Q: What are some of the trends you're seeing in the different ways people are working today?

A: Today's work demands are more technical and mentally intensive and require workers to have higher educational levels while giving them more decision-making responsibilities.

With the increase in globalization there is an increase of competition between companies. Companies are forced to improve productivity and reduce waste with a leaner staff. Today's staff typically has fewer benefits and less job security in the market. As a result there is higher stress levels in the work place. Research shows that high stress levels correlate with increased incidence rate of musculoskeletal disorders.

The telecommuting trend allows employees more flexibility in how to manage their time and provides them an opportunity to live where they want rather then live near the job. On the flip side, telecommuters are more isolated and may feel "out of the loop" and not part of the team. For some people this can cause stress and feelings of displacement.

From an ergonomic standpoint people who work from home are often working in ergonomically challenging workstations. (e.g. at the kitchen table, at home made desk arrangements, in poor supporting chairs) Employers generally do not provide equipment or furniture for the telecommuter and usually do not take the necessary steps to insure that their employees are working safely in the home environment.

Q: What is a repetitive motion injury?

A: Another term used for repetitive motion injury is work-related upper extremity disorders (WRUEDs). Literature suggests a correlation in the development of WRUEDs and four risk factors: excessive motion, static postures, psychosocial and task stress (i.e. time pressure, emotional threats, lack of control of work pace, workload), and personality traits (i.e. beliefs, coping behaviors). When considering the influence of these factors we can start to understand why one person performing the same type of work may develop a WRUED while another person may not.

WRUEDs are characterized by symptoms that progress gradually over time. Typical reported symptoms include: deep aching, numbness, tingling, spasms, cramps, swelling and diminished muscle control and usage. More often than not objective diagnoses for WRUEDs cannot be made. The key to effective intervention is early intervention.

Q: What is carpel tunnel syndrome and how do you get it? What can you do to alleviate it or avoid it? Is surgery the only option?"

A: Carpal Tunnel Syndrome (CTS) results from an entrapment of the median nerve in the wrist. Symptoms include tingling, numbness, pain and weakness. Literature is mixed as to the causes of CTS, as with most work-related upper extremity disorders there are many factors that contribute to their occurrence. From a bio mechanical perspective the contributing factors are repetitive wrist flexion and extension, strong gripping with ulnar deviation, impact forces on the palm, and vibratory forces. There are a number of other risk factors that have been linked to the prevalence of CTS, to include; being a woman at menopausal age, obesity, lack of fitness, diabetes, osteoarthritis, smoking, and excessive alcohol intake. By controlling both the bio mechanical and heath risk factors a person can reduce their chance of developing the condition.

Conservative treatment such as hand therapy, medication, splinting and education is very effective for the mild cases of CTS. Surgical treatment is usually needed for severe cases; however, management of moderate carpal tunnel syndrome is more complex. The type of treatment needed is dictated by the cause or causes of the condition and therefore can be different for different people but early intervention is key to a successful treatment result.

Q: I have a huge project coming up that will require hours and hours at the computer. What can I do to adjust my workstation and the tools within it so I don't end up in pain?"

A: The primary goal is to provide heavy computer users with postural flexibility so they have the freedom to change postures before discomfort occurs. The best solution is to use a sit/stand station where the user can easily alternate between sitting or standing throughout the day. But no matter whether they are sitting or standing the following tips will help to keep discomfort down and productivity up.

• Use a good supporting chair that allows for ease of adjustment and allows the feet to be on the ground with a hip angle of 90-110 degrees.
• Practice neutral posture with the upper arms close to the torso, the wrists straight, the head forward and the spine supported.
• Place the monitor at arms length away with the top of screen at or just below eye level (lower for bifocal wearers) and in line with the keyboard and document holder, if one is used. Use a glare screen to reduce glare that cannot be reduced from relocating the monitor or light source.
• If you are referencing paper documents be sure that task lighting is sufficient so eyestrain does not occur. Lighting should not be placed behind the monitor or in line of sight of the monitor.
• Place the keyboard on a surface that allows the elbow angle to be opened to 90-130 degrees while not elevating the shoulders, compressing the wrists or forearms or bending the wrist up or down.
• Take 5-minute stretch breaks every hour in addition to your regular 15-minute break and lunch break. It has been shown that with this extra 20 minutes of break time discomfort increases and productively does not go down.
• Provide your eyes a rest from the computer as often as you can. For instance when thinking about what you want to compose look away from the screen rather than stare at it. Your eye muscles are no different than any other muscle in the body only they are smaller than most and can fatigue faster. Remember the 20-20-20 Rule: Every 20 minutes, look 20 feet away, for 20 seconds.

Q: How often should I change position when I'm working? Is it important to get up and move around?"

A: Changing the postures one takes while working helps to decrease static muscle loading and improves overall comfort for the worker. Unfortunately most computer workstations are not adjustable to allow workers postural flexibility (i.e. sit-stand stations). Ideally a person should be able to change their postures to avoid discomfort rather than in response to discomfort. Making a healthy habit of taking breaks is essential to comfort at work. A study completed by Galinsky in 2000 for data-entry operators provides support for adding a 5-minute break for each hour workers are not taking their regular two, 15-minute breaks and their lunch break. Adding an extra 20-minutes of break time per day resulted in increased upper extremity comfort and reduced eyestrain while not negatively affecting productivity. Generally speaking productivity goes down as discomfort goes up. Often worker's perception is that they cannot afford to take a break due to the workload but in reality they can't afford to not take breaks.

Q: What are the advantages of using a keyboard tray, and how should it be positioned?"

A: Keyboard trays are beneficial when the job does not require multitasking. Trays are not recommended in multitasking jobs, as the tray forces the user to bend and over reach to access other tools such as the phone, ten key and writing pad that are typically located on the desk surface. They are also not recommended in confined workspaces.

An adjustable keyboard tray allows the user to change postures periodically while keying. Using the keyboard tray so the elbow angle is open to 130 degrees serves to relax the shoulder muscles and decrease upper shoulder and neck discomfort. Users who are not touch typists may not want to position the tray in this fashion as it will require a greater degree of neck bending to see the keyboard.

Q: What do you see as the ideal workstation? A corner or straight work surface, keyboard tray, task lighting, desk height, and how should they all be adjusted?

A: An ideal workstation is one that supports the work tasks, allows good workflow, provides the users the ability to work in optimal posture and offers postural flexibility. Accessories and accessory placement is dependent on job tasks, work style and worker characteristics and is not the same for each person or for different jobs.

Q: As an employer, I want to provide good ergonomics for my employees. What are some inexpensive solutions to make them comfortable?"

A: If employers would just address a few common ergonomic issues we would be a long way into reducing discomfort in the office environment. This is not a complete list but it is a good start.

The One-Minute Ergo Training

1. Place the writing surface at elbow height to reduce shoulder elevation or stooping over the desk.
2. Place the mouse on the same surface level as the keyboard to reduce over reaching and shoulder elevation.
3. Set a flat keyboard surface 1" below elbow height to reduce wrist extension.
4. Keep the elbow angle at no less than 90 degrees while keying to reduce shoulder elevation and arm compression.
5. Get the monitor in line with the keyboard to avoid neck rotation.
6. Place the monitor at least 30 inches away and at a height that allows you to use it without tilting your head up. For users with normal vision of single lens glasses you're the top of the monitor should be about the same height as your eyes. Generally monitors set lower than eye level are better so if you are going to error, error on the low side.
7. Use a document holder just down from the monitor and up from the keyboard to reduce neck flexion.