same body parts are used
repeatedly with few breaks or chances for rest.
• High repetition can lead to fatigue and microscopic tissue damage.
If no recuperation of the tissues is allowed through rest or task
rotation, injury can occur.
• Rest allows specific body parts to recuperate.
• If the posture is awkward, fatigue occurs much more quickly.

Fig 2. Combining the risk factors of force, awkward posture and repetition
increases the risk of injury.
Ergonomics PT4822

Biomechanical Background of Ergonomics

Introduction

Ergonomics is the study of people while they use equipment in

specific environments to perform certain tasks. Ergonomics seeks to
minimize adverse effects of the environment upon people and thus to
enable each person to maximize his or her contribution to a given job. It
is also defined as designing a job to fit the worker so the work is safer and
more efficient. Implementing ergonomic solutions can make employees
more comfortable and increase productivity. The international
ergonomics association defines ergonomics or human factors as
“ergonomics (or human factors) is the scientific discipline concerned with
the understanding of interactions among humans and other elements of a
system, and the profession that applies theory, principles, data and
methods to design in order to optimize human well-being and overall
system performance.

Biomechanics

Biomechanics is the study of the structural elements of the human

body in relation to how the body functions and how much stress,
acceleration and impact it can stand. Simply defined, it is the application
of the principles of mechanics to living biological material. Today, the
total energy demanded from a person in the performance of an industrial
task has often been drastically reduced through better engineering and
technology. However, stress may be created in small components of the
worker’s anatomy. Ergonomists use information about the functional
anatomy of the living body to eliminate, reduce or manage such stresses.
Ergonomists apply the principles of biomechanics to problems of
occupational health, occupational safety and industrial productivity.
Ergonomics PT4822

Equipment

Improperly designed chairs or other poorly designed equipment

may obstruct the blood flow to body tissues. It is essential that designers
as well as the evaluators of tools and equipment be familiar with the
location of blood vessels vulnerable to compression. Of special
importance is aknowledge of the location of blood vessels and other
pressure sensitive anatomical structures in the hand.

For example, poorly designed or improperly held hand tools

may squeeze the hand’s ulnar nerve, which can lead to numbness and
tingling of the fingers. The simplest of hand tools, if designed without
due consideration to biomechanical principles, can adversely affect the
health of workers as well as their performance and productivity. Even
slight changes in the posture of a limb may affect the mechanical
advantage at which muscles operate, and hence their efficiency, to a
considerable degree. Outward rotation of the forearm is a very important
movement in industrial operation. Outward rotation is employed, for
example, when the right forearm and hand are used to close valves,
tighten screws and operate lathes. The effectiveness of the muscle is
impaired when the angle between the forearm and upper arm is larger or
smaller than the optimum of approximately 90 degrees.

Types of Movements of Body Members

• Positioning movements
• Continuous movements
• Manipulative movements
• Repetitive movements
• Sequential movements
• A static posture
Ergonomics PT4822

In details:

• Positioning movements are those in which the hand or foot moves

from one specific position to another, such as when reaching for a
control knob.
• Continuous movements are those that require muscular control
adjustments of some type during the movement, such as when
operating the steering wheel of a car or guiding a piece of wood
through a band saw.
• Manipulative movements involve the handling of parts, tools and
control mechanisms, typically with the fingers or hands.
• Repetitive movements are those in which the same movement is
repeated. Hammering, using a screwdriver and turning, a hand
wheel are examples of repetitive movements.
• Sequential movements are relatively separate independent
movements in a sequence.
• A static posture involves maintaining a body segment in a specific
position for a period of time. The ability to describe movements of
the body in such operational terms permits ergonomists to apply
the principles of biomechanics to problems associated with
workplace health, safety and productivity.
Ergonomics PT4822

Human Machine System

Human–machine system is a system in which the functions of a

human operator (or a group of operators) and a machine are integrated.
This term can also be used to emphasize the view of such a system as a
single entity that interacts with external environment. Human machine
system engineering is different from the more general and well known
fields like human–computer interaction and sociotechnical engineering in
that it focuses on complex, dynamic control systems that often are
partially automated (such as flying an airplane). It also studies human
problem-solving in naturalistic settings or in high-fidelity simulation
environments.

The Human Machine System consists of three main systems (Figure

3) :

• The first component: is the human component which includes all

human characteristics, like anatomical, physiological and
psychological elements.
• The second component: is the machine component like chairs,
tools and equipment with which the human-being interacts.
• The third component: is the environment, it is the place and the
circumstances in which the work is carried out and it includes
physical and social aspects.
o The physical aspects include noise, vibration, light, climate and
chemical substance.
o The social aspects include the family and the surrounding people
as colleges.
Ergonomics PT4822

Fig 3. Human Machine System

Equivalent Inertia of Human-Machine Systems under Constraint

Environments

Almost all of the operations that human beings undertake, both

they and the objects are constrained in a variety of ways. However,
human beings actively utilize those constraints to alter the transmitting
force between the human and the object. For example, when writing on a
piece of paper, one can write small, complex characters quickly and
precisely by placing the hand on the desktop. Also, when one brakes
suddenly while driving a car, one is able to transmit greater force to the
brake pedal by pressing one’s hips against the seat and utilizing the
reaction force, another study analyzes the characteristics of human-
machine systems, it is popular to model both the human and the machine
using mechanical impedance, which consists of stiffness, viscosity, and
inertia. The inertial characteristics, in particular, are all determined by the
posture and the environmental constraints, ignoring the effect of changing
the shapes of the muscles. Therefore, by studying the equivalent inertia of
Ergonomics PT4822

human machine systems, it might be possible to clarify the physical

significance of the skillful strategies of human beings.

Generalized Coordinates of the System

The human-machine system treated as a single mechanical system

that moves with interacting forces between the human and the object.
Consider the case where the human-machine system is in a steady state.

A Case of Single Contact Point

The case to consider is when only a single point of contact exists

between the human and the object, as illustrated in (Figure 4). To make
clear that contact exists at only one point.

Fig 4. Example of human machine system with single contact point

Ergonomics PT4822

A Case of Multi Contact Points

The next case to consider is when multiple k points of contact exist
between the human and the object (Figure 5).

Figure 5. Example of human machine system with multiple contact points

Ergonomics PT4822

Ergonomics for Posture

Standing Position

Standing is a natural human posture and by itself poses no

particular health hazard. However, working in a standing position on a
regular basis can cause sore feet, swelling of the legs, varicose veins,
general muscular fatigue, Low back pain, stiffness in the neck and
shoulders, and other health problems. These are common complaints
among sales people, machine operators, assembly-line workers and others
whose jobs require prolonged standing.

A person's body is affected by the arrangement of the work area

and by the tasks that he or she does while standing. The layout of the
workstation, the tools, and the placement of keys, controls and
displays that the worker needs to operate or observe will determine,
and as rule, limit the body positions that the worker can assume
while standing. As a result, the worker has fewer body positions to
choose from, and the positions themselves are more rigid. These
restrictions give the worker less freedom to move around and less
opportunity to alternate which muscles are used. This lack of flexibility in
choosing body positions contributes to health problems.

These conditions commonly occur where the job is designed

without considering the characteristics of the human body.

What are some of the health hazards?

Keeping the body in an upright position requires considerable

muscular effort. Standing effectively reduces the blood supply to the
loaded muscles. Insufficient blood flow accelerates the onset of fatigue
Ergonomics PT4822

and causes pain in the muscles of the legs, back and neck (these are the
muscles used to maintain an upright position).

The worker suffers not only muscular strain but other discomforts
also. Prolonged and frequent standing, without some relief by walking,
causes blood to pool in the legs and feet. When standing occurs
continually over prolonged periods, it can result in inflammation of the
veins. This inflammation may progress over time to chronic and painful
varicose veins. Excessive standing also causes the joints in the spine,
hips, knees and feet to become temporarily immobilized or locked. This
immobility can later lead to rheumatic diseases due to degenerative
damage to the tendons and ligaments (the structures that bind muscles to
bones).

What are some recommendations for improving workplace design?

• In a well-designed workplace, the worker has the opportunity to

choose from among a variety of well-balanced working positions
and to change between these positions frequently.
• Working tables and benches should be adjustable. Being able to
adjust the working height is particularly important to match the
workstation to the worker's individual body size and to the worker's
particular task. Adjustability ensures that the worker has an
opportunity to carry out work in well-balanced body positions. If
the workstation cannot be adjusted, platforms to raise the shorter
worker or pedestals on top of workstations for the tall worker
should be considered.
• Organization of the work space is another important aspect. There
should be enough room to move around and to change body
position. Providing built-in foot rails or portable footrests allows
the worker to shift body weight from one leg to the other. Elbow
Ergonomics PT4822

supports for precision work help reduce tension in the upper arms
and neck. Controls and tools should be positioned so the worker
can reach them easily and without twisting or bending.
• Where it is possible, a seat should be provided so that the worker
can do the job either sitting or standing. The seat must place the
worker at a height that suits the type of work being done. For work
that requires standing only, a seat should be provided in any case to
allow the worker to sit occasionally. Seats at the workplace expand
the variety of possible body positions and give the worker more
flexibility.
• The benefits from greater flexibility and a variety of body positions
are twofold. The number of muscles involved in the work is
increased which equalizes the distribution of loads on different
parts of the body. Thus, there is less strain on the individual
muscles and joints used to maintain the upright position. Changing
body positions also improves blood supply to the working muscles.
Both effects contribute to the reduction of overall fatigue.
• Quality of footwear and type of flooring materials are also major
factors contributing to standing comfort. For further details on
these subjects, refer to these related documents on OSH Answers:
• Foot Comfort and Safety at Work.
• Prevention of Slips, Trips and Falls.
• Anti-fatigue Mats.
Ergonomics PT4822

How can job design reduce the effects of working in a standing

position?

The basic principles of good job design for standing work are:

• Change working positions frequently so that working in one

position is of a reasonably short duration.
• Avoid extreme bending, stretching and twisting.
• Pace work appropriately.
• Allow workers suitable rest periods to relax; exercises may also
help.
• Provide instruction on proper work practices and the use of rest
breaks.
• Allow workers an adjustment period when they return to work after
an absence for vacation or illness so they can gradually return to a
regular work pace.

What is an example of a workstation designed for a standing worker?

Workplace design should fit the variety of workers' shapes and sizes and
provide support for the completion of different tasks.

Different tasks require different work surface heights:

• Precision work, such as writing or electronic assembly – about 5

cm above elbow height; elbow support is needed.
• Light work, such as assembly-line or mechanical jobs – about 5-10
cm below elbow height.
• Heavy work, demanding downward forces – from 20-40 cm below
elbow height.
Ergonomics PT4822

Fig 6. Different tasks require different work surface heights.

What can workers do to reduce the discomfort of working in a

standing position?

• Adjust the height of the work according to body dimensions,

using elbow height as a guide.
• Organize your work so that the usual operations are done within
easy reach.

• Always face the object of work.

• Keep body close to the work.
• Adjust the workplace to get enough space to change working
position.
• Use a foot rail or portable footrest to shift body weight from
both to one or the other leg.
• Use a seat whenever possible while working, or at least when
the work process allows for rest.
Ergonomics PT4822

Fig 7. Ideal Working in Standing Position

What are some do's and don'ts regarding footwear?

Your feet can only be as comfortable as the footwear permits.

• DO wear shoes that do not change the shape of your foot.

