Occupational
Safety and Health Administration
Types of Injuries Most injuries in construction workers are sprains and strains of the muscles. Construction work can also cause injuries to the joints, bones, and nerves. These injuries often occur from constant wear and tear on the body. Taken together these injuries are called musculoskeletal disorders. Generally, musculoskeletal disorders in construction workers affect the hand and wrist, the shoulders, neck and upper back, the low back, and the hips and knees. There are a number of well-known diagnoses of musculoskeletal disorders. They include:
Of course there are many other types of musculoskeletal injuries and problems, including strains and sprains, muscle and joint pains, broken bones, etc., which may be related to work on the construction site. A sprain is an injury or tear to a ligament. Ligaments attach one vertebrae to another and help support the spine. Strains is an injury to muscles that have been stretched or used too much. Strained muscles and sprained ligaments both irritate the muscles around them. This adds to the pain and discomfort. Risk Factors for Musculoskeletal Disorders Different types of construction work are often associated with different types injuries. For example, workers who do overhead work, such as painters and sheet metal workers, tend to have many more shoulder and neck problems. Trades at the highest risk of shoulder problems include: scaffold erectors, insulators and painters Workers who work at floor level and kneel while working, like floor layers and roofers, sheet metal workers and insulators have many more knee problems. Other trades which kneel a lot and have a higher risk of knee injuries include roofers and carpenters. Carpenters and other trades that require constant use of hand tools, have more hand and wrist problems. Tendinitis in construction workers is most common among roofers and sheet metal workers and masons. It is also well known among rodmen who twist wire ties have ganglionic cysts (often called bible bumps) on their wrists. Raynauds Syndrome is common among workers like lumberjacks, jack hammer users and others that use vibrating hand tools. Carpal tunnel syndrome has been reported in carpenters, electricians and sheet metal workers. Working as a laborer or scaffold erector where heavy lifting and carrying is common, is associated with back problems. Each of these types of work expose the construction worker to a different type of risk factor. Risk Factors are activities, actions, conditions or exposures that can increase your chance (risk) of developing a musculoskeletal disorder. There are some differences in the risk factors that are associated with musculoskeletal disorders of the hands, wrist, neck and shoulder also known as the upper extremities, the back, and the hips, knees, ankles and feet or the lower extremities. Risk Factors for Hands, Wrist, Neck and Shoulders Risk factors for musculoskeletal disorders of the hands, wrist, neck and shoulder may include:
Each of these risk factors is discussed in detail below. 1. Forcefulness or Muscle Effort Force is the amount of effort it takes to do an activity or work. Pushing, pulling, gripping a tool are examples of activities that require you to exert force or muscle effort. Keeping your body in one position for a period of time (for example, doing overhead work) also requires muscle effort. The more force you have to exert, the greater the stress on your body. The type of grip you use also makes a difference in the amount of effort you have to use. A pinch grip which uses only the fingers to hold an item, requires more muscle effort than a power grip. A power grip (full-hand grip), which uses the larger muscles of your arm, has about four times the strength of a pinch grip. A pinch grip can cause fatigue and injury. The position of your hands and arms in relation to your body will also affect the amount of force you need to exert. If your wrists are bent downward, backward, or to one side or the other you will need to use more force to do your work. The more time you spend with your wrists bent while working and exerting muscle effort, the greater your risk of developing a musculoskeletal disorder. A slippery handle or a handle with a small diameter is hard to hold, so you tend to grip it more tightly (apply more force). When your hands and fingers are cold, you grip tools more tightly to control them. Gloves which are too tight or too loose or made of certain materials (some chemical-resistant gloves) make you grip tools more tightly. However, it is important to remember that gloves are an important part of Personal Protective Equipment (PPE) and should be worn when required. 2. Awkward Body Postures Think about the most comfortable working posture for your neck, shoulders, arms, wrists and hands. Your shoulders are down and relaxed, your arms are close to your sides, elbows bent and wrists and hand straight, almost as if you were going to shake hands with someone. This is called a neutral posture. When your working posture is out of the neutral position, the stress on your joints, muscles, tendons, nerves and blood vessels is increased.. The amount of muscle effort is also increased and your risk of fatigue and injury also increases. It takes more muscle effort to work at eye height than to work at elbow height. Working with your arms raised is a very awkward posture which puts stress on the muscles, tendons and joints of your arms, hands and shoulders. Working at elbow height also allows you to use your body weight to push the tool being used. 3. Repetitive Work Nailing a deck and screwing drywall are examples of repetitive tasks. Doing the same motions over and over again puts stress on muscles, tendons and joints. 