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Avoiding the pain and injury of restaurant work

Restaurant work can, over time, throw a body out of whack. And bodies out of whack mean managers under stress from employees who aren’t at the top of their game, who miss work to nurse their aches and pains, and who may file costly workers compensation claims. Acute injuries (resulting from a specific accident or event) in this industry have been on the decline, according to the National Restaurant Association. What’s more, two-thirds of injuries and illnesses reported among eating-and-drinking place workers in 2004 resulted in no lost workdays. That’s good news, but what’s tougher to measure are the injuries that creep up gradually and tend to get ignored.

Restaurant work can, over time, throw a body out of whack. And bodies out of whack mean managers under stress from employees who aren’t at the top of their game, who miss work to nurse their aches and pains, and who may file costly workers compensation claims.

Acute injuries (resulting from a specific accident or event) in this industry have been on the decline, according to the National Restaurant Association. What’s more, two-thirds of injuries and illnesses reported among eating-and-drinking place workers in 2004 resulted in no lost workdays. That’s good news, but what’s tougher to measure are the injuries that creep up gradually and tend to get ignored. Aspirin and adrenaline keep them at bay for a while, but left untended they can cause chronic problems.

The five major problem areas are hands, shoulders, lower back, knees and feet. Here’s advice on keeping your employees off the DL and on the playing field.

Hands

Temporary and occasional wrist/ thumb pain probably isn’t anything to worry about. But if employees complain about it frequently, and it won’t go away even when they’ve had a few days off, it’s time to have it checked out. “What happens, especially in an industry like foodservice where schedules can be crazy and many part-time workers don’t have insurance, is that they’ll ignore it, pop an Advil and just live with it,” says Stacey Doyon, president-elect of the American Society of Hand Therapists. “But it’s so much harder to treat four months down the road than it is two weeks into it. Managers need to tune in. If they see someone shaking out their hand or grabbing their hand a lot—especially employees in the more-susceptible 30 to 50 age range—they need to ask what’s going on.”

Tendonitis is inflammation of the tendons, the rope-like structures that go from the muscle in the forearm to the fingers and hands. “They glide back and forth over and over again as the muscles contract, enabling the fingers and hands to move,” explains Dr. Ed Toriello, a New York-based orthopedic surgeon and spokesperson for the American Academy of Orthopedic Surgeons. “When they grind back and forth excessively, it’s like a rope that will fray and ultimately tear. That’s what can happen when someone is consistently doing a lot of lifting and holding things in an awkward way—such as serving heavy dinner plates with the thumb leveraging the weight, or chopping vegetables for long periods. The effect is cumulative.”

Doyon says tendonitis is more common and easier to treat than carpal tunnel syndrome, another wrist malady. “Initial symptoms of carpal tunnel syndrome are numbness and tingling on the palm side of your hand and in the thumb, index and middle fingers primarily. It happens when you have your wrist bent back or down for extreme periods of time or a lot during the day. The nerves get irritated because they get kinked. Later on, it can cause weakness and pain, which usually becomes much worse at night.”

Watch out for ...

Tendonitis occurs both in the wrist and the thumb; carpal tunnel syndrome is in the wrist

Prevention tips

  • Train your employees to stop trying to carry everything all in one trip.
  • Provide support staff to servers who are delivering food to large tables. The same goes for clearing off those tables.
  • Watch how staffers carry things and recommend changes if they’re putting themselves at risk. Heavy trays and plates should be balanced on the palm for better weight distribution, for instance, instead of being grasped by the edges with fingers and thumb.
  • In the kitchen, make sure that one person doesn’t always get stuck chopping vegetables for hours on end. And encourage the crew to take frequent breaks from tasks requiring such repetitive hand motions.
  • Provide information on a variety of stretches and exercises that employees can do to build strength and flexibility in their wrists and hands.
  • For those whose jobs require repetitive hand motions, avoid scheduling multiple consecutive long shifts.

How to feel better

When tendonitis hits, experts say the best medicine is rest, icing the area (15 minutes at a time, with a towel or other barrier between the ice and the skin) and taking non-steroidal anti-inflammatory pain relievers such as aspirin or ibuprofen. These measures, plus gentle stretching exercises to keep nutrient-rich blood flowing to the afflicted area, should take care of the problem. For early-stage carpal tunnel syndrome, the same types of pain relievers help, as can splinting the wrist throughout the night. For late-stage carpal tunnel syndrome, surgery typically is required.

Shoulders

The most movable joint in the body, the shoulder is also one of the most unstable. According to the Centers for Disease Control and Prevention, 14 million Americans a year seek medical care for shoulder problems.

The shoulder has three bones—collarbone, shoulder blade and upper arm bone—and two joints to facilitate movement. Muscles, tendons and ligaments hold the bones in place and soft tissues, like the bursae, permit gliding between bones, muscles and tendons.

Natural, age-related degeneration of such soft tissues is the primary source of shoulder discomfort, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. But overuse can cause injuries and contribute to early degeneration.

“Carrying heavy loads, day after day, can certainly result in shoulder discomfort and injuries,” says Toriello. “For most restaurant workers with this problem, it’s likely tendon-related.” Bursitis, or inflammation of the bursa sacs that protect the shoulder, may also occur.

Signs include discomfort and pain in the upper shoulder or upper third of the arm. Tendonitis and bursitis also cause pain when the arm is lifted.

Watch out for ...