• DO choose shoes that provide a firm grip for the heel. If the
back of the shoe is too wide or too soft, the shoe will slip,
causing instability and soreness.
• DO wear shoes that allow freedom to move your toes. Pain and
fatigue result if shoes are too narrow or too shallow.
• DO ensure that shoes have arch supports. Lack of arch support
causes flattening of the foot.
• DO wear shoes with lace-up fastenings.
• DO tighten the lace instep of your footwear firmly. The foot is
prevented from slipping inside the footwear.
• DO use padding under the tongue if you suffer from tenderness
over the bones at the top of the foot.
Ergonomics PT4822

• DO use a shock-absorbing cushioned insole when working on

metal or cement floors.
• DO choose footwear according to the hazard at your workplace.
• DO select safety footwear, if required, that is CSA approved
and carries the proper ratings for the hazard. The OSH Answers
document Safety Footwear has additional information.
• DO select footwear taking into account individual fit and
comfort. Try them on and walk around for a few moments
before buying.
• DO NOT wear flat shoes. A small heel can decrease strain on
the Achilles tendon and allow for more comfortable walking
and standing.
• DO NOT wear shoes with high heels. Recommendations vary
but, in general, heels should have a broad base and be less than
4 cm to 6 cm height (1.6 inches to 2.4 inches). When standing
often, other recommendations are that the heel should be no
more than 2 to 2.5 cm (about 1 inch).

Fig 8.With regarding footwear

What is recommended regarding floors in a workplace?

• Keep work areas clean.

• Avoid standing on concrete or metal floors. Recommended for
standing work are wooden, corks or rubber covered floors.
Ergonomics PT4822

• Ensure that the floors are level and non-slippery.

• Cover concrete or metal floors with mats. Slanted edges on mats
help prevent tripping.
• Do not use thick foam-rubber mats. Too much cushioning can
cause fatigue and increase the hazard of tripping.

Sitting Position

What is a good sitting body position?

There is no one or single body position that is recommended for sitting.

Every worker can sit comfortably by adjusting the angles of their hips,
knees, ankles and elbows. The following are general recommendations.
Occasional changes beyond given ranges are acceptable and sometimes
beneficial.

• Keep the joints such as hips, knees and ankles open slightly
(more than 90°).
• Keep knee joints at or below the hip joints.
• Keep ankle joints in front of the knees.
• Keep a gap the width of three fingers between the back of the
knee joint and the front edge of the chair.
• Keep feet flat on the floor or on a foot rest.

Fig 9. Good sitting body position

Ergonomics PT4822

• Keep the upper body within 30° of an upright position.

• Keep the lumbar support of the back rest in your lumbar region
(around the waistband).

Fig 10. Continue with good sitting body position

• Always keep the head aligned with the spine.

• Keep upper arms between vertical and 20° forward.
• Keep elbows at an angle between 90° and 120°.
• Keep forearms between horizontal and 20° up.
• Support the forearms.

Fig 11. Continue with good sitting body position

Ergonomics PT4822

• Keep the wrists straight and aligned with the forearms.

• Place the working object so that it can be seen at viewing angle of
10° to 30° below the line of sight.

Fig 12. Continue with good sitting body position

Fig 13. Continue with good sitting body position

• Keep shoulders low and relaxed.

• Keep elbows tucked in.
• Tuck chin in and do not bend forward when looking down and
forward.
Ergonomics PT4822

• Change positions frequently but remain within recommended

ranges.
• Alternate crossed legs.
• Avoid bending to the side.
• Avoid bending forward.
• Do not slouch.
• Do not sit for more than 50 minutes at a time

Fig 14. Correct Sitting Posture

Ergonomics PT4822

Ergonomics for Movements

Lifting

Lifting heavy items is one of the leading causes of injury in

the workplace. In 2001, the Bureau of Labor Statistics reported
that over 36 percent of injuries involving missed workdays were the
result of shoulder and back injuries. Overexertion and cumulative
trauma were the biggest factors in these injuries. Bending, followed
by twisting and turning, were the more commonly cited movements
that caused back injuries. Strains and sprains from lifting loads
improperly or from carrying loads that are either too large or too
heavy are common hazards associated with manually moving
materials.

When employees use smart lifting practices, they are less

likely to suffer from back sprains, muscle pulls, wrist injuries, elbow
injuries, spinal injuries, and other injuries caused by lifting heavy
objects. Please use this page to learn more about safe lifting and
material handling.

Lifting Principles
Lifting Stages

Preparation

Lifting

Carrying

Setting Down
Ergonomics PT4822

1. Preparation

Before lifting or carrying, plan out your lift. Think about:

• How heavy/awkward is the load? Should I use mechanical

means (e.g. a hand truck) or another person to help me with
this lift? Is it possible to break the load into smaller parts?
• Where am I going with the load? Is the path clear of
obstructions, slippery areas, overhangs, stairs, and other
uneven surfaces? Are there closed doors that need to be
opened?
• Are there adequate handholds on the load? Do I need gloves or
other personal protective equipment? Can I place the load in a
container with better handholds? Should another person help
me with the load?

2. Lifting

Get as close to the load as possible. Try to keep your elbows and
arms close to your body. Keep your back straight during the lift by
tightening the stomach muscles, bending at the knees, keeping the
load close and centered in front of you, and looking up and ahead.
Get a good handhold and do not twist while lifting. Do not jerk; use
a smooth motion while lifting. If the load is too heavy to allow this,
find someone to help you with the lift.

3. Carrying

Do not twist or turn the body; instead, move your feet to turn. Your
hips, shoulders, toes, and knees should stay facing the same
direction. Keep the load as close to your body as possible with your
elbows close to your sides. If you feel fatigued, set the load down
Ergonomics PT4822

and rest for a few minutes. Don’t let yourself get so fatigued that
you cannot perform proper setting down and lifting technique for
your rest.

4. Setting Down

Set the load down in the same way you picked it up, but in the
reverse order. Bend at the knees, not the hips. Keep your head up,
your stomach muscles tight, and do not twist your body. Keep the
load as close to the body as possible. Wait until the load is secure to
release your handhold.

Carrying
Once you have successfully lifted something, you probably have to carry
it somewhere. Whether you have to carry it in one hand or two, the
recommendations are about the same:

• Make sure you have a firm grip on the object so it doesn’t slip

• Keep it as close to your body as possible (better leverage)

• Keep your head and chest up with your shoulders pulled slightly
back

• Keep your elbows straight (if appropriate e.g. carrying groceries)

• Keep your back straight (don’t lean too much

forwards/backwards/side wards) and lightly tense your abdominal
muscles

• Take small steps and look out for tripping hazards

Ergonomics PT4822

• When you arrive at the “drop-off zone", set things down the way
you lifted them - carefully!

Fig 15. Proper Lifting and Carrying

Pushing &Pulling

Who uses pushing and pulling motions at work?

Workers use various pushing and pulling techniques in a wide range of

activities, such as:

• Using manual carts and trucks.

• Sliding objects such as cartons on flat surfaces (tables, floors,
etc.)
• Operating tools and controls.
• Opening and closing doors.
• Wrapping or enclosing objects in packaging materials.
Ergonomics PT4822

Are there any statistics to show how common injuries are from
pushing and pulling activities?

Because these actions are among the most common work activities,
they are also the cause of many injuries. However, there are no
comprehensive injury statistics. As well, the injuries resulting from these
activities are not always recorded very specifically. Most common are
overexertion injuries (e.g., back strain). Injuries due to slips and falls are
also often associated with pushing and pulling. Additionally, injuries to
fingers and hands can result when caught in, on, or between objects (e.g.,
between a cart and the wall) and to lower legs when bumped by carts.
Therefore, existing statistics do not reflect the importance of pushing and
pulling as work factors causing injury because the injuries fall into
different categories making them difficult to analyze.

Are there any "limits" for the amount of force one should exert?

Because of the complex nature of body motion during pushing and

pulling, no numerical standard has yet been developed that can be directly
applied in industry. Many factors affect the amount of force that a worker
can develop in a horizontal push and pull:

• body weight and strength

• height of force application
• direction of force application
• distance of force application from the body
• different positions (standing, kneeling, overhead, and seated)
• posture (bending forward or leaning backward)
• friction coefficient (amount of friction or grip between floors
and shoes)
• duration and distance of push or pull
Ergonomics PT4822

If a pushing/pulling job is to be per formed manually, your primary y goal

is to minimize the forces required by the operator to initiate and sustain
rolling, turning, and positioning. Five main topics must be considered in
order to design a safe and productive push/pull task:
• The people
• Task Design
• Operating environment and floor conditions
• Cart or equipment design
• Caster and wheel design
The People
Unless you are designing for a specific person, you will usually try
to design for the widest range of people you might expect to perform the
task. In most workplaces, you have little control over who will perform
any given job. Even if you know the person or people that are
Performing it today, that can quickly change. Therefore, in most
cases, the following will apply:
Design Force Requirements for the Smaller Female
A small female is likely to be able to generate the least amount of
force overall and therefore represents a reasonable “worst-case.”
Companies in the United States often design manual material handling
tasks so that at least 75% of the female population and 99% of the male
population can safely perform them. If you wish to be more conservative
in your design, meaning you will protect a larger portion of the working
population, you might design for 90% or more of the female population
to make the job more accessible to a wider population of workers.
Match Footwear with Floor Conditions to Maximize Traction
To avoid slipping, researchers suggest a COF of 0.6 or greater.
Ergonomics PT4822

Task Design
Depending on task, equipment, and operator factors, you will find that
acceptable force levels for females can range from as low as 13 lbs. to as
high as 57 lbs.
Operating Environment
A good match between the wheel diameter, wheel material, and the
rolling surface conditions is of utmost importance. The following general
rules apply:
The Rougher or More Uneven the Rolling Sur face, the Larger the
Wheel Diameter Should Be.
Even in facilities with very smooth floors, the operator often crosses
cracks, seams, expansion joints, grates, door thresholds, or other surface
irregularities that can cause a small diameter Wheel to stop. A larger
diameter wheel will roll over such irregularities with relative ease.
The More Potential for Floor Debris, the Larger the Wheel Diameter
Should Be
Debris on the rolling surface is much the same as a rough or uneven
surface.
Special Conditions: Oil, Grease, Chemicals, Etc.
Floor contaminants can reduce the traction between the shoes and floor,
making it difficult and dangerous for the person to apply the necessary
push/pull forces, and may also interfere with caster maintenance and
function. Consult a qualified caster supplier to match wheels and casters
to your conditions.
Special Environments: Special Floor Coatings, Dust, High Moisture
or Wash Down ,Extreme Temperatures, Etc.
In some industries, carts and equipment must be washed regularly, and
the casters must therefore be able to withstand this without detriment to
Ergonomics PT4822

their performance. Consult a qualified caster supplier to match wheels

and casters to your conditions.
The Path of Travel Should Be Free of Obstacles and the Operator
Should have Clear Visibility in the Direction of Travel
Implement Effective Floor Inspection and Maintenance Procedures
Floor maintenance and housekeeping can have a dramatic effect on the
forces experienced by the operator, the stability of the load, the life of the
equipment, etc.
Equipment Design
Optimally, each person should be able to select their own point of
contact, either through an adjustable handle system, or a continuous
handle system that may be grasped at the height of choice. The following
general rules apply:
For Pushing, Handhold Height Should Be Between Elbow and Hip
Height
Since elbow and hip heights vary from person to person, there is no single
recommended handhold height for pushing. If an adjustable height
horizontal handle or continuous vertical handles are supplied, a range of
approximately 29 in. to 47 in. will accommodate about 90% of the
American working population.
For Pulling, Handhold Height Should Be Between Hip Height and
Knee Height, and the Handhold May Need to Be Offset From the
Equipment to Ensure Adequate Foot Clearance
Since hip and knee heights vary from person to person, there is no single
recommended handhold height for pulling. If an adjustable height
horizontal handle or continuous vertical handles are supplied, a range of
approximately 18 in. to 39 in. will accommodate about 90% of the
American working population.
The Loaded Car t or Equipment Should Be Stable
Ergonomics PT4822

