Thank you for your due diligence on this one Ergo Team. It became very obvious to me upon reading this that self promotion was occurring.

Again as I always advise people who have questions around medicine, rehabilitation medicine etc is to use only the good science that is readily available in the literature and on line. Google, Wikepedia , self help forums and sights sponsored by pharmaceutical firms etc are not necessary representative of the best evidence in determing solid answers. I always urge readers and clients to go to sights affiliated with bona fide high level Universities who have specialists in the area of study being queried. Example go to McMaster University in Canada to pull data and articles from the world wide research group Cochrane Group about the management of back injuries and pain; or go to the work by Snook and Ciriello to learn more about manual materials handling, and use the PhD and Masters of Science level authors and contributors to this site for example (I was not paid or asked to say this but use this sight as an ergonomic specialist and Physiotherapist for its proper use of scientific evidence) to gain a proper understanding of the science of ergonomics.

Having said this let's turn to some of the current evidence about chiropractic care - specifically the manipulation of the spine and joints of a child whose growth plates are not closed over- the research has shown for many many years that manipulation of the bones of children has a high probability of damaging the growth plates and therefore the normal develpment of the long bones of the body and the vertebrae. Bottom line therefore is kids up to the age of maturation of the growth plates should not at any time have manipulative treatment on the part of any chiropractor or physiotherapist who performs these manouvres. I hope this helps.

Jane Sleeth OPC Inc 

Hi Hufri

Jane Sleeth here with OPC Inc. I will respond to this question as we do with all ergonomic questions posted to us 1. OPC does not have any financial affilication with any products, furniture or equipment and no vested interest in recommending a certain product(s).

2. We always refer to the science of ergonomics to guide the standards and decisions.

With this in mind we look at both the biomechanics & physiology of the upper extremities.  1. when using a pointing device it is critical to avoid compression at the carpal tunnel anatomical area of the wrists 2. we want to see the hand/elbow in a more neutral posture which is 45 degrees pronation 3. we want to encourage the smaller motor units to peform this work as these are designed for the finer motor work inherent in the use of the mouse versus the shoulder which are gross motor units (this is why we discourage employees from using traditional mice); and 4. we avoid the use of the thumb at all costs as it is a saddle shaped joint and therefore the most unstable joint in the body

Now we look at products which allow  the 4 objective principals outlined above; you can see in ErgoBuyer there is the vertical mouse which meets principal 1 and 2. The contour touch pads which take care of 1, 3 and 4; and the large trackballs such as the Kensington Scroll Trackball which takes care of 2., 3., 4.

There is no one perfect solution or fit - and we also need to consider the anthropometrics of the uer and the job demands and requirements.

There are products such as outlined above which will provide good responses; Just be aware of receiving advice from people selling these products; stick to the science; understand your job demands and the correct response will occur. If not there is always a good line up of excellent ergonomic scientists who contribute to this Website.

Hope this helps.

Jane Sleeth Optimal Performance Consultants Inc. North America wide services since 1991

I have been reading these posts with enthusiasm as there are good discussion posts here. Can we get government health leaders, compensation boards and business to read as there are great points for them to consider!

In Ontario Ergonomics is "ruled' in a way by the General Duty Clause of the OH&S Act. Federally the OH&S Code is used with guidelines to employers to refer to. BC tried another route by Regulating ergonomics and the many union groups (BC is heavily unionized by strong unions).  As OPC's offices are in both Ontario and BC it has been interesting to see that few if any employers in BC are in compliance (they are legislatively exhausted so to speak) and in Ontario with the General Duty clause only, more employers are in compliance. So perhaps more regulations is not the answer?

