Health Society of South Africa

PREVENTING REPETITIVE STRAIN AMONG GROCERY STORE EMPLOYEES
How to avoid hand and wrist injuries

Hidden Hazards for Hands and Wrists

Whether you check groceries, decorate cakes, cut meat or stock shelves, your job as a grocery store employee requires repetitive hand and wrist motions. Bending, turning and gripping - if done too often in the wrong position or too forcefully - are hidden hazards that can lead to repetitive strain (a group of upper-body injuries). The end result? Fatigue, pain or more serious injury. See if you're putting yourself at risk for repetitive strain. Read the questions below, checking those you answer with a "yes." This simple assessment may help you uncover a hidden hazard or two.

Do you usually grip items with just your fingers instead of with your whole hand?
Do you use a dull knife to cut meat?
Do you hold cakes with one hand extended while icing them with the other?
Do you repeatedly pick up heavy items with a bent wrist when stocking shelves?
Do you scan heavy items such as dog food instead of keying them in?
Do you frequently cut open all the boxes before stocking shelves?

Try Your Hand at Safety
If you answered "yes" to any of these questions, you may be at risk for repetitive strain. But you can begin now to prevent hand and wrist problems by using safe positions, minimising the force you place on your hand and wrist, and reducing repetitive motions. Varying the way you use your hands while off the job can also help, as can doing hand and wrist exercises to increase flexibility and strength.

Your Hand and Wrist at Work

You may not think about hidden hazards unless something goes wrong. You may also have given little thought to the "hidden machinery" of your hand and wrist. After all, it simply does its job. Right? For
the most part, yes. But understanding how your hand and wrist work may help you see how unsafe positions, too much force and repetition are a costly combination that can lead to repetitive strain - and what you can do to prevent it.

Inside Your Hand and Wrist

Carpal Tunnel. In the centre of your wrist, bones and soft tissue form a narrow tunnel through which tendons and the median nerve pass.
Tendons. Tendons attach muscles to bones, helping to move your hand. The synovial (lubricating) sheath surrounding tendons allows them to slide back and forth in the carpal tunnel.
Muscles. This soft tissue provides the power for moving your hand and fingers.
Arteries. Blood circulates to your hand and wrist through arteries, supplying fluids and nutrients.
Median Nerve. The median nerve carries messages that tell your hand to move and can transmit pain.

Hand and Wrist Positions
Your hand and wrist can bend up (extend) and down (flex) and twist sideways. Keeping your wrist in a straight, neutral position puts the least strain on muscles, tendons and nerves.

Grips
Your hand and fingers can grip and lift items. Using your whole hand (power grip), instead of just your fingers (pinch grip), puts less force and strain on your hand and wrist.

A Costly Combination
Repeating the same forceful motions with your hand and wrist in awkward, unsafe positions may be a costly combination for you - one that's measured in more than just rands and cents. It's a combination that can cost you your comfort, if the injury becomes serious enough.

Unsafe Positions
Holding your hand and wrist in awkward positions - either flexed, extended or twisted - can put pressure on nerves, muscles and tendons. Plus -

Too Much Force
Too much force from gripping heavy objects too hard or in an awkward position can put extra pressure on nerves, muscles, and tendons. Plus -

Repetition
Repeating the same motion for long periods of time can stress your muscles. Equals -

Hand and Wrist Problems
Repetitive strain can lead to a variety of hand and wrist problems. Inflamed or sore tendons (tendinitis) may progress to swollen tendons and synovial linings (tenosynovitis) and to a swollen or pressured median nerve (carpal tunnel syndrome). Symptoms may include pain, swelling, tenderness, weakness, numbness or tingling. You're at greater risk for problems if you're fatigued or under stress. Women are also at greater risk due to smaller frames or hormonal changes that can cause greater sensitivity to inflammation.

An On-The-Job Prevention Plan

You can't avoid repetition altogether. It's simply a part of your job. But you can take steps to minimise repetitive motions and their effects. Take another look at the tasks you perform every day. What can you do to safeguard your hands and wrists? Here are a few tips to get you started with an on-the-job prevention plan.

For Checking
Your job may require unloading baskets, scanning, keying in prices and bagging groceries. No matter what the task, try to keep your hand and wrist in a neutral position, try to minimise the force on your hands and wrists, and look for ways to reduce repetition. Even with the speed that's required to check groceries, you can still protect yourself.

For Cake Decorating
Alternate icing and decorating to give your hands and wrists a break from repetitive activities. To reduce stress on hands and wrists further, ice cakes on a platform or table, rather than on your extended hand.

For Meat Cutting
Keep your wrist in a neutral position and keep knives sharp, so you don't have to press as hard when cutting. Frequently wash your hands in warm water to help your blood circulate. If you wear gloves, wear thin ones, so you don't have to grip hard. Alternate cutting, wrapping and preparing displays.

For Stocking Shelves
When cutting boxes, put your wrist in neutral and rotate the box, rather than twisting your wrist. Keep knives sharp, replacing blades often. When stocking shelves, alternate positioning and cutting boxes. Don't grip heavy cans with a flexed or extended hand.

Shaking hands. Throughout the day, shake your hands and wrists to improve circulation and prevent muscle tension from building up. These "mini-breaks" give your hands and wrists a chance to recover from strain.

