by Josh Cable
To the layperson, sprains and strains probably seem like small potatoes. Of all the calamities that life could visit upon a person, an ankle sprain might seem like a minor scrape in the grand scheme of things.
Safety professionals, however, know that sprains and strains are anything but small problems. In fact, sprains and strains are multibillion-dollar problems, according to the 2005 Liberty Mutual Workplace Safety Index, which estimates that overexertion - defined as injuries caused by excessive lifting, pushing, pulling, holding, carrying or throwing of an object - in 2003 cost employers $13.4 billion.
Safety professionals in construction should know this better than anyone. According to data from the Bureau of Labor Statistics (BLS) for 2005, construction's lost-days nonfatal occupational injury and illness incidence rate for sprains and strains (83.1 cases per 10,000 full-time workers) was higher than any other industry sector. BLS data for 2005 also shows that construction's overall lost-days nonfatal occupational injury and illness incidence rate (239.5 cases per 10,000 full-time workers) was higher than any other sector - by a comfortable margin.
To figure out why sprains and strains are prevalent in construction is not rocket science. Construction, after all, involves gritty, physical labor - often performed by workers who aren't in peak physical condition. With that in mind, it should come as no surprise that the BLS statistics for 2005 indicate that construction not only led the way in the lost-days injury and illness incidence rate for sprains and strains, but also in the lost-days incidence rate for cuts and lacerations; fractures; and multiple traumatic injuries.
The Things They Carry
Construction safety and ergonomics expert Sang Choi, Ph.D., CPE, an assistant professor at the University of Wisconsin-Whitewater's Department of Occupational and Environmental Safety and Health, recently surveyed 20 highway construction contractors in Wisconsin in an effort to quantify the types of tasks they were performing, the types of injuries and illnesses they were experiencing and the types of ergonomics programs they had in place. According to Choi, the returned surveys represented 10,359 employees.
Choi's survey revealed that workers at 12 of the 20 firms were lifting and/or carrying objects for 3 to 4 hours per day. Five of the 20 firms reported that their workers were lifting and/or carrying objects for 1 to 2 hours per day.
Choi noted that the results from this survey were consistent with previous surveys he has conducted in other construction trades.
"The trend is very similar," Choi said. "Close to 50 percent of the time, construction workers are involved in manual materials handling."
Choi's survey of highway contractors in Wisconsin found sprains and strains to be the most common type of injury and illness, accounting for 39 percent of the total reported cases. Back injuries were No. 2. According to Choi, the majority of both types of injuries were caused by overexertion when lifting and/or carrying objects.
Choi noted that, in the future, he plans to survey a larger sampling of firms in an effort to develop a national database of ergonomic information for the construction industry.
No Magic Bullet
According to Choi, all of the firms surveyed said that they had a written safety program in place. However, only 45 percent - nine of 20 respondents - reported that they had an ergonomics program in place.
Some of the firms reported that they had certain elements of an ergonomics program - such as lifting education and stretching - in place. For example, nine out of 20 respondents indicated that they used PPE such as anti-vibration gloves.
Still, the key to minimizing sprains and strains, Choi asserted, is to create an ergonomics program that includes all of the necessary elements - not just one or two. Such a program should include pre-work stretching; engineering controls such as adjustable-height workstations and ergonomic hand tools; and administrative controls such as job-task rotation and training on proper lifting techniques.
The key word is "comprehensive." For example, Choi said, a pre-work stretching program by itself is not enough to effectively prevent sprains and strains and other ergonomic injuries.
"That would be a really dangerous concept to say that a stretching program is all that's needed to mitigate ergonomic hazards," Choi said.
Stretching for Safety
Walbridge-Aldinger, a Detroit-based general contractor that recently was named by Occupational Hazards as one of America's Safest Companies, is a textbook example of a construction firm that uses a multi-faceted approach to prevent sprains and strains.
More than a decade ago, sprains and strains "used to plague our company," admitted Stephen Clabaugh, assistant vice president, health and safety. Back then, sprains and strains were a bane to productivity, attendance, work force retention and workers' compensation costs, among other things.
According to Clabaugh, Walbridge-Aldinger - which employs 1,200 salaried and hourly trade employees in the United States, Canada and Mexico - has "come a long way" since then. The company has been able to dramatically reduce sprains and strains to the point where, according to Corporate Safety Director Mark LaClair, such injuries today are a rare occurrence.
"About 10 years ago, 25 percent of our injuries were sprains and strains," LaClair said in a November interview. "In this calendar year alone, knock on wood, we've had zero."
To turn things around, Walbridge-Aldinger enlisted the help of HealthSouth Corp., a Birmingham, Ala.-based health care services provider. According to Clabaugh, HealthSouth consultants conducted observations at several Walbridge-Aldinger job sites to identify ergonomic hazards and to suggest specific countermeasures, including stretching.
Today, Walbridge-Aldinger conducts pre-work stretching sessions at all of its self-performing job sites. Those sessions are led by one of Walbridge-Aldinger's 30 full-time safety professionals - if they are available - or by a foreman, all of whom received training from HealthSouth on how to lead stretching sessions.
"It's intended to be a short duration - usually no more than 5 minutes," LaClair said. "And it's designed to loosen up and limber up the muscles."
Depending on the type of work that's on the docket that day, stretching sessions can target particular muscle groups. For example, if employees will be working on a wall form that day, LaClair said that the foreman or safety professional might choose stretching activities that target the upper back and shoulder areas.
Why is stretching effective? Choi notes that the Dictionary of Human Factors and Ergonomics defines a "strain" as an injury or disability involving the overuse, overextension, compression or twisting of a muscle, ligament or joint. It defines "sprain" as an injury, typically occurring at a joint, in which the ligaments are stretched and/or torn. With those definitions in mind, Choi noted that stretching is beneficial because it helps lubricate the muscles, ligaments and joints of the body before putting them into action.
