I interviewed Alice Martinson, MD about soft tissues injuries, one of her passions after almost 40 years as a board-certified orthopaedic surgeon, 25 of which were as a Naval Medical Officer.
You mentioned loss control was of interest — which areas in particular are of interest?
What I'm most interested in is loss control through the prevention of musculoskeletal injury. I have seen so many work-related injuries in my long career that I know did not have to happen if folks had used common sense. After seeing the same injury pattern happen over and over again when it does not have to happen, I have come to believe that if I know of simple prevention strategies, I should pass them on whenever I can. Nothing discourages me more than to see an individual's personal and economic future compromised by a preventable injury.
How can employers benefit from having a loss control program in that area?
Musculoskeletal injuries are far and away the most common work-related injuries – particularly back injuries. For a company to focus on employee output while overlooking employee safety is self-defeating, because lost work days and medical costs directly affect the bottom line. (WCxKit)
What type of loss control is used for prevention of musculoskeletal injuries — like low back — is it ergonomics, job matching, physical demands job descriptions, others?
I'm glad you asked about assessment of job demands. That is probably the most overlooked aspect of loss prevention. Far too many company leaders have no real idea of the physical demands made on their employees. Careful job analysis will be eye-opening for a great many of them, and it will also let a prospective employee know more accurately what is expected in the jobs they are taking on. In my view the easiest and most effective loss prevention strategy is job matching. It is pretty hard to do properly when the actual physical requirements of the jobs are not appreciated. A good example of this would be hospital nursing or radiologic technician job descriptions. They carefully spell out the intellectual and administrative roles these folks are supposed to play, but nowhere in the ones I have read is it mentioned that the job requires moving many patients who are physically impaired or unpredictable.
Some hospitals have finally come to understand the risks their professionals undertake in these jobs and have established "lifting teams." The following links are to the press release and to the published study of the consequences of one such effort: https://www.miamivalleyhospital.org/mvhdefault.aspx?id=10770 and www.innovations.ahrq.gov/content.aspx?id=1813.
Ergonomic analysis is a logical follow-on to job demand assessment. Once you see clearly the actual nature of the jobs that need doing, it is usually not hard to figure out a way to get them done better and more safely – that's what ergonomics is in a nutshell.
The reports from the hospital cited above clearly demonstrate that what makes any loss prevention strategy effective is commitment to the goals and principles of maintaining a healthy, safe workforce. If, however, the incentives are concentrated just at the worker-supervisor interface, those incentives inevitably turn to suppression of work injury reports as employees get the message injuries "are not tolerated.” As in all other leadership challenges, enthusiasm and sustained attention to detail are the keys to successful implementation of loss prevention strategies, and those things HAVE to come from the top down.
Are there specific injuries that can be avoided?
The most fruitful area to start in is prevention of low back injuries. The first and most obvious loss prevention strategy is to match the employees' capabilities to their assignments. Pre-employment screening, except in highly-selected cases, is not cost effective. Keep it simple. A woman who is 5' 2" can no more safely lift a 70-pound object of irregular shape than she can fly. Yet in the past month I have evaluated several cases where that is exactly how she was injured, because that is what her job required her to do. The same can be said about morbidly obese individuals. Almost all of them have some degree of lumbar spine pathology, and if they are required to lift large heavy objects, it is only a matter of time before they will get a compensable back injury, because the bulk of their bodies does not allow them to use the proper lifting mechanics.
The situation of morbidly obese employees in general is another area where prevention can be fruitful. Osteoarthritis of the knees is virtually universal in long-standing obesity. If such a person is placed in a job requiring frequent squatting or climbing of stairs and ladders, they will develop knee pain and one or more surgical procedures is sure to follow. Somewhat akin to the knee injuries are shoulder injuries. Morbidly obese individuals cannot arise from a chair without using their arms. Shoulders were not designed to be weight-bearing joints, so when they are used for that purpose, they break down. Large rotator cuff tears and shoulder arthritis will develop, and if a shoulder becomes painful in the course of work that stresses that joint, the problem will end up being compensable as well. (WCxKit)
Please understand – I am not saying that obese individuals should not be hired or that they do not make good employees. Nonetheless, it is in everyone's best interest that the individual's capabilities match the job and the risks he or she is being assigned to undertake. Most companies of any size have employee assistance programs for those who are having problems with abuse of tobacco and other substances. Obesity is the abuse of food. Developing a meaningful incentive program to support and encourage obese employees in the weight loss process pays off many times over by improving employee health, minimizing lost time from work, cutting down on both workers compensation and health insurance costs, and preventing a lot of personal misery. Besides – it is the right thing to do.
Author: Alice M Martinson, MD has practiced for 40 years as a board-certified orthopaedic surgeon, 25 of which were as a Naval Medical Officer. Relying on her extensive military experience with injury evaluation, she performs IMEs and consults on loss control issues. Contact: 870-480-7475 or docalice@aol.com. Go to our Directory to read more about Doc Alice. See LowerWC.com for more information. Contact: info@reduceyourworkerscomp.com.
Read more by Dr. Alice Martinson: The Role of Chronic Soft Tissue Overload Syndrome and Lower Workers Comp Costs and: An MD Explains How Stretching Helps Relieve Postural Strain Complaints in the Upper Back.
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