Archive 2001

Myth: Accommodating injured workers is costly.

Fact: 70% of accommodations for injured workers cost under $500 U.S.; and many have little to no cost at all. (Job Accommodation Network)

Myth: Back belts are effective in preventing low back injury.

Fact: There is a lack of conclusive scientific evidence to support the use of back belts to prevent low back injury. In fact, many experts recommend employers instead develop a comprehensive ergonomics program focusing on workplace design and education. Further details can be found at the National Institute for Occupational Safety and Health (NIOSH) site at: http://www.cdc.gov/niosh/homepage.html

Myth: Sitting is a "light duty" job for someone with a low back injury.

Fact: While often viewed as "light" work, the pressure on the spinal discs is actually greater when sitting than when standing.

Myth: The top of the computer monitor should be at eye level.

Fact: Recent ergonomics research indicates that the entire viewing area of the monitor should be between 0° and 30° below horizontal eye level (with the screen tilted up towards the operator) to maximize both neck and eye comfort.

"Problems cannot be solved at the same level of awareness that they were created." — Albert Einstein

May, 2001 — During her time as Labor Secretary, Elaine Chao has met with a number of business, employee, and employer groups. Of these meetings she has reported, "One thing is clear from these meetings: there is no consensus on the ergonomics issue. The stakeholders who have come to the Department of Labor to discuss ergonomics are coming from completely different positions, ranging from those who want no action to those who thought that the previous rule did not go far enough."

On Thursday, April 26th, Labor Secretary Chao testified before the Senate's Subcommittee on Labor, Health, Human Services, and Education - of the Senate Appropriations Committee.

"It is vitally important that we avoid a repeat of the last ergonomics standard," commented Chao. "It would be wise to consider the factors that preceded last month's vote by Congress before charting a new course."

Chao calls ergonomics "an extremely complicated issue" and promises to give it "the greatest thought and study." When asked whether she would enforce the regulation, she replied, "I don't know -- I can't answer that."

Her non-answer has left the Bush administration's options open on ergonomics, but that has been good enough for business lobbyists.

Several business groups, including the U.S. Chamber of Commerce, have filed lawsuits challenging the legality of the ergonomics regulation. At a recent Chamber luncheon, Lott told Chamber members to "Stay in court as long as you have to until the cavalry gets there with another result."

Some members of Congress want to use the untested Congressional Review Act to overturn the regulation, but observers call that a "nuclear bomb" because it would preclude any regulation on ergonomics in the future. Compared with that, a Bush decision to issue an administrative stay, which would suspend the regulation pending further review, could look like a reasonable compromise.

Concerning the just released Bureau of Labor Statistics (BLS) data, Chao said, "Recently, the BLS released new data on job-related injuries and illnesses for 1999. The data show that there has been a continuing decline in musculoskeletal disorders that result in employees missing time from work. Employers reported 582,300 such injuries in 1999, down from 592,500 in 1998 and from more than 763,000 in 1993. This 25 % decline has occurred even though more Americans were in the workforce. While I'm encouraged by this progress, I also recognize that musculoskeletal disorders remain nearly one-third of all work-related injuries." (* see NOTE below)

The regulation requires employers to establish programs to reduce injuries to muscles, ligaments, joints and nerves caused by work tasks. The rule will cost business anywhere from $4.6 billion a year to more than $100 billion, depending on whether you believe the Occupational Safety and Health Administration's estimate or private-sector projections. Business groups have urged the Bush administration to suspend the regulation and reopen the rule-making process to make it less onerous for employers.

Unlike Linda Chavez, Bush's first choice to lead the Labor Department, Chao has been greeted with warm words by labor unions as well as businesses. "I can work with both groups," Chao says. "It's going to require balance, someone who can listen and understand both sides."

But it's the White House, not just Chao, that will make the ultimate decision on ergonomics. Bush administration officials, with the encouragement of congressional Republicans, are exploring whether they can undo some of the regulations issued by the Clinton administration in its final weeks, says Senate Majority Leader Trent Lott, R-Miss. "We are very unhappy with ergonomics," Lott says.

Susan Eckerly, chief Senate lobbyist for the National Federation of Independent Business and a member of the Labor Department advisory team for the Bush transition, notes how difficult pleasing both labor and business can be when she worked at the Labor Department under Elizabeth Dole.

"It's going to be tough," Eckerly says. "I hope she picks her battles wisely."

*NOTE: The ergonomics regulations from the Occupational Safety and Health Administration were aimed at preventing carpal tunnel syndrome (CTS), tendinitis and other health problems associated with repetitive motion, awkward postures, contact stress and the like. The OSHA regulations had been lauded by many doctors of chiropractic who treat workplace injuries, and especially by those DCs who work as industrial injury consultants.

