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Risk factors of CTD 
• Work does not have to be harmful if the limits of the human 
body are understood and not exceeded 
Example: 
You will not take your family car and roar down 
a country road banging through pot holes and 
screeching around corners. The mechanical stress 
would cause fatigue in parts of your car that would 
eventually cause serious damage 
• Just like cars, people have certain limits 
• If we work outside those limits we will cause fatigue in body 
parts, shortening their functional life 
• If we exceed the capacity of the body, the components will 
fatigue, become unreliable and eventually fail
Risk factors: 
• Risk factors usually have their harmful effects on the operator 
in some combination 
Example: 
when we talk about a stressful posture, we imply that this posture is potentially 
harmful when it is used repeatedly (Risk factor = REPETTITIVENESS), 
normally in association with muscular exertion (risk factor = FORCEFULNESS)
• Risk factors of concerned usually have their 
harmful effects through prolonged exposure. 
The injuries are mainly cumulative. 
• That means that they develop over a period of 
time, usually months or even years 
‘chronic vs acute’
Six general occupational risk factors: 
• Repetitiveness - Repeated or sustained 
exertions 
• Forceful Exertions - Also called forcefulness 
• Stressful Postures - Also called awkward 
postures 
• Mechanical Stress - Also called mechanical 
stress concentration 
• Temperature Extremes - The effect of heat and 
cold 
• Vibration - Both high and low frequencies
REPETITIVENESS 
If you think of what is 
involved in many jobs 
you will realize that they often 
require the worker to constantly 
repeat certain sequences of 
movements or to maintain 
certain stressful postures for 
prolonged period of time. 
• Such movements or postures, which are normally 
harmless when used once in a while or briefly, may 
cause injury when they are used repeatedly on daily 
basis 
• Example: if we lightly squeeze a soft drink can with 
our hands. Initially the sides of the can crinkle, but it 
regain shape. 
– The force we applied was not strong enough to 
immediately destroy the can. However, if we 
repeatedly apply this same pressure say 15 to 20 
times, the can will develop fatigue and tear apart
The result of repetitive force 
HHaasssslele – – P Paainin - -I NINJJUURRYY 
• It is the same with the human body, but instead of 15 or 20 
times, the frequency is measured in hundred and thousands of 
repetitions. 
• The repeated application of force that is not strong enough to 
cause immediate damage, but over time it will fatigue in the 
tissues. 
• This usually means that this job soon become a hassle. 
• After a period of time, there will be pain as the tissues involved 
(the skin, muscles, tendons, joint, ligaments, nerves, and blood 
vessels) are repeatedly rubbed, compressed and stretched 
from movement and exertion. 
• If these tissues are not allowed to recover, the cumulative 
damage will result in serious injury.
• Unfortunately there are no precise guidelines for the rate 
of repeated or sustained exertions that would cause 
injury 
• The degree of stress and the resulting risk of injury 
depends on the kind of muscular movements involved 
and on the presence of other risk factors such as 
forcefulness and postures used.
FORCEFUL EXERTIONS 
(FORCEFULNESS) 
• When you contract your muscles, you exert force in order to 
move your limbs, lift of hold an object, operate a tool, or 
maintain a posture. 
• As your muscles contract and relax, the tendons are 
stretched. They may rub or press on adjacent tissues. The 
degree of musculoskeletal strain depends on how much force 
you exert. 
FORCE = amount of work which the muscles, tendons, joints and 
adjacent tissues must do in order to perform the 
particular action. 
• The force exerted depends on a variety of factors, including 
posture, weight, friction and recovery time.
Importance of force and posture 
You can perform work more efficiently 
with some postures than others. 
• In certain posture you have to exert more force to perform the 
same job. 
• Example; pinch grip requires more force than a hook grip. 
• To demonstrate yourself, compare what it feels like to pick up 
and hold a heavy book by the binding in two ways 
Between your 
thumb and the pads 
of your fingers, 
with your hand 
above the book 
Hooking your fingers 
under the book 
and holding it 
against your forearm 
Which is easier?
Other factors to consider 
• The weight of load that has to be moved or manipulated 
is very important. 