An unstable load can fall and injure people, and damage equipment and
product. Load Instability can also increase the amount of required force,
as the operator attempts to control the load. Further, if the load begins to
fall, the person may attempt to catch it, resulting in sudden exposure to
high forces, a common cause of injury.
Handholds Should Not Extend Beyond the Sides of Equipment
Extending body parts beyond the side of the equipment exposes them to
crushing injuries.
A Handle is required for Effective Pulling, But Not Always for
Pushing
For pulling, the best grip is a power grip (using the palm, fingers and
thumb). The fingers should not overlap, and the handle should be wide
enough to accommodate the entire hand.
For a cylindrical handle, this equates to about a 1.5 in. to 2.0 in. diameter
(3.8 cm. to 5.1 cm.), and at least 5 inches in length to accommodate the
width of the hand. Pushing can be performed with such a handle, or the
person can apply force to a flat surface, as long as the coupling is good
and the hands do not slip or contact edges, sharp protrusions or other
pressure points. For most applications, a designated handhold is
advisable.
Ergonomics PT4822

Work Related Musculoskeletal Disorder Assessment and

Prevention

Introduction

There are a large variety of MSDs that have some commonality

both in the physiological or anatomical characteristics and in the general
location of the problem. For introducing and describing common MSDs it
is best to categorize them by the anatomical characteristics, while later, in
providing more detailed scientific evidence for risk factors, it is best to
categorize them by joints. It would not be unusual for a complaining
worker or the medically untrained ergonomist lump medically different
disorders into one collective “shoulder” disorder, since, probably, neither
can identify the disorder more specifically. From the anatomical
viewpoint, MSDs can be classified into six basic types: tendon, muscle,
nerve, vascular, bursa, and bone/cartilage.

Tendon Disorders
The tendon is the part of the muscle and the surrounding fascia
transmitting force from the muscle that attaches to the bone and produces
joint motion. In places where there is a great deal of movement (e.g.,
fingers, wrist, shoulder ) the tendon may pass through a sheath that
protects and lubricates the tendon to reduce friction. When this sheath and
the tendon within become inflamed, it is termed tenosynovitis. When a
tendon without the sheath becomes inflamed, it is termed tendinitis. This
inflammation can progress to the point of having micro-trauma or even
visible fraying of the tendon fibers. Sometimes, the disorders are further
identified by the sublevel where found on the tendon. Enthesopathy or
insertional tendinitis occurs at the tendon–bone interface with relatively
Ergonomics PT4822

little inflammation. A common one is enthesopathy of the extensor carpi

radialis brevis from the lateral epicondyle, resulting from forceful,
twisting motions, which then is referred to as lateral epicondylitis, or
more commonly as tennis elbow. Peritendinitis refers to the inflammation
of the tendon proper, where there is no tendon sheath, while the
inflammation of the muscle–tendon interface is termed myotendinitis.
Although, technically they are all different disorders, they are often found
together and exhibit similar symptoms of localized pain and tenderness
and are typically collectively referred to as tendinitis.

Fig 16. Tendon Disorders

Muscle Disorders
Muscle disorders start as simple muscle soreness or pain, termed
myalgia, in workers, both old and especially new, performing
unaccustomed strenuous or repetitive work. The affected area will be sore
and tender to touch because of microstrain and inflammation of the tissue,
termed myositis. If the work is soon stopped (e.g., a one-time job or a
weekend activity), relief will occur in several days. If the work is
Ergonomics PT4822

continued in a gradual manner (i.e., a break-in period), generally, a

conditioning process occurs, the muscle heals, becomes accustomed to
task, and becomes more resistant to injury. However, if the work is
continued in an excessive manner (i.e., few rest periods, frequent
overtime), the muscle strain and myalgia become chronic and the disorder
becomes myofascial pain syndrome. The muscle may spasm, dysfunction,
and temporary disability may result. In chronic stages, the disorder is
characterized by chronically painful spastic muscles, tingling sensations,
nervousness and sleeplessness and is termed fibromyalgia. It is
aggravated by both repeated activities and also, paradoxically, by rest; it
may be worse upon rising in the morning.

Nerve Disorders
Nerve entrapment occurs between two different tissues, muscles,
bones, ligaments, or other structures, and may be due to a variety of
diseases, such as hyperthyroidism or arthritis, vascular disorders or
edema, in addition to chronic work-related trauma. During entrapment,
pressure on the nerve will impair blood flow and oxygenation of the
Schwann cells and the myelin sheath with consequent effects on axonal
transport system and production of action potentials. If the pressure is
high enough, mechanical blocking of the depolarization process will
occur (Lundborg, 1988). A complicating factor is that entrapment at one
location of the nerve (which may be up to 1 m in length) increases the
susceptibility to further injury at points either distal or proximal to the
first location, due to impairment of the axonal flows of ions. This
multiple entrapment, known as the double crush syndrome, makes it even
more important that ergonomists consider the whole extremity when
analyzing a job and diagnosing potential problems.
Ergonomics PT4822

Vascular Disorders
In vascular disorders, one or more of three different factors,
vibration, cold temperatures, and direct pressure, cause ischemia of the
blood supply to nerves and muscle resulting in hypoxia to the tissue with
tingling, numbness and loss of fi ne control. In the hand–arm vibration
syndrome (HAVS) vibration (e.g., from power tools) activates the smooth
muscle surrounding arterioles causing a clamping action and loss of blood
flow (ischemia) to the hand, resulting in a blanching or the colloquial
white finger syndrome. This will also result in numbness and an inability
to perform precision work. Cold temperatures have a very similar
ischemic effect on the arterioles through a local vasoconstrictor reflex.
However, some individuals, especially women in northern climates, have
an especially pronounced response leading to painful sensations, termed
Raynaud’s syndrome. Direct pressure on the circulatory vessels can also
cause ischemia and loss of fine motor control, effects similar to vibration
or cold. This can occur in the thoracic outlet syndrome, where the
subclavian vessels are in close proximity to the brachial plexus and are
similarly entrapped within the shoulder area, or in the hypothenar
hammer syndrome, where the ulnar artery is compressed against the
hypothenar eminence (muscle below the little and ring fingers) during
hand hammering.
Ergonomic Interventions in Hand Tools
Since tools, as we know them, were developed as extension of the
upper extremities to reinforce the strength and the effectiveness of these
limbs, this section will focus primarily on ergonomic interventions in
hand tools. Approximately 6% of all compensable work injuries and 10%
of all industrial injuries in the United States are caused by the use of hand
tools . This means over 73,000 injuries involving at least 1 work day lost
amounting to over $10 billion annually in costs (Bureau of Labor
Ergonomics PT4822

Statistics, 1995.) The most injured body parts by both non-powered and
powered hand tools were the upper extremities (59.3% and 51.0%,
respectively) followed by back, trunk, and lower extremities. Fingers
accounted for 56% of upper extremity injuries or about 30% of all body
parts.

General Tool Principles

• An efficient tool has to fulfill some basic requirements It must
perform effectively the function for which it is intended. Thus an
axe should convert a maximum amount of its kinetic energy into
useful chopping work, separate cleanly wood fibers and be easily
withdrawn.
• It must be properly proportioned to the body dimensions of the
operator to maximize efficiency of human involvement.
• It must be designed to the strength and work capacity of the
operator. Thus allowances have to be made for the gender, training,
and physical fitness of the operator.
• It should not cause undue fatigue, i.e., it should not demand
unusual postures or practices that will require more energy
expenditure than necessary.
• It must provide sensory feedback in the form pressure, some shock,
texture, temperature, etc. to the user.
• The capital and maintenance cost should be reasonable.
Ergonomics PT4822

Work-Related Musculoskeletal Discomfort in the Neck & Shoulder

due to Computer Use
Musculoskeletal disorders have been observed and experienced
widely at workplaces where the computers are frequently used. Increase
in the number of employees working with computer and mouse coincides
with an increase of work-related musculoskeletal disorders (WRMSDs)
and sick leave, which affects the physical health of workers and pose
financial burdens on the companies, governmental and non-governmental
organizations.

WRMSDs cover a wide range of inflammatory and degenerative

diseases of the locomotor system, such as inflammations of tendons, pain
and functional impairments of muscles, compression of nerves, and
degenerative disorders occurring especially in the shoulder region due to
occupations with large static work demands [European Agency for Safety
and Health at Work. The multifactorial causation of WRMSDs is
commonly acknowledged.

Different groups of risk factors including physical and mechanical

factors, organizational and psychosocial factors, and individual and
personal factors may contribute to the genesis of WRMSDs (EUOSHA,
2008). Repetitive handling at high frequency, awkward and static
postures, demanding and straining work and lack of recreation times, high
time pressure, frequently overtime hours, repetitive or monotonous work,
reduced physical capacity, obesity, and smoking are all the risk factors
that contribute to WRMSDs either each one solely or by interacting each
other.
Ergonomics PT4822

Pathophysiology
Several structures have been shown to cause pain in the neck and
shoulder area. When irritated or inflamed, e.g. nerves, muscles, bones,
discs, facet joints and ligaments are capable of evoking pain. The risk
factors for NSPRCU have been documented by many studies. Very
commonly, they encompass:
• Work related factors (such as repetitive motion, forceful exertions
or strain, awkward postures and/or unnatural positions and
uncomfortable positioning of limbs, such as flexion, extension or
deviation of the hand).
• Personal characteristics, such as gender, and body mass,
• Environmental, sociocultural and psychological factors. The
mechanism of how these factors on NSP and to what extent each of
them are involved in the development of the condition is currently
not well understood. In the following some ideas revealed in recent
years are presented.
Work Related Factors and NSP
The intensive computer work requires repetitive movements of the
upper limbs, such as typing the keyboard and drig-draging the mouse, but
also static muscle activity to keep the arms in a stable position. The
computer work will also overload the neck, shoulder, and upper limb
muscles and joints. Muscles and joints become stressed once their support
structures are weakened. As the tissues continue to be overloaded,
ischemic cumulative injuries start to take place, perhaps due to the
conversion of endothelial xanthine dehydrogenase to xanthine oxidase.
Thus, as a result of the tissue overload inflammation with swelling, nerve
compression i.e. median and ulnar nerve compression) and deterioration
of tendons and ligaments with pain are provoke. Moreover, a poor
posture with the consequent overload of the neck and shoulder muscles,
Ergonomics PT4822

can result in calcifying tendonitis and cervical spondylosis . Nerves

passing from the spinal cord via the notches between the vertebrae can
get compressed and NSP and paresthesia may developed.

