Yes, in agriculture. In 1997 California became the first state in the nation with an occupational safety and health regulation targeting ergonomic risk factors and repetitive motion injuries. The California Occupational Safety and Health Administration (Cal/OSHA) Standards Board promulgated General Industry Safety Order 5110, Repetitive Motion Injuries, which was subsequently approved by the Office of Administrative Law and became effective on July 3, 1997. Since then the so-called "ergonomics standard" has been the subject of ongoing litigation brought by both employer and labor groups.
In October of 1997, Superior Court Judge James T. Ford, hearing a challenge to the standard, responded by eliminating some of the language in the original text of the regulation. Most notably, he struck out the exemption for employers with nine or fewer employees, the language calling for "objective" diagnosis, and the entire section defining satisfaction of employer's obligation. In December 1997 the Standards Board itself appealed Judge Ford's changes. On March 13, 1998, the Court of Appeal ruled that Judge Ford's Order to eliminate parts of Section 5110 will be stayed until it issues a decision on the appeal filed in December. Given this March ruling, Section 5110 in its original July 3, 1997, form as adopted by the Standards Board is currently, and will remain, in effect unless and until the Court of Appeal takes action to change it.
So for at least the time being, employers are required to abide by the ergonomics standard as issued. This means that, if you have 10 or more employees and if two or more diagnosed repetitive motion injuries (RMIs) have occurred in your workplace within the past 12 months, you must implement the three-step ergonomics program prescribed in the standard. That program consists of (1) conducting a worksite evaluation for exposures causing RMIs; (2) taking steps to control exposures that have caused RMIs; and (3) implementing a training program that explains what RMIs are and the steps you are taking to control them. (See GISO 5110 for a complete statement of requirements.)
The standard itself, with an updated history of the action to date, is available on the Department of Industrial Relations (DIR) website, http://www.dir.ca.gov. Once there, click "Occupational Safety and Health," then "Occupational Safety and Health Standards Board," and then "Ergonomics Standard Status."
Prevention of MSDs
Whatever your stand on the politics of Cal/OSHA's role and methods regarding ergonomics in the workplace, there is reason for concern about improving prevention of the broad category of musculoskeletal disorders (MSDs), which include back injuries, repetitive motion injuries, and others. The incidence and costs of this group of injuries have steadily increased through this decade. In California, claims filed as "cumulative injuries" constitute a share that is twice the size of any other specific injury category, according to a study by the California Department of Insurance in 1993. And they include some of the most costly injuries reported. While no one has put a figure on costs of work-related back injuries in California agriculture, researchers B.S. Webster and S. H. Snook reported in 1990 that a study of more than 98,000 workers' compensation claims from 45 states, including California, showed the average overall cost per back injury case to be some $6,800 in the 1980s. With 3,350 being reported each year in California agriculture, according to an AgSafe estimate in 1993, that yields a conservative cost estimate of over $22 million per year for back injuries alone.
On the positive side, there is growing evidence that employers and employees can take some practical steps toward prevention of these injuries. With respect to California agriculture, most of that work is being done by a team of University of California researchers under the organization of the UC Agricultural Ergonomics Research Center (AERC). Team members include Dr. John Miles, Biological and Agricultural Engineering, UC Davis; Dr. Julia Faucett, Occupational Health Nursing, UC San Francisco; Dr. Jim Meyers, School of Public Health, UC Berkeley; Ira Janowitz (CPE), Ergonomics Program, UC San Francisco; and Projects Coordinator Diana Tejeda, UC Davis.
The Center has two multi-year research projects currently under way: a study of ergonomics in plant nurseries with Environmental Horticulture Advisor John Kabashima, UCCE, Orange County; and a study of ergonomics in wine grape vineyards with Viticulture Farm Advisor Rhonda Smith, UCCE, Sonoma County; Viticulture Farm Advisor Ed Weber, UCCE, Napa County; and Advisor Linda Garcia, UCCE, Sonoma County. The Center has also just been informed of approval of a new multi-year grant to study the efficacy of general ergonomics programs (like that prescribed in California's new regulation) in reducing MSDs. That study will be conducted in cooperation with Agricultural Personnel Management Advisor Steve Sutter, UCCE Fresno County.