• All things being equal, a heavier load requires a greater 
exertion, that is, more force to manipulate it 
• The friction of an object moved if it is also slippery, will 
require more force to keep it in your hand 
• Similarly, you will have to work harder to push a cart if 
your feet tend to slip on the floor than if your footing is 
secure
Forceful 
Exertion 
• Although force, can be estimated by measuring the number of 
muscular exertions, there are no fixed guidelines for what 
degree of force is harmful. 
• As with repetitiveness, the hazard from force, depends on: 
– What part of the body is exerting the force 
– What kind of movement is involved 
– The presence of other risk factors, such as repeated 
exertions
STRESSFUL POSTURES 
• Certain postures, when used repeatedly or when 
sustained, can be stressful to the structures of the body, 
especially when force is exerted. 
• posture is so critical to ergonomics and affects various 
parts of the body
Hand postures 
in which the hand is wrapped 
around and object with 
continuous contact between 
the tip of the thumb and the 
fingers 
In which only the pads of 
thumb and fingers touch the 
object, is best for precision 
task 
Power grip 
Pinch grip 
USE POWER GRIP 
AVOID PINCH GRIP 
• Using a pinch grip when you have to exert a lot of force can result in 
pain and injury 
• Unless the work being performed is very precise, the pinch should 
be replace with power grip. 
• Also important to provide for a good grip of objects being handled. 
• Avoid slippery handles 
• Increase friction by providing tool handles with textures or coated 
handle coverings or by providing gloves with non-slip palms.
Wrist posture 
• The least stressful posture for the wrist is called the 
neutral posture. 
• The wrist normally assumes this posture when your hand 
is hanging comfortably at your side.
Wrist posture 
•Non-neutral wrist postures are potentially stressful 
Hyper-Extension 
(hand bent backward away 
from the palm) 
Flexion 
(hand bent toward the palm) 
Ulnar Deviation 
(hand bent toward the little finger) 
Radial Deviation 
(hand bent toward the thumb
Important of hand and wrist posture: 
• Cumulative Trauma 
Disorders (CTD) of 
the upper 
extremities are 
“wear-and-tear” 
injuries that affect 
many people who 
do hand-sensitive 
work. 
Posture of hand and 
wrist that must be 
avoided
SHOULDER POSTURES 
• Stressful postures of the shoulder can cause a 
significant reduction in endurance 
Awkward postures of the shoulder
• All stressful postures result in strength reduction 
• Notice in the table below, that when the arms are fully 
extended, we are at our weakest 
EXTREME POSTURE % STRENGTH REDUCTION 
from NEUTRAL POSTURE 
Ulnar Wrist Deviation 25% 
Radial Wrist Deviation 20% 
Wrist Extension 25% 
Wrist Flexion 55% 
Arm Fully Extended 81% 
Floor Level Lift 40% 
High Vertical Lift 60% 
45° Twist During Lift 15% 
90° Twist During Lift 30%
NECK POSTURES 
• Any improper neck postures may lead to muscles fatigue and/or 
headaches. 
•The neck is stresses by holding the tilted forward of backward more than 
20° for extended period of time 
Neck ≤20° Backwards 
• Care must also be taken to prevent moving the head repeatedly from 
side to side and excessive twisting. 
• Stressful neck postures should not be repeated more than 2 times/min 
Sideways Twisted
MECHANICAL STRESS 
• Mechanical stress is produced by the contact between some 
parts of the body and the sharp edges of tools, parts, work 
surfaces or work pieces 
(a) 
(b) (c) 
• Hand tools are common cause of mechanical stress. The figure 
above gives a good example of how a hand tool can compress finger 
tendons. (a) A sharp-edged tool (b) is more likely to produce injury 
than a rounded tool (c).
Other parts of the body are also quite sensitive to 
mechanical stress. They include: 
• Backs and sides of 
fingers 
• Inside of wrist 
• Soft tissues of the 
thighs during 
prolonged sitting 
 Elbow (“funny bone”) 
 Armpit and chest 
 Tops of feet 
 Front of lower legs
TEMPERATURE EXTREMES 
• Extremes of both cold and heat can be stressful 
• Skin temperature should not be allowed to fall below 
68°F (20°C) due to contact with air, tool exhaust or cold 
materials 
• This conditions may impair the sense of touch and 
reduce dexterity in the hands. 