Personal Characteristics and Physical Environment

• The individual factors, which include the age, gender, obesity,
hormonal balance and systemic diseases (e.g. diabetes), also play a
role in causing NSPRCU.
• Physical tissue changes like sarcopenia that develop with
increasing age can cause neck pain.
• As the time passes, the disks between the spinal vertebrae start
to degenerate and lose their compliance. They will shrink, and
allow less space between the vertebrae, which, in addition, may get
dislocated. Such changes can lead not only to pain but to a decrease
in the range of the neck motion.
• The relationship between overweight and NSP is unclear, some
researchers believe that obesity tends to impair well-being through
musculoskeletal pain and difficulty of daily movements. They
found that overweight was a significant determinant of NSP, while
some others have not found such an association.
• Many work sites fail to accommodate female anthropometry
due to their smaller body sizes. Several researchers have reported
that NSP is more prevalent in females than in males. Women are
subjected to greater exposure to biomechanical stressors when
performing the same tasks as men. As women have smaller
shoulders, the sizes of average keyboards force women to stretch to
work with the mouse and track-ball and hold their arms in a
strenuous posture.
Ergonomics PT4822

Clinical manifestation

The initial symptoms of NSPRCU are neck and shoulder stiffness,

fatigue and dull pain. The pain may be aggravated by moving of neck and
shoulder, and it may be stronger at night. If a cervical disc herniation with
a nerve and/or nerve root compression exists, the pain may be stronger
and accompanied by other sensory abnormalities in the affected nerve
distribution. Also in the carpal tunnel syndrome related to computer use,
shoulder, wrist and hand pain as well as numbness and paresthesiae in the
whole median nerve distribution area of the hand may be found.

Treatment

The treatment of NSPRCU includes abstinence from the computer

use and keeping body and mind relaxed. Some traditional therapeutic
methods and/or physical interventions can also be used. Massage and
acupuncture may release the pain symptoms. Active physical training,
early mobilization, including range of motion exercises for the neck and
shoulders, also, can give good results in getting rid of the symptoms . If
the pain still remains after more than week period of above general
treatments, non-steroidal anti-inflammatory drugs or local cortico-
steroidal injections can be applied, and a short-term pain relief has been
documented in many cases. Sometimes surgical procedures are necessary,
when cervical cord, nerve roots or nerve trunk (i.e. in the carpal tunnel
syndrome) is compressed.
Ergonomics PT4822

Prevention

Usually, NSPRCU can be prevented by:

• Promoting the ergonomic adjustments of working environment.

• Changing the poor working habits.
• Increasing exercise during the work. Following suggestions may
be helpful to prevent the NSPRCU.
• Ergonomic posture is important, especially if a person sits at a
desk much of the day. The trunk thigh angle should exceed 100◦
perhaps be rather close to 135◦ as then the pressure in disks is
about the same as when standing. The computer screen should be
adjusted 15◦ below the horizontal eye level. When typing from
documents at desk, they should be placed on document holder so
that they are 15◦ below the eye level. This prevents from
continually looking up and down.
• Ergonomic arm supports, keyboard, mouse, chair, etc. are useful
for NSPRCU prevention. Especially ergonomic arm supports
which can significantly decrease neck and arm muscles’ loading
and prevent NSPRCU.
• Take short breaks with stretching the neck at least every hour
recovers circulation and relaxation techniques.

Fig 17. Ergonomic Arm Support

Ergonomics PT4822

• Sleeping conditions should be proper for the neck and the pillow
should comfortably support the head and neck. The mattress should
be firm enough.
Mouse Shoulder
Mouse shoulder (as good a name as any) is a syndrome arising
from prolonged elevation and bracing of the shoulder to accommodate an
inappropriately positioned mouse, or performing short range movements
of the mouse, or (usually) both. This syndrome results in severe shoulder
and shoulder blade muscle spasm (in the trapezius, deltoid, and teres
muscles) and trigger points with referred pain in the arm.
If left untreated, this problem can develop into a much more serious
rotator cuff injury.
Computer Mouse

Your mouse should be placed within easy reach of your dominant

hand. Traditional mouses do not promote comfortable working postures.
Traditional mouses tend to promote over activation of forearm muscles,
wrist extension and wrist deviation movements. The goal for best practice
computer mouse ergonomics is to keep your wrist in a neutral alignment
and utilize whole arm movements where possible.

Fig 18. Vertical & Horizontal Mouse

Important Tips
Ergonomics PT4822

• Do not hold or linger on holding the mouse when you are not using
the mouse. Rest your hand flat on the desk when you can rather
than allowing it to continually grip the mouse. Constant gripping of
the mouse promotes unnecessary sustained muscle contractions in
the forearm and can lead to fatigue and pain.
• Try swapping the hand with which you mouse with. Although
initially quite awkward, most people will get accustomed to using
the mouse in their non-dominant hand if they practice it for
approximately 1-2 weeks. Remember though, if you swap your
mousing hands, make sure that you switch the primary and
secondary mouse buttons so that you still use your index finger for
most clicks regardless of whether you are using your left or right
hand. This can be done by going to Settings→ Control Panel→
Mouse→ Button Configuration.
• Consider investing in an ergonomic mouse. Unlike traditional
mouses, ergonomic mouses have been designed specifically to
promote comfortable mousing and safe work postures. There are
many different types of ergonomic mice on the market however
they all tend to fall within 3 main categories - Vertical Mouse,
Trackball Mouse and Touchpad Mouse. Vertical Mice are by far
the most comfortable and widely used ergonomic mice.
• A good vertical mouse will place your hand into a vertical position
or hand shake position in order to operate the mouse. This posture
is best for reducing wrist and forearm pain. Trackball mice may
initially provide some relief of your pain, but tend to promote
repetitive finger movements over the long term and for this reason
are not recommended as a first line treatment. Touchpad mice are
another great ergonomic mouse, as they allow for left and right
handed mousing and for you to alternate the finger you use to
Ergonomics PT4822

mouse. If you are going to invest in an ergonomic mouse, start with

a vertical mouse first as these are the gold standards.

Postural Relief Position

The best way to prevent the problems associated with sterno-

symphyseal syndrome or computer back is to sit up straight. Back
supports that help maintain your proper lower back curve can also be
effective.

Fig 19. Postural relief position

Position in Steps
1. Sit at the edge of your chair with feet farther apart than your hips.
2. Turn your feet outward slightly.
3. Tuck your chin straight back slightly.
4. Breathe into your abdomen.
5. Actively exhale while
a. extending your fingers and turning your palms outward
b. raising your breastbone slightly
6. Repeat two to three times.
Common Examples of Lack of Ergonomics in Computer
Workplace
Ergonomics PT4822

1-Chair is too low for Desk

Analyze your computer posture when working at the desk. The ideal
posture at a computer is to have a somewhat right (90 degree) angle of
your elbows and your knees.

Fig 20. Bad Sitting Posture

2- Upward Sloping Keyboard

• With this upward sloping 'ergonomic' keyboard, it is still difficult
to maintain a neutral wrist position.
• This cause strain and extra stress when typing. If you have not
gone for any typing classes, you are most likely typing in a way
that best suits your body.
• We most likely all have some of the bad habits of typing, as
outlined in Typing Ergonomics.

Fig 21. Upward Sloping Keyboard

• Learning to type terribly is important, especially if your work

involves a lot of typing. You'll not want to deal with Carpal
Ergonomics PT4822

Tunnel, because by that it is awfully uncomfortable, painful and

cannot be reversed!

Fig 22. Ideal Typing Posture

• This Mueller Fitted Wrist Brace prevents carpal tunnel syndrome

because it prevents your wrists from bending at an awkward angle
when typing.

Fig 23. Mueller Fitted Wrist Brace

3- Use of Laptop as a full Desktop Replacement

Ergonomics PT4822

• Laptops are initially created to make the computer mobile, for

people on the move for work. However, contrary to popular belief,
it was not meant to be a full replacement for desktops.
• Using laptops as replacement for your desktop can do more harm
in the long run. You can run the risk of developing musculoskeletal
disorders.
• One of the crucial points of 'why laptops are not ergonomic' is
because the screen is too low for you and this causes the user to jutt
out his/her neck.
• This will throw off your posture, strain your neck and the pressure
of the weight of your head on your neck can cause it to
permanently form. This results in a forward neck posture, with a
rounded, hunched back.
4- Sitting For Too Long
• Human bodies are not made to sit for hours and hours. We can't
expect to sit for hours and not suffer some sort of physical
consequences such as lower lumbar back pain.
• Sitting still for hours puts immense pressure on your back -
equivalent to a few times of your weight.
• Get up and move about every half an hour or so. Also rotate
your tasks, such as change mouse hands, schedule meetings in
your 'breaks', do some filing etc. The key is to engage your
body use in variety of ways (as opposed to typing all day long
with a phone stuck to your ear).

Ergonomic Impact of Spinal Loading Recovery Positions on

Intervertebral Disc Health & Strategies for Prevention and
Ergonomics PT4822

Management of Low Back Pain

Introduction
Management of low back pain, particularly work related injuries, is
very controversial with numerous different treatment approaches ranging
from osteopathic manipulations to work hardening programs. However,
these strategies have been marked by many non-scientific interventions.
A comprehensive understanding is essential for clinicians to implement
effective evidence-based treatment and prevention.
Intervertebral Disc Anatomy and Physiology
The functional spinal unit consists of the two adjacent vertebral
bodies, the IVD, and the adjoining ligaments and fascia that cross the
segment. In comparison to the axial spine as a whole, the lumbar IVD to
vertebral body ratio is the largest in the lumbar spine, approximately 1:3
ratio. Along with action of the iliopsoas muscle, it is the intervertebral
disc height that accounts for the normal lordotic posture observed in the
sagittal plane. The intervertebral disc provides resistance to compressive
loads at the spine while simultaneously allowing very complex multi-
planar movements to occur. The intervertebral disc can be divided into
three separate regions; anulus fibrosus, nucleus pulposus, and
cartilaginous endplate.
The annulus fibrosus forms the outer walls of the IVD. The
annulus is considered fibrous cartilage and is comprised of predominantly
type I collagen . The fibers of the annulus are arranged in fifteen to
twenty five concentric lamellae at approximately 60 degree angles from
the vertical plane .The annulus has three distinct zones. The outer third
attached to the outer aspect of the adjacent vertebral bodies. The middle
third directly attaches to the cortex of the vertebral body, while the inner
third is confluent with the cartilaginous end-plate and creates a
continuous envelope around the nucleus pulposus . Innervation is only
Ergonomics PT4822

present in the outer third of the annulus in healthy intervertebral discs.

The posterior portion of the annulus is innervated by the sinuvertebral
nerve while the anterior portion of the outer annulus receives sensory
fibers through the paravertebral sympathetic trunks.
The nucleus pulposus is a gelatinous, highly hydrated structure
comprised primarily of type II collagen and water binding proteoglycans.
It is sandwiched between the cartilaginous endplate inferiorly and
superiorly. The endplate is comprised of hyaline cartilage, and is the
boundary between the vertebral body and the IVD.
Lumbar Intervertebral Disc Loading and Recovery Postures
Throughout the course of the day, the Lumbar IVD demonstrates
viscoelastic creep properties that determine the overall stature of an
individual. Tyrrell and colleagues used in-vivo stadiometry measurements
to detect 19.3 mm (1.1% of stature) variation in height between first
arising and the end of the day. Paajanen and colleagues using MRI to
confirm the role of the intervertebral disc, reported similar results with
subjects losing 13 and 21 mm of height during the day . Stadiometry and
MRI are the two primary methods of measuring spinal height change
following loading and recovery conditions. Stadiometry has been shown
to be a valid and reliable clinical tool to assess spinal height when
compared to quantifiable measures made from MRI Stadiometry
assessment has advantages over MRI in terms of costs, use in clinical
setting, as well as the ability to measure subjects that simultaneously
sustain compressive loads of the trunk.

