Friday Five – 9/13/19

This is a slightly different Friday Five.  I’m not going to post a check of what is new in the research in the areas of ergonomics and safety.  This week will be a quick recap of what I think were five important takeaways from the conference that I attended yesterday – “Everything You Wanted To Know About New Jersey Workers Compensation” which was hosted by John Geaney from Capehart Scatchard and Millenium Seminars.   If  you aren’t following John’s blog on workers compensation, you should be.

“Recovery on the job” – Trudy Mandia from AtlantiCare

I tweeted about this yesterday.  I hate the term “light duty”.  So many people get wrapped up with the word light with a lot getting it confused with the term “light work” which is considered to be a job with an occasional lift, push, pull, carry demand of 20 pounds.  Everyone tends to get wrapped up on the restrictions on an individual when they hear “light duty”.  Over the years, I have been on a mission to reframe the term as modified duty which is not so wrapped up in the restrictions on demands.  But, I love the term that Trudy talked about from AtlantiCare’s standpoint.  They no longer use the term light duty and have replaced it with “Recovery on the job” with the focus being on an individual’s current abilities and not focusing on what they can not currently do.

“Make sure that it isn’t boxes just being clicked”

Dr. Dwyer from Premier Orthopedics mentioned the reminder that with so many medical records being generated by different EMR packages, sometimes practitioners can end up clicking through.  Make sure that the physicians and therapists are being accurate when they are completing medical records in an EMR system and that they are also indicating both active and passive range of motion of the injured body part at all visits.

“Make sure that your employees know how long light duty will last”

This topic came up across multiple discussions through out the day because it is that important.  This is something that we tell clients that we meet with when we are talking about both regular job descriptions and tasks that might be available for modified duty.  Leaving an employee in a modified duty position for an indeterminate length makes some employees want to remain in that position for the remainder of their employment and also makes it easy to argue that the “modified duty position” is essential if an employee is left in that position for a prolonged duration of time.

“Job Descriptions”

Another topic that was mentioned several times because as John said yesterday, good job descriptions are the building block for creating a workers compensation program.  I’ve written about customized job descriptions multiple times on this blog, but members of yesterday’s panels provided reminders that good, solid, accurate job descriptions allow:

  • The physicians and physical therapists do their jobs to get the injured employee back to the essential demands of the position.
  • Allow physicians, employers, and case managers to possibly get an injured employee on modified duty when it becomes appropriate and helps to allow for progression of modified duty over the treatment timeline
  • Is necessary for having an effective interactive dialogue when the issues of accommodations comes up.
  • Need to accurately reflect current essential postural and physical tasks that are performed.

“Communication”

The issue of communication came up in several panel discussions during the day.  Communication between the employer, the case manager, the physician, the physical therapist, and the employee is key in moving towards a successful end state for an injury claim.

  • I was glad to hear that having a bilingual staff member to help with the communications process with injured workers at the Tropicana has made a big improvement in their program.  I know that in the provision of FCEs, we have been grateful when a translator has been provided if a claimant does not speak English but provision of a translator is not a common occurence.  Having a translator can make things go much easier and quicker when everyone is on the same page.
  • Make sure that you communicate your modified duty program guidelines to your injured employee when it is offered and put it in writing.  This helps to make sure that everyone is on the same page.

This is just a small sampling of some of the important topics that were discussed during the course of the day.  These one day conferences are a great opportunity to learn from the speakers, the attendees as they ask questions/make comments, and during the breaks to learn from the vendors and the attendees.

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(A photo I took during a previous conference in Atlantic City but yesterday’s weather conditions were similar)

 

 

Importance of Job Rotation, Job Title, and Essential Demands (and baseball)

I have had two separate discussions this week involving job titles, job descriptions, and when employees are required to do jobs that are outside of their “specific” job title – but still essential job demands of their overall “job title”.  During both discussions, a key detail to the “specific” job title in question was that the specific job title falls under a much broader category.

