Ergonomic injuries at work can be a widespread and costly problem. Dr. Manijeh Berenji shares common workplace injuries, and the ways you can improve your work spaces and environments to minimize the risk of this overuse type of injury.
Manijeh Berenji, MD, MPH
Manijeh Berenji, MD is an occupational medicine specialist in Boston, Massachusetts and is affiliated with Boston Medical Center. Learn more about Manijeh Berenji, MD
Melanie Cole (Host): Ergonomic or repetitive strain injuries at work are widespread, costly problems, not to mention they hurt when you are trying to do your job. My guest today is Dr. Manijeh Berenji. She’s an occupational and environmental medicine physician at Boston Medical Center. Dr. Berenji, let’s talk about workplace injuries. What do you see as the most common way that people injure themselves and where do these injuries take place on the body?
Manijeh Berenji, MD, MPH (Guest): Thank you so much. I appreciate the invitation. I really wanted to be able to address your inquiries. Repetitive injuries happen in all different types of occupations and different types of settings. At least in my current work here at Boston Medical Center, I see a lot of folks from the healthcare industry, from the custodial industry who do a lot of types of activities with their hands and as a result of these types of activities; whether they are pushing patients, pulling on various types of items, utilizing a pressure hose, you name it; these types of activities if they are done repetitively over a course of a month, over the course of a year, over the course of a decade; you actually can calculate the cumulative forces that are required to do these types of activities. And as a result, what ends up happening is that you potentially can strain your tendons, and this can really lead to people coming up with chronic pain symptoms. So, this is what I see in my practice on a daily basis.
Host: So, if we are just starting to feel our elbow or our wrist at the thumb, whether it’s somebody who types a lot or texts a lot; what do you want us to do when we are just starting to feel those things?
Dr. Berenji: I always tell my patients once you start feeling something; come in and see us. The sooner we are able to take a good history, we are able to pinpoint what might be the potential exacerbations that might be causing those particular types of pain symptoms. In the instance of repetitive typing, I do deal with a lot of transcriptionists who have to type a specific number of words per minute and again, you can calculate the cumulative forces required to be able to type at that rate. So, really coming in as soon as possible is the best way to be able to troubleshoot and coming up with treatment options as well as preventative strategies.
Host: Tell us about workplace ergonomics. What is that and how can somebody look at their workplace and say okay I need to set this up better for myself so that I don’t get those kind of biomechanical injuries?
Dr. Berenji: That’s an excellent question. So, at least for folks who work in the traditional white collar occupations whether they are doing a lot of repetitive typing; I always tell folks that it’s good to raise awareness among your colleagues. This is something that we all deal with. Making sure that there’s awareness about understanding the ergonomics of the workplace and really trying to get additional insight from the human resources department. In a lot of cases, especially with the patients that I see; a lot of times it’s just a matter of starting a conversation with the various stakeholders at your company. Whether it be your human resources department, whether it be senior leadership; I always tell folks it’s good to start small. If you are having this issue; I guarantee you, other folks at your workplace are having the same issue when it comes to the workplace and the ergonomics of your work station. So, being able to identify what the current setup is in your organization and again, just raising awareness among your colleagues and being able to seek out consultations with experts like myself; this is something that could help facilitate the process by which to institute ergonomic changes.
Host: Dr. Berenji, give us some workable examples of what you would like us to do as far as changes that can be made to improve our work station, good body position, good posture, positioning for the keypad or using the mouse. Tell us what you tell people about this every day.
Dr. Berenji: So, honestly, I learned a lot of this from my colleagues in the ergonomics field. Really a lot of this stuff is just common sense. Just understanding your workplace dynamics in terms of how your desk is situated, where your keyboard is, where your mouse is. I always tell folks make sure everything is in proper alignment in terms of how you reach for these various types of items. Making sure that you are not over reaching for your mouse. Making sure everything is nice and comfortable, so you are not having to strain your fingers or your hands or your wrists or your forearm or your elbow. It’s really common sense at the end of the day. But a lot of times, we have to do our jobs, we have to be able to get things done in a very quick manner. We sometimes forget about the very basics when it comes to proper positioning of our bodies and also making sure that the equipment that we use to do our job is setup in a way that will not exacerbate a potential for problems down the line.