Special Tips
Ergonomics PT4822

• Several authors have assessed the ergonomic impact of work

related spinal loading.
• Several authors have assessed the specific effects of work related
postures and activities including types of office chairs and standing
activities.
• Static loading, particularly while sitting, has been associated with
increased work related low back pain.
• Additional studies have demonstrated that sustained supine flexion
and side-lying flexion position also increase spine height following
periods of seated loading.
Prevention and Management Strategies for Low Back Pain
in the Workplace
• Management of low back pain secondary to disc related disorders
can be challenging for the patient and clinician. Providing
appropriate ergonomic suggestions based on the biomechanics of
the lumbar IVD can improve the tolerance to work. Ergonomic
suggestions that aim to maintain an optimal amount of disc
hydration while minimizing disc pressure will be discussed.
• The sitting position is a common quandary for individuals
experiencing back pain secondary to a disc related disorder. Sitting
is generally not very well tolerated by an individual. However, the
sitting position is difficult to avoid during travel to work. Sitting is
also a common position adopted at work. Therefore, the sitting
position should be carefully evaluated if there are discogenic
symptoms.
• Sitting position without support to the lumbar spine creates nearly
50 % increase in IVD pressure compared to sitting with lumbar
support.
Ergonomics PT4822

• Lifting can also increase pressure in the IVD. If the integrity of the
posterior annular fibers of the lumbar IVD’s are compromised,
lifting will increase the load placed on the IVD. Therefore, heavy
lifting soon after waking should be avoided. Lifting with loads
close to the body will create a shorter external moment arm for the
lumbar musculature. Lifting with
• Loads further from the body create a large external moment arm
and subsequently requires the thoracolumbar extensors to contract
with greater force. The increase in contraction by these
thoracolumbar extensors will create an increase in IVD pressure to
counter the external moment produced by the load anterior to the
body. Hence, body mechanics instructions incorporate advice to
keep external loads close to the body. Even small loads may
produce a large increase in IVD pressure.

Table 1. IVD in Dehydration and Rehydration Activities

Intervertebral Intervertebral
Ergonomics PT4822

Lumbar Disc Lumbar Disc

Dehydration Re-hydration
Activities Activities
Types of activities - Gravity activities -Gravity Eliminated
Walking activities
Jogging Supine
- Repetitive cyclic Side-lying
trunk Prone
motions (Figure 4 - 5) Reclined
- Trunk & pelvic -Sustained positions
rotations -Trunk lateral flexion
- High frequency, low positions
duration motions -Low frequency
movement,
longer duration
motions
Treatment - 3-dimensional axial - 3-dimensional axial
Intervention separations with separation
rotation sustained with flexion
oscillations in side-bend.
extension.
Time of day for Early in am or in the Afternoon, evening
activities afternoon after lying
for 10-15 minutes.

Information&Operation (Visual, Hearing & Control)

Ergonomics PT4822

Introduction
Control rooms are used in a variety of industries. Digital displays
are often prominent as wallboards (overviews) and as multiple desktop
displays. If the displays are not optimally configured for the work tasks
and lines of sight, then individuals can develop visual and physical
discomfort, and there may be adverse effects on work flow. This business
case study reports the process used by an architect-ergonomist team to
provide very early schematic design advice for 15 control rooms in which
visual ergonomics was an integral component.
End users were engaged in the design process by blending the
requirements of ISO11064 for the conceptual design of control rooms
with a modified participatory ergonomics approach. The principle
observation is that the process engenders greater ownership of the design
by the end users and pride in their new workplace when the control room
is built. Engaging end users in the schematic design process also provides
an opportunity for developing creative solutions to visual ergonomics
design problems.
Other researchers reported ergonomics design approaches in
delivering digital solutions to achieve a unified experience from
interaction and business process design perspectives. Then, it analyses the
opportunities that new technologies may bring in for enhancing current
ergonomics design approaches from integration and intelligence design
perspectives. To address the challenges in today’s ergonomics practices
in delivering digital solutions, an interaction, process, integration and
intelligence (IPII) design approach is proposed. A case study is presented
that implemented the IPII approach. The quantitative data gathered from
the case study demonstrates that the IPII approach has achieved
significant advantages in reaching the goal of a unified experience and
operational benefits for delivering digital solutions. The IPII approach
Ergonomics PT4822

also demonstrates improvements compared to today’s ergonomics design

approaches, such as user-centred design, for digital solutions. Finally, the
paper highlights the contributions of the IPII approach for future
ergonomics practices in delivering digital solutions.
Computer and Visual Ergonomics
Here are some of the top computer ergonomics tips recommended by the
U.S. Department of Labor's Occupational Safety & Health
Administration (OSHA). These tips are designed to reduce the risk of
stress, physical injury and computer eye strain from prolonged computer
use.
• Sit so your head and neck are upright and in-line with your torso,
not bent down or tilted back.
• Face your computer screen directly. Avoid viewing your screen
with your head turned or your back twisted.
• Keep your elbows comfortably close to your body.
• Use a chair that provides support for your lower back and has a
cushioned seat with a contoured front edge.
• Keep your mouse close to your keyboard so you don't have to
reach for it.
• Position your computer display so the top of the screen is at or
slightly below eye level. This will allow you to view the screen
without bending your neck.
• Adjust the position of your display to prevent reflections of
overhead and outdoor lighting appearing on your screen.
• Put your monitor close enough to your eyes so you can
comfortably read text on the screen without leaning forward.
Ergonomics PT4822

• When working with print documents, use a document holder that

positions them at the same height and distance as your computer
screen.
• Use a hands-free headset when talking on the phone while working
at your computer.

Digital Eye Strain

Computers, tablets, e-readers, smartphones and other electronic

devices with visual displays all can cause tired eyes, digital eye strain and
computer vision syndrome. Learn how to protect yourself from digital
eye strain, including how especially designed computer glasses can
relieve tired eyes, 10 tips to reduce computer eye strain, how computer
ergonomics can minimize your risk of computer vision problems, and
more.

We live in a digital world and extended screen time is quickly

becoming the norm in our everyday lives. Prolonged usage of digital
devices, including computers, tablets, and smartphones, increases your
exposure to Harmful Blue Light, which can lead to eye strain, blurred
vision, headaches, and trouble sleeping. Reduce your exposure with
regular breaks and digital protection glasses.

Steps you can take to reduce your risk of eye strain and other
common symptoms of computer vision syndrome (CVS):

1. Get a comprehensive eye exam.

Having a routine comprehensive eye exam every year is the most
important thing you can do to prevent or treat computer vision problems.
During your exam, be sure to tell your eye doctor how often you use a
computer and digital devices at work and at home.
Ergonomics PT4822

Measure how far your eyes are from your screen when you sit at your
computer, and bring this measurement to your exam so your eye doctor
can test your eyes at that specific working distance.

2. Use proper lighting.

Eye strain often is caused by excessively bright light either from outdoor
sunlight coming in through a window or from harsh interior lighting.
When you use a computer, your ambient lighting should be about half as
bright as that typically found in most offices.

3. Minimize glare.
Glare from light reflecting off walls and finished surfaces, as well as
reflections on your computer screen also can cause computer eye strain.
Consider installing an anti-glare screen on your display and, if possible,
paint bright white walls a darker color with a matte finish.

If you wear glasses, purchase lenses with anti-reflective (AR) coating.

AR coating reduces glare by minimizing the amount of light reflecting off
the front and back surfaces of your eyeglass lenses.

If you have not already done so, replace your old tube-style monitor
(called a cathode ray tube or CRT) with a flat-panel LED (light-emitting
diode) screen with an anti-reflective surface.

Old-fashioned CRT screens can cause a noticeable "flicker" of images,

which is a major cause of computer eye strain. Even if this flicker is
imperceptible, it still can contribute to eye strain and fatigue during
computer work.

Complications due to flicker are even more likely if the refresh rate of the
monitor is less than 75 hertz (Hz). If you must use a CRT at work, adjust
the display settings to the highest possible refresh rate.
Ergonomics PT4822

5. Adjust your computer display settings

• Brightness: Adjust the brightness of the display so it's

approximately the same as the brightness of your surrounding
workstation. As a test, look at the white background of this Web
page. If it looks like a light source, it's too bright. If it seems dull
and gray, it may be too dark.

• Text size and contrast: Adjust the text size and contrast for
comfort, especially when reading or composing long documents.
Usually, black print on a white background is the best combination
for comfort.

• Color temperature: This is a technical term used to describe the

spectrum of visible light emitted by a color display. Blue light is
short-wavelength visible light that is associated with more eye
strain than longer wavelength hues, such as orange and red.
Reducing the color temperature of your display lowers the amount
of blue light emitted by a color display for better long-term
viewing comfort.

Visual Clarity

• To reduce stress to the eye muscles, follow the 20x20x20 rule.

• Every 20 minutes look at something 20 feet away for 20 seconds.
• To keep eyes well lubricated, one should blink often.
• For ultimate clarity, a monitor with at least 1024 x 768 resolutions
and a dot pitch of .28 or less should be used.
• For better visual clarity, the monitor screen should be cleaned at
least once a week.

Ergonomic Aspects of Hearing

Ergonomics PT4822

Noise may be defined as undesired sound continuous exposure to

such sound has severe effect on hearing ability of individuals. It results
noise induced hearing impairment in individuals due to repeated exposure
of loud sound. It also affects the work ability and posture of individuals.
Generally, a person having hearing threshold level 25 is termed as normal
and a person having hearing threshold level more than 85db is considered
as permanently hearing impaired. The mechanism of noise-induced
hearing loss involves the destruction of hair cells in the Organ of Corti
within the cochlea of the inner ear.

Noise may be defined as undesired sound continuous exposure to

such sound has severe effect on hearing ability of individuals. It also
affects the work ability and posture of individuals. Noise is measured in
decibels (db). Generally, a person having hearing threshold level 25 is
termed as normal and a person having hearing threshold level more than
85db is considered as permanently hearing impaired.

Researchers estimate risk of hearing impairment of worker engage

in sheep husbandry. The amount of sound energy absorbed by the
workers annually is found to be 89.8db of Leqover 2020hr/year. B&K-
2218 precision integrated sound level meter is used for noise
measurement. In milking worker exposed to an average of 86.5 dB Leq
and peak value is 106dB. In ploughing it is 99.3 dB and in forage baling
it is 98.1dB. ISO/DIS 1999 model is used to calculate mean exposure
level.

Other researchers investigate effects of noise on student’s learning

achievement. Subjective evaluation is also carried out by using
questionnaire. Measurement of noise indicates that LAeqranged between
61.3-73.2dB. Responses from respondent indicate that 57% respondent
Ergonomics PT4822

feel that noise obstructs their learning achievement. For restriction of

noise experiment were carried out.

Accommodation through Improved Design

Ergonomics PT4822

Introduction
Often we think of accommodation as an effort aimed at helping
someone overcome legally defined physical, sensory, or mental
impairments by modifying the design of physical layouts, tools,
equipment, or job task(s). In other cases one attempt to enable an
individual to perform activities of daily living to meet the requisite
occupational responsibilities. Reasonable accommodation is a material
component in legislation that aims to help impaired individuals to
integrate into the mainstream of society as fully functional and integrated
citizens. What constitutes impairment and how reasonable
accommodation efforts may be are continuing processes that are typically
resolved through societal processes. All of us have some degree of
impairment when compared against a more capable individual, and we
are all impaired, to some extent, by less than ideal layouts, equipment,
tools, or task designs that have been poorly conceived.