4. Vibration from Hand Tools Damage to the blood vessels and nerves in your hand and fingers can result from the long term use of powered hand tools. Rotary hammers, chainsaws, grinders and jackhammers all cause vibrations to travel through the hand. The risk of conditions, such as Raynauds Syndrome, from powered hand tools is increased if you are also exposed to cold, because the cold causes you to use a much tighter grip on the tool. 5. Contact Stress (Tools and Sharp Objects) Tools and materials (wood, metal) can press against the soft part of the palm of your hand or other soft tissues of your body. When tools or sharp edges press into the palm of your hand, they can press on or compress the soft blood vessels and nerves in your hand. When blood vessels are compressed, the amount of blood that gets through to the tissues is reduced. Compressed nerves can cause numbness and tingling. Continuous compression may cause irreversible damage to the blood vessels, nerves and surrounding tissue. Risk Factors for Back Injuries and Pain There are a number of common risk factors associated with injuries to the back. They include:
1. Lifting Lifting is a forceful movement requiring energy and muscle effort. It stresses muscles, tendons and ligaments and increases forces on your spine. This is true even if you use proper lift techniques. If you bend from the waist and lift at the same time, the forces on your spine are increased even more. This is also true if you reach, twist or hold the object away from you body as you lift. Using one arm to lift an object or carrying and object on one shoulder or one hip also places extra (and uneven) stress on the spine. Factors that affect the stress of a lift on the back and other parts of the body include:
2. Pushing, pulling, tugging and sliding
3. Twisting, Reaching, Sideways Bending, Unequal Lifting Any amount of twisting,
reaching or bending while lifting causes more stress on the back.
Remember: The more reaching, twisting, sideways bending and unequal lifting/carrying you do, the greater your risk of back injury. 4. Working in a Single Position (static postures) Working in one position for an extended period of time causes muscle fatigue. Bending over, leaning forward, and/or working with arms above shoulder height for a period of time stresses the lower back, neck and shoulders. Even sitting for long periods causes back fatigue. If you have already have low back pain, constant standing can be painful. Putting inserts in your boots and standing on padding rather that hard ground or concrete may help. It's important to move around, change positions and rest your muscles as often as possible. 5. Whole Body Vibration Whole body vibration is mainly a problem for heavy equipment operators and truck drivers. Over time, certain types of vibration can cause little changes (cumulative traumas) in the spine that can build up until there is permanent damage. Other Risk Factors to Consider Other risk factors contribute to the development of musculoskeletal disorders on the site. The include:
1. Floor surfaces and obstacles in the work area & House keeping Practices Good housekeeping practices are important to reducing musculoskeletal disorders
2. Height of the work Work areas not designed so that both tall and short people can work comfortably are a problem for each:
3. Working beyond your capacity Being physically fit has many advantages but strong muscles and fitness do not necessarily protect the spine from injury. Lifting affects spinal discs no matter how fit or strong you are. It is important to remember that everyone has limitations. Working beyond our limitations puts all workers at risk for injury. 4. Lifting techniques Lifting involves many different muscle groups. Lifting from the ground to waist level uses muscles of the leg and thigh. Lifting between the waist and the shoulder, uses mostly back muscles. Lifting above shoulder height uses muscles of the upper back and shoulder. Most of us have been taught that the proper lift technique is the squat lift with the knees bent and back straight. A squat lift puts stress on the lower leg, knees and thighs. It also requires a lot of energy. The proper lift depends more on the size and shape of the object you are lifting than of any set technique. If an object is too big or bulky you may not be able to hold it against your body as you lift. When you hold an object away from your body, the forces on your spine increases. This happens no matter what lift technique you use. People who do a lot of lifting will often lift freestyle rather than squat. Freestyle (what most of do when no one is watching back bent, legs almost straight) puts more stress on the back but requires less energy than squat lifting. It is important to be careful about the way you lift. No matter how you lift, if the object is too heavy, back injury may occur. The best way to prevent back problems is to eliminate or reduce the need for heavy lifting. 