Tissue Adhesions and Dysfunctional Movement Patterns Can Be Risk Factors for Injuries in the Workplace
Many institutions publish excellent guidelines on identifying risk in and around the workplace. For example, the Health and Safety Executive, a UK government organization concerned with the health and safety of Great Britain’s people at work or in the community, is one of the thousands of websites that use a digital platform to inform.
Information given out on these professionally managed websites regarding risk factors for work injury or accidents acts as a “filter.” Filtration is a process that separates the impurities, or risks, from the good of the process. So the question is: what are you trying to catch in the filter of your risk management?
The above pictures are a minute representation of postures workers assume during their work hours. Often these awkward postures either must be sustained to maintain accuracy of the work involved, or moderate force is also required in these types of positions, or workers must routinely get in and out the awkward positions throughout a work shift.
The same is also true regarding awkward postures for professional sports:
Although many of the assumed postures do not result in an instantaneous injury, the body can develop tissue adhesions that will eventually affect how tissues move and muscles behave. The end result will be stiffness, soreness, edema, discomfort, limited joint motion and tissue flexibility, and of course, pain, unless corrective measures are introduced prior to an injury.
In addition, different workers performing the same job tasks, will need to perform them differently due to their varied body types, strengths, and existing movement pattern dysfunctions. One worker is slim without difficulties in joints. The second worker is older and has been a physical worker their entire adult life. This person is carrying extra weight in the abdomen, which now increases the difficulty of squatting. Instead they must stoop over, thus dramatically increasing a risk of low back or possibly hamstring injury.
When you speak with workers on this topic, you may very well hear something like: “I don’t have any trouble moving like this. I always do and I never feel any pain.” Comments like this reveal that the worker doesn’t understand that he or she is just one more stoop away from hurting his or her low back. And, of course, it may not be at work. This scenario can play itself out in a home setting as well. The end result is an injured worker, and the time and cost now associated with finding help until they recover.
Risk Management = Proactive Movement Correction
Thanks to sports, we now know, through current research and publications in peer reviewed literature, that tissue adhesions, contusions, and other seemingly small innocuous injuries lead to movement dysfunctions: changes in how tissue moves and how voluntary muscles act (Hui Liu a 2012).
In light of this, even though a workstation has been ergonomically re-designed, a worker with muscle movement pattern dysfunctions will not “self-correct.” The body, when placed in a better posture or position will still require retraining (Peter Kent1 2015). This is conducted after going through movement screens and tissue adhesions are beginning to resolve (Richard W. Willy 2012) (Cook 2010).
This is one of the reasons why Musculoskeletal Disorders, MSDs, continue to reign high in worker’s compensation claims. Risk design is important not just for ergonomic reasons, but for movement patterns as well. This is an area that very few organizations, from industrial manufacturing companies to dental offices, assess. Specific and highly trained skills are necessary to determine what is to be filtered in the process of a risk assessment.
When we get together for a risk assessment of a work area, think of what you would like to filter.
- Cook, Grey. 2010. Movement: Functional Movement Systems: Screening Assessment and Corrective Strategies. Aptos CA: On Target Publications.
- Hui Liu a, William E. Garrett b, Claude T. Moorman b, Bing Yu c,*. 2012. "Injury rate, mechanism, and risk factors of hamstring strain injuries in sports: A review of the literature." Journal of Sport and Health Science 92-101.
- Peter Kent1, 2*, Robert Laird3 and Terry Haines. 2015. "The effect of changing movement and posture using motion-sensor biofeedback, versus guidelines-based care, on the clinical outcomes of people with sub-acute or chronic low back pain-a multicentre, cluster-randomised, placebo-controlled, pilot trial." BMC Musculoskeletal Disorders 2-31.
- Richard W. Willy, PT, PhD1,*, John P. Scholz, PT, PhD2, and Irene S. Davis, PT, PhD3. 2012. "Mirror gait retraining for the treatment of patellofemoral pain in." Clin Biomech 1045–1051.
Look on the Other Side of the Coin
Most manufacturing companies have heard, read and used a GEMBA walk within a LEAN approach to identify waste, develop more efficiency, produce what is necessary, and increase good communications through discussions with workers in a specific area and reviewing current processes.
GEMBA walks, LEAN manufacturing and Kaizen events are only a few methods and ideologies that help to spur and create the necessary positive changes in an organization. The experienced quality leader will also note the existing positive processes and conditions that produce a quality end product with efficiency, less waste, and engaged workers.