• When the hands are cold and numb, you tend to 
misjudge the amount of force necessary to perform a 
task. 
• Additional stress is created by a tendency to over-exert 
under these conditions.
Extreme heat are harmful in two ways. 
First 
• Handling hot tools, surfaces or work pieces without protective 
gloves can result in burns 
Second 
• Environmental heat, especially if accompanied by high humidity, 
can increase the physiological strain during whole-body exertions. 
• This is because muscular activity produces heat. 
• The body can release most of this heat through perspiration under 
normal circumstances. 
• As the temperature in the air and humidity rise, the body must work 
harder to give off this heat. Various heat related disorders can result, 
among them are heat stress and heat stroke 
• NOTE: Work which can be performed easily in a comfortable 
temperature can cause excessive stress on the body in hot, humid 
working conditions.
VIBRATION 
EXPOSURE MEDIUM EFFECT DESCRIPTION 
TO : 
Normally 
associated with 
people who 
drive vehicles, 
eg: fork trucks, 
platform trucks 
Increase an 
individual risk for 
back injuries 
• Back 
• Buttock 
Low-frequency 
vibration 
Can occur with 
the use of 
powered hand 
tools and 
impact tools 
Damage to the 
nerves, blood 
vessels and 
bones of the 
hands and arms 
Vibration • Hands
PERSONAL RISK FACTORS 
• Also recognized as other factors. 
• Factors may affect an individuals overall risk for overexertion 
injuries: 
– Age 
– Fitness level 
– History of injury 
– Medical conditions 
– Smoking 
– Obesity 
– Gender 
– Physical structure
The “HIT LIST” 
• A method of helping us become more aware and 
experienced in ergonomics is to summarize the most 
common risk factors seen in the plant. 
The Ergonomic “ Hit List”
the Washrag. 
• It is a summary of the stressful hand and wrist 
postures making it very easy to spot 
Continuous movement of the wrist and hands, increase like likelihood of 
repetitive motion disorders
There are three postures that commonly observes in the 
plant have a direct effect on the low-back 
• “Butts Up” position 
• It is the most common in the plant 
• A good indicator of risk for possible low-back problems 
Can be seen off-loading 
conveyors, 
pushing and positioning 
component carts lifting 
and loading material, 
etc
• “ Horizontal Distance” 
• Usually seen when loads are being handled away from 
the body 
• This can put great forces on the spine 
Anytime there is a lack of 
clearance which prevents 
the worker from getting 
close to the load there will 
be trouble. 
Look for this around 
conveyors and tables
• “Twist and Shout” 
• Usually seen when loads are being moved from one 
location to another. 
• The twisting motion puts extremely high forces on the 
lower back 
Look for transferring 
components or finished product 
from one surface to another 
such as off-loading conveyors, 
repetitive splicing type 
operations or transferring 
product from a conveyor to a 
pallet.
There are two postures that are the result of failure to locate 
the work to be done in the proper place 
• “Shoulder Too High/Shoulder Too Low” position 
This usually the result of 
controls or tools located at 
the wrong height. 
Look for this at work 
stations, especially product 
assembly
• “Comfort Zone” position 
• Usually seen when loads are being lifted from floor level 
or t work stations 
Observe work 
stations to make sure 
that the work is 
located well within 
reach. 
This can also greatly 
effect product quality 
and productivity
There are two positions s commonaly observed when tools 
are being used 
• “Tool/Target” position 
This can also result from working 
too high or to low. 
Look for this posture whenever 
tools are used
• “Elbow Out” 
This is most common 
where screwdrivers and 
pliers are used. 
It can also be observed 
when the product is being 
worked on or manipulated
There are two postures that are not seen as often but also 
can cause ergonomic injury/illness problems 
• “Hungry Head” position 
This usually the result of 
inspection and/or handling 
material. 