I try to avoid sports analogies when meeting with clients because they can sometimes be cliché, especially depending upon the setting.  However, a recent Phillies game went into extra innings and became a great example of the situation that both clients were questioning.   While we refer to most major league baseball players by the position that they play, the overall job title that applies to them is baseball player.  During this extra inning game, the Phillies manager had to make some adjustments in the 13th inning (not really different than unplanned overtime) which included moving an outfielder to pitching and having a pitcher play in left field.  While not uncommon, moves like this don’t happen in every extra inning game.  What made this game memorable is that Vince Velasquez, the pitcher who was placed in left field, made two highlight worthy throws to throw runners out.  Each of these players were moved from their “normal” job to a different job, but still under the same title, and were able to fulfill their role – well maybe not for the outfielder who pitched because the Phillies lost the game.

We have several clients that use a system similar to this, in that when a person applies for a position with the company, they will apply for Job Title “A”.  For these clients, Job Title “A” will have several sub-titles or location areas that the employee may be directed to work within after company specific training.  They may have been hired with experience in other sub-titles or locations but these companies, much like the military, will place these new employees where they have a demand.   One of the companies uses a title of Mechanical for the position.  Those within the Mechanical position may work in carpentry, plumbing, electrical, rigging, welding, etc.  While an employee may be placed in one of these areas dependent upon company needs, they are all trained to be able to perform the tasks of mechanical employees so that when the need arises they can fill that particular need.  On the public sector side of this issue, we have seen similar job descriptions that require staff of public works departments or the buildings and grounds department within a school district have to be able to perform multiple roles as needed.

Cross job utilization can allow for companies to identify modified duty accommodations that an employee may be able to fill, help to spread out overtime over a larger group of employees if an individual employee is injured or ill, and allows some employers to reduce the amount of different job titles that they need to perform post-offer pre-employment tests for – if the job demands to be able to perform across multiple roles can be demonstrated to be an essential demand.

**  Of note for the diehard baseball fans, prior to these highlight reel throws Vince Velasquez was famous for throwing out a runner using his left arm after being struck in the right arm by a 96 mph line drive during the 2018 season.

Friday Five – 8/2/19

The Friday Five is a set of five links that I have come across this week that pertain to ergonomics, occupational health, safety, human performance, or human factors.  For whatever reason, I found them interesting, but they are provided with minimal or no commentary and are not meant to be endorsement for a given product or research paper.

Diane Gyi et al. have created a new anthropometry data set for plus sized workers.  With increasing obesity levels, this new dataset is very important as many of the original data sets  that were utilized were based on measurements of military personnel.  A course from The Back School on ergonomics for plus sized workers was a good reminder for me that this category requires some different ergonomic considerations because there are some different biomechanical needs when setting up or correcting workstations.  It was also a good reminder that this category is not necessarily about obesity – the plus sized worker category includes anyone that is outside of the normative data sets, regardless of the reason why they fall outside of the normative data.  (When I originally took the course, it reminded me of The Incredibles when Bob tries to become a non-super hero, stuffing himself into the small car or into his cubicle at work).

Dominique Larouche et al. look at the issue of safe handling techniques for paramedics when transferring patients from stair chairs to stretchers.  One of the interesting points is that they believe that training needs to be oriented more towards the ability to adapt work techniques based on the environment and on the work teammates.

Joshua Zheng Rui Ting et al. investigated the effect of an ergonomics/exercise intervention compared to an ergonomics/health promotion intervention on workability levels in the office worker population.   For the general population, there was no significant difference in results.  But for a subgroup of office workers who reported neck pain (greater than 3/10 at start of study), the ergonomics and exercise intervention group demonstrated trending improvements in workability when compared to the ergonomics/health promotion group, if they completed at least 70% of the exercise sessions.

Peter Love et al. dealt with the difficulties in establishing operational guidelines for construction safety when the information on injuries is not readily available to use to set best practice guidelines.

Kaitlin Gallagher et al. noted that walking breaks can help to reduce low back pain that is induced by prolonged standing.   Walking and moving is something that I have been an advocate of for a long time.  Walking is not only great to break up prolonged postures (sitting or standing) but the overall movement is helpful for preventing other health issues as well.

 

Friday Five -7/26/19

 

The Friday Five is a set of five links that I have come across this week that pertain to ergonomics, occupational health, safety, human performance, or human factors.  For whatever reason, I found them interesting, but they are provided with minimal or no commentary and are not meant to be endorsement for a given product or research paper.

