OOS- an ongoing problem
By Dr Evan Dryson
In spite of many efforts in recent years by OSH and other agencies to
increase awareness of the condition and to promote preventive
strategics, Occupational Overuse Syndrome (OOS), also known as 'RSI'
continues to be a problem in occupations where rapidly repetitive,
unforceful motions are a large component of the job.
To some extent
this increased awareness has itself resulted in an increased
identification of pre-existing cases of OOS. Increased productivity
coupled with reduced staffing levels has resulted in new cases. But
there also remain misunderstandings about the conditions which hinder
effective management.
Some basic principles may help to dispel some of
these misconceptions:
1. OOS is not just a strain or sprain of the muscles.
Everyone is
familiar with the aching muscles that result from unaccustomed physical
exercise. This aching settles within a few days and the muscles are the
stronger for it. OOS is not like this Ñ rather it is a complex disorder
of the muscles and the nervous system producing symptoms which may also
involve structures other than muscles, such as nerves and blood
vessels. Aching muscles however is a major symptom.
Continued use does
not make the muscles stronger, but in fact make the condition worse.
This explains why the usual treatments for
damaged muscles, such as physiotherapy and medication are often not
effective. Active exercise in fact may make OOS worse.
The reason is
that OOS results from muscles that are held contracted but which are not
doing heavy work. Thus symptoms cannot be blamed on the fact that the
person 'was gardening at the time', or 'has just finished painting the
house'. These activities are different in substance to those which cause OOS.
2. OOS doesn't go nay by ignoring the pain and carrying on.
On the contrary, the pain just gets worse, and eventually makes continued
working impossible anyway. It is far better to ask for
help earl so that appropriate management can be instituted.
The longer a condition has been ignored, the longer it will take to treat, and
rehabilitation will be correspondingly harder. A Stage 3 OOS may take
years to settle, and some never do. It is essential to prevent a Stage 1
or 2 OOS developing into a Stage 3 condition.
3. There is no single effective treatmentfor OOS.
Making ergonomic corrections to the workplace is essential, but it is largely
preventative. It may not be enough to allow a existing OOS case to settle, and it will not
prevent all cases.
Treatment of OOS requires a team approach, with
various health professionals but also the employer and the employee,
and the ACC. Most Stage 1 OOS cases will settle with ergonomic
adjustment and perhaps I short period off work to break the cycle.
All Stage 2 and 3 cases should be enrolled into a management
programme, the elements of which are:
- Getting control over the symptoms
(rest, various physical treatments, relaxation techniques, increased physical fitness). - Fixing the ergonomics
(all operators using an electronic keyboard for a substantial percentage of the day should have adjustable furniture with an adjustable keyboard holder). - A graded return to work
The principle of a graded return to work is that a person with OOS will at a certain stage be able to do some repetitive work without symptoms, and will be able to build up this ability by doing the work (work-hardening). It is a powerful treatment tool, but needs close supervision on site. The work has to be part of normal work activities and not 'made up' work which has no benefit except to fill in the time. Naturally any ergonomic defects will need to have been corrected first.
It is not helpful for an employer to demand 100 percent fitness before return to work. Staying off longer does not make OOS less likely recur, and actually impedes rehabilitation.
Rehabilitation back into his or her usual job is the goal for the OOS sufferer. It is obviously easier to rehabilitate by means of a gradual return to work at an existing job than it would be into a new job, even supposing a new job is possible to obtain with this sort of disability. The employer's co-operation is vital, both to preserve the job and to facilitate the graded return.
There are benefits to the employer too. A graded return starts a lot sooner than waiting for 100 pcrccnt fitness, and is far more likely to be successful. The employer gets some productive work, and their ACC Experience Rating Ievy is correspondingly reduced. Conversely, failure to rehabilitate may mean a Iengthy period off work, whether on or off the payroll, and the Experience Rating will be affected accordingly.
Dr Eva Dryson DIH, FACOM,MCCM is the Regional Medical Officer (Northern) for the Department of Labour's Occupational Safety and Health Service.
With Compliments
Alan Boyd
A Division of Interline Commercial Furniture
P.O. Box 11-714
18-24 Allen Street
Wellington, N.Z.
Telephone (04) 801-6243
Fax (04) 801-6245
