This is impossible to answer with certainty. However, susceptibility is shown in many ways. Reactivity to drugs or pollens and, through genetic inheritance, susceptibility to a variety of medical conditions are examples. There is no reason why susceptibility to OOS should be any different.2. How much of OOS is a variation of hypochondria? Surely those that are the most susceptible to OOS are those that are looking for excuses for poor performance.Another personal aspect is our reaction to our environment - our stress reactivity. Some people are more reactive to stressors than others. This is neither good nor bad in itself, it is just the way we were made. There are two aspects to this reactivity - physiological and psychological. Physiological reactivity reflects the nature of our bodies. Comments below will amplify this point.
Psychological reactivity will also receive comment. People who are naturally tense or who drive them selves hard, for example are more at risk as mentioned in the answer to the next question.
This is a risky assumption. The second proposition may, of course, be true for a particular case, but is an extremely dangerous generalisation. The exact percentage of people with OOS who come into this category is impossible to say. I and my colleagues believe it is very small. This mechanism, when it does operate, is usually on a sub-conscious level.3. How do you recognise when someone is potentially at risk when furniture etc. is correct?The reverse of the second sentence above might hold for a particular individual - those that strive are most at risk. These are the valuable employees and to label them as poor performers looking for an excuse would be a grave error. You also need to be able to answer the question: which came first, the poor performance or the OOS problem.
To answer the question of susceptibility fully we need to explore the types of individual susceptibility that could exist. These are:
- A person with a tense personality.
- Some people are naturally tense. (We found one or two who could not relax during the session).
- The person who strives.
- Some people are naturally tense. (We found one or two who could
- People who drive themselves to do a good job on time may well be at greater risk. These are valuable employees. There are many instances where they have, for some reason, suddenly crashed. They often work through breaks, work overtime whenever offered, are slow to detect aches and pains in their own bodies because their discount their importance and are quick to accept urgent deadlines etc. All these add up to a person at risk by placing more straws on the camel’s back.
- Altered function in the pain/nervous system
- On another tack, one group of researchers found altered pain system responses in the affected (but not the non-affected) arms of non-affected controls.
This is consistent wite the idea that nerveus traffic and muscle tension sets off some undesirable reaction.
It seems as if the pain system resets itself to start reacting at lower levels of provocation. Even just one good provocative incident is enough to so reset the pain system. i.e.: (and as we know) a person who spends a week on urgent work (perhaps even only a day or two) may set off the reaction and leave thems elves with a long term problem.
Although it is easy to be misled by simple pictures of complex systems, it seems also that no exercise does not allow the setting of the pain system to rise to its normal state, and that some exercise, not to the point of pain, is indicated. (I have written asking for details of the exercise regime that the physiotherapist he uses has developed, and for a report on its efficacy).
See the answer to the next question as well.
4. How do we know when people may have potential problems?
It is impossible to tell who is susceptible by a diagnostic or predictive test.5. What is the link between OOS and psychological problems?We suspect that some people may be more liable to these conditions through their personality- the kind of person who is tense and/or drives themselves to be productive. An alert manager should be able to recognise this characteristic in an individual. Because there are other types of susceptibility this will account for only some of the people who are susceptible.
Therefore, the only ways to deal with this problem are to:
The second point means that staff should feel (be made to feel) free to speak to their supervisors to report aches and pains. A system should be in place to follow up such reports and provide the needed personal and workplace assessments. This need not be formal - especially in smaller offices - the important thing is that the person’s problem is dealt with promptly.
- Educate and training people
- Detect problems early.
Correct furniture (good ergonomics), by itself, will guarantee nothing, as is just one aspect of a solution. This is good news, by the way, as you don’t need to throw money at so called ergonomic furniture - which it often is not.
Much ergonomic furniture must cater for everybody that might use it in every possible situation. This approach is certainly necessary where different people use the same workstation - where there is shift work, for example.
Where the workstation is used by only one person a different approach is better. This is where we assess the needs of each individual at each workstation, taking into consideration the task they do. We then tailor the workstation to their needs. The approach is more costly in terms of time and intelligence on the part of the manager and/or supervisor, but blanket spending on furniture is reduced. When a person leaves, the process will need to be repeated.