Look for this at work stations in 
final finish, maintenance and 
inspection areas
• “Sit-Stand” position 
• Usually seen when around conveyors and tables 
Observe work stations 
to make sure that there 
is adequate space for 
the feet and that there 
are no knee 
obstructions
• “Bad Vibes” 
• This is a problem that can occur with powered hand tools 
This can result from 
using pneumatic tools 
that are worn out. 
It can also occur when 
the work is performed 
on or around vibrating 
bins or feeders.
• “Don’t Give Me Static” position 
• This position occur when stationary positions are 
maintained. 
Look for instances of 
prolonged standing or 
holding. 
Static problems can also 
occur when carrying boxes 
or other objects.

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CTD

  • 1.
  • 2. Risk factors of CTD • Work does not have to be harmful if the limits of the human body are understood and not exceeded Example: You will not take your family car and roar down a country road banging through pot holes and screeching around corners. The mechanical stress would cause fatigue in parts of your car that would eventually cause serious damage • Just like cars, people have certain limits • If we work outside those limits we will cause fatigue in body parts, shortening their functional life • If we exceed the capacity of the body, the components will fatigue, become unreliable and eventually fail
  • 3. Risk factors: • Risk factors usually have their harmful effects on the operator in some combination Example: when we talk about a stressful posture, we imply that this posture is potentially harmful when it is used repeatedly (Risk factor = REPETTITIVENESS), normally in association with muscular exertion (risk factor = FORCEFULNESS)
  • 4. • Risk factors of concerned usually have their harmful effects through prolonged exposure. The injuries are mainly cumulative. • That means that they develop over a period of time, usually months or even years ‘chronic vs acute’
  • 5. Six general occupational risk factors: • Repetitiveness - Repeated or sustained exertions • Forceful Exertions - Also called forcefulness • Stressful Postures - Also called awkward postures • Mechanical Stress - Also called mechanical stress concentration • Temperature Extremes - The effect of heat and cold • Vibration - Both high and low frequencies
  • 6. REPETITIVENESS If you think of what is involved in many jobs you will realize that they often require the worker to constantly repeat certain sequences of movements or to maintain certain stressful postures for prolonged period of time. • Such movements or postures, which are normally harmless when used once in a while or briefly, may cause injury when they are used repeatedly on daily basis • Example: if we lightly squeeze a soft drink can with our hands. Initially the sides of the can crinkle, but it regain shape. – The force we applied was not strong enough to immediately destroy the can. However, if we repeatedly apply this same pressure say 15 to 20 times, the can will develop fatigue and tear apart
  • 7. The result of repetitive force HHaasssslele – – P Paainin - -I NINJJUURRYY • It is the same with the human body, but instead of 15 or 20 times, the frequency is measured in hundred and thousands of repetitions. • The repeated application of force that is not strong enough to cause immediate damage, but over time it will fatigue in the tissues. • This usually means that this job soon become a hassle. • After a period of time, there will be pain as the tissues involved (the skin, muscles, tendons, joint, ligaments, nerves, and blood vessels) are repeatedly rubbed, compressed and stretched from movement and exertion. • If these tissues are not allowed to recover, the cumulative damage will result in serious injury.
  • 8. • Unfortunately there are no precise guidelines for the rate of repeated or sustained exertions that would cause injury • The degree of stress and the resulting risk of injury depends on the kind of muscular movements involved and on the presence of other risk factors such as forcefulness and postures used.
  • 9. FORCEFUL EXERTIONS (FORCEFULNESS) • When you contract your muscles, you exert force in order to move your limbs, lift of hold an object, operate a tool, or maintain a posture. • As your muscles contract and relax, the tendons are stretched. They may rub or press on adjacent tissues. The degree of musculoskeletal strain depends on how much force you exert. FORCE = amount of work which the muscles, tendons, joints and adjacent tissues must do in order to perform the particular action. • The force exerted depends on a variety of factors, including posture, weight, friction and recovery time.
