MANUFACTURING EXAMPLE
A patient comes to see a physical therapist in an outpatient clinic. The patient works in a manufacturing plant that packages hams. The patient describes having right-sided neck and shoulder pain that gets worse at the end of the workday, but gets better over the weekend. According to the patient, she stands all day and uses her right hand to stuff hams into a sleeve. The patient reports that she does one ham every six seconds with only two fifteen-minute breaks during the day and a thirty-minute lunch break. The patient has worked at this facility for five years. This patient will likely benefit from traditional physical therapy treatment; however, until the ergonomic issues at her place Job hazard analysis ● Involve the employees : In this case, the employee has already sought treatment by coming to therapy, so she will likely not need much encouragement to be involved. However, she may have some concern that she will lose her job if she is not as productive as she once was. So it will be important to discern exactly what this patient’s concerns are. In this example, the patient has stated that her primary concern is getting rid of the pain. If adequate modifications cannot be made at her present job, she plans to look for other work. ● Review accident history : There was nothing reported in the accident history for this position, as the employee sought treatment on her own and not through workers’ compensation. The subjective interview with the patient will provide a more accurate assessment of the near misses and risks associated with this job. Already she has reported right- Subjective evaluation and observation During the subjective portion, the employee mentions that she also has hand and wrist discomfort at the end of the day as well as sore calves. The objective exam reveals the patient stands on an anti- fatigue mat with the counter positioned just above waist level. The patient rests both forearms on the ledge above the conveyor belt while stuffing the hams. The stuffing movement is Evaluation of risk factors So using this information the risk factors can be identified: ● Awkward posture : In this case the employer has already positioned the conveyor belt at a good height, to reduce forward bending, but this patient has been complaining of neck pain and is identified as frequently looking down and to the right. This is a likely cause of neck pain. ● Contact stress : This patient rests her forearms on the ledge above the conveyor belt. ● Lifting : Each ham weighs between five and fifteen pounds. The patient is lifting each ham from the conveyor belt into a sleeve. Recommendations ● Environmental modifications : Unfortunately, in this example, there are no simple environmental modifications as none of the equipment is easily moveable or adjustable. ● Procedural modifications : Here the patient can have some control to decrease pain. Instead of looking down and to the right, the employee can try to look straight ahead as much as possible. This should help to minimize the neck pain. Currently this patient primarily uses the left arm as a stabilizer and the right arm does all the movement. It may be possible to pull the sleeve over the ham with the left hand. This would enable the patient to alternate between two different techniques and positions to reduce repetitive strain on the right shoulder and wrist. ● Equipment modification : This example is a patient requesting assessment, and though the employer is allowing
of employment are addressed, she will not experience lasting improvement. This can be handled in two different ways. Evaluators can obtain permission from the employer to perform an onsite evaluation. If the injury has been reported to workers’ compensation, sometimes workers’ compensation will request this. If the employer does not allow a worksite evaluation, a simulated work environment can be set up during the therapy treatment with recommendations given to the employee that are within their realm of control. For purposes of this example, assume that the employer granted permission for a worksite evaluation. sided neck and shoulder pain. She reports no additional near misses. ● Conduct a preliminary job review : The job description of this position states that the employee is expected to stand at her workstation the entirety of the day and is expected to stuff six hams a minute. ● List, rank and set priorities for hazardous jobs : This position should be a high priority, as the employee is already having pain and discomfort, and has sought treatment. ● Outline the steps and tasks : The steps involved with this job include the following:
1. Grab the sleeve with left hand. 2. Grab the ham with the right hand.
3. Stuff ham into sleeve. 4. Twist sleeve closed. 5. Set covered ham back on the conveyer belt.
performed with resisted internal rotation of the right shoulder and repetitive flexion/extension of the wrist. The patient uses her left arm to stabilize the ham while stuffing it. According to the patient each ham weighs between five and fifteen pounds. The patient frequently looks down and to the right to watch the hams come toward her on the conveyor belt.
● Lighting : No issues have been identified in this example. ● Repetitive motion : The patient lifts and stuffs ten hams a minute causing frequent movements of the right shoulder and hand, as well as frequently looking down and to the right with the head. ● Static posture : The patient stands all day with a break for lunch and two rest breaks. This is most likely the cause of the sore calves, and the patient is holding the left arm in one position throughout the day to stabilize the ham. ● Vibration : The movement of the conveyor belt likely provides some vibration, though this is probably minimal. the assessment, there may not be a budget for equipment. Recommendations could be made for padding of the ledge she rests her arms on. ● Rest breaks and exercises : It is unlikely that this will be encouraged by the employer as the patient is requesting this not the employer. So recommendations should not interfere at all with the patient’s job. Because of the right-sided neck, shoulder, hand and wrist discomfort as well as the calf pain, frequent stretch breaks would benefit this employee. The neck and shoulder can be stretched while working by turning the head to the opposite direction, and by doing shoulder rolls and retractions. The hand, wrist, and calves can be stretched during the sanctioned breaks and lunch time with arms extended and wrists stretched into flexion and extension, and the fingers stretched into full extension.
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