Ontario has embraced ergonomics for the simple reason that auto sector has realized it is a tool which can allow them to remove excess workforce numbers on the lines; and add more work tasks to each worker on an assembly line. Material costs & human errors costs have also been realized by industry. This spilled over to non auto sector and now even into office environments.  So, the lesson learned - talk about the real savings in business and operations - do not focus on the H&S benefits or the intangibles - just present a hard fact based business case. Then and only then will more business engineers and designers embrace ergonomics as the tool it reallly is; and engineering tool which makes work easier on humans with which to decrease human error; decrease rework rates; enhance true productivity; decrease size of workforces.

Regs don't work - but the business case sure does1

Hope this helps as we find this is all clients really want to know.

JE Sleeth OPC Inc

Hi Yaniel - you are studying at my old stomping grounds as I grew up in Montreal - enjoy the city!

I see you have had some of the top experts help you out with your question - and we often refer to Dr Budnick and Dr Selan's work in our own ergonomic analysis.  B Silversteins concept of the combination of hazards which creates potential ergonomic risk on an exponential level is also helpful.

We hired a Masters levels student from the U of Windsor in Ontario to take all of the Ministry of Labour for Ontario's ergonomic standards (if you call them they will deny they use standards however this is misinformation on their part!) and we validated each one in the literature and then used them in reliability studies at Chrysler in Brampton ON, the TTC in Toronto, the Coast Mountain Bus Co in Vancouver BC (Joint project with Worksafe and Coast Mountain) and then with the WHSCC in NFLD/Labrador.

This is published in Lori Ross's Masters Thesis with the U of Waterloo - each of our consultants across Canada is only allowed to use these standards when analyzing job demands for our clients. Depending on the nature of the work and the job demands we will often use a few standards to ensure the data is more reliable - Z-365, Dr Selan's approach, and Kilbom, A are most commonly used by our team.

Thank you for your feedback about our firm and website - we work hard to bring good science to ergonomics to the benefit of our clients

Let me know if this is helpful to you and best of luck with your continued studies!

JE Sleeth OPC Inc

Good morning - this is interesting to read about the need for an MD referral. Considering that General Practitiioners/Family Docs have no training or education in the area of ergonomics or occupational related injury; and have no idea about the workplace why would a Referral or Request be invited by the employer.  They invite further interference from an outside party who really has no business in doing so.

What we do in our practice across Canada is we advise the employer to not worry about who the payer is.  The employee is their hire and their responsibility.  Setting up a healthy workstation using ergonomic principles is part of their due diligence.  Thirdly asking the employee to provide "proof" of the need for an assessment sends a clear message "I do not believe your judgement in needing a simple ergonomic assessment"

If the employee requests an ergonomic assessment then so be it. It should mean that a trusted and committed employee needs some assistance with their health and ergonomics.  So send in the professional who is a certified, qualified ergonomist and get the job done right the first time.

This works for each of our clients across the country.  (and no not all employees are going to abuse the system which some supervisors tend to assume).  Afterall if the qualified ergonomist finds there are no hazards or risks present then the expenditure on equipment, seating, tools is not justified and further funds will not be required.

Keep it simple, use the science and avoid the use of MD notes at all costs.  JE Sleeth OPC Inc Canada

Not to flog a dying horse or however that goes - please go back and read my response as guessing what is wrong versus using solid clinical reasoning may result in our professional making things worse (and then you lose trust on the part of the client and the individual)

Instead the Red Flags for medical issues MUST be ruled out first - that being neuroligal and vascular as well as neurovascular.  Only once that is ruled out would we look at ergonomic issues - and again even then never make the jump in causation by virtue of someone saying they have symptom xyz therefore it is the job or a certain task.

A formal, informed and scientific approach must be used in these and all cases particularly if we want to ensure our profession is respected and valued.

JE Sleeth  OPC Inc

www.opctoday.blogspot.com

Hi Anne - Dr Joe Selan has provided a great standard which we have validated in the literature here in Canada and reliability tested - we use his Text and standards a good deal in our practice here.  To add further reliability to the ANSI standards you can also evaluate using A Kilbom's standards for upper extremity repetition analysis.

