One Pharmacist's Battle With Work-Related Injuries

Tom English

Pharmacy Today. 2001;7(5) 

Introduction

Mae Jackson's list of work-related injuries would make a quarterback wince. Years of twisting the caps off medication and prescription bottles, stretching her 5' 1" frame to reach high shelves, cradling a phone on her shoulder while entering data into a computer, and standing all day on a concrete floor without padding has contributed to her carpal tunnel syndrome (CTS), de Quervain's disease, and thoracic outlet syndrome. Yet, just like a star football player clinging to hopes of glory, Jackson cannot bring herself to leave the profession she loves.

"I love pharmacy and enjoy the patient relationships. Pharmacists have so much to offer. But my orthopedist told me to find another job or find another position in pharmacy because of my repetitive motion problem," Jackson said. "It hurts to work. I have to psyche myself up to go, and I risk permanent damage. I am thinking that my body succumbed to the pressures before my mind could accept it."

Pharmacists who suffer similar ailments should know that they are not alone and hope endures. Although the Occupational Safety and Health Administration (OSHA) Ergonomics Program Standard, which would have required employers to set up ergonomically correct work environments, was rescinded by President George W. Bush in March, some legislators are intent on improving conditions. Also, exercises can help strengthen the affected muscles (see "Simple tips,").

Multiple Pains

Ergonomics is the science of fitting the job to the worker. This ideal has not been achieved during Jackson's career. Pick almost any area of the body and Jackson can tell you where it hurts. Jackson blames the pains in her shoulders, back, neck, wrists, legs, and feet on improper ergonomics.

The Morehead City, N.C., relief pharmacist struggles to make the best of her bad situation. She has tried to work through her back pain but, since November, has been on a reduced workload of 4-hour shifts, 4 to 5 days a week. That is when hand pain began waking her up at night. In December Jackson was diagnosed with CTS. She now works with braces on both hands.

"I did not associate carpal tunnel syndrome with pharmacy. I thought it was for people who spend all day long on the computer," Jackson said. But the years of twisting her hands to open and close vials, counting tablets and capsules, placing labels on vials, and inputting data have taken a toll. Jackson had to take 6 weeks off recently because the repetitive motions were undoing the improvements she was making in physical therapy.

Jackson's height is also a liability in a profession where counters and shelves are built high above head level. Hunched shoulders became her natural position out of habit.

"My shoulders were up by my ears because I was trying to get my arms up to do the job," Jackson said.

In a touch of irony, the pharmacist had to get a prescription order from a physician requiring sneakers while on duty. Jackson's aching feet could not take the daily punishment in loafers.

A dose of reality came from all this physical pain: What will she do if she recovers from the pain and it comes back while at work?

"I am now being treated for high blood pressure because of [worrying about the pain]. I could not do my workouts because of the blood pressure," Jackson said. "But I have no option about getting out of the profession. I will continue on. I have a mortgage payment and medical bills."

Jackson's medical expenses are being covered by health insurance, but not worker's compensation.

Slow Road to Recovery

John Farrell, an occupational therapist at Beaufort Physical Therapy in Beaufort, N.C., has developed a rigorous rehabilitation regime for Jackson. For CTS, Jackson does splinting, tendon glides, and nerve glides. Cross-friction massage, iontopheresis (using electricity/polarity to drive a charged pharmaceutical agent into the skin), and splinting are used for the de Quervain's disease -- a painful disorder that affects the tendons at the base of the thumb. And, to address thoracic outlet syndrome, trigger point therapy and ischemic compression with stretch and spray (after compression, the muscle is stretched and sprayed with Fluori-Methane, which deactivates the trigger point) are used. Farrell also recommends modifying positions while performing specific tasks in the pharmacy.

"My home exercise list is so long, I had to write it down because I cannot remember it all," Jackson said. "Between exercises for my back, hands, and shoulders, I have at least an hour's workout. That does not include the recommended 1 to 2 hours at the gym on various strengthening equipment."

Jackson believes that "an unhappy pharmacist will have unhappy patients," so she encourages pain sufferers to take steps to improve their health and mental well-being. Pharmacists should wear comfortable shoes, sit down and take a break every once in awhile, arch their back every hour or so to relieve stress, vary the way they open bottles, stretch leg muscles, and, if in pain, visit a physical or occupational therapist before it becomes unbearable.

