Monthly Archives: February 2014

Helping Local High School

Roberts Hawaii Helps Themselves While Helping Local High School

Roberts Hawaii, the premier tour and transportation company in Hawaii has cooperated with a local high school to produce an in-house safety video for their drivers to learn better safety techniques in loading/off-loading baggage on their buses and vans.

Safety Manager, Jennifer Hill says, “The last picture is of me handing Waianae High School’s Searider Productions’ director our donation check for their help in the video’s production.  All the kids you see in the pictures are going to Florida next month for a national video production competition.  100% of our donation will be used for their trip.”

The video production titled, “Think Before You Lift” where company employees wrote and acted a script with various safety tips in handling baggage for their specific buses and vehicles.

Roberts Hawaii’s safety program includes a wide range of programs including injury prevention and management program implemented through Integrated Injury Management Service Inc.  Terry Lawson, PT, CAE, CEO of Integrated Injury Management is a kama’aina (long-time Hawaii resident), currently residing in California, has been working with Roberts Hawaii for over three years in developing this program. It is the first to be implemented state-wide, through local physical therapy clinics providing pre-employment/post-offer functional testing, fit-for-duty testing and Functional Capacity Evaluation (True Capacity Evaluations). All functional testing in the program is to determine the ability of workers to safely perform job tasks.

The local clinics participating are:

Concentra Medical Center/Physical Therapy-Honolulu, Oahu

Elite Physical Therapy and Sports Medicine-Wailuku, Maui

Club Rehab-Kona, Hawaii

“Think Before You LIft” is one in a series of cooperative video productions Roberts Hawaii has sponsored primarily for safety applications.  These productions by Roberts employees are very helpful to not only get the safety word out, but to get employees working together on projects to help themselves and their communities.  And it’s not hard to tell by the faces of the employees and student that they had a great time doing it.

All the best to the Waianae High School’s ‘Searider Productions’ as they take off to Florida for their national video production competition!

IS7A0721 IS7A0723 IS7A0596-1

Carpal Tunnel

Carpal Tunnel: Work or Not Work-Related? What’s Really Important…

I’ve read recent Linked In Work Comp Analysis Group comments regarding  Daniel Miller’s posting, “Carpal Tunnel Syndrome Often Misdiagnosed; Not Work-Related” with interest.  Obviously there is conflicting data and many opinions.

As an ergonomist-job analysis specialist and a 30-yr work-injury treating physical therapist with reasonable knowledge of the science and physiology as well as experience regarding mechanism of injuries typically called “carpal tunnel”, there is no question that repetitive motion to the extent called for in many job “causes” increased soft tissue friction, fatigue, inflammation, swelling and associated “mechanical-overcrowding” of structures, pain of whatever tissue or area involved.  In addition, surrounding body areas will experience supporting muscle fatigue, reactive postures compounding the problem.

These multiple variables cause diagnostic problems that most treaters attempt to oversimplify.  For example the common assumption of “carpal tunnel” with typical ineffective rehab treatment, surgery, and questionable outcomes, while ignoring other potential causes such as the other areas of the “triple-crush” chain (elbow, thoracic-outlet, cervical) for fear of “expanding the injury” an losing credibility or favor with referrers or payers.  An alternative would be to courageously address and educate on the underlying poor cervical posture will often eliminate the complaints of finger numbness and tingling and encourage better habits that will minimize future problems.

There is no doubt that “life-style” is a significant risk factor including not just additional personal time on the computer, smartphone, or tablet, but other common health risks such as diabetes, obesity, hypertension, lack of exercise, diet, etc…  These are also specific risk factors for musculoskeletal injury and conditions.

What is so sad is that despite the monstrous costs, incredible confusion and frustration including the mentioned scientific evidence that “carpal tunnel” is NOT work-related (although I obviously disagree in that generalization); despite all this:  Employers and their representatives continue to ignore the simple and common sense approaches to PREVENTING this conundrum.   Here are two that come to mind:

1. Legally and appropriately SCREEN-OUT new hire candidates with signs and symptoms of existing (pre-existing) repetitive motion conditions.  Yes, it is entirely legal and defensible when performed according to ADAAA/EEOC and state guidelines and RECOMMENDATIONS.  Studies have shown that:

  • 1/3 of CT cases occur in the first year of employment
  • 15% occur in the first 3 months of employment
  • Resulting in the new employer  paying for the previous employer’s problem (or the employee’s personal pre-existing non- work-related condition)

2. Implement early discomfort detection and treatment programs in line with OSHA guidelines and RECOMMENDATIONS. Treat employees as well as their ergonomic concerns and opportunities to interact and intervene BEFORE the inevitable “claim” and resulting antagonistic and costly sequelae.

Notice I didn’t say, “Go out and buy expensive ergonomic workstations for everybody in the company.”  Obviously very costly and it doesn’t help.  But don’t continue to hide your head in the sand or wring your hands and complain about these problems when there are simple and effective solutions.


  1. Don’t hire your next claim. Legally SCREEN-OUT those with pre-existing conditions that make them at risk or impending and significant harm to themselves or others.  Don’t buy trouble.
  2. Get expert advice on reasonably mitigating common injury mechanisms including such simple alternatives as: lifting with 2 people instead of one, job rotation-(switch to the other side of the assembly line 4 times per day, schedule switches between different machines, tasks, etc…), pre-shirt and in-shirt stretching and general fitness-type exercise to get the blood and lymph moving from problem areas
  3. Implement early detection and OSHA “first-aid” treatment programs.


Hundreds of the most well-known companies are using these simple methods with positive and documentable results.  With the high costs of each injury, preventing or mitigating just one will easily pay for all the above-mentioned programs with plenty left over.  Feel free to contact me for documentation or further information.


Terry Lawson, PT, CAE