Case history:

Ms T is a 35 year old school cleaner who has worked in her role for 12 years.

Around four years ago additional classrooms were added to the school, increasing the cleaning demand, this work was expected to be completed within a similar time frame.

Ms T attributes this as a contributing factor to her developing elbow and forearm pain around two years ago. Initially the pain was mild, but it gradually increased over time. Aggravating factors included vacuuming, mopping, wringing out cloths and using trigger spray bottles.

Ms T did not report her pain until recently, at which time her problem was diagnosed as bilateral tennis elbow.

Upon reporting her injury she was put off work for a week before returning to work on reduced hours and alternative administration duties. She performed these duties well, but the position was short term and only available for eight weeks.

Upon completion of these duties, Ms T applied for a position as an office clerk at the school, which she is currently undertaking on a trial basis.

She is undertaking massage treatment and was provided with a forearm brace, but does not believe either is providing assistance.

She has been able to continue to perform most domestic tasks, but can no longer participate in her sewing hobby due to soreness with gripping the fabric.

Her inability to perform normal work and social tasks has resulted in some anxiety about her work prospects for the future, and her ability to provide for her family.

Key Learnings:

Delaying an injury report makes the injury more difficult to overcome.

In general, the longer a musculoskeletal problem has been present, the longer it takes to improve. This lady has had soreness in her forearms for close to two years and it is highly likely it will take a year or two for their problem to settle.

Early reporting systems need to be well structured to be effective. Important elements of early reporting systems include:

A) Letting staff know about early reporting

• At induction
• Ongoing education
• Encouraging supervisors to encourage early reporting

B) A streamlined reporting process that is clear to all

• A 1300 number for a large organisation
• Clarity about who the reports should be made to
• A streamlined incident reporting system
• Supervisors take reports seriously

C) Staff will avoid early reporting if the consequences turn out to be negative. Successful early reporting systems provide:

• • Positive support to reporting problems
  • Pragmatic solutions that keep people in their job
  • An accepting approach, ie accept if a person says they have a problem, then that is the case.

Early identification of her problem may have prevented the problem developing to the extent where medical restrictions were needed. Early identification of the problem can be followed by education about different ways of completing the job. A professional tennis player changes the way he or she hits their backstrokes so they don't need to stop playing tennis for a year.

Modifying the way the job is done can include learning to do the job in a different way together with modification of the equipment used. The following are some examples:

• Regular rotation of task, eg mopping for 20 minutes followed by cleaning a bathroom
• Using a different grip, such as a looser grip on the mop
• Changing the handles of commonly used equipment, to take the pressure off the relevant part of the forearm (the cleaning suppliers may be able to help, alternatively an Occupational Therapist could advise on appropriate equipment)
• Identifying equipment that does not require as much force

For example, Ms T said that when using the mop she did a side to side motion. A back and forth motion would have placed less demand on the affected group of muscles in her forearm.

It is also likely that Ms T could have identified other changes that would have helped her arms in the early stages.

This case is a good example of something that could have been prevented by a strong focus on early reporting of problems.