5. Tool Belts Wearing a tool belt which can weigh anywhere from 25 to 60 pounds puts stress on the lower back and hips. Adding suspenders to your tool belt can help redistribute the weight, but it requires adjustment until you get the shoulder-waist-hip distribution that's best for you. Suspenders can also cause shoulder discomfort. The best strategy is to reduce the weight of your tool belt. If you don't need it, don't carry it. 6. Temperature Cold can increase the risk of muscle strain. Muscles tend to tense muscles when it is cold; this makes strain more likely. (Note: Add the OSHA Cold Stress card as an appendix or the URL if on the Web Site) Heat Stress is a concern when working in hot or humid environments. Heavy physical work raises your body temperature. Heavy work in hot environments can lead to a series of problems including dehydration, heat cramps, confusion, heat exhaustion and heat stroke, which is life threatening.(Note: Add the OSHA Heat Stress card as an appendix or the URL if on the Web Site) Non-Work-Related Risk Factors for Musculoskeletal Disorders Some risk factors for musculoskeletal disorders have nothing to do with work. Certain medical conditions such as rheumatoid arthritis, diabetes, hormone imbalances and pregnancy can increase your chances of getting some musculoskeletal disorders. Your general health and age as well as spare-time activities may also play a part in the development of musculoskeletal disorders. If you work for yourself or on your own house in the evening and weekends, chances are you are being exposed to some of the same risk factors you face on your job. Even if your free time activities are very different from your work activities they may involve similar risk factors, such as repetitive actions, mechanical stress or awkward postures. If, for example, you're a pitcher during softball season, play a lot of tennis, or have hobbies which involve fine precision work (carving, model-making) you may be exposed to risk factors of musculoskeletal disorders. . Remember that the greater the number of risk factors you are exposed to, the higher your risk of developing musculoskeletal disorders. The longer your exposure, the higher your risk. Making Construction Work Safer In most cases, the cause of musculoskeletal disorders can traced body movements and the demands of the job. Given the physical nature of construction jobs, it is not surprising that many complain of back, shoulder, or knee problems. Many of these conditions could be prevented if we reduce the amount of awkward, heavy, repetitive activities required by the job. While construction jobs will never be like desk jobs (and who would want that anyway?), they can be made to be safer. Elements of a Good Health and Safety Program Successful programs aimed at reducing musculoskeletal disorders have six essential elements. Your program may include more elements. The six essential elements include:
Management Leadership and Employee Participation Management commitment to control and reduce work-related musculoskeletal disorders starts at the top and must run through every level in the organization. The commitment includes assigning program responsibilities and the authority to those that run the program, providing adequate financial, personnel and material resources, analysis of the worksite activities and infrastructure to identify risk factors and hazards, information dissemination, training and medical management. The most effective solution to reducing safety and health hazards on the construction site is a combination of leadership and worker involvement. Involved employees provide input and report the presence of risk factors on the site, report symptoms and injuries, suggest and design solutions and provide the central resource for maintaining a risk free project. If there is a functioning safety committee on your project, control and prevention of musculoskeletal disorders should be one of its areas of concern. If there is no committee, consider forming one to address musculoskeletal disorders and other safety and health concerns on your project.. Hazard Awareness and Identification Superintendents, foremen and workers must be aware of risk factors and hazards on their jobs and in their work environment that lead to musculoskeletal disorders. A key component of a successful program is the ability of the workforce to learn, identify and report the risk factors, hazards, signs and symptoms of musculoskeletal disorders. Skills in hazard awareness are developed through training programs and hands-on practice. There are many programs and free materials available in print and on the web that can help in this training. Information on where to get some of this information is included in the back of this manual. Job Hazard Analysis and Solution Development A Job Hazard Analysis helps find what risk factors or hazards exist on the job site. Careful evaluation of the job site identifies risk factors and hazards; use of checklists help record your observations for further examination. Several check lists for recording risk factor and hazards are included in this