Design-Induced Accommodation Challenges

Often poor design of jobs, equipment or workplaces, impair
performance, safety, and health of all workers. If that is the case,
improved design can increase productivity and quality of work for all
workers, including those who are impaired. Accommodation
requirements are often eliminated or mitigated if designs follow
ergonomic design principles.
Designers often suffer from one or more of the following fallacies:
• This design is satisfactory for me; thus, it will therefore be
satisfactory for everybody else.
• This design is satisfactory for the average person—it will therefore
be satisfactory for everybody else.
Ergonomics PT4822

• The variability in human beings is so great that it cannot possibly

be catered for in any design; however, since people are so
wonderfully adaptable, it does not matter anyway.
• Ergonomics is expensive and since products are actually purchased
on appearance and styling, ergonomics considerations may be
conveniently ignored.
• Ergonomics is an excellent idea. I always design with ergonomics
in mind— but I do it intuitively and rely on my common sense so I
do not need tables of data.
Overcoming design flaws typically requires focal attention to human
requirements for
• Ability to lift, carry or otherwise move everyday objects
• Eyesight (even when wearing glasses or contact lenses),
speech, or hearing
• Manual dexterity
• Memory, learning, concentration, understanding
• Mobility
• Perception of the risk of physical danger
• Physical coordination
• Hydration, sustenance, and continence issues
• Environmental tolerance

• Others.

The following information summarizes several tips for completing

an ergonomic analysis. The first step in an ergonomic analysis is to define
the population that is to be served. For example, when implementing
ergonomics for an individual who uses a mobility aid, the mobility aid
and its user must be considered one unit. The type of mobility aid may
change what is considered “ergonomic.” Implementing ergonomic
Ergonomics PT4822

principles for an individual with a disability can be very specific to that

individual. Also, when dealing with accommodation issues in the
workplace, special attention should be given to the location and set-up of
assistive technology to ensure good ergonomics. Second, the individual’s
workstation and work-site must be addressed.

A. Worker

General guidance on accessibility and proper ergonomic positioning can

be obtained from the Americans with Disabilities Act Accessibility
Guidelines (ADAAG) . Typically, anthropometric data are used to design
workstations that adjust to fit the smallest member of the population (the
5th percentile female) and the largest member of the population (the 95th
percentile male). However, a majority of those left outside of this range
are people with disabilities. This means ergonomics is situational. Thus,
when accommodating an individual with a disability, an effective
analysis may need to go beyond general guidelines.
• What are the subject’s anthropometric data? Document the
subject’s stature; eye, shoulder, and knee height; arm reach; leg
length; and waist level. Anthropometric data are used to specify
appropriate reach and space requirements for various populations.
• What psychosocial factors are influencing the worker? Document
if the individual works alone, in a cubicle, or is isolated and
whether the individual has freedom over workstation (e.g., radio
use, decorations).

What types of personal protective equipment (PPE) are used?

Document any gloves, arm guards, hardhats, safety glasses,
respirators, or shoes.
Ergonomics PT4822

B. Workstation

1. Office
• Is the keyboard placed low enough so that the employee’s posture
is ergonomic and the employee feels comfortable? It is important
to maintain a neutral wrist posture and use a light touch on the
keyboard. Upper arms should hang loosely by the sides with
forearms parallel to the floor. Keyboard height should be between
25 and 31 inches.
• Are the space dimensions within the workstation sufficient? The
top of the computer monitor should be level with the operator’s
eyes and positioned at a comfortable viewing distance. (This is task
specific.) Repositioning with an adjustable monitor arm is an
option. The monitor should be placed directly in front of the chair
and over the center of the workstation knee well. Screen height
should be between 33 and 42 inches, the angle of the monitor
screen should be between 0 and 7 degrees, and viewing distance
should be between 18 and 28 inches.
Ergonomics PT4822

Is the chair properly adjusted? A fully adjustable seat and

adequate legroom should be provided. In general, the
clearance between the top of the seat pan and the bottom of
the work surface should be about 11 inches with about 24 to
32 inches provided horizontally at the knee and ankle
respectively. The seat should be large (minimum of 18.2
inches wide) and fully padded. It should be covered with a
porous roughly textured moisture absorbing material. The
seat pan height and depth should be adjustable as well as the
angle and height of the seat back. A properly designed
backrest should support the upper and lower spine. A stable
five-leg base and seat swivel helps with reaching items
located to the sides of the workstation. If seating adjustments
are such that the employee's feet do not touch the ground an
adjustable footrest should be provided.

Is glare diffused with panel diffusers and/or glare screens? Task

lighting with a dimmer control should help, and adjustable
blinds can taper excessive sunlight.

2. Industrial

Is the work surface adjustable? The surface should be sturdy

enough for workers to lean on for balance and should have
rounded work surface corners and edges. Work surfaces
should be between 25 and 34 inches from the floor for seated
and 33 to 45 inches from the floor for standing. Work
surfaces should be less than 2 inches thick, and knee space
should be 30 inches wide by 19 inches deep.

Is the pace setting appropriate? Document what body parts

remain idle and what body parts are in steady motion.
Ergonomics PT4822

Are forceful exertions, such as gravity, friction, and reaction

forces, present? Document any lifting, moving, reaching
required and whether these forceful activities are associated
with extreme upper or lower body movements.

Are the "proper" tools available? Tools that are pneumatic; tools
that can be used in either hand; tools with pistol shaped
handles for power grips; tools with round edges, padded
handles, spring activation, and space between closed handles
will reduce palm stress and grip force. Newer tools equipped
with tool wraps and tool balancers/positioners are also
helpful.

3. Service

Are work surfaces adjustable? Work surfaces should meet the

needs of workers with different heights; reach ranges, and
standing/sitting limitations.

Is traffic flow designed to most effectively meet the needs of

workers, contractors, and customers? Document the most
frequently traveled areas and whether goods are stored in an
accessible place.

Are repetitive job tasks rotated among several workers

throughout a shift? Document activities such as lifting,
typing, tagging, taping and bar coding.

Is anti-fatigue matting available in areas where individuals must

stand for long periods of time? If available, document
whether the matting is properly fixed to the floor.
Ergonomics PT4822

Are mechanical aids available for use whenever possible?

Compact lifting devices, carts, and other light weight
material lifts should be available for lifting and moving
boxes and other materials.

Is a preventive maintenance program in place for all equipment?

4. Health Care

Have employees been trained in the proper use and selection of

patient lifting and transfer devices? Is there periodic re-
training and evaluation on the use of this equipment?
Patients can be grouped according to limitations making the
availability of similar equipment in areas of close proximity.
Shower chairs can be used for toileting and showering
reducing the amount of transfers into and out of wheelchairs.
Lift teams can be created for specific areas of the facility.
Group experienced, trained employees with new employees
to re-enforce proper lifting and transferring techniques.

Are laundry and food carts pushed rather than pulled? Do carts
have an oval or round push bar around waist height? Are
powered push/pull devices available for use with beds and
heavy or multiple carts? Some manufactures have a
motorized option available on a hospital bed.

Are there different height laundry folding tables for different

size employees? Do laundry personnel use spring loaded
bottoms in carts for dispensing linens? Existing folding
tables can be retrofitted with height adjustable table legs.
Ergonomics PT4822

• Have job task analysis been performed to identify awkward

postures and motions in all jobs? Examination of past injury
reports can identify areas of concern to address first. Look for tasks
involving reaching, bending, prolonged static postures, forceful
exertions, and heavy lifting.

5. General

What equipment is fixed/ moveable and where is it located in

relation to the worker?

Does the job include repeated and sustained exertions?

Document whether the job entails stagnant postures for
prolonged periods, repetitive motions, and whole body
exertions (lifts, pushes, pulls, etc.).

What is the duration and frequency of awkward postures?

Awkward postures include flexion (side to side), extension
(upward bending), and deviation (outward bending) of the
hand/wrist; flexion past 90 degrees and arm rotation of the
elbow; reaching overhead, behind the body, and across the
body with the shoulder; forward flexion and extension
greater than 30 degrees of the neck; and bending and
twisting greater than 20 degrees with the trunk.

What are the general environmental factors? Document noise

levels, ventilation, flooring material, lighting, air quality, and
temperature variations, specifically when the worker is
exposed to temperatures greater than 75 degrees or less than
50 degrees.
Ergonomics PT4822

C. Work-site

1. Spacing
• Is additional surface and maneuvering space provided for assistive
devices? Provide a minimum of 30 inches by 48 inches of
maneuvering space at workstations and storage areas. There should
be 48 inches of clear space between work surfaces, and objects
below 80 inches above the floor are typically inaccessible. Objects
protruding more than 4 inches from the walls should be removed.
• Are distances between entrances, work areas, restrooms, and office
equipment minimized?
• Are walkways blocked? Obstructed walkways should be opened to
eliminate the potential for trips and falls. At least one clear path of
travel (without stairs) at least 36 inches wide, except for a
minimum of 60 inches in two-way halls and 32 inches through
doorways should be provided. Allow a minimum of 60 inches of
clear, level floor space in front of and behind a door and 18 inches
on the latch side of the door.

2. Flooring
• Is non-slip flooring secure?
• Are proper treads, handrails, and detectable warnings installed?
• Do the walls and floors have a color contrast?
• Have changes in floor level been identified with visual and texture
contrast?
• Has ramp slope been minimized and any threshold with a rise
greater than 0.25 inch been ramped? Carpet pile deeper than 0.5
inch should be avoided and abrupt changes in friction eliminated.
Ergonomics PT4822

3. Doors
• Are door closers adjusted so that from an open position of 70
degrees, the door will take at least 3 seconds to move to a point 3
inches from the latch? (This is measured to the leading edge of the
door.)
• Is door hardware, such as levers or pull handles, provided? These
should be installed 36 to 48 inches above the floor and have a
shape easy to grasp.
• Do doorways provide at least 32 inches of level clearance?
• Are kick plates installed 12 to 18 inches above the floor?
• Do the inside and outside of doors provide 60 inches of clear floor
space and 18 inches to the latch side?
• Are automatic and power assisted doors provided where necessary?
Revolving doors should be avoided.

4. Storage
• Are materials stored in an accessible area, between 15 inches and
48 inches above the floor?
• Are drawers accessible? Avoid drawers deeper than 12 inches.
Deep storage should have Lazy-Susan carousels, pull-out shelves,
or drawers with full extension bearing slides.
• Are hard-to-reach materials labeled? Materials should have visible
labels and color codes.
• Do electrical wires dangle? Hazardous hanging electrical wires
should be avoided and others hidden from view.
• Are electrical outlets accessible? Electrical outlets should be
provided at least 15 inches above the floor.
• Are all casters appropriate to the floor covering?
Ergonomics PT4822

• Are items placed in the most “accessible” place possible? Position

storage for pushing rather than pulling, pulling rather than carrying,
carrying rather than lowering, and lowering rather than lifting.
Make storage available for intermediate transporting and
transferring of materials.

5. Other
• Is an accessible area of rescue assistance established?
• Are accessible drinking fountains provided?
• Is clear space for a forward or side approach provided for vending
machines? Vending machines should be on an accessible route and
within accessible reach ranges.

D. Administrative Controls

• Are employees properly trained in ergonomic principles? Training

should include proper lifting techniques, adequate maintenance and
correct equipment use, and neutral postures.
• Are rest breaks built into the workday? To reduce stress on eye
muscles, an individual should look away from the workstation and
refocus on an object at least 25 feet away and blink often. Rest
breaks should also include simple, brief exercises such as shoulder
shrugs, neck rolls, ankle rotations, leg extensions, overhead
stretches, handshakes, and finger spreads.
• Are job tasks varied? An individual should alter positions every 45
minutes, e.g., distribute tasks between right and left hands,
alternate between intensive fine motor and gross motor
manipulation, and change between sitting and standing.
Ergonomics PT4822

Ergonomics and Assistive Technology

When setting up a workstation for a person with a disability,

ergonomic principals remain the same. Please refer to this Workplace
Ergonomics Reference Guide for proper work surface setup and good
placement tips. It is advisable to adhere to good ergonomic positioning
while utilizing the appropriate assistive technology.