In short - interesting but overrated.6. Can what you said today actually be put in practice within the Work Force? Does it work?It is often said that the person got the OOS problem as a result of a psychological problem. In this case the manager or doctor usually sees the person after they have got the OOS problem and note a psychological one as well. But which came first. This is a very common trap. Unless there is extremely strong evidence that there was a psychological condition BEFORE the OOS developed, then it is an extremely dangerous to conclude that the OOS problem was a result.
Only too commonly people with severe chronic pain (constant severe pain lasting more than three months) DO develop psychological problems as a result of the pain. (Often these people are able, after more time, to cope with the pain and lead fulfilling lives).
The phrase “all in the mind” is often used to mean that someone has a psychological problem. This phrase is meaningless because the brain cannot generate pain signals. When it is used it blocks communication between the person and the doctor or manager. At the very least it is non- therapeutic.
The “all in the mind attitude” is entirely irrelevant anyway - the bottom line is that a person in pain needs and deserves relief. Telling them a falsehood does not help them get over the pain and will almost always increase it. The person needs to understand the origin and nature of their problem.
What is true that the state of the mind influences the way pain is perceived. This results from the physiological control of the pain system by nervous messages flowing down from the brain. This is good news because it indicates that psychological therapy - even the placebo effect - is of use in the treatment of chronic pain syndromes.
A common therapy for people with pain is psychological and/or psychiatric counselling. Some resist this treatment because they perceive a stigma associated with these words. Most are helped once they get past this barrier.
7. What are the implementing procedures for control and assistance?
Staff at the Sutherland Shire County Council, one of Sydney’s largest, became free of OOS when the following system was introduced.
1. Existing staff were properly informed, educated and trained in promoting comfort to prevent OOS. The nature and causes of OOS, working technique, relaxation, micropauses, exercises were the topics. 2. New staff were properly trained, as in 1. 3. Workstations were assessed, see attached sheet and our checklist 1. 4. Managers and supervisors were educated about their responsibilities. 5. Staff were encouraged to report symptoms of pain early - see attached sheet. 6. Staff believed they could do this without fear of reprisal. 7. Staff so reporting were dealt to by: (i) being sent to a medical specialist who gave them: - a medical assessment instruction in working and relaxation techniques - minimisation of time off work - a regular review of the case (ii) having an immediate ergonomic assessment of their workstation and a rapid response to the recommendations of the assessment; (iii) involving the person in the solution. As a result of this the Council experienced no cases of OOS where time off work was required, except for one person who slipped through this net, went to her own doctor and was given poor treatment and advice. This was in a large organisation at the height of the epidemic in Sydney (about 1984). With current ACC legislation, the costs of implementing a system such as the above are likely to be less than increased premiums should people be off work with OOS.
8. Why hasn’t the simple use of relaxation not been more widely publicised? It has, at least to some extent. It is a relatively recent concept, but is being used by most Occupational Health Nurses in New Zealand and Australia now. But generally, you are right. In almost all publications on OOS, there is little mention of relaxation. OSHA and the HSE (opposite numbers to OSH in the United States and the UK) have little overt time for relaxation. They prefer to concentrate on getting the ergonomics right - fitting the task to the person - so that the issue “does not arise”. There is nothing wrong with this but it does miss out on an opportunity. My view is that however good the ergonomics are, people still have to use their bodies, so they might as well know how to do it the best way possible. There are many instances where people working at identical workstations (ergonomically optimal) have seen one person get OOS and the co-worker avoid it. My fear here is that employers will want to concentrate on relaxation to the exclusion of the other strategies. The concept of relaxation, used in the sense of “working with relaxed muscles” can unify our prevention strategy as long as we do not carry it too far: 1. Good ergonomics promotes relaxation. 2. Work organisation should not place undue time pressures on people, preventing relaxation. 3. Personal relations should promote relaxation. 4. The use of good working techniques can promote relaxation. 5. Learning relaxation techniques can promote comfort and productivity. 6. Exercises and Micropauses promote relaxation. We should not carry the emphasis on relaxation too far. If there is one thing that the OOS saga has taught us, it is that there is no one way of guaranteeing a solution. Ergonomics, relaxation, work organisation and all the other aspects needs to be considered together. 