Jodi Oakman et al. performed a 6 year study looking at issues of workability and musculoskeletal pain in a Finnish food industry company. They looked at the relationship between workability and musculoskeletal pain, physical work conditions, and psychosocial work conditions as well as what interventions made changes to workability levels. (Of note, this study was interesting to me as I have been working with an employer that has performed a musculoskeletal discomfort survey with its employees to help to identify tasks that may be contributing to musculoskeletal discomfort.)

A study by Sherry Hassam et al. looked at a 24 month intervention using the “Walking Works Wonders” program to evaluate changes to office based participants in a standard walking program and a tailored intervention program when compared to a control group.  While both exercise groups demonstrated improvements in measures of well being and resting heart rate, those in the tailored intervention demonstrated additional improvements in BMI measures and waist circumference.

A companion study to the above walking intervention study by Kazi et al. notes that sitting at work for the 1120 participants in the study accounted for nearly 60% of their daily sitting time and that those is sales and customer service positions have higher BMI and poorer health than those in other employment sectors.

Jesse Jacobs et al. looked at employee attitudes towards acceptance of wearable devices in the workplace.  They found that employers who want to implement wearables “should (a) focus its use on improving workplace safety, (b) advance a positive safety climate, (c) ensure sufficient evidence to support employees’ beliefs that the wearable will meet its objective, and (d) involve and inform employees in the process of selecting and implementing wearable technology.”

Xavier Robert-Lachaine et al. looked at the feasibility of using magnetic and inertial measurement units for analyzing performance of manual material handling tasks.  They found that while visualization of the data collected for the head, arms, and legs did not demonstrate significant visual difference from data collected visually by observers, there was a greater difference between visualization of data and observer’s evaluation of trunk movement.  They found that using these units can be acceptable, visual verification of the data is still important to ensure validity as magnetic disturbances can increase measurement error and affect collected data.

Taking A Deeper Dive Into Your Injury Data

Recently, WorkersCompensation.com and Safety+Health Magazine ran two articles that provided interesting injury information that came from taking a deeper dive into reported injury data.

WorkersCompensation.com reported that injury rates in construction workers in Tennessee were higher for those on the job under two years. In both Tennessee and Ohio, injury rates for workers with less than 1 year of experience accounted for 47.5% and 45.6% of the total injuries, respectively. Workers with less than 6 months of experiences accounted for 37.1% and 33.6%, respectively.   The article notes two important thoughts:

  • Fingers and hand injuries were among the top 10 injured body parts – an issue that can be reduced with appropriate PPE
  • Teaming up new, inexperienced workers with mentors to learn to recognize work hazards

Safety+Health took an interesting look at the effects of shift length and inexperience on the risk of injury to those working in the mining industry. They reported on data from a study by researchers at University of Illinois at Chicago that found that miners working shifts longer than 9 hours “were 32% more likely to suffer work-related fatalities and 73% more likely to be part of an incident that caused injuries to multiple miners.” Risk factors for injury for those working more than 9 hours included workers that had less than 2 years experience in the job as well as irregular work schedules. Among the suggestions to reduce the risks were fixed schedules and a recommendation into looking deeper into the effects of longer shifts on “fatigue and nutrition”.

One of the key things that we ask on our FCE intake paperwork is the amount of time that a claimant has been working in their current position. More often than not, many of those who have been sent to us for the functional capacity evaluation have less than 1 year in the position in which they were injured. Length of employment at time of injury is a data point that all employers should be monitoring. When trends appear such as in the two studies noted, employers need to take a look at hiring practices and new hire training practices. They may find that their hiring process should include a post-offer pre-employment test of physical abilities to ensure that new hire candidates meet the essential physical and postural demands of the position.

Looking at injury data (OSHA logs, loss run data, etc.) should be a part of the process of setting up a post-offer pre-employment process in conjunction with performing on-site measurements to create a customized job description of the essential postural and physical demands. The injury data may help to pinpoint job tasks that require a deeper look to determine why employees are getting injured. Is it an ergonomic issue? Is it an issue of strength? Is it an issue of better standard operating procedures?

One of our clients asked for our assistance in reviewing the injury data after initiating a post-offer pre-employment testing process for an ambulance transport service to determine the effectiveness of the program. We looked at data from 3 years prior to initiation of the process as well as 3 years after (we encourage employers to look at this more frequently).   The initial review of the data indicated a minor drop in injuries after initiating the program (an overall drop of 6 injuries after initiating testing).