We have analyzed hundreds of data entry operators for the financial sector across Canada using these two tools.  We then developed standards for the client following this.

Gene has some software related to self assessments & education which might be a good adjunct to your analysis.

JE Sleeth Sr Consultant OPC Inc

www.optimalperformance.ca

HI Bret - thank you for your reply.  In order to ensure I remain on top of things re T spine and use of thrust type manual therapy please send along any research & evidence you have - just summaries are fine & don't go out of your way ok - I want to be on top of these changes and your advisement is a good start.  Thanks much for your help JE Sleeth www.optimalperformance.ca

HI Dennis - here is the best advice which many health professionals tend not to tell you from a prognostic perspective;  do not expect to be pain or symptom free just because you had surgery.  This is rarely the case as surgery like any treatment is not a panacea for MSI issues.

And don't forget if you have returned to the same activities and same set up at your workstation then you will of course encounter similar physical issues as before - the surgeon cut the ligament at the carpal tunnel but don't forget scar tissue then forms in the area which acts like the ligament all over again.

So, 1. manage your expectations of how you should be feeling and do not expect to be pain free all of the time 2. make sure you have an ergonomic expert assess your workstation and job demands - and to then make cost effective changes for you which may include alternate pointing devices, voice recognition software etc. 3; check with your Physiotherapist to see if scar tissue is interfering with your healing & functional process

Best of luck - let me know how you do with this.

JE Sleeth Senior Ergonomic Consultant OPC Inc www.optimalperformance.ca

HI Jason - whatever you do please ensure any advice you take is that from a qualified ergonomist and please ask them if they represent any lines of furniture or equipment or receive any sort of compensation for recommending a particular product.

We review chairs on an regular basis for many of our clients in Canada.  As such we have a great working knowledge of about 50 or so products out on the market.  And of course they all are so great they could even fly you to the moon if you wanted to!

Whatever you chose please ensure the chair maximizes adjustability in particular for the seat pan length; and the armrests (4 D movements ideally); and for the chair to allow for dynamic rocking movement thru the day.

By the way the chair will not be the magic elixor to remove your back discomfort. Unless you adjust the chair for your body type and job demands; and unless you get up and out of the chair every 45 minutes or so to stretch; and unless you undertake an active, exercise based Physiotherapy program all together then expect the chair to have a limited impact.

Good luck in your search - go to the good manufacturers websites such as Knoll, Steelcase, Herman MIller, Teknion, Haworth and look at each of their task chairs.  Any of these companies task chairs will meet your requirements!

JE Sleeth Senior Consultant OPC Inc

Hon B.P.&H.E. (Kin), B.Sc.P.T.

Good afternoon

First thing that comes to mind given my strong medical background as part of my Physiotherapy training in a large hospital setting is to ensure that the T Spine pain is not arising from a medical related issue.  When I hear female and I hear T spine pain which is not seeming to improve with ergonomic and Physiotherapy intervention is to refer the employee to her MD ASAP - to rule out the Red Flags; making sure there is no metastatic SOL at the T spine which is the most common spot secondary to breast cancer; infection; fracture (not necessarily from trauma as it can be due to osteoporosis, ankylosing spondylosis etc).  This is the very first thing I would order even if I am asked ot perform an ergonomic assessment.

Once that is completed and ruled out - the next assumption being made is that of spinal instability?? In all my years of work as an Ergonomist and Physiotherapist I have yet to see anything like this - go back to your anatomy - the T spine is so very very well buttressed with the facet joint angle; rib attachment; ligaments etc etc that this is pretty much an impossible thing to occur.  So, refer the employee back to the PT for a correct diagnosis (and don't be afraid to demand this of the professional).

