Sharon winced as she turned to read the poster on the wall. Bold letters at the top read: "Back Belts Don't Save Backs!" She sighed. The persistent pain in her back had told her the same for the last five days. Sharon rarely missed work but had hardly been able to get out of bed to visit the chiropractor.

Production demands had been high last week and with the machine down on Thursday, she and her team had doubled efforts on Friday to meet their quota. She hadn't expected to be unable to sit up in bed the following morning. Five days later, three of which were spent off work, she found herself in the chiropractor's waiting room.

Sharon looked down at the stack of forms in her lap. Did everyone take as long as she did to fill out all the workers' compensation forms? The nurse called her name. Sharon winced again as she got up and headed into the back room.

Designing jobs and workplaces to match human capabilities and limitations is the focus of ergonomics. Interest in this science has grown steadily, along with the rising number of workers' compensation claims for work-related, non-traumatic injuries or disorders involving soft-tissues (nerves, tendons, muscles and supporting structures) known as work-related musculoskeletal disorders (WMSDs or MSDs).

Part One of this two-part article surveys the ergonomic terrain surrounding the converting industry today. For converters, it involves far more than a uniquely shaped keyboard and a new monitor position. The seven core elements that should be part of any ergonomic program will help converters develop a roadmap to navigate around potential pitfalls.

WMSDs cost employees and employers alike billions of dollars each year. Workers' compensation costs for WMSDs are estimated between $13 billion and $20 billion annually nationwide, but when indirect costs such as absenteeism, lost wages, lost production, retraining of personnel, changes in work procedures, reduced morale and poor quality are factored, in those costs can easily triple.

Consider the statistics from a 2001 National Institute for Occupational Safety and Health (NIOSH) report reviewing Bureau of Labor and Industries statistics gathered in 1996 relative to converting and primary paper manufacturing industries (see table).

Factoring in that back injuries carry a median of five days away from work (DAFW) and sometimes exceed 20 DAFW, it is not difficult to see costs skyrocket. The combined costs associated with these types of disorders are driving many converters to take action to reduce the number of incidents and implement ergonomic programs.

Government agencies such as the Occupational Safety and Health Administration (OSHA) and NIOSH have developed many rules and standards to insure employers provide safe work environments for their employees. However, the most common workplace injuries are not so much associated with unsafe working conditions as they are with job requirements in which employees must perform tasks in a manner inconsistent with the capabilities of the human body.

For example, Oregon State reports that overexertion represented 26.6 percent of the events resulting in injuries for which workers' compensation claims were accepted. NIOSH corroborates this stating that overexertion is the most common event leading to musculoskeletal disorders. The 2001 NIOSH report concludes that 52.2 percent of the more than 600,000 recorded MSDs were related to the back and were primarily caused by overexertion.

In other words, WMSDs occur when preventable physical demands in the workplace cause preventable wear and tear on the body. It is the preventable nature of these disorders that underlies legislative activity to aid employers in reducing WMSDs.

Each state has a certain degree of flexibility with regard to ergonomic requirements and programs. For example, Washington and California have adopted specific ergonomic standards and employers in those states must comply with the requirements of the standard. Other states have opted to follow OSHA's industry-specific guidelines where applicable and then use related ergonomic principles to focus on identifying and correcting hazards for their respective workplaces.

Whether due to state-driven standards or the general guidelines for compliance, the goal of ergonomic initiatives is to reduce work-related injury and suffering. In addition, effectively implementing such initiatives can reduce costs for all stakeholders and improve bottom-line business results.

An effective ergonomic program should contain at least the following seven elements to insure successful navigation of the ergonomic terrain. These include management commitment; employee involvement; identification of problem jobs (or caution/ hazard zone jobs); development of controls for problem jobs; training and education of employees; medical management; and proactive ergo-nomic programs for new processes.

For an ergonomics program, it is vital to tangibly demonstrate management commitment. This can be done by assigning staff directly to the program and providing time to deal with ergonomic concerns, by establishing clear goals for the program and evaluating the result, by communicating to all stakeholders the importance of the program, and finally, by making resources available for the program itself.

Employee involvement insures employees are motivated to take ownership of ergonomic-driven changes. This can easily be accomplished by creating teams to collect input and evaluate and make recommendations on corrective actions for workplace hazards.

Probably the most critical element of an effective ergonomics program is properly identifying problem jobs. The challenge is gathering enough information to determine the scope and characteristics of hazards leading to MSDs. A wealth of research is available highlighting known problem jobs as well as tools available to assist employers. One straightforward method is to review the MSD incidents on record for a particular job. Reviewing employee reports, OSHA records, workers' comp claims and conducting interviews will most often yield clear indications of an existing hazard.

Other tools are available for identifying problem jobs before they become MSD incidents. Guidelines help evaluate jobs for conditions such as awkward posture, high hand force, repetitive motion, repeated impact, heavy, frequent or awkward lifting and moderate to high hand-arm vibration. Job screening, employee interviews and job checklists are typically used to properly identify the specific hazard.

Once a hazard or problem job has been identified, the next step is to implement controls to eliminate or reduce the hazard. A simple brainstorming session with the employees in the job will both reinforce their involvement and often lead to surprisingly simple solutions. State and federal occupational health personnel can help consult. Many cities have ergonomic coordinators available to provide input. A complete listing of coordinators is available from OSHA.

Effective controls are divided into two categories: engineering controls and administrative controls. Engineering is preferred because it can more completely reduce the employee's hazard risk. These controls include workstation layout changes, improved tools (e.g. lighter weight, better grip, less resistant) or changes in the way materials and tools are transported and positioned in machines. Administrative controls focus more on procedure and policy changes such as rest breaks, worker rotation, additional training and work practices.

Long-term success of an effective ergonomics program requires training and education (or re-education). Whether this is overall training on ergonomic principles in general or specific training related to changes in job tasks, it is critical for sustaining changes that have been made.

The final two elements focus on long-term, proactive efforts in an effective program. Medical management emphasizing prevention through early detection, prompt treatment and timely recovery; and ergonomic principles applied in new processes, building in good workplace practices upfront rather than redesigning later, results in lasting benefits to all stakeholders.

For an expanded version, go to www.convertingmagazine.com