"Ergonomics has become kind of a scary topic in the past few years, as debate about regulatory standards has raised questions about what it means. From an engineer's viewpoint, ergonomics is just another way of describing how work methods and tools evolve toward designs that are easier to use and are more efficient," according to Engineering Professor Miles. "We begin our projects with the same steps that the Cal/OSHA standard prescribes. Dr. Julia Faucett oversees collection and analysis of MSD incidence data by going through OSHA 200 logs ("Log of Occupational Injuries and Illnesses") with employers. She points out that probable MSDs are not always identified as such in the logs. Especially early developing MSDs may be reported as sprain or strain injuries. "In both of our current projects," she says, "we have seen clear evidence of MSDs associated with certain tasks." While the actual number of MSDs is not large, the number of lost workdays associated with them is, by a factor of more than ten lost workdays per injury.
While the current regulation does not require employee symptom surveys, the UC team uses one with cooperating employers to get detailed information on workers who have symptoms of developing MSDs. In one research project, 55% of workers surveyed reported some type of musculoskeletal symptom. The majority of these reports involved back pain. Symptoms in the neck and shoulders, upper extremities, and lower extremities were also reported.
The team does not rely on reported injury experience alone to identify potential problem job tasks. It looks at results from a workplace ergonomics risk factor screening, much like the process the standard requires, and then interviews workers and supervisors about jobs and tasks that they believe to be especially stressful. Results are compared to identify a set of job tasks that stand out as being of concern from all three perspectives. Not too surprisingly, all three types of indicator tend to point to the same tasks as potentially problematic.
Ira Janowitz, the team's certified professional ergonomist, conducts the risk-factor screening. "We use a checksheet," Janowitz says. One has only 12 rows of risk factors to be checked off and is really very quick to use. "The point is that you are looking for pretty extreme examples of risk factors, such as sustained or repetitive forward bending (stooping), highly repetitive and forceful hand work, and lifting and carrying very heavy loads. Most jobs involve at least some of these factors. The objective is to identify those tasks that involve the highest level of risk factor exposure. The use of checklists and symptom surveys are part of a good early warning system, so that we don't just recognize problem tasks after they produce injuries." This checksheet and a guide to implementing an ergonomics program in agricultural workplaces is available either from AgSafe (phone 209/728-2466, fax 209/728-9466 or e-mail AgSafe@goldrush.com) or from the AERC's website at Davis (http://www.engr.ucdavis. edu/~ergo/help).
At this point in the projects, the research team meets formally with cooperating employers to mutually decide on which high risk job tasks to try to do something about. "It's not easy," Miles observes. "We haven't got a practical and effective engineering fix for many of the problems in agriculture on the market right now." That especially applies to highly repetitive cutting tasks like pruning. "We know that the object is to eliminate or significantly reduce the number of forceful hand closures for each work cycle, which suggests a form of automated cutters." While there are some commercially available now, they are very expensive and have some practical limitations. Also, they are not applicable to even the relatively small range of cutting tasks that Miles' team has investigated so far.
What do you do when there's no ready answer to your need? Ergonomist Janowitz points out that, if there is no effective engineering control, then workers and employers should turn to what he terms "administrative controls." "Basically," he says, "you want to reduce the ratio of risk factor exposure time to rest or recovery time in each work cycle." That can be achieved in any of a number of ways, including rotation of workers through a specific job task, use of increased micro-breaks, and alteration in the arrangement or order of tasks in a work cycle. For example, in a repetitive cutting task, workers can be rotated to other duties in 2- to 4- hour shifts. If that is not feasible, then ensuring that workers take mini-breaks of a few seconds or so every few minutes in addition to their regular breaks may give the body sufficient recovery time.
Janowitz also suggests rethinking the use of personal protection for some tasks. "Of course the first thing many people think of is the back belt," he says. "But back belts are not viewed as an effective preventive device by NIOSH, which did a pretty complete review of the research to date. No one should view provision of back belts as an adequate control for lifting or bending risk factors." Another often seen "remedy" is a splint, such as wrist or finger splints. Janowitz points out that Cal/OSHA and others view such splints as remedial in that they may aid recovery, but they have no demonstrated preventive capacity. "Personal protective ideas that do seem to work are unfortunately few. Things like gloves, vibration insulation for power tools, pads for standing or kneeling for prolonged periods do work. In the case of the highest risk tasks we've seen in agriculture to date, involving stooping, lifting and carrying heavy loads, or highly repetitive cutting, there just is not much in the way of proven personal protective equipment."
