Back to Basics is a weekly feature that highlights important but possibly overlooked information that any EHS professional should know. This week, we examine how ergonomics can help reduce workplace injuries and the costs associated with them.
Ergonomics are no big deal, right? There’s no federal standard for ergonomics or the prevention of musculoskeletal disorders (MSD). In 2001, Congress rescinded the Clinton administration’s 11th-hour ergonomics standard.
When the Occupational Safety and Health Administration (OSHA) cites an employer for MSD hazards in the workplace, the agency can only cite violations of the General Duty Clause (§5(a)(1)) of the Occupational Safety and Health Act. The dollar amounts of penalties for General Duty Clause violations are limited by statute. So, no big deal, right?
The workers’ compensation costs associated with MSDs can be sobering.
Insurer Liberty Mutual recently released its 2024 Workplace Safety Index, revealing the top causes of workplace injuries contributing to $58 billion in annual workers’ compensation costs—the direct costs of medical care and lost-wage payments. The index’s “Top 10” include the causes of workplace MSDs: awkward postures, overexertion, and repetitive motions.
Overexertion involving outside sources (carrying, holding, lifting, pulling, pushing, or throwing objects) costs employers $12.49 billion a year. “Other exertions or bodily reactions” (awkward postures like bending and twisting, climbing, crawling, kneeling, reaching, sitting, standing, running, and walking) cost employers $3.68 billion annually, while repetitive motions involving microtasks cost $1.54 billion.
Liberty Mutual also analyzed the top causes of injuries in eight industries: construction, healthcare and social services, leisure and hospitality, manufacturing, professional and business services, retail, transportation and warehousing, and the wholesale trade.
Overexertion involving outside sources (lifting, carrying, etc.) was the top cause of serious, nonfatal injuries in manufacturing, costing the industry $1.69 billion a year. It was also the top cause of injuries in the wholesale trade, costing $1.22 billion a year. It was the second leading cause of injuries in business and professional services, costing the industry $1.23 billion annually.
Overexertion involving outside sources (lifting, carrying, etc.) and other exertions or bodily reactions (awkward postures) were among the top five causes of injuries in the construction, healthcare and social assistance, leisure and hospitality, retail, and transportation and warehousing industries.
Earlier this month, the National Safety Council (NSC) released a report examining the correlation between MSDs, which are the most common workplace injuries, and racial disparities. The report, “The Intersection of DEI and MSDs: Ensuring Equitable Outcomes,” identified workplace factors leading to inequitable MSD outcomes and provided solutions for injury and illness mitigation, referencing more than 100 academic and scientific sources.
The report outlined possible solutions for addressing both workplace inequities and injury risks based on the “hierarchy of controls,” including:
- Elimination: Paying attention to jobs that demand high exertions, awkward or sustained postures, and a fast pace and eliminating them when possible.
- Substitution: Adapting workplace design to those of different sizes and abilities and providing ergonomic accommodations for employees with medical conditions or disabilities.
- Engineering: Providing adjustable assistive devices and technology, including carts, co-bots (semi-autonomous machines that work alongside workers to perform hazardous work tasks), conveyors, counterbalances, hoists, lifts, ramps, and turntables, to minimize strain and repetitive motions and incorporate designs that respect different cultural norms and practices.
- Administrative: Using policies and procedures to ensure accessibility for all workers and an open and anonymous reporting system and promoting diverse representation in safety leadership and training materials, as well as seeking and including feedback on job tasks and risk factors from a diverse group of employees to implement solutions that are helpful to everyone.
The NSC’s MSD Solutions Lab produced the report.
Ongoing MSD research
The NSC’s MSD Solutions Lab continues to publish research into solutions for MSD risks. Last fall, the MSD Solutions Lab released findings suggesting that investments in technology to reduce workplace MSDs can improve both worker well-being and an organization’s bottom line.
The white paper, Emerging Technologies for the Prevention of Musculoskeletal Disorders, acknowledged that employers may not have the access and knowledge they need to assess and implement risk-reducing technologies effectively.
It also suggested that employers and workers may benefit from the use of wearable sensors, which can provide real-time feedback to reduce back injuries caused by improper lifting, overreaching, and poor posture.
Emerging technologies that may help prevent MSDs include the following:
- “Computer vision,” a potentially helpful tool for larger organizations seeking to aggregate data and analyze ergonomic risks. The NSC’s “Work to Zero” initiative released an earlier white paper on applications of computer vision to mitigate fatal workplace injury risks.
- Wearable sensors as a supplement to engineering controls, which may help control the costs of ergonomic solutions.
- Using passive exoskeletons for manual material handling. Studies have shown a reduction of muscle activity by up to 40% using exoskeletons.
The report also examined the potential for co-bots to reduce workplace MSD risks. Co-bots include “follow-me” robots, called autonomous mobile robots (AMR), which can move loads around a facility, following an operator and performing material-handling tasks like carrying, pulling, or pushing a load.
Some AMRs can even autonomously navigate a workspace using advanced sensors, artificial intelligence (AI), machine learning (ML), and computing to interpret their surroundings.