Available Assistive Technology

• Screen reading software operates a speech synthesizer, which
voices the contents of a computer screen, allowing people who are
blind or have low-vision to access the computer environment.
• People who are blind may use a Braille Embosser which provides
hard copy Braille output from a computer.
• Individuals with low-vision may need a larger monitor or a closed-
circuit television (CCTV) to magnify the print. The monitor
should be placed perpendicular to the windows or in such a
location that the windows are not directly in front of or behind the
monitor.
• Individuals who are Deaf or hard of hearing can use a videophone
or teletypewriter (TTY) to provide telephone accessibility.
• Assistive listening devices make conference rooms and
auditoriums accessible for individuals who are hard of hearing.
• Persons with dexterity limitations may use voice recognition
software allowing them to input data by using their voice alone or
in conjunction with the mouse or keyboard.
• Alternative keyboards and pointing devices can facilitate the use
of personal computers.
Ergonomics PT4822

Beyond the Office

The Ergonomics of Telework In this information age, more and

more professionals with disabilities are seeking telework as their most
appropriate form of reasonable accommodation. Per Public Law 106-346,
Section 359, the Office of Personnel Management outlines the
specifications for implementation of this guideline. Each executive
agency shall establish a policy under which eligible employees of the
agency may participate in telecommuting to the maximum extent possible
without diminished employee performance. The requirements of this
Section are to be applied to 25 percent of the federal workforce, and to an
additional 25 percent of such workforce each year thereafter (Public Law
106-346, Section 359: 10/23/2000). The mere establishment of a telework
policy does not automatically infer compliance with the law. Agencies
must consistently review their telework policies to ensure that the
practical enforcement of this regulation readily facilitates telework in all
circumstances where it is deemed appropriate based on the essential
functions of the job. If a telework policy is in place at an agency and
assigned duties allow for this accommodation, employees who exhibit
satisfactory performance and wish to participate must be allowed to do
so. Once telework has been arranged, it is vital to execute the same
ergonomic principals discussed in this reference guide when arranging a
home office environment. Please refer back to the guide for specific
recommendations.
Assistive Technology Devices for Children with Cerebral Palsy

Hip Extensor Tricycle

Children with CP often have weak hip extensor muscles, a condition that
often manifests itself in poor gait. Traditionally therapists have used
calisthenics and the use of a traditional tricycle in a program to strengthen
Ergonomics PT4822

the leg muscles. The biomechanics of traditional tricycle use, however,

are not effective in exercising the hip extensor muscles. Other means of
exercising the hip extensors, such as standing hip extension against the
resistance generated from an elastic cord at the ankle were disliked by the
children. The challenge to develop a therapeutic device that would
exercise the hip extensor muscles and be enjoyable for children was
posed to engineers by physicians working with such children in the
Department of Physical Medicine and Rehabilitation.

Fig 24 . Hip Extensor Tricycle (HET).

Assistive Technology for Seniors Using Wheelchairs

Wheelchair with lift seat

Many people, particularly seniors, require assistance to move from a
seated to a standing position and from a standing to a seated position. In
general, devices designed to assist in this maneuver are complex and
expensive. This led to the design and fabrication of the sit-to-stand (STS)
wheelchair. The STS wheelchair fulfills the need for an inexpensive
system that helps the user move from the seated to the standing position.
Ergonomics PT4822

Fig 25 .Wheelchair with lift seat

The STS was designed with the following parameters in mind:

1. The lifting force must be higher at the beginning of the lift and
decrease as the seat lifts the user. (This is required to allow the user to
“back into” the wheelchair when going from the standing to the sitting
position.)
2. The lifting velocity and force must be independent and adjustable.
3. All components must fi t within the footprint of a normal wheelchair.
4. No external power sources are required.
Knee Extension Propelled Wheelchairs
Older wheelchair users and people without adequate hand strength
sometimes use knee extension to propel their wheelchair backward. These
same users of wheelchairs may have limited neck mobility and find it
difficult to see exactly where they are going, possibly putting themselves
or other persons in danger of unintended contact.
Ergonomics PT4822

Fig 26. Knee Extension Propelled Wheelchairs

Fig First Generation of Leg Propelled Wheelchair

Ergonomics PT4822

Seats, Seating, and Seat Selection: Implications for Pressure

Ulcers
Pressure Ulcer
Pressure ulcers are a medical complication associated with
immobilization, affecting bedridden individuals and wheelchair users.
Pressure ulcers develop when soft tissue is compressed between a bony
prominence and a surface for an extended period of time. The regions of
the body commonly affected by pressure ulcers include the sacrum,
ischium, heels, elbows, scapulae, trochanters, and the occiput. The main
factors behind the formation of a pressure ulcer are the high mechanical
stress and shear forces generated during the compression of the soft
tissue.

Contino
us
Loading

Mechanica
l
Deformati
on

Tissue
Injury

Pressure
Ulcer

Fig 27 . Pressure Ulcer Formation Process

Ergonomics PT4822

Prevention of Pressure Ulcers

Repositioning
Given that excessive pressure, shear forces, and friction applied to
the tissue around bony prominences are the main cause for pressure ulcer
development, prevention methods are aimed at eliminating or reducing
these forces. The gold standard for pressure ulcer prevention is the
frequent repositioning of the individual to allow periodical relief of
pressure in areas at risk (i.e., sacrum, ischial tuberosities, and
trochanters).
At locales where individuals at risk of developing pressure ulcers
are under the care of health professionals, for example at hospitals and
nursing homes, the staff of the institution plays a vital role in preventing
the formation of pressure ulcers.
Patients or residents in these institutions who are unable to leave
their bed or move independently rely entirely on the institution staff to be
repositioned.
Specialized Cushions and Mattresses
A common and widely used method to aid in the prevention of
pressure ulcers is the use of specialized wheelchair cushions, bed
mattresses, and overlays to reduce the pressure at the interface between
the skin and the chair/bed. Although the use of these special surfaces does
not eliminate the need for periodical repositioning, by reducing the
interface pressures these devices may allow a person to remain in the
same position for a longer period of time without compromising the
integrity of the tissue. This is of particular importance for wheelchair
users, who perform most of their daily activities sitting in the wheelchair,
as well as for institutions where the staff available to aid in the
repositioning is limited, and the time between repositions is longer than
that usually recommended. Based on their operating mode, support
Ergonomics PT4822

surfaces can be divided into non-powered and powered systems. Non-

powered systems provide a static redistribution of pressure while
powered systems provide a dynamic redistribution of pressure.

Fig 28 . Specialized Cushions

Non-powered Pressure Redistribution Surfaces
These surfaces do not require any source of power to function.
They are designed to maximize the surface area in contact with the skin,
thus reducing the pressure at the skin–surface interface. Also, their
compliant surface allows regions of high pressure under bony
prominences to sink into the surface, thus diffusing the pressure to
surrounding areas . Non-powered support surfaces can be made of
different components including, viscoelastic foams, elastic foams, closed
cell foams, open cell foams, and elastomers. They can also be composed
of cells or bladders fi lled with water, air, gel, and viscous fluids. The
support surface can be made of any single type of component or a
combination of different components . Specialized wheelchair cushions
Ergonomics PT4822

are currently the only devices available for providing pressure relief while
sitting, and are routinely can prescribed by physical and occupational
therapists.

Fig 29. Non-powered Pressure Redistribution Surfaces

Air-filled cushions are composed of multiple cells that are inflated

to a desired air pressure. The amount of pressure reduction provided by
air-filled cushions can be affected by variables such as the size, shape,
material, air capacity, and air pressure of the inflated cushion. In
particular, the inflating pressure of the cushion has been studied and
associated with the cushion’s performance. Varying the inflating pressure
can change the amount of pressure relief provided by the cushion. Pitfalls
of this type of cushion include difficulties to adjust the inflating air
pressure by the user and/or caregiver. In addition, if not enough air
pressure is utilized to inflate the cushion; the user can “bottom out” in the
cushion, eliminating any pressure relief.
Ergonomics PT4822

Viscoelastic foam mattresses are made of heat-sensitive foam that

allows them to mold to the contour of the body, providing a reduction in
the interface pressures and a reduction of friction and shear forces. In a
study performed with patients in an acute care setting, the reported
benefits of using this type of mattress were a reduction in the ward’s
pressure ulcer incidence from a range of 3.5% to 4% to less than 1%;
however, no direct comparison was made against other pressure relieving
systems . Different studies have compared the use of standard hospital
mattresses and cushions against mattresses and cushions made from
viscoelastic foam in the same population.
Powered Pressure Redistribution Surfaces
This type of support surface requires an external source of power to
function, whether in the form of batteries or an AC plug. They are
capable of providing a dynamic redistribution of pressure, wherein air or
water is actively pumped so that the pressure within the supporting
surface is continuously changing.
Alternating pressure air systems include cushions, mattresses , and
overlays. This type of system is made of air-filled cells through which air
is pumped to maintain an alternating interface pressure .Some systems are
equipped with a liquid crystal display through which adjustments to the
alternating cycle can be made. In addition, they can also be equipped with
audio alarms in case of electrical or pressure failure . Other alternating
pressure air systems use variable density foam within the air cells; this
makes the flow of air through the cells more subtle, and reduces the
unpleasant sensations that some alternating pressure air systems can
generate.
Ergonomics PT4822

Practical Part

• Practical Situations
• Example of Ergonomics Project
Ergonomics PT4822

Practical Situations and Solutions

A journalist with bilateral carpal tunnel syndrome was limited to two

hours of typing and writing per day.
His employer purchased writing aids and an alternative keyboard;
installed speech recognition software; allowed him to take breaks
throughout the day; and provided him with office equipment to rearrange
his workstation.

A customer service agent for an insurance company was pregnant

and experiencing significant leg and back pain when sitting for long
periods of time.
She also needed to use the restroom frequently. The employer provided
an adjustable workstation to enable the employee to alternate between
sitting and standing positions. The employer also allowed her to take
more frequent rest breaks by dividing her existing thirty-minutes of break
time into several smaller increments of time so she could use the restroom
as-needed.

An employee with focal hand dystonia mentioned difficulty keeping

up with prolonged writing tasks.
The employer provided ergonomic writing aids as an accommodation.

A social worker with chronic fatigue syndrome experienced

headaches and photosensitivity.
Accommodations included changing the lighting in her workstation from
fluorescent lighting to task lighting, adding a glare guard to her computer
monitor, providing window blinds, and implementing other workstation
changes to enhance ergonomics.
Ergonomics PT4822

A sales clerk with cubital tunnel syndrome lost the ability to move
her right hand.
The individual needed to use the computer to create reports. Her
employer purchased a left-handed keyboard, foot mouse, forearm
supports, an articulating keyboard and mouse tray, and an ergonomic
chair.

An office worker with a bleeding disorder was limited in the amount

of time she could work at a keyboard.
JAN suggested using speech recognition software to decrease
keyboarding time and suggested implementing an ergonomic workstation.

A drafting engineer had third degree burns to 80% of his body.

He was limited in sitting for extended periods. He was accommodated
with an ergonomic workstation, including a sit/stand work station.

A clerical worker provided by a staffing agency needed an ergonomic

set up for her workstation.
The staffing agency provided the ergonomic equipment and the employer
had its IT department install it.

An insurance clerk was experiencing pain in her back, neck, and

hands from sitting for long periods of time doing computer work.
She was accommodated with speech recognition software, an ergonomic
chair, and an adjustable sit/stand workstation.