  • 10. Importance of force and posture You can perform work more efficiently with some postures than others. • In certain posture you have to exert more force to perform the same job. • Example; pinch grip requires more force than a hook grip. • To demonstrate yourself, compare what it feels like to pick up and hold a heavy book by the binding in two ways Between your thumb and the pads of your fingers, with your hand above the book Hooking your fingers under the book and holding it against your forearm Which is easier?
  • 11. Other factors to consider • The weight of load that has to be moved or manipulated is very important. • All things being equal, a heavier load requires a greater exertion, that is, more force to manipulate it • The friction of an object moved if it is also slippery, will require more force to keep it in your hand • Similarly, you will have to work harder to push a cart if your feet tend to slip on the floor than if your footing is secure
  • 12. Forceful Exertion • Although force, can be estimated by measuring the number of muscular exertions, there are no fixed guidelines for what degree of force is harmful. • As with repetitiveness, the hazard from force, depends on: – What part of the body is exerting the force – What kind of movement is involved – The presence of other risk factors, such as repeated exertions
  • 13. STRESSFUL POSTURES • Certain postures, when used repeatedly or when sustained, can be stressful to the structures of the body, especially when force is exerted. • posture is so critical to ergonomics and affects various parts of the body
  • 14. Hand postures in which the hand is wrapped around and object with continuous contact between the tip of the thumb and the fingers In which only the pads of thumb and fingers touch the object, is best for precision task Power grip Pinch grip USE POWER GRIP AVOID PINCH GRIP • Using a pinch grip when you have to exert a lot of force can result in pain and injury • Unless the work being performed is very precise, the pinch should be replace with power grip. • Also important to provide for a good grip of objects being handled. • Avoid slippery handles • Increase friction by providing tool handles with textures or coated handle coverings or by providing gloves with non-slip palms.
  • 15. Wrist posture • The least stressful posture for the wrist is called the neutral posture. • The wrist normally assumes this posture when your hand is hanging comfortably at your side.
  • 16. Wrist posture •Non-neutral wrist postures are potentially stressful Hyper-Extension (hand bent backward away from the palm) Flexion (hand bent toward the palm) Ulnar Deviation (hand bent toward the little finger) Radial Deviation (hand bent toward the thumb
  • 17. Important of hand and wrist posture: • Cumulative Trauma Disorders (CTD) of the upper extremities are “wear-and-tear” injuries that affect many people who do hand-sensitive work. Posture of hand and wrist that must be avoided
  • 18. SHOULDER POSTURES • Stressful postures of the shoulder can cause a significant reduction in endurance Awkward postures of the shoulder
  • 19. • All stressful postures result in strength reduction • Notice in the table below, that when the arms are fully extended, we are at our weakest EXTREME POSTURE % STRENGTH REDUCTION from NEUTRAL POSTURE Ulnar Wrist Deviation 25% Radial Wrist Deviation 20% Wrist Extension 25% Wrist Flexion 55% Arm Fully Extended 81% Floor Level Lift 40% High Vertical Lift 60% 45° Twist During Lift 15% 90° Twist During Lift 30%
  • 20. NECK POSTURES • Any improper neck postures may lead to muscles fatigue and/or headaches. •The neck is stresses by holding the tilted forward of backward more than 20° for extended period of time Neck ≤20° Backwards • Care must also be taken to prevent moving the head repeatedly from side to side and excessive twisting. • Stressful neck postures should not be repeated more than 2 times/min Sideways Twisted
  • 21. MECHANICAL STRESS • Mechanical stress is produced by the contact between some parts of the body and the sharp edges of tools, parts, work surfaces or work pieces (a) (b) (c) • Hand tools are common cause of mechanical stress. The figure above gives a good example of how a hand tool can compress finger tendons. (a) A sharp-edged tool (b) is more likely to produce injury than a rounded tool (c).
  • 22. Other parts of the body are also quite sensitive to mechanical stress. They include: • Backs and sides of fingers • Inside of wrist • Soft tissues of the thighs during prolonged sitting  Elbow (“funny bone”)  Armpit and chest  Tops of feet  Front of lower legs
  • 23. TEMPERATURE EXTREMES • Extremes of both cold and heat can be stressful • Skin temperature should not be allowed to fall below 68°F (20°C) due to contact with air, tool exhaust or cold materials • This conditions may impair the sense of touch and reduce dexterity in the hands. • When the hands are cold and numb, you tend to misjudge the amount of force necessary to perform a task. • Additional stress is created by a tendency to over-exert under these conditions.
