Stop the Pain Drain

You can easily see how pain will undermine the financial base of your business. This is more than just ergonomics!

• By Julie Donnelly, BS, LMT
• Oct 01, 2006

PAIN is putting a strain on your bottom line. Employees who are suffering from repetitive motion injuries are not able to work at their ultimate performance level, causing decreased productivity and often incurring medical problems that can lead to disability claims.

You've hired ergonomic experts to change the computer stations. You've given your employees new keyboards. You've tried every type of mouse on the market and spent thousands of dollars on chairs. You've read scores of articles describing the two biggest repetitive strain injuries--low back pain and carpal tunnel syndrome--until you could actually repeat the symptoms in your sleep. You've analyzed, prioritized, been reactive and proactive. You've run the gamut, and still your employees are in pain.

According to the Chronic Pain Association, U.S. companies lose an estimated $90 billion each year to sick time, reduced productivity, and direct medical and other benefit costs because of chronic pain among employees. Add to this the fact that it is estimated stress is costing industry $300 billion--and pain is stressful--and you can easily see how pain will undermine the financial base of your business. Employees diagnosed with repetitive strain injuries will frequently get on the treadmill of doctor appointments, medications, and various forms of therapy that have less than total success. While this is happening, you need to shift work to other employees or just let the work pile up.

What's missing? The problem is that even with the most ergonomic workstations, people are still doing the same movements over and over. Their muscles get contracted and tied into knots, which puts a severe strain on the insertion points at the joints. Job-related repetitive strain injuries are costing industry millions of dollars in lost time and disability claims. As worker's compensation fees soar, industry is desperately seeking answers to what is causing the repetitive strain injuries that have become rampant.

The term "repetitive strain injury" should immediately bring attention to the muscles, but why a muscle will cause pain and how to treat the muscle have been the missing components in the search. Short of having the employee change jobs, there isn't anything that can help--or is there?

Isolating the Muscles that Cause Pain
Ample time and money have been spent to review how an individual sits at a desk and types on a computer. Posture is always emphasized, and lumbar supports are added to chairs to help rest the back. However, even with the very best posture and the most advanced equipment, repetitive strain on the low back and arm muscles is inevitable.

Employees who sit for hours or use their hands to perform the same task repeatedly--employees on an assembly line, for example--have not been studied as closely. If an employee stands at an assembly line and uses his arm in the same direction over and over, it is likely that he'll have pain in his shoulder. Or if she is sitting all day, her low back and possibly her knees will hurt. Employees who type at a computer for hours at a time or do fine-motor movements with their fingers will get all of the symptoms of carpal tunnel syndrome.

The first step to reversing the pain drain is to watch the movements that employees do repetitively.

Why Muscles Cause Pain
All muscles originate on a stationary bone ("point A"), cross over a joint, and then insert on "point B," a moveable bone. When the muscle contracts it pulls on the insertion point, and the joint moves. However, when a muscle is repeatedly moved in exactly the same direction, often for hours at a time, the fibers actually shorten. This phenomenon is called "muscle memory," and it is the key to the pain and lack of range of motion that is common in repetitive strain injuries. As the muscles shorten, they are still attached to points A and B, but the tight muscle is putting tension on the insertion point and holding the joint in the bent position. This tension causes pain when the individual tries to move the joint.

A useful analogy is to compare this situation to pulling hair. If you pull your hair at the end, your head will hurt. However, there isn't anything wrong with your head, and you don't need drugs or surgery to release the pain. You simply need to let go of your hair. In the same way, when a muscle is putting tension on a joint, the answer isn't drugs or surgery. It is simply to release the tension, and the pain will disappear.

The 'Hidden' Muscle that Causes Low Back Pain
The muscle that contracts to pull a person into the sitting position, the iliopsoas, originates on the front of the lumbar vertebrae, passes through the inside curve of the pelvis, and inserts on the inside of the thigh bone. I call it "hidden" because rarely will a physician or therapist even consider the iliopsoas muscle when treating for low back pain, yet it is the key to finding the answer to this condition.

When a person sits for an extended period of time, muscle memory will cause the fibers of the iliopsoas to shorten. The problem occurs when the person tries to stand up and the fibers don't stretch enough to allow the pelvis to fully rotate on the pivot point. The lumbar vertebrae are pulled forward and down, and the pelvis also rotates forward and down. This movement will put pressure on the front side of the lumbar vertebrae, and the brain will simply register it as "low back pain."

People will lean forward and rub their low back and feel some relief. They think the relief is coming from the rubbing of the lumbar area, but it is actually because bending over will bring point A closer to point B. In this case they are moving back into the contracted position so the muscle is not pulling on the vertebrae, but when they try to stand up straight, the pain returns. A simple stretch often relieves the tension and eases the pain. Because bending forward will contract the iliopsoas muscle, bending back will stretch it.

Carpal Tunnel Syndrome: Hand/Wrist Pain and Numbness
A scourge that has risen to epidemic proportions, carpal tunnel syndrome is a case where muscles are ignored and all focus is on a 2-inch area of the wrist. This is totally shortsighted! A look at the structures of the wrist (see image above) demonstrates why the muscles of the forearm are the villains in wrist pain and numbness of the hand.

The function of the flexors, which are located on the underside of the forearm, is to curl the hand into a fist and bend the wrist. To do this movement, the tendons of the flexors run through the small carpal tunnel and insert into the hand and fingers. Along with the tendons is the median nerve that gives feeling to the thumb and first two fingers. When the flexor tendons are tightened because the muscles are contracted from repetitive use, they impinge on the nerve, and numbness is felt in the hand.

Also putting direct pressure on the nerve in the carpal tunnel is the muscle of the thumb. This muscle originates on the bridge to the carpal tunnel and inserts into the base of the thumb. As it contracts, it draws the thumb in toward the palm. However, if you have employees who spend hours picking up items and putting them elsewhere, the muscle will become shortened by muscle memory. The muscle is now pulling tightly on the bridge to the carpal tunnel, pressing it down on the nerve and causing numbness in the fingers and pain in the wrist area.

The extensor muscles are on the top of the forearm and insert directly onto the carpal bones. When the extensor muscles contract normally, you open your bent fingers. However, when muscle memory causes the extensors to shorten, they pull on the carpal bones. This tension will change the dimensions of the carpal tunnel and also put pressure on the median nerve.

The Solution: Plugging the Pain Drain
Once you contact a trained professional with expertise in the area of muscular repetitive stress who can identify which muscles are being used over and over, the next step is developing a treatment program to reverse the movement and enable muscle fibers to lengthen. Optimal results are found when the employee learns how to continue the treatment on a regular basis. Because the movement at work is repetitive, the treatment also must be done repetitively.

When an employee knows how to release the tension caused by repetitive strain injuries, the results are remarkable. Tension is removed from the joints and pain is quickly eliminated, having a positive impact on both the employee's job performance and his or her daily life. Morale is raised because the employee realizes that management cares, and loyalty is increased.

There are only winners. The employee is able to reverse or prevent pain, the company has a more productive workforce, and you have found a solution to a costly problem.

This article appeared in the October 2006 issue of Occupational Health & Safety.

This article originally appeared in the October 2006 issue of Occupational Health & Safety.