Ergonomics in the Workplace
Complex Issue Demands Input from All Stakeholders

April, 2001 — According to the lead article in the January 2001 issue of the Journal of the American Chiropractic Association (JACA), foot imbalances can trigger problems throughout the body — even without perceptible foot pain.

Doctors of chiropractic interviewed for this article say that foot imbalances can cause structural misalignments resulting in a functional "short" leg that contributes to pelvic rotation, spinal subluxations, and neuromuscular imbalance.

According to the article, the act of walking and bending the foot forward (pronation) is one of the major causes of foot injuries, with ill-fitting shoes being another source of foot problems.

Dr. Ted L. Forcum, author of a chapter on the foot in Conservative Management of Sports Injuries, states, "Pronation is a normal action. It's designed to allow the foot to absorb shock and adapt to uneven ground. However, overpronation allows for hypermobility of the foot and increased rotation of all the joints of the lower extremity …. Underpronation tends to be the exact opposite — the foot is so rigid that it does not allow for proper shock absorption or adaptation to uneven ground."

Even if pronation is not a problem, footwear can be. Many people ignore warnings and fail to take simple, preventative measures to protect their feet. Dancers, athletes, older individuals, and those who are overweight or diabetic are especially at risk.

Dr. Karen Konarski-Hart blames fashion changes that lead women from high heels to pumps and back again as a source of many of the foot problems she now treats. "I'm seeing the results of many years of foot abuse in such major syndromes as … tearing of the plantar ligament on the bottom of the foot … pain under the anterior arch of the foot, and … the breakthrough of a nerve sheath, usually under the fourth toe of the foot."

Many doctors of chiropractic prescribe orthotic inserts for their patients with foot problems. "Orthotics not only allow for proper alignment, but they also can help to reduce excessive motion in the joints of the lower extremity and back," Dr. Forcum explains. "Orthotics have a very high success rate — as high as 76 % for runners."

Bone-on-skin problems encompass as many as 100 conditions. Several of them are associated with deformities of the foot, such as claw toes, hammertoes, and mallet toe. "Essentially, those are situations where a bony deformity pushes against the footwear and creates compression of the skin and soft tissues," Dr. Forcum explains.

The doctors of chiropractic interviewed for this article recommend home exercises for prevention of foot problems: i.e., calf stretches; gripping action with the toes; massage; developing balance; and strengthening the range of motion of ankle and forefoot.

For details of these exercises and the complete report, go to: http://www.acatoday.com/media/releases/010901.html

Information source: American Chiropractic Association Website at: http://www.acatoday.com

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Congress Votes To Repeal Workplace Safety Rules

Read this article and decide if Congress is really working for you.

March, 2001 — At the time of this writing, legislation to repeal brand new workplace safety regulations awaits President Bush's signature, following an intense lobbying campaign that included assurances to lawmakers uneasy about voting against organized labor.

The repeal was propelled by business interests who criticized the cost and scope of the ergonomics regulations issued late in the Clinton administration … along with a desire by the congressional GOP leadership to give Bush his first legislative victory.

NOTE: The ergonomics regulations from the Occupational Safety and Health Administration were aimed at preventing carpal tunnel syndrome (CTS), tendinitis and other health problems associated with repetitive motion, awkward postures, contact stress and the like. The OSHA regulations had been lauded by many doctors of chiropractic who treat workplace injuries, and especially by those DCs who work as industrial injury consultants.

The House passed the (repeal) legislation on March 7th, on a largely party line vote of 223-206, less than 24 hours after Senate passage, despite a vigorous fight from Democrats and labor. Even before Congress finished voting on the repeal, the White House sought to reassure critics that (it) would revisit the issue of workplace injuries caused by repetitive motion and other on-the-job ergonomic conditions.

In seeking to "buck up" moderate Republicans and conservative Democrats, the White House announced that it is committed to protecting the health and safety of workers … and that the Department of Labor will pursue a comprehensive approach to address this issue … emphasizing that there is a real concern about the overly burdensome current rules and their negative impact on jobs and economic growth.

Rep. Nancy Johnson, R-Conn., who voted to repeal the regulations, said she was assured by Labor Secretary Elaine Chao that ergonomics injuries would be addressed in well-thought-out regulations that did not penalize businesses and still helped workers. "I don't feel like I'm voting against labor. I don't feel like I'm voting against a commitment to address ergonomics in the work force," Johnson said. "I believe I'm just going to do it in a way that protects jobs and helps workers in the most rapidly effective way."