"We take care of everyone else's health, but we forget about our own," Jackson said.

Downfall of the Standard

The OSHA standard was designed to protect employees' health and help reduce health care costs associated with treating work-related musculoskeletal disorders (MSDs). These ailments affect an estimated 1.8 million workers in the United States each year.

The standards required employers to provide current and new employees with information on the signs and symptoms of MSDs and, in the event of a work-related injury, to implement a program including management leadership and employee participation, MSD management, training, and job hazard analysis, reduction, and control. Identification of possible triggers of MSDs, such as repetition, forceful exertions, awkward postures, and contact stress -- all features of pharmacy practice -- was also required. With an estimated savings potential of $9.1 billion annually and a $27,700 direct cost savings per MSD prevented, the standard was applauded. However, the compliance price tag of $4.5 billion a year for employers was the standard's undoing.

The standard took effect on January 16, but an act that allows Congress to disapprove rules and regulations issued by federal administrative agencies was invoked. President Bush upheld the repeal, calling the standard "unduly burdensome and overly broad." Both Bush and Secretary of Labor Elaine L. Chao called for a more comprehensive approach to ergonomics.

"There needs to be a balance between and an understanding of the costs and benefits associated with federal regulations. In this instance, though, in exchange for uncertain benefits, the ergonomics rule would have cost both large and small employers billions of dollars and presented employers with overwhelming compliance challenges," Bush said. "Also, the rule would have applied a bureaucratic one-size-fits-all solution to a broad range of employers and workers -- not good government at work."

Jackson and Farrell, who plan to conduct a study of pharmacists on the use of ergonomics to prevent work-related repetitive use injuries, lament the federal decision. Jackson said that the standard would save money and time because of the potential savings in medical claims, disability, and time out of work.

"Hopefully the publicity about the OSHA ergonomic standards will raise the awareness of retail drug companies," Jackson said. "Maybe [chain drug store management] will make the humanitarian decision to take care of their employees before the government forces them to do it."

Farrell thought the repeal "was a giant step backwards."

"With health care cuts taking place across the board, a plan to prevent injuries at the worksite would save hundreds of thousands of dollars in later treatment. The old adage 'an ounce of prevention is worth a pound of cure' rings true," Farrell said. "I have also heard that many companies are offering monthly bonuses for employees as a group if no work injuries are reported. This puts undue pressure on an individual employee not to come forward with a work-related injury. This is just the beginning of what is to come."

There are advocates for improved workers' health on Capitol Hill. Sen. Christopher S. "Kit" Bond (R-Mo.) called for a blue ribbon commission to determine strategies that will protect employees from ergonomic hazards, and Sen. John Breaux (D-La.) introduced a bipartisan bill that requires the Labor Department to address MSDs and workplace ergonomics hazards within 2 years. This bill requires that any such standard "should take into account the cost and feasibility of compliance with such requirements."

Simple Tips and Exercises to Reduce the Pain

A day in the life of a pharmacist can stress the body as well as the mind. Fortunately, there are some simple techniques you can use to relieve minor pain before major problems develop. The American Physical Therapy Association recommends the following:

For carpal tunnel syndrome

  • Make a loose fist, then release, fanning out fingers. Repeat five times.

  • When using a keyboard or typewriter, move only your fingers -- always maintain a straight-wrist position. If your keyboard has a pad at the bottom, use it to rest your wrists during breaks. Sit with your spine against the back of your chair, shoulders relaxed, elbows along the sides of your body, wrists straight, and feet flat on the floor.

  • Be sure to take regular short breaks when pursuing activities that require repetitive motion of the hand and wrist.

  • Fist extension exercises (see below)

For shoulder pain

  • Sit upright. Place your right hand on top of your left shoulder. Hold that shoulder down as you slowly tip your head away to the right. Keep your face pointed forward, or even turned slightly toward the right shoulder to stretch all the muscle fibers. Hold this stretch gently for 5 seconds. Do this once for each side.

  • Stand in a relaxed position with your arms at your side. Shrug your shoulders up, then squeeze your shoulders back, then stretch your shoulders down, then press them forward. Count to seven as you complete one rotation of your shoulders. Repeat four times.

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