To use safe positions. Hold your hand and wrist in a neutral position as much as possible. Wait for items to come to you; don't reach for them.
To minimize force. Use the power grip, not the pinch grip. Instead of scanning them, key in heavy items such as large bags of dog food. Use two hands to bag heavy items. Drag, rather than lift, items when possible.

To reduce repetitions. Know where the bar code is printed on products. Keep the scanning plate clean with non-abrasive cleaners and paper towels. Pick and pass items to help alternate the use of your hands. Key in multiple purchases of a single item.

Exercises for Your Hand and Wrist

Increasing the flexibility and strength of your hands and wrists can help decrease your chance of repetitive strain injuries. Try the following exercises, doing each of them once an hour, or at least twice a day. It only takes a few minutes each time.

Increasing Flexibility
Using the same motions day in and day out can make your muscles stiff. Increasing flexibility with exercises can warm you up and make it easier for your hands and wrists to bounce back from stress. When exercising, try to use opposite motions from the ones you use most often at work.

Wrist flexion and extension
Lower and raise your wrists from a neutral position.
Hold for a count of 5 in each position, then relax; repeat 5 times.

Finger stretch
Spread your fingers as far apart as possible.
Hold for a count of 5, then relax; repeat 5 times.

Thumb stretch
Gently pull back on the thumb of your other hand.
Hold for a count of 5, then relax; repeat 5 times, then change hands.

Wrist rotation
Put one hand under the elbow of your other arm.
Turn your palm up, then down, keeping your fingers relaxed and elbows still.
Repeat 5 times, then change hands.

Increasing Strength
It only stands to reason that weak muscles are more likely to be injured. Here are some exercises specifically designed to strengthen your hands and wrists. When you do these exercises at home, you can improvise by using soup cans for weights.

Rubber ball squeeze
Place your fingers around a small rubber ball and squeeze.
Hold for a count of 5, release, and repeat 5 times; change hands.

Wrist curls
Rest your forearm on a table.
Grasp a 500 gram to 2 kilogram weight, curling your wrist upward and keeping your forearm still.
Slowly uncurl, relax, and repeat 5 times; change hands.

Weightlifting
Without locking your elbow, lift a weight such as a cooler until your arm is parallel with the floor. Use a weight light enough so you can lift and lower it 12 to 15 times.
Change hands.

When You're Away from Work

Your free time may be relaxing for you, but it can be more of the same repetitive work for your hands and wrists. Remember to vary your activities while you're away from your job, so you don't continue to stress your hands and wrists. Also, do your best to stay fit to lower your risk of repetitive strain even more.

Vary Your Activities
Varying your activities gives your hands and wrists "time out." Of course, you can't stop using them altogether, but you can make some adjustments. For example, substitute low-stress hand activities at the end of a long shift or week or if you're experiencing symptoms of repetitive strain. Save higher-stress hand activities for times when your hands and wrists are well rested. If repetitive strain is a big problem for you, though, you may need to find new hobbies, crafts and sports.

Hobbies and crafts
If knitting, crocheting or quilting is your craft, go shopping for patterns or yarn during times of extra strain to give your hands a rest. If you're a woodworker or musician, buy supplies or sheet music, read up on woodworking techniques or listen to a tape of a piece you're working on.

Sports activities
If you're a bowler, tennis player or a mountain biker, find other sports you can occasionally participate in. Swimming, running and hiking are types of activities that don't put a lot of stress on your hands.

Household chores
Don't sweep, iron, hammer, paint or mow the lawn when your hands are tired; instead, wash laundry, sort out files or straighten rooms. If you're a gardener, don't dig or pull weeds when you're feeling strain; for a change of pace, water or repot plants.

Stay Fit to Lower Your Risk
Eating right, exercising regularly and relaxing are all a part of staying fit, which provides an extra buffer against the stress and strain of daily activities. Not smoking can help, too, since smoking restricts circulation, especially to your hands and wrists.

If Your Hand and Wrist Pain is a Problem

Pay attention to pain. It's a sign that something is wrong. If you experience pain early in the day or after doing a normal amount of work or if you feel numbness or tingling, seek help immediately. Early treatment helps minimise problems. But if you wait, you may develop a more serious injury and even require surgery to correct the problem.

Seek Help
Report symptoms of repetitive stain to your manager, who may recommend that you see a doctor. Your doctor may prescribe anything from mild pain relievers and anti-inflammatories to physiotherapy. You may also be given a splint to keep you wrist in a neutral position at night. In rare cases, surgery may become necessary for severe pain or cases where nerve damage is a risk.

Use Self-Care
More than likely, you can contribute to the healing process and take steps to reduce symptoms. Don't rely on pain relievers alone to solve your problem. Follow your doctor's advice about ice to reduce swelling, rest to allow your hands to recover and light massage to aid circulation. It may be best to continue flexibility exercises, but go easy on or eliminate strengthening exercises as directed by your doctor.

Your Safety Checklist

Safe solutions are close at hand. Look at the list below and check the steps you're taking now to protect your hands and wrists at work and at home. Then make it a goal to check all these steps. In time, safe working habits can become second nature to you.

Keep your hand in a straight, neutral position whenever possible.
Grip items with your whole hand, not just your fingers.
Use two hands to lift whenever possible.
Alternate hands when you can.
Vary the tasks where you use your hands-both on and off the job.
Shake out your hands frequently throughout the day.
Exercise regularly to stretch and strengthen your hands and wrists.