In any organization that creates products for customers, it is that end product and the high value it imparts that the customer appreciates. The common thread through manufacturing processes is to involve both the vertical management and the horizontal workforce together to identify the good and the “what is needed” for added value with less waste.
These activities often require an evolution of skill sets that happens over time through planning and conducting GEMBA walks in order to hone the process. The best and most obvious skill to develop is the eye. The eye can focus on one small object, or span out to view the larger surround. It is here, observing by eye, that the movements of workers at their stations can be viewed and more thoroughly analyzed.
Typically, when observing a worker at a station, we look globally: how far is that worker walking to obtain a part or tool? Are there too many or too few parts or tools? Maybe the worker is moving the parts too many times, or perhaps having to lift heavier parts too many times. In the process of removing waste through designing smaller work stations, reducing an overflow of parts, and creating additional work stations, workers may now only need to move their arms little, or take a few steps occasionally.
On the one hand, we are possibly helping to reduce human error, and therefore may be reducing the risk of mishandling something that results in an accident or injury. The workstation now may be such that more types of workers will be able to perform the job tasks at that station. Those are all benefits.
The “other side of the coin” is: are we creating a scenario for the worker to sustain relatively static postures, that, over time, increase fatigue in postural muscles, thereby increasing the possibility of mental fatigue, stiff muscles, sore feet and neck?
In the past few years, many of us have heard or read about the new “silent killer”: prolonged sitting. The deleterious effects of sitting are reducing quality of life by dramatically decreasing physical abilities and increasing onsets of various disease processes.
In manufacturing, however, the opposite maybe taking place: prolonged static standing. This is a common posture in assembling, the food industry, and other labor jobs. Many assembling plants are looking to minimize foot step movement and the number of times product is handled in order to decrease risk of physical injury and increase efficiency of the work tasks. The goals are excellent, but these “optimizations” may result in workers virtually frozen in prolonged standing postures.
Prolonged standing, as illustrated in the table above, has negative effects on the human body that are well documented: pooling of the blood in the lower extremities and increased muscle fatigue due to prolonged co-contraction of muscles for erect standing. Both create discomfort or pain in the feet, legs, lower back, neck, shoulders, and hips.
At Physical Performance Solutions, we have treated hundreds of individuals over the years whose static postures were a large contributing factor to soft tissue injury. In our work assisting organizations to reduce soft tissue injury in the workplace, we are seeing firsthand some of the results of these changes. Many studies published in peer review literature are coming up with similar conclusions. (FTüchsen, 2005), (Marwan El-Rich 2005).
Static loads and fixed postures are increasing stress and strain on the spine, ligaments, and surrounding soft tissues, in addition to sustained compressive forces on all load bearing joints. Occupational Health and Safety published about this subject in 2003, (Joy M. Ebben 2003), yet there more workstations than ever that are increasing standing postures. Our evidence is more than anecdotal; we are seeing more individuals with tissue adhesions not just in the lower neck/upper trapezius region, but also lumbar spine and calf muscles as well. Prior to recent redesign of particular workstations, those types of complaints and identification of adhesions was minimal.
Here are some suggestions to see if the changes your organization has made may be contributing to the “other side of the coin.” Some of these indicators should be fairly easy to track and document, while others will be more difficult due to the individual nature of each employee.
- Compare quality of product over time. There should significantly fewer mistakes. If there are mistakes, can you identify who is making the mistake? What time of day is the mistake being made? This is taking into account all parts and supplies are defect free.
- What are the age ranges of the workers at particular stations? How many women vs. men, and what are their ethnic and social backgrounds?
- Is there a consistent job rotation of the work area?
- Have there been any accidents, injuries, or other physical complaints prior to and after any changes?
- Are there new workers in the area now?
- Have soft tissue musculoskeletal disorders within that area decreased? By how much?
Manufacturing production and Lean are truly more than finding the waste and inefficiency that is external. It is also looking at any tradeoffs that might be created by reducing “wasted” movement and locking a worker into a static position for hours at a time.
Is the organization saving money in one area, but creating expenditure elsewhere, as expressed, perhaps, in days off from work due to soreness? Workers experiencing issues from changes in work movement patterns may not be confident enough to speak up for fear of losing their jobs. They might also have difficulty articulating what they are experiencing. Many workers do not truly realize that just standing can have so many ill effects on the body.
This is a microscopic view in relation to all of manufacturing and all companies that utilize Lean concepts and practices around the world. However, the “other side of the coin” bears watching, and companies that are proactive will begin to practice new approaches to further create a positive culture within the organization and an excellent product.