manual. Once the risk factors, hazards and injuries are identified and recorded, the safety and health committee, in collaboration with management, contractors and workers, have the facts to develop solutions, e.g., improve site housekeeping through the alteration of material delivery schedule, use self-raising platforms or buddy system for lifting, etc. Some general solutions are listed below. Training Training provides the basis for consistent awareness, identification, analysis, targeting and control of musculoskeletal disorders hazards. The training should reach workers, foremen, and superintendents as well as others participating in the musculoskeletal disorders control program at no cost to them. Medical Management and Alternate Duty The key to rapid successful return to health, duty and productivity is prompt access to health care for assessment, treatment and follow-up. The longer a worker is away from work the less likely the worker will return. Replacement of a skilled workers is expensive or, at times, difficult to impossible. It is a benefit to workers and employers to bring an injured worker back to alternate or reassigned duties as soon as medically appropriate. Program Evaluation Evaluating the effectiveness of a program is just as important as instituting the program. Is your program reducing musculoskeletal disorders, hazards and risks? Does an initial upsurge in musculoskeletal disorders reporting mean your project became less safe because of the program? Does this upsurge mean that a hidden population of injured workers has gotten treatment and will be returned to a healthier level of life and productivity? Have you successfully identified and targeted your musculoskeletal disorders hazards? Program evaluation will help answer all these and more questions. Looking at your work-site Checklists are useful tools for determining the presence of symptoms, hazards and risk factors of musculoskeletal disorders at your work-site. Checklists are a way of collecting the same kind of information each time you look at a site. They also serve as reminders to look at the most important activities related to musculoskeletal disorders on the site. The following checklists are sample approaches to learning about hazards on your work-site, identifying solutions and how well your prevention program is working. These kinds of checklists can be changed to suit your worksite or your personal styles. Worksite Evaluation Checklist Why should I fill out the checklist? This checklist is intended to help develop an "eye" for musculoskeletal problems and to prevent injuries. Who fills out the checklist? Jointly updated by contractors and workers or their representatives How often do I update the checklist? Every 2 weeks or as a site changes. Changes may include but are not limited to weather conditions, introduction of new workers on the site, new materials, change in operations, new phase of the project, etc. Do I need to fill out the entire checklist? Each time the checklist is updated fill out the Job Site Information Section. Some parts of the checklist may not apply to your kind of work. Fill out what applies to your job or site activities. Job Site Information Date: _________________
Site: ___________________________________________ General Contractor:
_____________________________________________________ Materials Handling & Lifting List those tools and materials weighing over 20 lbs that are lifted by hand. These might include bricks or blocks, drywall, plywood, rebar, structural iron, roofing materials, forms, jack hammers, tampers, saws, pneumatic wrenches or anything over 20 lbs. Fill out the box
List the materials and tools weighing over 50 lbs that workers lift without assistance; how often do they perform these lifts each day. Fill in the box below.
Are there handles for materials that must be carried? Yes____ No____ If there are no handles, why? How can handles be easily installed? If there are handles, are the handles easy to use and comfortable? Yes____ No____
Are workers encouraged
to get someone's help to lift heavy materials? Are dollies, hand-trucks,
wheelbarrows or other assists available for moving materials? If dollies, hand-trucks,
wheelbarrows or other assists are available, are they being used? Are materials delivered
as close as possible to where they will be used? What jobs cause workers to lift overhead? Fill in the box.
Are materials stored
on walking or working surfaces? Could the materials
be stored at waist height? Which tasks do workers have to reach far to pick up or lift materials? Fill in the box.
Tools Are tools kept sharp
and in good condition? What can be done to improve tool maintenance?________________________________ What tools weigh more than 20 lbs? Fill in the box.
What hand tools use on site vibrate? Fill in the box.
What hand tools have to be used in awkward postures or in difficult positions? Fill in the box
List the hand tools that have poor handle designs, grips that are too big or small, blow cold air on the workers' hands or have chilled handles. Fill in the table
Repetitive Work List the jobs that require motions be repeated many times for 1 hour or are repeated throughout the workday? Can the repetitions be reduced by job rotation or rest breaks? Fill in the box.