It's no different than golf, according to LaClair.
"When you get up onto the first tee and you grab your clubs, you usually don't step up to the ball and whack it and chase it," LaClair said. "You take a few practice swings and twist, just to get the blood flowing and the muscles going so when you do exert the force onto the ball, you're not going to be paying for it the next day. The same principle exists."
Choi advocates pre-work stretching in construction for another reason: It gathers all the workers in one place before work, creating the perfect opportunity for toolbox talks and other pre-job safety planning that can help workers avoid sprains and strains and other hazards.
At Walbridge-Aldinger, stretching sessions are followed by "pre-shift huddles." During pre-shift huddles, workers and supervision review the site's pre-task analysis - which some companies call the job-safety analysis - discuss the work that's on tap that day, identify the potential hazards before that work takes place and implement the proper safety procedures to mitigate those hazards. Each pre-shift huddle concludes with the words "work safe" and the company's motto: "If it's not safe, I won't do it, and I won't let others do it."
According to Clabaugh, daily pre-shift huddles are all about "being proactive."
"You're identifying the potential hazards and you're getting everything in place to do the job safely upfront," Clabaugh said.
Proper lifting technique - lifting with your legs, keeping your back straight and avoiding bending and twisting - certainly is one component of preventing sprains and strains, particularly sprains and strains of the back.
As part of their new-hire orientation, Walbridge-Aldinger employees must complete 18 safety awareness online modules - one of which is dedicated entirely to manual materials handling and awareness of proper lifting strategies (such as asking for help if a load exceeds 50 pounds and using carts to transport materials).
However, if a work site is cluttered and disorganized, training on poor lifting technique and proper body postures can fly out the window. That's one reason why Walbridge-Aldinger has adopted Toyota's lean manufacturing philosophy.
The philosophy involves identifying and reducing waste - such as overproduction, waiting and transportation - and adopting a system of workplace organization and visual controls known as the "Five S's." Loosely translated from Japanese to English, the Five S's are: sort, set in order, shine, standardize and sustain.
As an example of how the principles of lean manufacturing have enhanced safety - and minimized sprains and strains - Clabaugh pointed to an "old way of doing business."
"We'd have a laborer carry two 5-gallon gas cans out of a C container or storage area and walk the distance of the job site and walk down a ramp into a construction pit to fuel our equipment," Clabaugh said, noting that lifting and carrying the gas cans for such a distance posed the potential for sprains and strains or, at the very least, discomfort.
Using the principles of lean manufacturing, Walbridge-Aldinger purchased four-wheel carts from Home Depot and secured the gas cans to the cart, allowing workers to pull the cart from the C container or the storage area to the work area.
Another example is the C container, which is where all of the construction materials are stored on a job site. Under the principles of lean manufacturing, Clabaugh said, the C container is designed to be clean and efficient, "where you don't have to step over or climb over anything and where everything either is on a shelf or on the wall at waist level to avoid repetitive bending and lifting."
"Lean, quality and safety all go hand in hand," Clabaugh said. "And it's the principles of lean that have helped us identify those areas that can impact ergonomics."
Keep it Site-Specific
Any construction safety program that's worth its salt is built on pre-job planning that evaluates the scope of work and the logistics and potential hazards of the specific work site - before work begins. It's no different for preventing sprains and strains.
"Your strategies have to be site-specific," Choi said. " ... The safety professionals need to go out on the job site before the workers get there and figure out what kinds of ergonomic hazards exist."
At Walbridge-Aldinger, each job site has a written logistics plan, which is "key to the success of the project."
"A logistics plan identifies where the equipment lay-down area is going to be in relation to the job," Clabaugh explained. "It identifies how the equipment is going to be transferred from the lay-down area to the actual construction site in the most productive and safest manner possible." The plan also addresses issues such as where the gas storage tanks will be located and how those tanks will be accessed for refueling equipment.
"The logistics plan really falls in line with lean manufacturing," Clabaugh added.
Engineering controls are mentioned last here, but they're certainly not least in importance when it comes to minimizing sprains and strains and other ergonomic injuries.
Even if you teach your workers to avoid bending, twisting and other awkward body postures, they still might be at risk of injury if they're using poorly designed equipment and tools. According to Choi, poorly designed hand tools increase the amount of vibration transmitted to the hands, increase the forces required to operate the tool and increase the number of awkward postures and positions taken when using them. Consequently, Choi encouraged construction firms to purchase ergonomically correct hand tools for their employees.
Before purchasing hand tools, Choi said, the workers who regularly will be using the tools should have the opportunity to try them out. Choi noted that most hand tool manufacturers and distributors provide samples or allow workers to put the tools through their paces during a trial period.
"Construction companies should take advantage of those kinds of offerings," Choi said.
According to Clabaugh, Walbridge-Aldinger has learned that workers are "worth the investment" in ergonomically correct tools and equipment as well as in "top-of-the-line" PPE. For example, Clabaugh noted that when Walbridge-Aldinger was deciding on full-body harnesses to purchase, the company let workers sample several brands.
"We said, 'You guys are going to be wearing these harnesses 8 hours a day. We want you to be comfortable,'" Clabaugh explained. Instead of buying $45 harnesses, Clabaugh added, Walbridge-Aldinger opted for $225 harnesses that are lightweight and comfortable.
"We've learned that you have to invest in safety," Clabaugh said. "And your return on investment is just phenomenal."
- Pre-work stretching
- Adjustable-height workstations
- Ergonomic hand tools
- Clean, organized work sites
- Job-task rotation
- Training for safe manual materials handling