Chiropractic in the Workplace: Combating Repetitive Motion Injuries

Journal of the American Chiropractic Association, Aug 2004

Working can be hazardous to your health-especially when it comes to repetitive motion injuries and peripheral joint trauma. The Occupational Safety and Health Administration reports that 1.8 million work-related musculoskeletal disorders are logged every year, a catalog of on-the-job injuries and strains that result in $15-20 billion in workers' comp costs alone.1

For every case of carpal tunnel syndrome (CTS)-just one of the many common workplace repetitive motion injuries-25 workdays are lost, according to Northwestern Health Sciences University Director of Occupational Health Joseph Sweere, DC, DABCO, DACBOH, citing the Bureau of Labor Statistics.

Because of all the attention paid to CTS, computer operators and secretaries come to mind. But the range of industries and jobs that can lead to repetitive motion injury is truly staggering, says Dr. Sweere.

Probably the industry most at risk for these disorders is the meat and poultry processing industry because of the repetitive microtrauma involved. Workers' tools may not be as sharp as they could be. The shape and size of the handles and controls of workers' tools may not be a good fit between the hand and the task, and these people often work in very cold environments, which acts as a vasoconstrictor. Without question, they're at significant risk," Dr. Sweere says.

And the list goes on: food processing in general; aircraft or product assembly; the upholstery, garment, and textile industries; metal fabrication of all kinds; shoe and leather goods manufacturing and repair; tailoring and sewing; carpentry; flooring and carpet layers; painters, wallpaper hangers, and plasterers; bank tellers and grocery checkout clerks; riveters and others who use chainsaws, jackhammers, and other vibrating tools; musicians; and clerical workers. "You start putting together a list like that, and you see why there's such public health concern about all of these jobs," he says.

Seated workers, he notes, are particularly vulnerable-and estimates indicate that those workers comprise some 70% of the United States working population. "Most clinicians will be reasonably familiar with the concept of avoiding static loading-holding one body part in a stationary posture for a prolonged period," Dr. Sweere says. "That always results in the buildup of waste products and metabolites such as lactic acid, uric acid, and carbon dioxide. The tissues need to move in order to mobilize that waste product, so the worker should get up, move about, and stretch the forearms, wrists, elbows, shoulders, back, neck, and lower spine. Anything that can facilitate the mobilization of waste products is imperative. But it often doesn't happen, and that's how overuse injuries occur."

A wide range of opportunities allows doctors of chiropractic to get involved with employers in preventing these sorts of workplace injuries, according to Dr. Sweere. Since 1983, he has headed Northwestern's postgraduate program in occupational health and applied ergonomics, which has trained about 2,000 DCs.

"Astute employers are absolutely seeing the logic of prevention. Doctors of chiropractic, who by nature prefer to be pro-active, rather than to do damage control, can be very involved in a preventive role," Dr. Sweere says. "There's much to be gained by working directly with employers to facilitate a more user-friendly workplace." A nonprofit organization, the International Academy of Chiropractic Health Consultants (IACOHC, online at http://www.iacohc.com), serves as a resource center for chiropractors interested in this growing field.

Five predetermining factors make a person vulnerable to repetitive joint trauma. These factors include:

1. Posture

2. Repetition

3. Force

4. Temperature extremes

5. Vibration

Each of these factors adds to the risk of injury; when 4 or 5 are present-as with, say, a meatpacking plant worker who must stand in the same position for a long period, repeating the same motion with great force over and over again in a cold environment-the potential for damage grows exponentially.

"What happens often is that we have a repetitive activity with hands, fingers, and forearms-especially with clerical workers or others who sit or stand-but the trunk and rest of the body are held in the same position. There's a conflict there-an overuse phenomenon with one part of the body, while other body parts are held too long with almost no movement at all," Dr. Sweere says. "There can be a combination of dynamic overload and static overload, and either one can be a problem, so we want to minimize both."

Among some of the new tools that help clinicians and employers improve the situation are air-inflatable gloves, which are designed to minimize the impact of vibratory force on the hand and wrist; new types of chairs that allow seated workers to assume an infinite range of postures so they can shift and move during a long, seated workday; and new types of hand tool designs with better grips and better positioning for more efficiency with less vibration.