They Suffer More Injuries Targeted in Defeated Safety Rules

By LISA GIRION, Times Staff Writer

From nursing-home attendants to cashiers, women in mostly low-paying jobs suffer a disproportionate share of the painful repetitive-stress injuries that the Occupational Safety and Health Administration's defeated work place safety rules had aimed to reduce.

Although they comprise 46% of the work force in the U.S., women accounted for 64% of all repetitive-motion injuries that resulted in time off the job and were reported to the government in 1998, the latest year for which detailed statistics are available.

Labor unions made an issue of the gender-skewed numbers in a last-ditch effort to salvage the rules. They held out as victims women whose injuries are byproducts of repeating the same task for months and years on computers, at checkout counters and along assembly lines, often at work stations designed for the average size man.

The ergonomics regulations installed by the Clinton administration would have required employers to make workers aware of musculoskeletal injuries and to redesign jobs that cause serious injury. Voting largely along party lines last week, Congress nullified the rules and President Bush has indicated he would support the rollback.

Opponents said the rules were costly and unnecessary because employers already have plenty of incentives to improve work place safety and have redesigned many jobs. They also pointed to the decline in repetitive-stress injury, or RSI, cases over the last few years, a trend safety advocates say is skewed by workers' fear of reporting.

In characterizing ergonomics as a women's issue, labor unions reignited a work place debate over what role gender-specific traits may play in susceptibility to repetitive stress injuries.

For workers such as Kim Johnson, a nursing assistant in a convalescent home, the debate on gender versus job is all but academic. Johnson, a single mother in Compton who supports five children under the age of 12 on $7.98 an hour, spends much of her day squatting to crank beds up and down so patients can eat, bathe and rest. During her first year on the job, she had to take time off without pay when the pain in her swollen right knee became more than she could handle.

"It's a good job. But I had no idea it would be this stressful for my body. It's hard. I just take it one day at a time," said Johnson, 34.

Female nursing aides, orderlies and attendants are hardest hit by RSIs, according to an analysis of 1998 Bureau of Labor Statistics data by the AFL-CIO. Knee injuries are only the beginning. Back and shoulder injuries are common among care givers whose primary duty is lifting patients to and from beds, bathtubs, wheelchairs and commodes.

It is a spine-crushing task. Literally. Each lift compresses the spinal cord with a force as great as that experienced by warehouse workers moving crates, said William Marras, a professor of industrial and systems engineering at Ohio State University.

Strength, size, age and anatomical gender differences all play a role in the number of lifts a person can tolerate before his or her body begins to break down, Marras said. But his studies have shown that almost everyone has a limit.

"In the case of patient handling, [gender] is not going to make a difference between having the problem and not having the problem," Marras said. "It's going to be bad for the men as well as the women."

Most adult patients weigh more than 75 pounds, the lifting limit many physicians and biomechanical experts believe is safe. To improve worker safety, nursing homes in Quebec, Canada, since 1992 have been required to install mechanical patient lifts during construction or renovation. A pilot program that equipped a few Washington state nursing homes with mechanical lifts achieved a 19% reduction in workers' compensation claims.

"We're going to pay one way or the other," said Don Chaffin, a leader in ergonomics research and professor of biomedical, industrial and operations engineering at the University of Michigan. "And I would rather have us pay for work place improvements than pay the medical bills for these millions of workers in the next few years not to mention the pain and suffering."

Long before ergonomics- the adaptation of jobs to human capabilities- emerged in Britain during World War II, workers were plagued by repetitive-motion injuries such as "washer woman's thumb," a condition recorded in the late 19th century.

Today, the most frequently reported RSI is carpal tunnel syndrome, a condition in which swelling in the wrists pinches a nerve, causing numbness and burning in the fingers and hands.

"It's like your hands are on fire. It's just excruciating," said Debbie Teske, a Maryland resident, who developed carpal tunnel in both hands while working as a telephone company service representative. "For people who've never had carpal tunnel, I tell them it's like having a tooth drilled into the nerve."

She said the pain is so severe that she has trouble bathing, washing her hair, brushing her teeth, turning doorknobs and holding a steering wheel. Teske, 44, said she spent many days typing at a computer.