Then and only then have a look as to whether her arms are being well supported on adjustable width armrests (you said she is a <5th percentile female yes?).  Holding the arms in typing and mousing postures for >34-66%  of each day will increase the static load at the shoulder/neck specifically Lat Dorsi and Trapezius MMs.  Over time the loading at the T Spine discs will increase which may be contributing to  ongoing symptoms

If the chair is new and fits well simply ask the dealer to retrofit the chair with 4 D adjustable armrests. Show the employee how to use them and why these are important for her.

Let me know how this goes and if I can assist further

JE Sleeth Hon B.P.&H.E.(Kin), B.Sc.PT.

Oh goodness there seems to be no end to products which will do everything but solve world hunger - sorry for sarcastic start to the email however it gets frustrating trying to educate employees as to why some equipment is a well researched and bona fide solution & why others are just plain trash.

We had the exact same type of glove being attempted to be sold to a Chrysler facility about 10 years ago here in Canada.  So I can see we have come full circle.

Adding any sort of added compression be it a glove or a wrist rest at or near the carpal tunnel and ulnar notch of the wrist will increase the pressures within the CT and the flexor tendons at the wrist. This has been shown to exacerbate underlying CTS or ulnar nerve symptoms.

Adding gloves which cover the sensitive palmer surface of the hand and fingers also decreases the sensotry feedback the brain needs to have at any one time.

So the bottom line is trust your instincts on this - and then alwyays go back to your anatomy, physiology and biomechanics basics.  These are a scam - keep applying appropriate ergonomic principles to all aspects of this office and you will gain success over time

PS - can we all agree to stop using cumulative trauma disorder, repetative strain etc - these are misnomers - Musculoskeletal disorders is a more appropriate and accurate term for these symptoms and injuries.

JE Sleeth Sr Ergonomic Consultant & Physiotherapist, Canada

www.optimalperformance.ca

Good morning

You have some great solutions suggested to you by these interested professionals which is great.

One cautionary note and one of the assumptions which is not based on good science; there is no solid, peer reviewed research which shows links between fluorescent lighting and migraines.  This has been an oft repeated assumption on the part of employees and as such has taken on a "truth" of its own.

To zero in on solutions in the absence of evidence for cause makes for bad science.  Migraine causation is mutifactorial in nature and is still not well understood in the medical literature.

My suggestion therefore is to take a holistic look at this while at the same time informing employees of the facts; migraines are not caused by the workplace. The solution lies in having employees by all means being set up and using their equipment and lighting properly. It also lies in the employee determining the other triggers for their migraines (and don't forget many people mislabel their headaches as migraines and often this is NOT the case) such as foods, stressors, lack of exercise.

There is great new evidence published in a few top level medical journals for effective treatment of bona fide migraines; plain and simple use of aspirin.  Maybe adding a water fountain (to rehydrate), removing chocolate and coffee vending machines) and adding an aspirin vending machine would be the better solution!

JE Sleeth Sr Ergonomic Consultant & Orthopaedic Physiotherapist

www.optimalperformance.ca

Good morning Dennis

Interesting question in that it is a very commonly posed one.  The issue here as I see it as both an Ergonomic Consultant and Physiotherapist is that of pain versus function. 

It may help for you to commence reading some articles about chronic pain which can occur long after healing has occured even post operative healing as is the case with your CT Release surgery.  Your issues are more that of learning to live with and cope with on going pain as thousands of people do across North America.

Surgery corrects or tries to correct the underlying mechanical reasons for your symptoms such as loss of muscle mass and strength, loss of sensation.  The goal of surgery is not foremost to be altering pain levels as it is the brain which interprets pain not the hand.

Over time and with some of the ergonomic suggestions provided to you this may improve.  In the interum start wtih some reading by Melzack & Wall who first started the research about pain and the gate theory of pain out of the University of McGill in Montreal.

Best of luck with this - this is a matter of changing your thinking about the presence of pain - keep your functional  levels as high as you can with work, play and day to day life, despite the presence of pain.

JE Sleeth Sr Ergonomic Consultant, Orthopaedic Physiotherapist

www.optimalperformance.ca