9. Where do you seek understanding treatment and advice for sufferers? This can be difficult. Most doctors do not, in our experience, have a particularly good grip on OOS. The following are possible strategies: 1. Contact one of the Occupational Health Nurses at your local OSH Branch Office, or one of our Medical Officers at the Penrose, Dunedin and Head Offices. S/he may be able to tell you of a doctor with particular competence in OOS. 2. Use the grapevine to find out if there is an OOS support group in your area. The group organiser may be able to tell you if there is a doctor who is good at dealing with OOS. Take care, however, with support groups. They can tend to support the suffering rather than the person (this is a well recognised phenomenon, not just my prejudice speaking). They can do well if run on objective lines. The next comment applies only to people with long term intractable pain. 3. Refer your staff to books. A list is attached2. A great deal can be gained by reading. This does two things: it gives people relief that they are not the only ones with the problem “I’m not a freak”. And it gives people direct help. People’s ability to get information from books varies, of course, (some adults can’t read). This could be assessed discreetly in a particular case. In this case get the family and friends involved if possible, and refer to a Citizen’s Advice Bureau. Remember that whatever YOU, a manager, do will be therapeutic in some way. Your response to the person will either be therapeutic or non- therapeutic - this is inevitable because people respond to each other. Hinting to the person (I’m thinking of the sub-conscious reaction here rather than the conscious) that they are to blame will be counterproductive. The person with pain (not “in”, “with”) needs and deserves relief. 10. Where does one get practical advice for the acquisition of furniture and design of the layout? 11. How do we go about providing appropriate ergonomic furniture? There are several options here. 1. Consultants can provide advice. Contact the New Zealand Ergonomics Society for a list of people in your area that can act in this way3. 2. A number of texts have advice. (see1 and 4). 3. OSH field staff can give limited advice. (See under Department of Labour in the white pages of the phone book). 4. OSH is conducting an ergonomic assessment of office chairs shortly. Results of this will be available for purchase. As important here is the question: How can I get bad advice? Neglecting the input of staff and relying on some designers who think in macro terms of how things look rather than the micro terms of how things function, will both lead to bad advice. To get good input from your staff, see the appendix, which can be adapted to suit your purposes and budget. 12. When is it most likely to become a problem in my workplace and how do we have everything in place to avoid it? All other things being equal, OOS seems to happen or resurge after some sort of change in the workplace. Some examples of changes are obvious, others are less so: 1. The arrival of a new supervisor 2. A sudden change in workload 3. A person off (sick or leave), leaving others to cope with an increased workload. 4. Some uncertainty developing in the workplace - job changes, etc. 5. Deadlines at the end of the month Any one of these might be the straw on the camels back for an individual. To anticipate and prevent these problems is a management function. 13. How do we get the message relating to OOS across to staff? 14. How do we educate staff on how to reduce OOS? OOS offers a great opportunity to develop good staff relations. The fact that you are taking an interest in your staff by organising OOS training should go far. You need trainers who are credible and trusted. When you hire trainers, get them to submit a resume of their thinking on OOS and a seminar programme in advance. See that this fits in with your knowledge of OOS and the overall scene at your work - ask for an independent opinion if you can. Ask to see their evaluation questionnaire. Make sure that trainers deliver their message in a way that makes it possible for your staff to make up their own minds and come to their own decisions. Avoid “do this - do that” trainers. Get your own feedback from your staff about trainers. Contact the addresses below for the names of experienced trainers in this field in your area. 15. How do we encourage staff in the ways they can accept to reduce OOS in themselves? 16. How do get staff to do the job who haven’t got a problem? How do we get staff to be disciplined in actions required to avoid the problem? 17. How do we deal with periodic lack of staff committed to avoiding OOS? 18. How do we deal with the ability of staff to learn more about the remedies of OOS? 19. How do we persuade staff to take it seriously? 20. How can we promote acceptance that there is a problem? I have answered some aspects of these questions. In what follows I will assume that staff have been given training and education about OOS, and that because management has done an ergonomic assessment of workstations and made the required workplace modifications, staff are able to avoid the problem, all other things being equal. This is a frequently asked question and there are two aspects to its answer: Can people do what is necessary to avoid OOS? Do they do what is necessary to avoid OOS? Let’s list what we want people to do to avoid OOS: 1. Appreciate the nature and causes of OOS 2. Know how to adjust their workstations to minimise muscle tension. 