Autonomous and semi-autonomous material-handling equipment can be used to reduce overexertion from carrying, lifting, lowering, pulling, or pushing loads; eliminate repetitive activities like performing the same hand motion repeatedly in high-precision, monotonous, or pick-and-place work that poses MSD risks; and reduce worker exposures to an environment with varied temperatures or hazards that are uncomfortable and unsafe for material handling.
Earlier this year, the NSC released a report that concluded that larger organizations with more than 1,000 employees are generally more effective at mitigating MSD risks. The first “MSD Solutions Index Pledge Community Report” surveyed 52 organizations that had joined the NSC’s MSD Pledge.
On June 13, the NSC announced that over 200 organizations, representing nearly 2.9 million employees, have joined its MSD Pledge.
In its report earlier this year, the NSC offered steps employers can take toward more impactful MSD prevention programs:
- Engage senior leadership, designating an MSD solutions champion to represent the workforce, and create and empower an MSD solutions team to collaborate throughout the organization.
- Collect and respond to employee feedback regularly, measuring the progress of MSD programs and safety culture and tracking the impact, solutions effectiveness, return on investment, and year-over-year change.
- Identify risk factors through involvement with frontline workers in implementing appropriate changes.
OSHA inspection and enforcement
OSHA has an ongoing National Emphasis Program (NEP) for inspection and enforcement in warehouses, postal processing facilities, distribution centers, and high-risk retail establishments, which can include assessments of ergonomic and heat hazards.
Under the program, agency inspectors conduct comprehensive safety inspections focused on hazards related to powered industrial vehicle operations, material handling and storage, walking and working surfaces, means of egress, and fire protection. They also assess heat and ergonomic hazards and may conduct health inspections if they determine such hazards are present.
Inspectors also assess ergonomic hazards while reviewing the employer’s injury and illness logs, conducting worker interviews, and performing a walkthrough of the establishment.
OSHA has repeatedly cited Amazon, Inc., for ergonomic hazards in several of the company’s warehouses and issued hazard alert letters about ergonomic hazards and delays in providing medical services to warehouse employees.
Early last year, OSHA cited safety and health violations at Amazon warehouses in Deltona, Florida; Waukegan, Illinois; and New Windsor, New York. The agency determined that workers at the three warehouses were at high risk for lower-back injuries and other MSDs.
Later that year, the agency cited Amazon for exposing workers to ergonomic hazards at warehouses in Aurora and Colorado Springs, Colorado; Nampa, Idaho; and Bayonne and Logan Township, New Jersey.
OSHA also issued a series of hazard alert letters to Amazon warehouses nationwide about MSD hazards and delays in providing medical care. Hazard alert letters impose no penalties, but OSHA has a policy of following up on them.
Ergonomics defined: Preventing MSDs
Ergonomics is “the scientific study of people at work … to prevent soft-tissue injuries,” according to the National Institute for Occupational Safety and Health (NIOSH). As Liberty Mutual’s data demonstrates, MSDs show up in a wide swath of industries, including agriculture, construction, health care, manufacturing, mining, transportation, and the wholesale and retail trades.
Both material and patient handling pose risks for back injuries. Back injuries were associated with the highest total employer costs, according to Liberty Mutual. Worldwide, back pain is responsible for more years lived with a disability than any other condition.
NIOSH offers guidance on manual material handling, as well as safe patient handling and mobility and ergonomic interventions for soft drink beverage delivery.
NIOSH also has a Revised NIOSH Lifting Equation (RNLE) for calculating the risk of work-related MSDs. The RNLE provides guidelines for designing safe lifting tasks and a risk assessment tool.
The equation’s inputs include:
- Weight of the object being lifted,
- Horizontal location of the hands away from the midpoint between the ankles,
- Vertical location of the hands above the floor,
- Vertical travel distance of the hands between the origin and destination of the lift,
- Asymmetry angle of how far the object is displaced from the front of the body,
- Frequency of the lifting task,
- Duration of all lifting tasks and rest time in an 8-hour workday, and
- Coupling quality of gripping or grasping the object while lifting.
Repetitive motion poses MSD risks for poultry processing workers. MSDs in poultry processing include carpal tunnel syndrome, epicondylitis (an elbow problem), low-back injuries and muscle strain, rotator cuff injuries (a shoulder problem), tendonitis, and “trigger finger” (when a finger bends, gets stuck, and then snaps straight). In 2013, OSHA issued updated guidelines for the Prevention of Musculoskeletal Injuries in Poultry Processing.
OSHA’s recommendations for poultry processing employers include looking for tools like knives, pliers, and scissors that are designed to minimize bending the wrist either side to side or up and down and minimize the force and contact stress to the fingers and palm of the hand.
Appropriately sized tool handles can help users with small hands maintain a “C”-shape grip between the fingers and thumb. Tools with a wraparound handle or strap allow the user to maintain control of the tools while relaxing fingers on the handle. Powered hand tools can reduce the force necessary to operate the tools.
Understand that while there’s no federal ergonomics standard, MSDs can end in burdensome medical care and lost-wage costs. The application of ergonomics just might save you.