Ergonomic Emphasis

PTs can play a prominent role in educating patients on proper ergonomics at work and home

Do you remember driving a car for the first time? Adjusting the seat so your feet would reach the pedals, moving the side and rearview mirrors to see, and changing the position of the steering wheel to be able to reach it comfortably? You probably didn't realize it, but each of those times you sat in a car and made those adjustments, you were performing the basic principles of ergonomics - adapting your surrounding environment to fit your body.

Ergonomics stretches (pun intended!) to every way we live our lives -- from lifting children out of their cribs to putting groceries away in an overhead cupboard. Physical therapists with knowledge of kinesiology and musculoskeletal demands can contribute to ergonomics and play a key role in reducing injuries as well as facilitating successful return to work after an injury.

Ergonomics is commonly applied to multiple work settings with the greatest emphasis in administrative (office) and industrial or production-based work. The education of physical therapists includes anatomy and biomechanics to be able to assess physical job demands and make ergonomic recommendations for efficiency improvement and injury prevention in both settings.

In all settings, ergonomics creates an emphasis on adjusting the workplace to fit the worker instead of asking the worker to stretch beyond his physical capacity to fit the workplace. In administrative settings, ergonomics will focus on areas such as desk and chair height, computer monitor heights and distance from the user, mouse placement and any other areas the worker needs to reach beyond his seated position for items. Office setting ergonomics may also include assessment of computer monitors and the advantages of desktop or laptop computers for users.

In industrial settings, ergonomics will focus on proper lifting, reducing overhead reaching and assessing the work area where repetitive movements take place. Healthcare comprises a third setting where ergonomics is important. Think about the environment of a dentist who may have a flexed posture for most of the day to be able to look into patients' mouths, or the many careers involved with safe patient-handling techniques -- ergonomics applies to each and every one.

Job Demands

A significant component of ergonomics requires knowledge about the job demands, something very familiar to physical therapists since understanding job requirements is critical to a successful therapy intervention. It's very common for physical therapists to ask their patients about job-specific duties when assessing an injury and creating an individualized plan of care. Information about those job requirements carries over to understanding the range of motion and strength needed at multiple joints of the body to establish realistic goals with the patient. Many times, the role of ergonomics will progress toward input into authoring job descriptions including physical expectations, where other business areas such as human resources also contribute to the ergonomic efforts.

Ergonomics is critical in setting up workers, departments and companies with a focus on injury prevention. This type of work requires commitment and collaboration from all involved parties to foster a culture of prevention. Successful ergonomics means being prepared to help others think proactively instead of reacting to problems and injuries that arise, finding ways to use resources (time and money) as effectively as possible and educating all impacted parties on the reasons why investing in ergonomics is important.

It's also critical to keep track of the ways ergonomics impacts a given area. Measuring ergonomics work can be done in many ways, including the cost savings of worker's compensation claims, in the number of lost days at work due to an injury, and indirectly in employee turnover and engagement. Without that data, ergonomics is easy to undervalue and de-prioritize.

Successful Return

Ergonomics is proactive in prevention of injuries, but when injuries occur, physical therapists can also apply the same anatomy and biomechanics principles to facilitate a successful return-to-work program. The first step of developing a return-to-work plan for a patient is to acknowledge the patient's current physical status and capabilities. Does the patient still have pain with certain movements? Is the patient able to utilize his full range of motion? What is the patient's strength with functional activities?

The second step involves close collaboration with the other healthcare providers contributing to the patient's care. What are the guidelines the patient's physician or surgeon wants the patient to follow during the healing phase? What other factors of the patient's case need to be considered before returning to work? Integrating each piece and advocating for the best plan for the patient is one of the ways physical therapists can be most effective.

The last step is to understand the patient's regular job requirements, either by a visual assessment or when interviewing the patient. Visual assessments can be done in person or with photographs or even simple sketches if needed when travel isn't possible.

Work Phases

Return-to-work programs are most successful if the patient's job can be broken down into two or more phases, and the program and stakeholders are flexible about making changes to fit the needs of the patient. Few patients are physically capable to return to their regular job following an injury. Most require a beginning phase that includes some parts of their job, but not all.

For example a patient may be able to build and lift all the necessary equipment pertaining to his mechanic job, but in the first phase of return to work, can't maintain the same time and productivity expectations. His program will start with the normal job routine, but the first phase will incorporate a slower pace, eventually building up to the second phase of full return to work as the patient can tolerate.

It may be simply endurance or weakness (compared to the neurological re-education of movement patterns, which would require a much more detailed return-to-work program), but most patients will require some adjustments when returning to work after an injury.

Ergonomics also connects directly with return-to-work programs in cases where a worker may sustain a chronic injury requiring changes to his work setting to comply with the Americans with Disabilities Act (ADA), thereby ensuring the employee is able to complete all of his job responsibilities within the physical setting.

Whether you are very interested or completely uninterested in ergonomics, physical therapists all touch on the foundational components of understanding a patient's job and assisting with his goals following an injury. There are many ergonomic classes, books and resources available online and through the APTA.

If you're interested in learning more about ergonomics, I suggest looking for patient handouts on MoveForwardPT.com and the APTA website for other helpful information. Several educational centers also offer certification in ergonomics. It's never a bad thing to be prepared, and you never know when a patient will ask you what type of chair he should be sitting in at work!

Lisa Mueller is a rehab supervisor working near Milwaukee. She also writes a weekly blog for ADVANCE titled "PT and the City."

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