3. Learn relaxation. 4. Use relaxed working techniques. 5. Take breaks. 6. Report aches and pains early. This list makes it obvious that unless staff have a minimal level of instruction and hardware and that a system is in place to receive and act on reports of pain, they will not be able to do the right things. We have discussed instruction and ergonomics, so I will take up from the point where there is resistance by staff to the measures you have suggested. Try to find out why there is resistance. If it is neglect or indifference then you will be able to point out that the job description, which the person has previously agreed to, requires these measures you are insisting on. Point out that when one person neglects to work safe, it impacts on others. You may need varying degrees of firmness here, which will be supported, of course, by your earlier efforts in education, ergonomic assessment etc. Where there is some deeper seated reason - it may be disbelief or even distrust of what you are suggesting, then you need to find this out so that it can be discussed. May be a dominant personality is undermining your good efforts. If all this fails, you can consider getting a person with OOS to come and talk to staff. This can be difficult to manage - people can end up scared rather than informed. 21. Eye strain is the most common complaint I have from keyboard operators. How do we adjust operating time on VDUs to overcome OOS? 22. How do we deal with eye strain? This is a big topic. Eyestrain is a commonly reported, genuine complaint of VDU operators. In the long term, however, VDU operation does not appear to affect eye health. It is best to think of eyestrain as Ocular Fatigue. This is not playing with words, but reflects the fact that the visual system includes the eyeballs, the muscles which control the position and focus of the eyeball, the nervous system, the visual information processing centres in the brain, and the muscles of the head, neck and shoulders which support the visual apparatus. Just as we said that OOS results from muscle tension, it may be useful to think of ocular fatigue as stemming from stillness of the eyes, head and therefore the upper body. This is another form of muscle tension. In addition to this (simplistic) viewpoint, we need to recognise the nature of the visual task of looking at a VDU screen. VDU work can be very different from reading paper. Many who use the game Tetris can attest that when you score up about 5000, your eyes get tired! This is due to the extreme concentration on the visual task. Much VDU work requires this close visual concentration, though it is probably not as extreme as Tetris. There is no doubt or question that VDU work causes ocular fatigue. Conversely, VDU work appears NOT to cause long term visual deterioration at a faster rate than it normally deteriorates. Several studies followed groups of VDU and non-VDU operators for several years and found that the rate of change of visual status is identical in both groups. What confuses many people is that they begin work at a VDU and find they get problems. The explanation for this is as follows: In the population at large 20 to 30% of people have some visual defect which would benefit by correction with glasses or contact lenses. Of this group, some have a minor defect only, but are so picky that they must have glasses. Others don’t mind coping with a greater defect - they don’t want to wear glasses. When people in the latter group begin VDU work, their defect begins to bother them. In other words, VDU work often shows up people with a visual problem. To cope with this, the following six strategies can be used: 1. Eye examinations for employees. Identify the people with problems before they begin work. If they need correction, special glasses ground for a reading distance of about 700mm are best. Bifocals, trifocals and varilux lenses seem to cause problems because of the need to tip the head back to see thought the lower portion of the lens. A competent optometrist will be on the ball here. Note that an examination by an optometrist gives a better result than the use of a visual screening device. If you have large numbers of people, you should be able to negotiate a special deal with a local optometrist. 2. Optimise the visual ergonomics of work. Provide a VDU screen which is adjustable for height, distance from the viewer a nd tilt. There are two visual problem with VDU: reflections in the screen and glare from bright sources of light in the field of view. Correct the former by placing the screen in a position which will avoid reflections, move lights and tilt the screen downward or fit a screen filter (last resort). The latter can be corrected only by repositioning the screen or masking the glare with heavy drapes. Many blinds do not attenuate the light enough to provide a solution. 3. Spread the workload evenly over the day and the week. Try to avoid peaks of urgent or concentrated work. 4. Train people in “relaxed looking”. The message about working relaxed should be transferable here. People who squint or stare to look at their screen can be identified by observation, and sent for an eye examination. A view of a distant scene will promote a far gaze - which is relaxing in relation to the close up constant focusing needed for the VDU screen. A view out of a window helps here. Paradoxically, an effect similar to a far focus can be obtained by looking at a small intricate sculpture, placed close by, with plenty of fine detail. 