EXPERTS DISPUTE 'EPIDEMIC' OF STRAIN DISORDERS

CINCINNATI-A 7% decrease in cumulative trauma disorders between 1995 and 1994, reported by the Bureau of Labor Statistics earlier this year, should put to rest any talk of an "epidemic," an employer representative says.

"We don't know why this dramatic decrease occurred, but it reinforces the fact that we do not yet have enough information to impose a standard program on industry at this time," said P.J. Edington, executive director of the Center for Office Technology.

The Alexandria, Va.-based COT is an association of employers and manufacturers dedicated to improving the office working environment and promoting informed approaches to safety and health issues associated with computers and office technology.

Nevertheless, "these encouraging figures should not minimize the importance of these injuries nor the need to continue ergonomics research," Ms. Edington said in a statement released at a recent conference, "Managing Ergonomics in the 1990s," in Cincinnati.

"In fact, more research is vital because current scientific literature does not explain why one employee working next to another performing the same activities may suffer discomfort or pain from a repetitive motion while the other does not," she said.

Numerous other occupational injury and ergonomics experts speaking at the conference shared Ms. Edington's opinion.

"There isn't any way to predict which worker is at risk to develop a back injury," according to Dr. William Lauerman, associate professor of orthopedic surgery and chief of spine surgery at Georgetown University Medical Center in Washington.

For the most part, musculoskeletal abnormalities detected on X-rays and with magnetic resonance imaging, or MRIs, are not predictive of low-back pain, he said.

"X-rays are overdone," he said. "It would take 2,000 X-rays to have one that materially impacts on treatment decision-making."

Many people have musculoskeletal abnormalities without symptoms while others with pain have no abnormalities.

In addition, 20% of people between the ages of 20 and 40 will have a herniated disk on an MRI, but only a fraction of those will have pain, Dr. Lauerman said.

At the same time, a person with pain may not have a herniated disk at all, he added.

Whether such injuries can definitively be attributed to the workplace also is a subject of much debate.

For example, Dr. Dean S. Louis, professor of surgery at the American Society for Surgery of the Hand in Ann Arbor, Mich., suggested that many so-called cumulative trauma disorders actually are part of the normal aging process.

"There is no proof that work causes disease," he said. "There is a whole host of lifestyle choices that make a person susceptible to injury."

But changes in the way health care is financed in this country are forcing many physicians to say an injury is work-related just so the patient receives adequate treatment, according to Dr. Louis.

Physicians in managed care plans are encouraged to push injuries into the workers compensation arena to keep group health plan costs down, he said.

And media reports about the growth of cumulative trauma disorders-carpal tunnel syndrome in particular-also are contributing to the "epidemic," Dr. Louis said.

"The psychosocial epidemic called RSI (repetitive stress injury) occurred in Australia in the early 1980s," he recalled. "Patients who were told they had RSI believed it was a disease and considered their symptoms as something other than the transient aches and pains of daily life. When compensability was denied, the epidemic ceased."