With only a small reduction in injuries, a deeper dive into the data was required. Several interesting variables were found during this deeper dive:

  • The number of neck, shoulder, and lower back injuries decreased but injuries involving the hands and exposure injuries increased
  • The number of employees decreased by 20% between the two periods
  • The number of transports increased after testing when there were less employees increasing the amount of exposure opportunities to be injured

Taking into account the reduction in the number of employees and the increase in patients transported, there is a 26.8% reduction in injuries.

Taking the deeper dive into the data allows for a greater understanding of the mechanisms that may be driving the injuries that your employees are experiencing. Make the time to look at your OSHA logs to see if there are injury trends, look at the amount of time employed at time of injury to see if there are trends with your new employees, or take a look at your loss runs to see if certain departments have either a greater number of injuries or a greater amount of lost time compared to other departments. All of these become a starting point in reducing future injuries.minied

 

 

 

“Orange Light Theory of Functional Fitness”

When we perform post-offer pre-employment physical ability tests, we remind applicants of the strength demands as defined by their potential new employer as we get to the strength portion of the test. While the main reason for telling them is so that we are clear and transparent about the expectations of the testing process, it also helps to set up a discussion with each applicant about their physical status.

Every post-offer applicant gets a quick reminder that if they are currently working out in a gym or at home, they should continue to do that once they start their new job. More importantly, they should not treat their job as a workout. If they aren’t currently working out, we tell them to go a gym, find a work out app to use at home, check out the available workout videos on places like YouTube or Amazon Prime Video, but most importantly to start doing something. Many of these come with position specific reminders – for patient transporters to start walking more if they don’t walk regularly because the position can require several miles of walking per shift, for train conductors to hit the stairs once in a while because their new employer has been adding as many double decker train cars as they possibly can, etc. The typical response is “I used to work out all the time but {insert some life event} got in the way….I swear as soon as I get this job, I will start working out, running, etc.”

Fortunately or unfortunately, depending on how you want to look at from an employment standpoint or a health/fitness standpoint, we have been seeing a lot of people that are just that tiny bit stronger than the essential demands of their soon to be position require. This is good for them, because they pass this phase in the process of pursuing their new job. But, it is not a lot of cushion from a physical abilities standpoint. When we see areas that they can improve in strength in the data collected during the test, we try to share that with them, just as we try to share some better techniques with them if their positioning to lift from floor height could use some improvement.

But, a lot of people as soon as they are aware of the fact that they have demonstrated the required strength start to tune out those pieces of advice and the statement they made about working out after getting the job has already started to fade into distant echoes. Because of this, I have tried getting a little more creative in trying to get these new hire candidates to understand the importance of keeping in shape and maybe even increasing their strength a little bit more.

 

My new go to explanation for the need to increase strength is the “Orange Light Theory” – almost everyone that comes through our doors, whether they drive or not, knows what it means when that little orange light begins to glow on the dashboard. The tank isn’t empty yet, but a gas station better be in the near future or there will be a problem. For those candidates who just squeak by on the essential demands by a couple of pounds of lifting or carrying strength, I explain to them that they passed – they still have gas – but that the orange light is on. They need to get a little stronger so that they have a reserve of strength to help them on those days when they work overtime or when they have to pick up the slack because someone called out sick, or when the unexpected happens like pipes bursting and causing a lot of work to happen in a short time – or more importantly, having the energy at the end of the day to play with their kids.   Giving them this visual seems to help put their current strength in a context that they can understand better.

While testing applicants to determine whether or not they meet the essential physical and postural demands for a position is the reason for performing a post-offer pre-employment physical abilities test, it is a great opportunity to help give enough knowledge to applicants to give them a reason to take ownership of their physical fitness so that hopefully, they don’t return to us for a functional capacity evaluation due to an injury.

An orange light comes on to let drivers know that they are almost out of fuel.
That pesky orange light comes on and lets you know that you are almost empty. We need to have a high enough fitness level to limit our body’s orange light from needing to come on while performing work related tasks.

Job Demand Lessons from the US Open

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Sporting events with storied traditions are not typically the settings for learning new lessons in the world of essential demands for job positions.  However, the 2018 US Open is a great lesson for employers in reviewing both their “essential job demands” as well as their post-offer physical abilities testing process. 