5. Give people breaks. Ten minute breaks every hour are good for visual relaxation from demanding tasks. 6. Education and training. Education and training on the above. You should contact an optometrist experienced in VDU work for details. 23. How do we deal with irregular work flows? I find this difficult to answer as I do not have direct knowledge of the particular situation(s). In general terms, however, there are two situations to deal with: 1. When work flows can be modified to remove irregularities. A detailed task analysis of the work should reveal where time can be saved or reallocated. 2. When irregular work flows cannot be remedied. In this case staff should not be left hanging. They should be informed of why the irregular work flow is necessary and unavoidable. They should know exactly what is expected of them - both the goals and the performance specifications. Goodwill from staff can make up for a good deal of pressure at work. But it has to be earned, of course. If people perceive that unfair demands are being placed on them, then they will react unfavourably. If they are left uninformed they may assume that the demand is unfair. In principle, when people work hard to deal with urgent work they will need a compensating period when work is not so fully demanding. The need to meet urgent unexpected deadlines should therefore be anticipated and catered for in advance. If the normal workload is just on the borderline of being too much, there may be no slack left over to deal with crises. This situation should be anticipated, and you may need to have quick access to temporary staff to cope. Where temporary staff need training to do the task, their use will not be an option for sudden demands. In this case the tasks which do not need special training should be identified and given to temporary staff. In summary, we need to remove uncertainty and provide clear goals and performance specifications. And always reward people for good performance. 24. What is the effect of outside stressors on OOS? Much of the comment above relates directly. To summarise, stressors are of three kinds: 1. Physiological. The amount of physical work required. 2. Environmental. Noise, vibration, fumes and fumes (etc.), lighting, air quality, heat. Work organisation, personal relations. etc. 3. Thoughts The relevant thing is not the stressors, but the stress reaction exhibited by the person. Stress has general effect of adding straws onto the camel’s back. Stress overloads the nervous system with nervous traffic, with the effects listed above becoming more likely. 25. How do we encourage certain staff not to aggravate OOS symptoms by similar home occupations ie. knitting (to excess) and similar hand and craft occupations? Tell them the issues. Discuss the situation openly. Staff (and management) need to accept that work is a partnership. Just as home activities can impact on work, so work activities can impact at home. Owing to our industrial relations “heritage”, these things are sometimes difficult to talk about. If a manager should ask a person to make changes to activities at home, because these activities appear to influence the work situation unduly, s/he should be quite sure that work life does not unduly influence the home situation. The word “unduly” is, of course, the catch. It is here that personal skills and goodwill are needed on both sides to find a solution/compromise. Too often the question of blame arises in these situations. We need to remember that even when the blame question is answered (if it can be), the undesirable situation remains unchanged. The pragmatic questions, leaving aside the blame one, should get the attention. Some USA companies supply their workers with personal protection (for example, earmuffs against noisy activities such as shooting). The rationale is that the cost of a person off with a problem at work far outweighs the cost of the protective equipment. REFERENCES 1. Department of Labour Occupational Overuse Syndrome: Checklists for the Evaluation of work. Wellington 1991 2. TEXTS ON PAIN Chronic Muscle Pain Syndrome Paul Davidson Villard Books (1990) Defeating Pain: The War Against a Silent Epidemic Patrick Wall, M Jones Plenum Press (1991) The Challenge of Pain Ronald Melzack & Patrick Wall Penguin 2nd ed. (1988) The Fabric of Mind Richard Bergland Penguin (1985) Controlling Chronic Pain Connie Peck Fontana/Collins (1985) Mastering Pain Richard Sternbach Ballantine Press (1987) 3 Carol Slappendel President, New Zealand Ergonomics Society PO Box 802, Palmerston North 4 GENERAL ERGONOMICS Department of Health Seating for office workers. Wellington 1989. Pheasant S T Bodyspace: Anthropometry, Ergonomics and Design Taylor and Francis. 1986 Grandjean E. 4th Edition Fitting the task to the man Taylor and Francis, 1991 5. Useful contacts: The President New Zealand Ergonomics Society PO Box 802 Palmerston North Address of the New Zealand Society of Physiotherapists.: The Executive Director New Zealand Society of Physiotherapists PO Box 27 386 Wellington Address of the New Zealand Association of Occupational Therapists: The President New Zealand Association of Occupational Therapists PO Box 68 291 Auckland