However, an employer should not abandon the idea of finding a partial or complete engineering control. A first, and often productive, place to begin is to consult with the workers doing the task. They often have innovative ideas that will help. Consult with others in your industry about the problem. Check on current research. In the case of powered clippers, development by the Ag Ergonomics group is ongoing.
Progress in Nursery Tasks
For another problem task, that of lifting and carrying plant containers in nurseries, Dr. Miles and his team have come up with a simple but imaginative handle-tool design. The tool is simply a hand grip attached to an extension that has at its base a system for coupling the tool to the lip of the container (photo on next page). By allowing the worker to pick up and carry containers without using a finger-pinch grip, the tool completely eliminates an ergonomics risk factor. The handle effectively extends the worker's reach some 12 to 18 inches, reducing the need for forward bending of the torso (i.e., stooping ) to pick up containers and put them down on the ground.
Miles has designed and field tested handles for both 5- and 1-gallon plant containers. The 5-gallon handles have worked very well and are now commercially available from Gempler's. "But," Miles says, "while the concept behind the 1-gallon multiple container handles is sound, in practice they have had difficulty with some container designs. Some thin-walled blow-molded plastic containers deform under pressure from the couplings and fall through to the ground. As you can imagine, this doesn't please workers." Miles' group is still working on improving the coupling systems for the 1-gallon containers.
Once the handles had been developed and shown to be practically useful in the field, Ergonomist Janowitz performed a detailed ergonomics evaluation of their use: "The handles significantly reduce the physical inefficiencies and ergonomics risk factor exposures involved in manually handling plant containers at or near ground level." Observations of forward bending (stooping) showed large reductions with handle use, from between 60 and 85 degrees when workers were not using handles, to 45 to 46 degrees consistently with the handles.
"To our knowledge, this is one of the first major reductions in stooping in an agricultural job in a very long time that doesn't involve mechanization," according to Janowitz. Miles agreed, saying, "the success of this tool in reducing forward bending holds promise for small tool approaches to a much wider variety of agricultural jobs in the future."
The handles completely eliminate the finger pinch grip used when workers lift containers manually and substitute a "power grip" using the whole hand. According to Janowitz, "Our grip-testing protocol estimated that, for 5-gallon containers, workers may have to exert more than twice the grip effort when not using the handles. For 1-gallon containers, workers may have to exert more than 4.5 times the grip capability than when not using the tool to make the same lift." Said another way, the handles appear to reduce grip force exerted by more than 50%. "These are such large magnitude improvements," Janowitz says, "that I expect to see reductions in a variety of sprain/strain-type injuries."
These improvements also reduce the overall strain of lifting. When the researchers used the NIOSH-published lifting equation to calculate a task's "recommended weight limit," the task of lifting multiple 1-gallon containers was improved by nearly 50%, while that for 5-gallon containers was improved by nearly 40%. All of the ergonomics improvements brought about by the handles were shown to be statistically significant.
To ensure that the handles did not otherwise negatively affect the task, workers energy expenditure both with and without handles was evaluated. There were modest improvements when using handles (nearly 5% for 1-gallon, and less than 1% for 5-gallon); however, they were not statistically significant. "The important thing here," Janowitz says, "is that use of the handles did not increase workers' energy expenditure. So the improvements in job safety are achieved without any increased energy cost to the workers."
A preliminary trial of handle use showed that MSD scores (calculated from a combination of reported injury data and symptom survey results) for workers not using tools got more than 30% worse during the 4-month trial period, while those for workers using the tools actually improved over 60%. According to Dr. Faucett, "There was fairly wide variation in effects on individuals, but our early analysis suggests that those workers who had the worst symptoms when the trial began also showed the most change - worse for those not using handles and better for those using them. This would be consistent with the chronic nature of musculoskeletal disorders, which tend to grow worse as they develop." A longer trial is under way.
"With respect to productivity effects, the 5-gallon handles performed up to our expectations," says Kabashima, "allowing for significantly decreased trailer unloading times and effectively no change in ground-to-ground spacing times. It's very important to show that the injury prevention and injury cost benefits are gained without paying a penalty in production."