Host: Well now a perfect example and I know you say it’s common sense, but people don’t always realize, should the keypad be at a 90 degree angle from your elbow and your shoulder? Should it be up on an angle? Some people have those keypads that are like lifted up a little, but does that strain your wrist and your forearm? Where do you want that actually and what kind of keypad should we be looking for, flat or up on an angle?
Dr. Berenji: So, I always recommend keeping things nice and flat and what you said was exactly right. Making sure that you do have a 90 degree angle between your elbow and the keyboard surface is ideal because you are limiting the forces on your respective joints as a result. But like I said, the best way to be able to determine the specifics of your workplace station is to actually take a picture and bring it to your consultation with your occupational medicine physician or with your ergonomic specialist at your workplace. Having pictures, in my opinion, is the best way to be able to identify things first and foremost to be able to come up with those quick solutions. Like I said, making sure that the way that your station is arranged, that there’s no potential for causing repetitive injuries and a lot of times, it’s just looking at the work station and a quick snapshot of your work area can really be helpful, at least in my practice.
Host: And as somebody who developed a problem myself, Dr. Berenji, and I changed my mouse so that I got one of those penguin ones that shifts my wrist instead of having my wrist pronated, I shifted it so that now I’m at a more neutral position and my pain went away. So, people do have to take a picture. Where does posture fit in, because boy, there’s a lot of chairs on the market. Some of them are very expensive. What do we want to know about chairs and our posture?
Dr. Berenji: So, again, this is another excellent area where I deal with a lot of folks with low back pain and especially the folks who work in an office setting. Having a chair that provides adequate support at the same time ensures that you are keeping your spine in proper alignment is key. I do know that there are a lot of fancy chairs out there that come at an extraordinary cost in my opinion, and a lot of times, they don’t even achieve those basic principles.
So, at the end of the day, my goal is to make sure that folks are able to keep their spines in proper alignment and if the constraints are that they can’t get a new chair; there are a lot of quick fixes that can be implemented to be able to help an individual keep their spine in proper alignment. I’m a big fan of specific types of mats that individuals can purchase for their chairs again, ensuring that they are keeping their spine in proper alignment but not necessarily breaking the bank in terms of buying a brand new chair for instance. So, again, I always tell folks when in doubt, take a snapshot of your work area, bringing it in to your occupational medicine specialist or your ergonomic specialist and there are ways that we can help work with you to find quick and easy solutions that are not necessarily cost prohibitive so that you can work at your maximum capacity and ensure that you are not going to develop low back pain, repetitive strain injuries and what have you.
Host: That’s great information. Wrap it up for us, really what you would like people to know about coming to see you when they first develop those pains, whether you want them icing their elbow after a day of typing, really what you want them to know in the take home message to be about workplace injuries and repetitive strain injuries and their work station, how they can work smarter.
Dr. Berenji: That’s a great, great question and I’m happy to address that. So, at the end of the day, I tell folks to keep a log of your pain symptoms. If you are finding that you are in pain at the end of every single day, then obviously, that’s a problem. I always tell folks to make sure that they are able to take snapshots of their work area and being able to talk to their family, friends and specialists in the community to be able to find ways to mitigate those symptoms and making sure that when things do escalate to the point where folks are having pain every single day and it’s inhibiting them from doing their jobs; that’s the time to come see us. If we are able to troubleshoot things early as possible, we can prevent these types of injuries from snowballing into major injuries that will potentially require major surgical interventions and like I said, if surgery is needed, surgery is needed. But if we can try to get upstream of those potential interventions and really identify things when they start happening in real time; that’s better for the patient and really that’s something that I’m very passionate about.
Host: That’s great information. Thank you so much Dr. Berenji, for coming on and explaining to people this is a really common and widespread problem and I think that people do need to know about ergonomics and biomechanics and setting up their work stations. Really important information. This is Boston MedTalks with Boston Medical Center. For more information you can go to www.bmc.org, that’s www.bmc.org. This is Melanie Cole. Thanks so much for tuning in.