  • 24. Extreme heat are harmful in two ways. First • Handling hot tools, surfaces or work pieces without protective gloves can result in burns Second • Environmental heat, especially if accompanied by high humidity, can increase the physiological strain during whole-body exertions. • This is because muscular activity produces heat. • The body can release most of this heat through perspiration under normal circumstances. • As the temperature in the air and humidity rise, the body must work harder to give off this heat. Various heat related disorders can result, among them are heat stress and heat stroke • NOTE: Work which can be performed easily in a comfortable temperature can cause excessive stress on the body in hot, humid working conditions.
  • 25. VIBRATION EXPOSURE MEDIUM EFFECT DESCRIPTION TO : Normally associated with people who drive vehicles, eg: fork trucks, platform trucks Increase an individual risk for back injuries • Back • Buttock Low-frequency vibration Can occur with the use of powered hand tools and impact tools Damage to the nerves, blood vessels and bones of the hands and arms Vibration • Hands
  • 26. PERSONAL RISK FACTORS • Also recognized as other factors. • Factors may affect an individuals overall risk for overexertion injuries: – Age – Fitness level – History of injury – Medical conditions – Smoking – Obesity – Gender – Physical structure
  • 27. The “HIT LIST” • A method of helping us become more aware and experienced in ergonomics is to summarize the most common risk factors seen in the plant. The Ergonomic “ Hit List”
  • 28. the Washrag. • It is a summary of the stressful hand and wrist postures making it very easy to spot Continuous movement of the wrist and hands, increase like likelihood of repetitive motion disorders
  • 29. There are three postures that commonly observes in the plant have a direct effect on the low-back • “Butts Up” position • It is the most common in the plant • A good indicator of risk for possible low-back problems Can be seen off-loading conveyors, pushing and positioning component carts lifting and loading material, etc
  • 30. • “ Horizontal Distance” • Usually seen when loads are being handled away from the body • This can put great forces on the spine Anytime there is a lack of clearance which prevents the worker from getting close to the load there will be trouble. Look for this around conveyors and tables
  • 31. • “Twist and Shout” • Usually seen when loads are being moved from one location to another. • The twisting motion puts extremely high forces on the lower back Look for transferring components or finished product from one surface to another such as off-loading conveyors, repetitive splicing type operations or transferring product from a conveyor to a pallet.
  • 32. There are two postures that are the result of failure to locate the work to be done in the proper place • “Shoulder Too High/Shoulder Too Low” position This usually the result of controls or tools located at the wrong height. Look for this at work stations, especially product assembly
  • 33. • “Comfort Zone” position • Usually seen when loads are being lifted from floor level or t work stations Observe work stations to make sure that the work is located well within reach. This can also greatly effect product quality and productivity
  • 34. There are two positions s commonaly observed when tools are being used • “Tool/Target” position This can also result from working too high or to low. Look for this posture whenever tools are used
  • 35. • “Elbow Out” This is most common where screwdrivers and pliers are used. It can also be observed when the product is being worked on or manipulated
  • 36. There are two postures that are not seen as often but also can cause ergonomic injury/illness problems • “Hungry Head” position This usually the result of inspection and/or handling material. Look for this at work stations in final finish, maintenance and inspection areas
  • 37. • “Sit-Stand” position • Usually seen when around conveyors and tables Observe work stations to make sure that there is adequate space for the feet and that there are no knee obstructions
  • 38. • “Bad Vibes” • This is a problem that can occur with powered hand tools This can result from using pneumatic tools that are worn out. It can also occur when the work is performed on or around vibrating bins or feeders.
  • 39. • “Don’t Give Me Static” position • This position occur when stationary positions are maintained. Look for instances of prolonged standing or holding. Static problems can also occur when carrying boxes or other objects.