The 1-gallon handle tools (later dropped from the trial) did not perform as well. "As had been indicated earlier," says Kabashima, "the 1-gallon tools did not perform as well as desired. The difficulty seems to be that the small containers deform in the multiple handles and one drops out every trip or two, slowing the overall production rate." Indeed, it took two workers 8 minutes instead of 6 to unload trailers of 300 containers with the tools. Interestingly, the difficulty seems to be related only to some 1-gallon containers and does not seem to occur at all with slightly larger, 1.5-gallon containers.
"These are all important results," team leader Miles summed up. "They tell us that agricultural field jobs that involve serious risk factors for musculoskeletal disorders can be effectively addressed using accepted ergonomics approaches. Further, they suggest an under-realized opportunity for intervention in these jobs using small tools. For the past several decades, engineering development in agriculture has concentrated on large machines, leaving small tools used throughout the industry largely untouched and unconsidered. It is time to take another look at many of the routine jobs and tasks in agriculture that are largely taken for granted as immutable."
Early Steps in Vineyards
The Ag Ergonomics team's work in wine-grape vineyards is in the middle of engineering design and pilot testing. Following a year-long effort to define job tasks and measure ergonomic risk factors and priorities, the team and its cooperators in Napa and Sonoma counties rated the following tasks as of high priority for action: (1) harvest - lifting and carrying loads, and repetitive cutting; (2) pruning - repetitive cutting; (3) shovel work - stooping, lifting, and throwing loads, and repetitive upper-extremity exertions; and (4) tractor driving - repetitive whole-body exertion, intermittent heavy physical tasks.
Here, as in plant nurseries, there are few off-the-shelf remedies to apply. Miles' engineering group is investigating powered cutters (including some now on the market), alternative ideas for moving harvested grapes down rows to bins, a wide variety of alternative shovel and weeder designs, and improvements to tractor mounting and dismounting. "It's clear," says Miles, "that we're not going to completely solve all these problems in one fell swoop any more than we could in the nursery setting. But, we're going to make some of these tasks easier on the workers." According to Napa County Viticulture Advisor Ed Weber, "it's important to know that somebody is taking these very specific problems of agriculture seriously. Employers and workers in this industry are concerned about keeping injury rates down and are looking for new ideas."
An Ongoing Challenge
The Agricultural Ergonomics Research Center's newest project, to begin in May 1998 for a three-year period, involves design and implementation of "model" ergonomics programs with several cooperating farm operations both to develop a "best practices" model for agriculture and to determine what degree of effect on MSDs and their symptoms such programs have. APM Advisor Steve Sutter, Fresno County, is a co-investigator on this project.
What is in the AERC's future? Miles says, "we think there's something like a 20-year agenda of work if we seriously look into even California's major commodities." In the near term, the team wants to invest more time and resources in the search for practical powered cutters and new approaches to tasks involving stooped posture. We have yet to really investigate what might be accomplished with new and emergent technologies like lasers, new ceramics, and others. As Miles points out, "Most of our agricultural tools date to the turn of this century or earlier. When your goal is not to displace workers with high-cost machines, but to give people better tools and arrangements for doing the work, then there's a lot of room for creative thinking by everybody involved. After all, it's not rocket science, only ergonomics."
Occupational musculoskeletal disorders (MSDs) may affect muscles, tendons, joints, nerves, and related soft tissues anywhere in the body. The lower back and upper extremities, including the neck and shoulders, are the most common sites. Because repeated exposure to force of the same muscle, tendon, or region may result in trauma, injury, and inflammation to the affected area, names such as cumulative trauma disorder, repetitive motion injury, repetition strain injury, and occupational overuse syndrome have been applied to these disorders.
As a group, occupational musculoskeletal disorders are characterized by one or all of the following localized symptoms, depending on the type of disorder:
Complaints may also refer to aching, burning, buzzing, or swelling. Referred pain may occur, such as from the neck and shoulder region down the arm, into the hand, or up to the head and face. Left unaddressed over time, these disorders can become permanently disabling.
Diagnoses most commonly associated with cumulative or repetitive trauma include:
An individual may also have more than one type of disorder at one time. It is not unusual, for example, to have an elbow tendonitis (epicondylitis) and pain in the neck and shoulder muscles at the same time or to have wrist tendonitis along with carpal tunnel syndrome.