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January 2004

Table of contents:

1. Early Intervention: Prevent OSHA Recordables
2. Jobsite Evaluations: A Useful Tool for Injury Reduction
3. Think Safe! - Body Mechanics and Low Back Pain

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Early Intervention: Prevent OSHA Recordables

Many organizations that have struggled to minimize OSHA recordables and Worker's Compensation costs have found an answer: Early Intervention (EI). With an EI program, companies have reduced their recordables by 30-50% and their Worker's Compensation costs by over 40%.

What is an EI Program? An EI program is designed to address work-related sprains and strains before they become OSHA recordables. It is for companies that want to be proactive in regard to injury management and cost containment. It can be a stand-alone program or serve as an extension of your current in-house occupational health program.

"With an EI program, companies have reduced their recordables by 30-50% and their Worker's Compensation costs by over 40%."

How Does an EI Program Work?
Each EI program is tailored to meet the needs of your organization. However, the basic components are the same:

1) An employee reports a mild sprain or strain.

2) A licensed therapist assesses the worker's reported injury, usually before s/he makes a visit to the doctor.

3) The therapist typically:

a. Instructs the worker in appropriate stretches or exercises for the involved area and the use of self-management techniques to alleviate symptoms.

b. Observes the employee as s/he performs his/her job in order to make specific recommendations that may prevent exacerbation of the condition. These interventions can reduce the costly progression of the worker's current condition and the chance of re-injury.

4) The therapist usually sees the employee for one to four visits, making a referral to a physician if and when it is believed to be necessary.

What are the Benefits of an EI Program?
There are many benefits that organizations realize when they implement an EI program. These are just a few:

• Work pain problems are addressed early, before they develop in to an expensive lost-time injury.
• EI visits are not recordable. All techniques used during an EI visit fall under OSHA's definition of "First Aid", thus making the visit non-recordable.
• There are no work restrictions for you to accommodate.
• The EI visit is significantly less expensive than a physician visit and there are no additional medical tests (x-rays, MRI's) ordered.
• Since the therapist directly observes the worker performing his/her job, recommendations for alternate work techniques can be made immediately, reducing the stresses on the aggravated area.
• Over 70% of our EI clients have not required additional medical follow- up.

If you are wondering if an EI program is right for your organization, give us a call at (866)298-1312 or drop us an email at info@cisonsite.com.

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Jobsite Evaluations: A Useful Tool for Injury Reduction

Part of the philosophy of rehabilitating an injured worker is to educate how to avoid injury-causing stresses. In most clinical settings this is done in a lecture format of "Don'ts": don't lift palm down, don't bend at your waist, etc. Occasionally, there is a related demonstration on what movement patterns to use. Unfortunately, these lectures or performances are rarely true to the employee's normal activities on the job.

We all strive to give our workers the most ergonomically safe workplace possible. However, despite these efforts, injuries still occur. These injuries are not necessarily due to job tasks or workstation design but to worker habits, postures, and abnormal movement patterns. These employee behaviors can be easily modified and are usually less costly and more effective than changing a workstation. Even with a perfect ergonomic setup employees may still occur injures if using poor body mechanics or work techniques.

Therefore, one of the best tools of injury rehabilitation and prevention is jobsite evaluation and training. Training of the employee at his or her workstation eliminates the poor carry-over of knowledge from clinic to jobsite. It allows for full demonstration of appropriate work techniques and postures. It also gives the therapist a better understanding of the employee's normal activity level and allows the therapist to develop a treatment program to help the client meet the required demands of the job.

There are other benefits to jobsite evaluations. The therapist can make recommendations to address any ergonomic issues that are present. Workers would also be trained in the proper usage of any new equipment acquired to address ergonomic issues. Another benefit of jobsite evaluations is that therapists are better equipped to make return to work restriction recommendations. Explanations can be given to the employee by an onsite therapist to translate vague restrictions into specific work activity limitations. Also, employees feel that the therapist has a better understanding of his or her daily job tasks, resulting in a better employee-therapist relationship.

In the end, performing a jobsite evaluation gives the worker more appropriate and realistic feedback regarding the proper postures and work techniques that are essential to remain healthy and return to normal functional levels.

