Exercise Surpasses Ergonomics in Treating Work Injuries

Exercise, not ergonomics or other "conservative" methods such as physiotherapy, is the most effective strategy for treating work-related complaints of the upper body, according to studies performed in the Netherlands.

Investing in expensive ergonomic equipment such as special keyboards and office furniture have only limited effectiveness in treating work-related ailments, according to an updated systematic review by Arianne Verhagen, Ph.D., a physical therapist at the Erasmus University Medical Center in Rotterdam.

Exercise, however, emerged as "a very good thing to do," she said.

Still, Verhagen said it isn't wise to do away with ergonomics completely. She claimed "conservative interventions such as physiotherapy and ergonomic adjustments play a major role in the treatment of most work-related complaints of the arm, neck or shoulder."

The review appears in the current issue of the Cochrane Library, a publication of the Cochrane Collaboration, an international organization that evaluates research in all aspects of health care.

In the review that was published in the Cochrane Library, Verhagen updated another review published in 2003 by adding new trials with participants who were industrial workers or hospital staff who suffered from chronic complaints varying from 3 months to a year. Workers with inflammatory or neurological diseases were not included.

The trials evaluated more than 25 conservative interventions including exercises, relaxation, ultrasound, biofeedback, myofeedback and workplace adjustments.

Verhagen said she is not surprised exercise appeared most helpful to people suffering from chronic complaints of the arm, neck or shoulder.

"I am an evidence-based person, and exercise seems to be the best intervention from this review," said Verhagen. "That's what I do. When I treat patients, I know that they almost always get better."

Workers' Comp an Important Factor

Orthopedic surgeon Nicholas A. DiNubile, M.D., a clinical assistant professor at the University of Pennsylvania, agrees there is limited scientific proof that conservative interventions are effective for these injuries.

"It's not that they are not effective, though," he said. "There is an important difference."

An orthopedic consultant for the Philadelphia 76ers and the Pennsylvania Ballet, DiNubile said he is a great believer in physiotherapy interventions such as exercise and stretching as well as ergonomic workplace adjustments and taking breaks.

"One must be very careful, however, when interpreting interventions done in a workers' compensation environment and trying to apply those findings to non-workers' comp issues," DiNubile said. He added it is important for researchers to ask themselves whether they are really measuring that intervention or if social or psychosocial issues might be involved.

"What applies in work-related injuries may not always be applicable to the average person who gets an injury," DiNubile said.

Participants in the Cochrane review came primarily from the United States and Europe, where workers typically receive compensation when out of work because of work-related injuries. Verhagen said she does not believe workers with chronic pain would report a particular intervention was not effective if, in fact, it worked. These factors were not considered in her study.

"I think normally, people would like to go back to work," she said.

The quality of these studies was poor, Verhagen said, making it difficult to draw more conclusions about the effectiveness of many of these interventions. One limitation centered on varied and vague definitions of "work-relatedness." In the Netherlands, "work-related" means people have complaints that get worse when they are working, yet decrease or diminish on the weekend or when they are on holiday.

More Research Needed

Verhagen said with a rapidly increasing incidence of work-related disorders, the need arises "to determine whether these interventions have a significant impact on short-term and long-term outcomes."

In particular, research is needed to look at the effectiveness of ergonomic adjustments in the workplace, with studies concerning how a chair or a monitor is placed, how a mouse is used and whether an ergonomic keyboard is effective, said Verhagen. She knows of no such current studies.

"We have ongoing workplace adjustments in the Netherlands, for example, that are very expensive," she says. "Most of these have not been evaluated regarding their effect."

"The costs associated with these disorders are high &endash; more than $2 billion of direct and indirect costs estimated annually in the United States alone," Verhagen said.

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