Awkward Postures List the jobs that require work at shoulder height more than 1 hour per day; jobs that require overhead work more than 1 hour per day? Can scaffolds, platforms or other equipment reduce work above shoulder height?
Kneeling List the jobs that require or kneeling for more than 1 hour a day? Are kneepads or cushions available? Are the pads or cushions being used? Fill in the box.
Working in one posture or position for a long period List the jobs that require workers to stay in one position for a long time. Fill in the box.
Twisting, Turning, Bending List the jobs that require a lot of twisting, turning or bending. Are there ways of reducing twisting, turning or bending? Fill in the box
Surfaces for Walking and Working List the jobs where the working and walking surfaces are not clean and dry; obstructed; uneven or not level. How can the surfaces be improved? Fill in the box.
Worksite Lighting Conditions List the work areas that are lit with artificial lighting. Is there enough light to do the work? To see materials being moved? Are walking surfaces adequately illuminated? Do shadows restrict visibility? Does glare restricts visibility? Fill in the box.
Standing List the jobs that require workers to stand all day. Which jobs require standing on concrete or steel? Fill in the box.
Sitting List the jobs that require sitting for more than one continuous hour. Are workers sitting in the cold to do the job? Sitting on building materials to do the job? Fill in the box.
Heavy Equipment Operators List the types of heavy equipment operating on the site. On which machines do operators need to lean forward to see or do their work? Do they have to stretch or use awkward postures to reach the equipment controls? Are the seats comfortable for the operators? Does the seating in any of the equipment vibrate a lot? Are the mirrors in the right spots for good visibility? Fill in the box.
Training List the training courses that superintendents had on preventing musculoskeletal disorders? What courses do they need to take? Fill in the box. If no courses were taken, write NONE on the first line.
List the training courses that foremen had on preventing musculoskeletal disorders? What courses do they need to take? If no courses were taken, write NONE on the first line. Fill in the box.
List the training courses that foremen had on preventing musculoskeletal disorders? What courses do they need to take? If no courses were taken, write NONE on the first line. Fill in the box.
Recording Signs and Symptoms of Musculoskeletal Disorders List the jobs and job titles of workers that have reported muscle pain, joint, back or neck pain in the last 2 weeks. What is the possible cause of the symptom, for example, lifting, awkward postures, working in one position for long periods, repetitive work, something else? You might also want to look at OSHA 200 logs, first aid logs or any other sources of information that is available on your site. Fill in the box.
Reporting
Solutions Now that you have reviewed all of the jobs for hazards and risk factors related to musculoskeletal disorders, this is the time to consider solutions that best fit your worksite and budget, but which fix the problems. Based on your review, list the jobs on site that are the most hazardous for musculoskeletal injuries? Work with the superintendents, foremen and workers to analyze the hazards you have noted as well as, risk factor information to select appropriate solutions. The analysis may be as simple as providing anti-fatigue mats for workers who stand on concrete all day, or as complex as developing a rotation schedule for workers who must work in cramped spaces all day. List the suggested solutions according to the ease of getting done, the expense and the potential to eliminate the identified risk factor or hazard (effectiveness)? Proposed solutions Most effective - - - - - - - - - - - - - Easiest to get done- - - - - - - - - - - - - Least expensive
Least effective - - - - - - - - - - - - - Hardest to implement - - - - - - - - - - - - Most expensive You also might want to develop a schedule that allows you to check back periodically to see if the solution actually worked. Program Evaluation Checklist Every health and safety program should have one part of its activities dedicated to the elimination of work-related musculoskeletal disorders, The most effective programs are evaluated on a regular schedule, especially as worksites change. This checklist provides a cursory evaluation of the main elements of your program to reduce musculoskeletal disorders. Fill this out to see where your program is working and where it might need improvement. If you answer No to any question, jot down why this activity does not occur in your organization. Management Leadership and Employee Participation
Hazard Awareness and Identification
Job Hazard Analysis and Hazard Control
Training
Program Evaluation
Medical Management and Alternate Duty
EXAMPLES OF ERGONOMIC SOLUTIONS IN CONSTRUCTION
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