Women accounted for 71 % of carpal tunnel injury victims in cases reported in 1998, according to the AFL-CIO. Although it occurs among railroad laborers and blacksmiths, carpal tunnel is perhaps most commonly thought of as a woman's problem.

But is it?

No Definitive Gender Studies

Some have theorized that water retention related to menstrual cycles and pregnancy may contribute to swelling in the wrists and play a role in carpal tunnel syndrome. There have been theories that suggest that it takes less swelling to pinch the nerve in the average woman's carpal tunnel, which is generally smaller than the average man s.

But several research physicians, public health and biomechanical engineering experts said they are unaware of any definitive studies on the impact of these and other supposed gender-specific traits on carpal tunnel and other RSIs.

"There is very little to suggest that it has to do with intrinsically being a woman, such as hormones, muscle strength and bone structure," said Dr. Laura Welch, director of occupational medicine at the Washington (D.C.) Hospital Center, who helped develop OSHA's ergonomics standards.

She and other leading motion-injury experts place much of the blame on the type of work women do.

"There are clearly more women in repetitive jobs, computer work and assembly jobs, light manufacturing that doesn't require heavy lifting. For a long time, these have been women's jobs," Welch said. "People think women's work is easy, but a lot of the high-risk jobs have a very high proportion of women."

While at the University of Michigan, Barbara Silverstein was one of the first researchers to look for gender differences in RSIs. She focused on carpal tunnel injuries among workers at a variety of factories.

"In the same jobs, there was no significant difference in the prevalence of carpal tunnel syndrome between males and females. But its rare that they are doing the same jobs," said Silverstein, who now works as safety and health assessment research director for the Washington state labor department.

Whatever its role, experts say gender is outweighed as a factor in RSI by the high-risk elements of many jobs, including repetitive motion, awkward positioning and working at a fast pace.

"There is probably some way in which personal characteristics contribute, but that' s probably small in comparison to job design and the overrepresentation of women in highly repetitive jobs," Welch said.

Another problem is that the design of work stations and hand tools, known as anthropomorphic ergonomics, often fails to match the work force, said Dr. Michael Roback, librarian for the American Assn. of Orthopedic Medicine and advisor to California!s Industrial Medicine Council.

"When it comes to hand tools, those are really set up for the male-sized hand and strength. Women aren't as strong as men, so they have to exert more force," Roback said. The more force a task requires, the greater the risk for injury.

Many work stations are built for an average-size man of about 5 feet, 9 inches tall. If not adjustable, Roback said that can contribute to motion injuries for many women and shorter or taller men. Assembly lines designed with average men in mind can force smaller workers to stretch uncomfortably- and often dangerously- to reach parts and equipment.

"The major factor is that work places are not specifically designed for differences in size," he said.

Older Workers More Vulnerable

The mismatch between job design and the work force has become more pronounced in the last 10 years as men have been replaced by women on the nation's assembly lines, said Chaffin the University of Michigan biomedical engineering professor.

In many cases, the women are older mothers who returned to work after faking time off to raise their children, he said.

But the work often comes at a high cost.

"As we grow older, our capability to maintain muscle tissue becomes a little more fragile," Chaffin said. "The older individual is simply more vulnerable in the work place being put in a job that pushes the limit."

Wide Variations in Abilities

Gender aside, Chaffin said his research has found wide variations in the capabilities of workers. In a random sample of 2,000 workers, the strongest was 10 times more capable than the weakest.

"When it comes to forceful exertion, women will, on a statistical basis, have more problems than men," Chaffin said. "However, there is a great overlap."

What's more, studies have shown that force requirements of jobs are very specific, he said. Overall strength is not a good indicator of a persons ability to do a certain task.

"It's a lot more than being a woman or a man. A large-boned woman might be at less risk [for injury] than a small-boned man," he said. "It is very complicated, and it really is why we need job-specific ways to adapt the wowork placeor individuals whether they be men or women."

Nursing aides, orderlies, attendants     44,271         $16,260

Registered nurses                               11,717            40,690

Assemblers                                          9,013            22,220

Cashiers                                              8,102            13,690

Maids and housekeepers                     6,362            14,230

Misc. machine operators                     6,356             21,690

Laborers (except construction)            5,429             17,860

Licensed practical nurses                     5,401             26,940

Freight, stock and material handlers      4,946            18,260

Sales workers, other commodities         4,365           15,830