But Democrats said that if ergonomics regulations were so important to Republicans, they would have worked to find a compromise or asked the Labor Department to alter the rules. Instead, Republicans brought the repeal to a vote with a little-used legislative maneuver that blocked any opportunity for lengthy debate, delay or compromise.

"If Republicans have their way, it will take years, millions of injuries and millions of dollars in lost revenue before new rules ever see the light of day," House Democratic leader Dick Gephardt said.

The OSHA regulations covered 102 million workers at 6.1 million work sites. The agency said the rules would prevent 4.6 million musculoskeletal disorders, and would mean average annual savings to business of $9.1 billion in the first 10 years they were in effect. Businesses had been given until October to comply.

Opponents of the regulations put the real cost much higher - as much as $100 billion a year in compliance expenses, and said state worker compensation laws would be pre-empted in some cases.

"OSHA made a major miscalculation in presenting a regulation that was so bad and so overreaching that it generated an extraordinary grassroots outcry from small and large employers who simply would not sit back and accept it," said Jerry Jasinowski, president of the National Association of Manufacturers.

Organized labor and Democrats worked furiously to hold onto support by moderate Republicans and conservative Democrats who had voted with them on previous ergonomics legislation and other union-favored issues, but could not maintain the coalition.

"A Republican leadership juggernaut in the House resorted to arm-twisting and steamroller tactics to assure a majority to crush the ergonomics standard and deliver for their big business backers," AFL-CIO President John Sweeney said.

The repeal was backed by 206 Republicans, 16 Democrats and 1 Independent. Voting against were 192 Democrats, 13 Republicans and 1 Independent. The 56-44 vote in the Senate was similarly along party lines.

Source: Associated Press

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Keeping Your Computer From Hurting You

The following is excerpted from a news item at: http://www.nextstep.com Next Step is a co-production of KRON/Bay TV and Business 2.0, San Francisco, CA.

Experts say that while there are all sorts of gadgets to keep you from hurting when you work at the computer, these gadgets do not solve the problem. They say computer users need to take the initiative, and recognize why their computers cause them pain.

When people who work on computers all day begin to hurt because of it, they start looking for help; and they usually turn to gadgets. Things like a wrist rest that clamps on the edge of your desk, that's supposed to support your forearm and make things work better. Or maybe a mouse that's a little odd looking, but supposedly ergonomically correct. But for some people, the answer is to get much deeper, to go right to the root of the problem.

Take the case of Casey Brendan who was in real trouble. He ultimately said "no thanks" to one doctor's recommendation for surgery, and ended up visiting a chiropractor, Dr. Ron Harwin.

Dr. Harwin didn't have any trouble diagnosing the problem. "Brendan had a very serious case of carpal tunnel. I wouldn't say it was the most serious case I've seen, but it was certainly moderately severe."

The immediate treatment was designed to simply make the pain stop. Harwin’s long-range plan is to change people's computer-use habits so they don't start hurting again. He says, “We were never designed to sit and pound keyboards. We're designed as hunters and gatherers; the design of our bodies genetically is thousands of years old. Modern society has existed for about 200 years. We're moving fast but the body's still made the old way."

Like Brendan Casey, most people feel the pain first in their hands and wrists. But Dr. Harwin believes we need to think about the entire shoulder-arm system.

"The wrist and the hand are the weak links of this entire system; they're designed to be refined and delicate," says Harwin, who preaches a basic gospel: Build a strong foundation so the weak links don't break.

“The problem is that the human shoulder is a loose-floating joint. It's very flexible, but not necessarily a rock-solid foundation.” So Dr. Harwin works to keep everything in balance. Aware that people can't spend every day in a doctor's office, a big part of his mission is to get computer users to take responsibility for their own health.

"There's only so much the employer (and the doctor) can do," says Harwin, "and then there's certain things we have to do for ourselves.”

Brendan Casey has taken Dr. Harwin's advise and everyday runs through simple exercises designed to keep him out of pain. He stands as proof that you don't have to give up when your computer starts causing you pain. But you do have to fight back.

Information source: news items at www.NextStep.com — a co-production of KRON/Bay TV and Business 2.0 in San Francisco, CA

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CTS -- Some of Us Are at Higher Risk

Carpal tunnel syndrome (CTS) was first identified by a British doctor in 1854 -- at the start of the Industrial Revolution when early factory workers found themselves standing in one spot and moving nothing but their fingers week in and week out.