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Think Safe! - Body mechanics and low back pain

What are Body Mechanics?
Body mechanics can be defined as the way our bodies interact with our environment throughout the day. Some days may be less demanding while others may be more demanding. Some work is inherently stressful to our bodies and it is key that we are aware of how our bodies are interacting with our environment. Think about how much you move around and bend during a normal day. The lower back is probably the most used part of the spine, which likely accounts for the fact that low back pain and injury disorders are the most common back complaints.

Neutral or balanced posture is key to healthy body mechanics. Here are some points on neutral posture:

• Shoulders aligned over hips, with a slight curve in the low back
• Knees relaxed
• Weight slightly forward in the feet
• Head directly above the body, not leaning forward
• A straight line from ears to ankles, going through the shoulder, hip, slightly behind the knees and slightly in front of the ankle bone

Exercise, weight control and a healthy lifestyle are other keys to healthy body mechanics.

Causes of Low Back Pain:

• straining the muscles or ligaments
• pressure on the intervertebral discs
• nerve compression or entrapment
• damage to the vertebra

What are the risk factors for low back injuries?
1) heavy physical work
2) lifting and forceful movements
3) bending and twisting (awkward postures)
4) whole-body vibration (WBV)
5) static work postures.

These work-related risks for injuries can occur separately or in some combination. The more of these factors happening at any one time the greater the risk of injury. Below are some tips and suggestions on how to minimize low back injuries in your body and at your workplace.

Tips on low back injury prevention
The following tips will help you to minimize your risks of low back injury when you are doing standing work:

1) Remember to move around -Even the guards in Arlington cemetery can't stand to attention all day long. Moving is important to keeping the spine healthy and it will also help to improve circulation and reduce muscle fatigue.

2) Take breaks and stretch - Recent research has confirmed that frequent brief rest breaks help to reduce fatigue and musculoskeletal discomfort. Gentle stretching during a break will help to ease muscle tension and improve circulation.

3) Watch your posture - Pay attention to how you are standing!

• Stand in a stable posture with you feet on a firm surface.
• Try to avoid twisting the lower back around to reach things and move your feet so that your whole posture changes instead.
• Try to minimize bending movements. If you must bend for objects that are in front of you try to bend at the knees rather than the back. If you must bend for objects to the side of you try changing your stance so that you are facing the object, and then bend down at the knees.
• Avoid overreaching - if you must reach up to a high level, get something firm to stand on, such as a stool of steps.
• Avoid reaching over obstructions - if possible move the obstructing object or change your position before you reach for what you need.

4) Lean where you can - Leaning on a solid support helps to reduce fatigue when you're standing. This might be a support that you can lean back against, a support that you can lean against sideways, or a support that you can lean forwards against or hold on to.

5) Keep your back strong and supple - try to exercise to strengthen your back muscles, and perform activities to maintain flexibility.

Activities done everyday can cause a large amount of stress on your back and neck, resulting in pain. By modifying the ways that you do your everyday tasks, you can decrease stress and the chance of injury or pain.

STANDING
Use a diagonal posture while standing. With knees bent slightly, place one foot forward - OR you may place one foot up on a box or ledge if available. The diagonal posture is best used when performing tasks such as brushing your teeth or shaving.

SITTING
While sitting, your knees should be even or slightly higher than your hips. Your lower back should also be supported. Also, to alleviate stress on your back, you should not slump in your chair. Placing your feet on a small box can help you achieve this position.

REACHING
When reaching for items overhead, use a diagonal posture - OR use a stool to reach the items.

BENDING
To pick up light items - bend over your hips with one leg elevated (like a golfer), or bend down on one knee to get at low lying items.

PUSHING
You should always try to push items, rather than pull them. Make sure to utilize both your arms and legs. If pulling an item (like your wheeled-luggage), try to keep the object at your side, and do not turn your lower back.

CARRYING
When carrying items, it may be best to distribute the weight between two items, rather than one heavy item. Also, keep the item close to your body when carrying it.

LIFTING
You should not raise your heels off the floor when lifting. This could cause you to lose your balance. Instead use the diagonal posture to lift. Also, always remember to use your legs as much as possible when lifting.

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