Each of the four tennis Grand Slam tournaments has their own specific styles – Wimbledon has grass courts and white tennis outfits, the French open is a demanding tournament due to its clay surface, the Australian Open has hard surfaces like the US Open, but the roof can be closed so play can continue during inclement weather, and the US Open is played on a hard court surface.  Until this year, the US Open had one unique functional difference from its three peers – ball boys and girls were required to be able to throw the ball overhand across the court, accurately, to their peers when balls were needed.  In the other three tournaments, the ball is rolled across the courts, underhand.  The US Open is also the only Grand Slam tournament that allowed adults over the age of 18 to apply as a ball boy or girl.

This year, the US Open determined that by changing the essential demand for this exchange of tennis balls on the court from throwing to rolling, it would open the applicant pool to a broader base of applicants. The US Open has not attributed the change to a decrease in the number of applicants with a strong enough throwing arm and adequate throwing accuracy but to a desire to increase the applicant pool to include those who may not have been able to be applicants due to this singular demand but meet all of the other demands.  This change marks an end to a several decades long tradition of throwing the tennis balls.

But, was it truly an essential demand to begin with?  Not necessarily.  As has been mentioned, most tournaments are able to function adequately with the balls being rolled across the courts.  It was an entertaining method of performing the task, but changing the method does not reduce the completion of the end result – the ball gets from one side of the court, whether it is rolled or thrown. 

What essential job tasks do you have that may have another method or technique for being performed that does not impair (either from a safety or a financial hardship aspect) the end result of the job task?  If this task is changed to an alternate method, have you accurately modified your post-offer physical abilities tests or the job demands description that are utilized during treatment and return to work testing? 

Post-Offer Physical Abilities Success Story

“You can arrive at your dream a lot of different ways, but you also arrive there as a different version of yourself based on whatever pathway you choose.”  – Joanna Gaines

Post-offer physical abilities testing is something that should really be straight forward.  Testing based on the minimum essential postural and physical demands for the position that has been offered to the candidate.  Seems pretty simple, the candidate either meets or does not meet the minimum essential demands.  But, it isn’t always that simple because the process involves people.

When a candidate fails a post-offer physical abilities test, the employer has to choose what path they will take.  Some employers may look to see if the candidate’s abilities meet the demands of different position.  Other employers may offer the candidate the opportunity to repeat the test at a later date.  Some employers may choose to not re-test.

One of the employers that we work closely with allows candidates to work on improving in the areas in which they did not meet the demands and attempt the test again with the next new hire class.  This particular employer has a fairly high passing rate (which is due to a phenomenal hiring process by the employer that helps to make sure that the demands of the position are consistently reinforced during every contact with the candidate), so the number of candidates who do not meet the demands is fairly low.  Of those that do not meet the demands on the initial test, some come back to test again.  It is a good job with solid benefits and is worth the time and effort for these candidates to try again.  Nearly everybody who re-tests comes back physically stronger and with improved range of motion and physical abilities and passes the test.  Many comment that not meeting the demands on the initial test was a significant wake-up call about their previous level of fitness.  They wish they were able to start the jobs with their original classmates but they are also content with the fact that they have not only done what was required to earn the job but have made lifestyle changes that will benefit them for years to come.  We don’t mind repeat tests for this employer as we know most candidates return, changed for the better.

Recently, we had a second test for a candidate from a different employer.  This candidate’s scenario was much different.  It was the first post-offer failure for the employer and it was a result of lack of medical treatment for an auto-immune disorder that attacked the candidate’s upper extremities in a way that did not allow the candidate to meet the minimum essential demands.  The employer did not have alternative positions with decreased physical demands to offer.  As the candidate had not yet received treatment for their condition, we suggested to the employer (along with the instruction of talking to their lawyers) that if the candidate has a change in physical function due to treatment that they be re-tested. 

When this candidate was scheduled for a second test, I was unsure of what to expect.  Luckily, the candidate returned with significantly improved function due to appropriate medical treatment and they were able to meet the minimum essential postural and physical demands of the position.  The candidate told us that as a result of not meeting the demands for a position,  they realized that they needed to become more proactive with their physician in seeking a successful treatment regimen for their condition.  For this candidate, not only did they obtain the position they wanted on the second test, they were able to become a successful advocate for their own healthcare status and understand the importance of that in keeping their condition in check. 