Compared with men, women have about three times the risk of CTS. Women's smaller bone structure means there is less room in the carpal tunnel area to begin with. Hormonal fluctuations -- during the menstrual cycle, pregnancy, and menopause -- can also make wrist tissue swell. Often during pregnancy, CTS symptoms may grow along with the baby (but usually subsides after delivery).

Several causation factors are sited

Carpal Tunnel Syndrome is considered a symptom complex rather than a disease entity. Usually, CTS results from swelling or fluids that contribute to pressure on a nerve; but health professionals of various health disciplines site several causation factors. Here are a few:

ruptured invertebral discs, nerve disorders, or compression of the nerve root at the sixth cervical vertebrae caused by misalignment of the vertebrae at the neck or Osteoarthritic (spurs);
repetitive physical tasks or mechanical injury (CTS is mostly associated with computer use, but any activity that demands constant finger or wrist motion -- embroidery, knitting, playing some musical instruments, racquet sports, hammering -- can cause the problem;
arthritic conditions; i.e., inflammation of the fibrous connective tissue components of muscles, joints, tendons, ligments and other "white" connective tissues (Fibrositis), or a systemic connective tissue problem characterized by inflammatory and degenerative changes in the muscles (dermatomyositis or polymositis);
obesity or extra weight: Excess tissue in the carpal tunnel causes greater risk of CTS-inducing pressure on the median nerve;
diabetes and thyroid conditions;
vitamin B6 deficiencies.

Here are a few clinical symptoms of CTS:

wrist pain (burning, numbness, tingling)
palm of hand (radiating burning or prickling sensation)
first three fingers (weakness, numbness, tingling)
weakness of thumb opposition
arm, elbow, neck, hip and thigh (tingling, burning and pain)
symptoms worse at night, or after performing physically

Symptoms like the following may also occur:

increased occurrence of dropped objects
loss of the sense of touch
loss of grip strength in the hand
pain in the shoulder while sleeping
tendonitis in the elbow/wrist joint

How you can tell if CTS is to blame

Today, CTS is talked about SO MUCH in the media and workplace, that when we notice a tingling in our fingers, we often jump to the conclusion that we have the problem!

But other things can cause CTS-like symptoms. For example, you may wake in the middle of the night with wrist and hand pain -- thinking the worst -- and then the next afternoon when your hand feels fine, you realize you had spent most of the previous day pruning in your garden -- with a tight grip on those old pruning shears while pricking your fingers on the spiky leaves of that ol' Holly bush.

So before you run out to consult your company's employee assistance program or union health rep, take this simple test:

With your hands in front of your chest and your elbows pointing out to your sides,
bend your wrists so that your fingers point straight down;
press the backs of your hands together; and
if this position causes CTS symptoms within a minute or so, there's a good chance you may be developing the problem.

So MANY treatment options!

If you have developed CTS, never fear. Help is on the way with many treatment options available. But before you succumb to the more drastic solution of drugs or surgery, consult your chosen Doctor of Chiropractic to learn the pros and cons of each of these treatments and therapies:

Wrist Surgery
Anti-inflammatory drugs, Corticosteroids, Novocaine Injections
Instrumentation Therapies; i.e., Ultrasound, TENS, Mineral Infrared Therapy, Light Beam Generator, Omega Ray, Electro-Acuscope/Myopulse System, Photon Sound Beam and Qigong for Arthritis
Magnetics
Wrist Splints
Exercise and Ice Therapy
Vitamin Therapy (i.e., Vitamin B6 Therapy, Niacinamide Therapy)
Herb or Enzyme Therapy
Cold Laser Treatment
Reconstructive Therapy, Neural Therapy, and Therapeutic Touch
Biofeedback
Homeopathy
Accupuncture
Rolfing and Hellerwork
Chiropractic (manipulative therapy of the carpal tunnel)

IN CONCLUSION:

No one therapy or treatment can "guarantee" a cure for CTS. But in our observation, a professionally supervised, thoughtfully prescribed chiropractic approach helps considerably -- often times resulting in full cure. For your convenience, in future issues of this Online Health News, we'll compare chiropractic care of CTS to mainstream medical treatments and various alternative (less invasive) approaches.

The bottom line is: You don't have to live with the pain and frustration of CTS. Chiropractic offers hope!

In preparing this news item, our ChiroLink reporter referenced to the following two articles:

"Treating Computer-Related Injuries (Carpal Tunnel Syndrome)" by Michael Castleman; found at: http://www.plantrx.com/ecenter/alternative_care/castleman/000609.html ; and
"Carpal Tunnel Syndrome" by Anthony di Fabio; provided by The Arthritis Trust of America; found at: http://www.garynull.com/Documents/Arthritis/carpal_tunnel_syndrome.htm

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