From nursing-home attendants to cashiers, women in mostly low-paying jobs suffer a disproportionate share of the painful repetitive-stress injuries that the Occupational Safety and Health Administration's defeated workplace safety rules had aimed to reduce.
Although they comprise 46% of the work force in the U.S., women accounted for 64% of all repetitive-motion injuries that resulted in time off the job and were reported to the government in 1998, the latest year for which detailed statistics are available.
Labor unions made an issue of the gender-skewed numbers in a last-ditch effort to salvage the rules. They held out as victims women whose injuries are byproducts of repeating the same task for months and years on computers, at checkout counters and along assembly lines, often at workstations designed for the average-size man.
The ergonomics regulations installed by the Clinton administration would have required employers to make workers aware of musculoskeletal injuries and to redesign jobs that cause serious injury. Voting largely along party lines last week, Congress nullified the rules and President Bush has indicated he would support the rollback.
Opponents said the rules were costly and unnecessary because employers already have plenty of incentives to improve workplace safety and have redesigned many jobs. They also pointed to the decline in repetitive-stress injury, or RSI, cases over the last few years, a trend safety advocates say is skewed by workers' fear of reporting.
In characterizing ergonomics as a women's issue, labor unions reignited a workplace debate over what role gender-specific traits may play in susceptibility to repetitive stress injuries.
For workers such as Kim Johnson, a nursing assistant in a convalescent home, the debate on gender versus job is all but academic.
Johnson, a single mother in Compton who supports five children under the age of 12 on $7.98 an hour, spends much of her day squatting to crank beds up and down so patients can eat, bathe and rest. During her first year on the job, she had to take time off without pay when the pain in her swollen right knee became more than she could handle.
"It's a good job. But I had no idea it would be this stressful for my body. It's hard. I just take it one day at a time," said Johnson, 34.
Female nursing aides, orderlies and attendants are hardest hit by RSIs, according to an analysis of 1998 Bureau of Labor Statistics data by the AFL-CIO. Knee injuries are only the beginning. Back and shoulder injuries are common among caregivers whose primary duty is lifting patients to and from beds, bathtubs, wheelchairs and commodes.
It is a spine-crushing task. Literally. Each lift compresses the spinal cord with a force as great as that experienced by warehouse workers moving crates, said William Marras, a professor of industrial and systems engineering at Ohio State University.
Strength, size, age and anatomical gender differences all play a role in the number of lifts a person can tolerate before his or her body begins to break down, Marras said. But his studies have shown that almost everyone has a limit.
"In the case of patient handling, [gender] is not going to make a difference between having the problem and not having the problem," Marras said. "It's going to be bad for the men as well as the women."
Most adult patients weigh more than 75 pounds, the lifting limit many physicians and biomechanical experts believe is safe. To improve worker safety, nursing homes in Quebec, Canada, since 1992 have been required to install mechanical patient lifts during construction or renovation. A pilot program that equipped a few Washington state nursing homes with mechanical lifts achieved a 19% reduction in workers' compensation claims.
"We're going to pay one way or the other," said Don Chaffin, a leader in ergonomics research and professor of biomedical, industrial and operations engineering at the University of Michigan. "And I would rather have us pay for workplace improvements than pay the medical bills for these millions of workers in the next few years--not to mention the pain and suffering."
Long before ergonomics--the adaptation of jobs to human capabilities--emerged in Britain during World War II, workers were plagued by repetitive-motion injuries such as "washer woman's thumb," a condition recorded in the late 19th century.
Today, the most frequently reported RSI is carpal tunnel syndrome, a condition in which swelling in the wrists pinches a nerve, causing numbness and burning in the fingers and hands.
"It's like your hands are on fire. It's just excruciating," said Debbie Teske, a Maryland resident, who developed carpal tunnel in both hands while working as a telephone company service representative. "For people who've never had carpal tunnel, I tell them it's like having a tooth drilled into the nerve."