* Photo by B. Candace Ray. Repetitive strain: Crane operator Irvin Villanueva spends his days looking up and needs to maintain his centre of gravity to avoid the load on the soft tissues in the neck and shoulder girdle.
* Photo by B. Candace Ray. Repetitive strain: Crane operator Irvin Villanueva spends his days looking up and needs to maintain his centre of gravity to avoid the load on the soft tissues in the neck and shoulder girdle.
Construction workers daily expose themselves to risks to health. The various hazards associated with the construction industry can be divided into: ergonomic, physical, chemical and biological.

In my field of sports and musculoskeletal medicine, I'm not likely to see workers with chemical or biological exposure, but I do see some with ergonomic and physical complaints.

Ergonomic hazards constitute the largest group of all the hazards, so are important and include highly repetitive tasks, awkward grips and postures, heavy and frequent lifting and overexertion.

Sometimes, it's a simple matter of using the wrong tools for the job or the right ones improperly.

Physical hazards include vibration - either whole body, as in pile drivers and excavators, or hand-arm vibration, as in pneumatic drills and jackhammers - noise and temperature extremes.

With heat being the obvious problem here in Bermuda, keeping hydrated is extremely important.

Construction workers and manual labourers are susceptible to musculoskeletal disorders from simple strains and sprains to tendonitis, lower back pain, carpel tunnel and fatigue. Some workers are exposed to several hazards simultaneously, which increase the risk of problems.

There's some evidence to suggest that those workers with no pre-existing spinal or disc problems will experience a 'sports specific' training effect, i.e. the soft tissues - muscles, ligaments and discs - will strengthen according to the repeated forces placed on them and thus make them actually less susceptible to injury.

The fit and strong soccer player is less likely to injure him or herself than an unfit and weak one.

Once there is significant existing disc and other pathology, then of course the risks increase.

However, for every construction worker that I might see with a low back problem, I'll see many more similarly afflicted sedentary office workers.

The jackhammer or pneumatic drill operator is subjected to hand-arm vibration, and susceptible to carpel tunnel syndrome (pinching of the median or 'middle' nerve as it passes through a tunnel in the central wrist towards the fingers) and even pinched nerves in the neck.

Some workers may benefit from special gloves, but the emphasis should also be on avoiding awkward hammer and drill positions where possible, taking adequate breaks and stretching the affected area.

The body is wonderfully designed to be in many, many different positions, but not necessarily any one position for a long period of time.

A crane operator spending much of the day looking up will be moving the neck into an extended posture, and any posture away from the natural centre of gravity will create extra load on the soft tissues in the neck and shoulder girdle.

Some operators, especially those with pre-existing lower neck degeneration, may be susceptible to pinched nerves as a bulging disc and thickened neck joints mechanically close off holes in the cervical spine (neck) where the nerves exit.

Sitting more erect in the cab and bringing the top of the breastplate higher can help to move the neck into a better position.

Sustained postures with the head down can be aggravating to the neck also, as again the motion is away from the centre of gravity and so the muscles at the back of the neck will be working much harder.

Any worker faced with sustained awkward postures should take adequate breaks and vary the tasks being performed where this is feasible.

Done properly, a balance needs to be achieved between good work performance on the job site and avoidance of potential injury.

Injury could put that worker off for prolonged periods, with the attendant economic and social implications. It is vastly better to avoid injury in the first place (as in the fence at the top of the cliff) than wait until injury occurs.

Some of the repetitive stress injuries can be complex, very difficult to treat and take a long time to resolve.

Most workers know how to lift properly - straight back and bent knees, keeping the object as close as possible - but may find themselves lifting awkward objects where correct posture is difficult.

Others may be the 'bull in a china store' and rush in to do heavy lifting on their own, where waiting a couple of minutes for help would be the sensible move.

For those with a history of problems, wearing a good lumbar support may provide a little protection and serve as a psychological reminder to be careful with the back. They should take the time to lift and 'engage' the core trunk muscles.

Physiotherapists are able to guide workers with appropriate core (deep abdominal and back muscle) exercises should they be struggling to deal with back problems, although the doctor may need to arrange an X-ray or scan if the problem is particularly difficult. Depending on the case - as with all injuries - manual therapy, specialized massage therapy or even acupuncture may be appropriate.

Shoulder problems are common in those doing shoulder driven activities from sport to construction.

In the construction industry, overhead lifting or painting may be the precipitating factor.

Generally the shoulder is stable with lifting done with the elbows near the sides, but not if the elbows are reaching above the horizontal.

As workers get older, they are more susceptible to injury here, particularly with respect to the rotator cuff muscles.

Physiotherapy can be of value in stabilizing the shoulder blade and taking mechanical load off the rotator cuff.

Acute strains and sprains obviously need rest, ice and possibly splinting in the immediate post injury phase.

Whatever their speciality and associated risks, all construction workers would benefit from engaging the core, avoiding awkward positions, varying tasks where feasible, taking adequate breaks, keeping hydrated and stretching affected areas. For further information, sports and orthopaedic physician Dr. Annabel Carter can be contacted at 292-6901.