An office worker in a hospital was experiencing muscle weakness in

his neck and arms due to ALS
His employer called JAN looking for product ideas, specifically
information on ergonomic chairs with a high back, neck rest, and arm
rests. JAN was able to e-mail a vendor list for equipment so the employer
could make an informed decision.
Ergonomics PT4822

A veteran with head and neck injuries and post-traumatic stress

disorder (PTSD) was working as a graphic designer in a cubicle
environment.
He had chronic pain, which was exacerbated by using a computer mouse,
and PTSD, which was exacerbated by noise. The employer preferred to
have the designer work in the office with his team, but there were no
private offices available. Instead, the employer provided an ergonomic
mouse and a noise canceling headset.

A technical consultant was having difficulty using the computer in

the afternoons due to fatigue.
He was accommodated with speech recognition and an ergonomic
workstation.

A computer operator was experiencing weight loss and

gastrointestinal limitations as a result of having HIV.
She was provided with an ergonomic chair with extra padding and began
to change seating positions often. This prevented her from getting sores
from sitting in one position for prolonged periods of time. Employee’s
workstation was also moved closer to a restroom to provide her better
access. Total cost to move employee to another workstation was virtually
nothing.

A clerical worker who stamped paperwork for several hours a day

was limited in pinching and gripping due to carpal tunnel syndrome.
The individual was accommodated with adapted stamp handles. Anti-
vibration wrap was placed around the stamp handles. In addition, tennis
balls were cut and placed over the wrapped handles to eliminate fine
motor pinching and gripping.
Ergonomics PT4822

A customer service representative with arthritis had difficulty typing

for long periods.
The individual was accommodated with an ergonomic keyboard and
tablet computer.

A clerical worker with scoliosis has sitting and standing restrictions.

Because the worker is required to work at a desk a majority of the time,
the worker was accommodated with an ergonomic workstation
evaluation, ergonomic chair, and a sit/stand computer workstation.

A butcher with carpal tunnel syndrome had limitations in grasping

and handling tools and other objects, especially various sizes of
knives.
He was accommodated with a set of ergonomic knives.

A mechanic with a bending restriction due to a low back impairment

has problems accessing the engine compartment and low task areas
of vehicles.
The mechanic was accommodated with a tire lift, a mechanic's low task
chair, and a specialty creeper designed to support the body while
accessing engine compartments.

An individual employed as a patient rights advocate had carpal

tunnel syndrome and fibromyalgia.
She had difficulty keyboarding, writing, and transporting supplies to
presentations. The employer installed speech recognition software for
word processing, provided her with writing aids, and gave her lightweight
portable carts to assist with transporting materials.

A truck driver with thoracic outlet syndrome was having difficulty

driving for long periods of time and unloading bags at his delivery
destination.
Ergonomics PT4822

The employer installed a small crane in the back of the trailer and
provided him with a lightweight aluminum hand truck to help him unload
materials. The employer also provided the employee a steering wheel
spinner knob to eliminate prolonged grasping of the steering wheel and
an anti-vibration seat to cut down on fatigue.

An insurance clerk with arthritis from systemic lupus erythematosus

was experiencing pain in her back, neck, and hands from sitting for
long periods of time doing computer work.
She was accommodated with speech recognition software, an ergonomic
chair, and an adjustable sit/stand workstation.
Ergonomics PT4822

Ergonomics in dentistry

Introduction
Ergonomics can be defined as: an applied science concerned with
designing and arranging things people use so that the people and things
interact most efficiently and safely.
The term work-related musculoskeletal disorders (MSDs) refers to
musculoskeletal disorders to which the work environment contribute
significantly or to musculoskeletal disorders that are made worse or
longer lasting by work conditions or workplace risk factors.
Common examples of such workplace risk factors include jobs requiring
repetitive, forceful or prolonged exertions of the hands; frequent or heavy
lifting, pushing or pulling, or carrying of heavy objects and prolonged
awkward postures.
The level of risk depends on the intensity, frequency and duration of the
exposure to these conditions.
Types of MSDs that may affect dentists
Back Problems
Lower Back Pain
Between 70 and 90% of people have recurrent episodes of pain, and one-
third of patients continue to have persistent, recurrent or intermittent pain
after their first episode. In addition to the difficulty with healing, the
degenerative process is ongoing with age, and many patients do not
minimize potential risk factors.
All of this can contribute to continue episodes of low back pain.
The cause of LBP is often multifactorial but combined motions of lumbar
flexion with rotation increase risk to the lumbar disk.
Ergonomics PT4822

This is further exacerbated by inflexibilities around the hips and pelvis as

well as relative weakness of the stabilizers of the lumbar spine, including
the abdominal and gluteal muscles.
Furthermore, back pain can exist due to abnormal postures, relative
weakness and decreased endurance, and then exacerbated by a ‘specific’
injury.

Low Back Pain

Upper Back Pain

While not as common as lower back pain, some individuals report

extensive pain in the mid and upper back.
The thoracic spine is designed for support in standing and for caging the
vital organs and is quite strong.
It only rarely experiences symptoms of degeneration since there is little
movement and great stability.
Probably, a more frequent cause of mid back pain is muscular pain from
the postural muscles and scapular muscles. The contributions of abnormal
posture, static postures, poor strength and endurance, and overall
individual conditioning need to be taken into account.
Ergonomics PT4822

Hand and Wrist Problems

A predominant cause of repetitive motion hand disorders is constant
flexion and extension motions of the wrist and fingers. Chronic, repetitive
movements of the hand and wrist, especially with the hand in ‘pinch’
position, seem to be the most detrimental.
Other common contributing factors to hand and wrist injuries include
movements in which the wrist is deviated from neutral posture into an
abnormal or awkward position, working for too long period without
allowing rest or alternation of hand and forearm muscles; mechanical
stresses to digital nerves from sustained grasps to sharp edges on
instrument handles, forceful work and extended use of vibratory
instruments.
SIGNS OF MSDs
1-Decreased range of motion
2-Loss of normal sensation
3-Decreased grip strength
4-Loss of normal movement
5-Loss of coordination
SYMPTOMS OF MSDs
1-Excessive fatigue in the shoulders and neck
2-Tingling burning or other pain in arms
3-Weak grip, cramping of hands
4-Numbness in fingers and hands
5-Clumsiness and dropping of objects
6-Hypersensitivity in hands and finger
Risk Factors for MSDS
Repetition of:
1. Forceful exertions.
2. Awkward postures.
Ergonomics PT4822

3. Contact stress.
4. Vibration.
5. Poorly designed equipment workstation.
6. Improper work habits.
7. Genetics.
8. Medical conditions.
9. Poor fitness level.
10. Physical/mental stress.
11. Lack of rest/recovery.
12. Poor nutrition.
MECHANISMS MSDS IN DENTISTRY
Prolonged Static Postures (PSPs)
When the human body is subjected repeatedly to PSPs, it can initiate a
series of events that may result in pain, injury or a career ending MSD.
Muscle Ischemia/Necrosis and Imbalances: During treatment, operators
strive to maintain a neutral, balanced posture and find themselves in
sustained awkward postures.
These postures often lead to stressed and shortened muscles which can
become ischemic and painful, exerting asymmetrical forces that can cause
misalignment of the spinal column.
Hypo-mobile Joints
During periods of PSPs or when joints are restricted due to muscle
contractions, synovial fluid production is reduced and joint hypo mobility
may result.
Spinal Disc Herniation and Degeneration
In unsupported sitting, pressure in the lumbar spinal discs increases.
During forward flexion and rotation, the pressure increases further and
makes the spine & disc vulnerable to injury.
Ergonomics PT4822

Neck and Shoulder Injury

Repetitive neck movements and continuous arm and hand movements
affecting the neck and shoulder demonstrate significant associations with
neck MSDs.
Carpal-Tunnel Syndrome (CTS)
It has been associated with both repetitive work and forceful work.
Symptoms can appear from any activity causing prolonged and increased
pressure (passive or active) in the carpal canal.
Low Back Pain
Low back discomfort has been associated with dental work in numerous
studies.
Psychosocial Factors
Dentists with work-related MSDs show a significant tendency to be more
dissatisfied at work.
They are burdened by anxiety, poor psychosomatic health and thus feel
less confident with their future.
Goals of ergonomics in any work place should include
1. Reducing the risk of CTD.
2. Increasing productivity.
3. Increasing safety.
4. Improving the quality of work.
5. Decreasing fatigue and errors.
1. Adopting a correct working posture.
2. Use of adequate light.
3. Good planning of dental care sessions.
4. Alternative planning of long and short sessions.
5. Alternating the body postures sitting and upright.
6. Having short breaks after each care session and long coffee or lunch
breaks, the sink should be installed at distance.
Ergonomics PT4822

7. The working day should not be longer than 7 hours.

8. Every 6 weeks a journey should be planned
9. Sports activities should be practiced for about 45 minutes three times a
week.
What are the Parameters of the correct working postures?
1. The sitting posture is upright and symmetrical.
2. The shoulders hanging down relaxed with the upper arms beside the
upper body.
3. The forearms have been lightly elevated.
4. The angle between lower and upper legs is approx. The legs are
slightly apart, making an angle of between.
5. The patient’s head is appropriately rotated in 3 directions
6. The patient’s head is appropriately rotated in 3 directions.
7. The light beam of the dental operating light is as parallel as possible to
the viewing.
8. The soles should he on the floor.
9. The patient’s head is rotated and the sitting location adjusted.
10. Instruments held in 3 supporting points.
11. The upper part of the body should be perpendicular on the chair
forward movements should be made without curving the spine.
12. The head could bend 20°-25°.
13. The arms should be close to the body.
N.B: While using automated instruments look for
1. Light weight, balanced models (cordless preferred).
2. Sufficient power.
3. Built in light sources.
4. Angled vs. straight shank.
5. Pliable, light weight hoses.
6. Easy activation.
Ergonomics PT4822

References
Berlaa, M. & Valéria Sousab, A. (2015). Implantation of an ergonomics
administration system in a company: report of an occupational therapist specialist in
ergonomics. Work 41 (2012) 2637-2642 DOI: 10.3233/WOR-2012-0655-2637
Hada,M, Yamadam ,D.& Tsuji, T.( 2006) .Equivalent Inertia of Human-Machine
Systems under Constraint Environments. DOI: 10.9746/sicetr1965.42.156
https://www.researchgate.net/publication/228900095

Haque, M.( 2015). Ergonomics, Biomechanics & Musculoskeletal Disorder- A

https://www.researchgate.net/publication/288725523

Kumar, S. (2009) .Ergonomics for Rehabilitation Profession.3rd Edition

Mallick , Z & Asjad ,M.( 2017). A Review of Ergonomic Aspects of Hearing

Impairment of Humans in Different Environments. International Journal of Scientific
& Engineering Research Volume 8, Issue 7, July-2017 ISSN 2229-5518.
http://www.ijser.org.
Minga, Z., Närhi ,M & Siivola,J.(2004). Neck and shoulder pain related to computer
use. Pathophysiology 11 (2004) 51–56. doi:10.1016/j.pathophys.2004.03.001
Owens, S., Gerke, D. & Brismee, J. (2019) Ergonomic Impact of Spinal Loading
and Recovery Positions on Intervertebral Disc Health: Strategies for Prevention and
Management of Low Back Pain. Book Citation Index.
https://www.therapeuticassociates.com/health-wellness/ergonomics/ergonomic-risk-
mitigation-and-prevention/

https://uwaterloo.ca/safety-office/occupational-health-safety/ergonomics/general-
ergonomics-guidelines