In each of these success cases, the post-offer candidates arrived at Point B – meeting the demands and obtaining the position – but they also arrived at Point B as improved versions of themselves with better fitness and abilities, and in the second case a better advocate for their own healthcare.

 

Friday Five – 4/13/18

The Friday Five is a set of five links that I have come across this week that pertain to ergonomics, occupational health, safety, human performance, or human factors.  For whatever reason, I found them interesting, but they are provided with minimal or no commentary and are not meant to be endorsement for a given product or research paper.

The topic this week is going to be a little bit different – ergonomics and space.  I noticed that Mike Massimino had posted on Twitter yesterday (@AstroMike) that it was #InternationalDayOfHumanSpaceFlight.  When I read his biography, one of the things that struck me from an ergonomics standpoint was the section about the attempts to automate the final Hubble repairs but in the end, it needed to be performed by human astronauts – and they needed to modify/create tools to get it done.  So, in honor of @AstroMike and all of the other astronauts who have done work in space, here is the Friday Five.

Due to the fact that we perform Post-Offer Physical Abilities testing at Biokinetics, this first study is interesting to me.  Taylor et al. looked at 8 NASA astronauts to look at performance on a series of tasks to determine whether task performance can be predicted when in a weighted suit.

Hackney et al.  look at the astronaut as an athlete (it’s an apt comparison, similar to the industrial athlete that we talk about within the occupational/industrial health realm) and what can be done to counter the decline of musculoskeletal strength and endurance during space flight to ensure that crew safety and mission success are not negatively impacted by astronaut performance.

Walters and Webb used a NASA Task Load Index to look at factors such as physical demands and effort for personnel involved in robotic surgery.  The goals were to determine appropriate staffing levels based on workload to maintain efficiency, team satisfaction, and patient satisfaction.

Strauss et al. reviewed data from extravehicular mobility training to look at the injuries and complaints that occurred during training at the Neutral Buoyancy Laboratory when astronauts were training in space suits to perform tasks and use the data to determine the best multidisciplinary approach to resolve these issues.

Petersen et al.  investigated a new testing battery to look at fitness of astronaut candidates for the European Space Agency.

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This is a shot of the Space Shuttle Discovery at the Steven F. Udvar-Hazy Center of the National Air and Space Museum that I took on March 30, 2018.  Back in 2001, I was lucky enough to get to spend a short period of time in one of the mock-up shuttles at Johnson Space Center that was used for training the astronauts.  It still amazes me that the astronauts could spend the time in orbit and perform science missions in the crew space which wasn’t very large.  We were also able to watch some of the training that was going on in the NBL from one of the control rooms.  I’d like to think that the training we witnessed was part of the data set for the paper by Strauss.

 

 

Friday Five – 4/6/18

It’s been a while, but I am going to get this started back up with a new edition of the Friday Five.

The Friday Five is a set of five links that I have come across this week that pertain to ergonomics, occupational health, safety, human performance, or human factors.  For whatever reason, I found them interesting, but they are provided with minimal or no commentary and are not meant to be endorsement for a given product or research paper.

Kesler et al.  looked at the impact of the size of SCBA units (the self-contained air packs that firefighters wear) as well as fatigue (based on different bouts of work-recovery) on the gait of firefighters.  As can be imagined, there are changes based on both parameters. A second study with similar parameters by Kesler looked at the impact on balance.  A third study by Kesler’s team looked at physiological stress and work output – as can be imagined, the baseline fitness of the individual firefighters has an impact on these values.

Putting ergonomics programs into place within companies has always been a tricky intervention.  Visser et al. compare participatory ergonomics programs of a face-to-face nature and e-guidance programs to see how well they work.  There are some interesting findings.

Michel et al. looked at the collaboration in the return to work process in French occupational centers in dealing with patients who had chronic low back pain.  There are some interesting aspects to the communication between the different participants in the rehab process.

Hegewald et al. take a look at the data on technical devices to reduce musculoskeletal injuries during patient handling.  The overall finding is very interesting.

As we have had the discussion with some surgeons who are located in our building, the review by Stucky et al. on complaints of surgeons of work related pain and musculoskeletal complaints and surgical ergonomics is very interesting.  Of note, operating exacerbated complaints in 61% of the surgeons but only 29% sought medical treatment.