Tendonitis, bursitis, arthritis

Prevention tips

  • Don’t let servers or bussers overload trays or try to carry too much at once.
  • Train servers to carry loaded trays perched over their shoulder, not with their arms extended out in front of their bodies. Doing so, Toriello says, “gets the load as close as possible to the axis of your body, your spine, which is meant to carry things.”
  • Encourage servers to vary the shoulder. “If they always carry on the same side the weight will start to throw them off and they’ll get aches and pains on that side.”

How to feel better

Staffers can reduce pain and inflammation with rest, applying ice and by taking anti-inflammatory medicines such as aspirin and ibuprofen. In some cases, a doctor or therapist may use ultrasound to warm deep tissues and improve blood flow. Gentle stretching and strengthening exercises are added gradually. If there’s still no improvement, cortisone injections may have to follow. And a final option is surgery.

Shoulder exercises

  • Stand, lean over and dangle your sore arm. Move the arm in a circular motion, beginning with small circles, then bigger ones. Repeat 5 to 10 times a day. Stop if you have pain.
  • Loop a piece of rubber tubing around a doorknob. Bend your arm 90° and grab the loop of the tubing, then pull across your stomach 10 times. Up the number as the pain lessens.
  • When your pain subsides, try upper body weight-lifting. Lie on your side. With a weight in your hand and forearm across the stomach, raise your forearm. Keep your elbow near your side.

Knees

Slipping on a wet floor or a stray string bean can wreak havoc on the knee in the form of sprains and muscle tears. Such acute injuries demand immediate attention and, with proper care, will usually heal themselves. Injuries due to daily wear and tear can be easier to ignore, but still need attention.

The largest joint in the body, the knee is made up of the lower end of the femur (thigh bone) and the upper end of the tibia (shin bone). The kneecap slides along a groove on the femur and covers the front of the joint. Cushioning the spaces between the bones are the cartilage and meniscus, which act as shock absorbers during movement. Various muscles and ligaments support the knee, providing strength and stability to the joint.

“What happens with athletes and many people in jobs where they’re on their feet all the time, carrying heavy loads, squatting, moving quickly and pivoting within small spaces is ‘overuse syndrome,’” says Dr. Kristine Clark, director of sports nutrition for Penn State University’s athletic department and nutritionist for the U.S. Women’s Olympic Gold Medal Soccer Team. “In weight-bearing joints like the knee, it causes degradation of the cartilage and meniscus, the soft tissues between the bones. If you’re overweight, the effect is even worse. It’s cumulative, and eventually leads to inflammation, pain and discomfort. These joints are where osteoarthritis appears first.”

Watch out for ...

Sprains, muscle tears, overuse syndrome

Prevention tips

  • Make sure your uniform requirements include comfortable shoes with good support and traction. Over-the-counter shoe inserts can help, as well.
  • For female employees, uniform recommendations should include full support hose.
  • Encourage employee wellness. Excess weight puts excess stress on knee joints, and smoking exacerbates the problem.
  • Discourage carrying too much at once, particularly if stairs are involved.
  • Evaluate employee work stations. Could they be better arranged to minimize motions like squatting and pivoting?
  • Strengthening and flexibility exercises may help employees with knee pain. “Knee injuries often have to do with loss of cartilage,” notes Clark. “The temptation can be to just rest the knee, but there are no blood vessels in cartilage and therefore physical activity stimulates blood flow. That’s the only way to carry important nutrients to the area.”
  • Supplements may help. Among those most recommended for joint problems are Glucosamine, Chondroitin sulfate and Collagen Hydrolysate, or CH-Alpha (see sidebar).

How to feel better

Acute knee injuries call for R.I.C.E.—rest, icing the area 20 to 30 minutes every couple of hours, compressing the knee by wrapping it snugly with a bandage and elevating the leg to reduce swelling and minimize the development of scar tissue. For knees suffering from overuse syndrome, anti-inflammatory pain relievers can help get employees through, and joint health supplements may help. However, as Toriello points out, “Once cartilage is gone, it’s gone, so the best way to cure this problem is to prevent it from occurring in the first place.”

Back

Slips and falls can throw the back out, and they’re not uncommon in restaurant settings. But chronic, work-related back problems often have more to do with regular, ongoing strain on the muscles that support the spine. This is where lifestyle and total body health play especially critical roles.

“Back pain and smoking are very closely related,” Toriello says. “A key to preventing back problems is to not smoke. The worst thing an employee can do is take a break, step outside and stand around having a cigarette. They should try to get their legs up at least above their hips when they take a break. And smoking causes vasal constriction.”

Being overweight is another big factor, particularly for employees who are constantly on their feet.

While muscle strains are most common, other conditions, such as herniated disks, can occur, as well. Disks sit between and help to cushion the vertebrae of the spine. Herniation, or rupture, is often the result of gradual, aging-related, degenerative processes but it can be brought on by the same factors that cause back muscle strain. Once a disk ruptures, the most common complaint is sharp or throbbing pain in the back and shooting pain down the leg.

If the damaged disk is in the center or lower part of the back, numbness, tingling and weakness in the buttocks, legs or feet may occur.

Watch out for ...

Muscle strains, herniated disks

Prevention tips

  • Strengthen abdominal muscles to support the back. That’s as easy as doing crunches and sit-ups at home.
  • Don’t smoke.
  • Stay aerobically fit; you’ll “have far less back pain,” Toriello says.
  • Bend and lift by squatting from the knees, not bending over from the back. Leg muscles are stronger than back muscles.
  • Keep heavy loads as close to the body as possible, versus carrying with arms extended.
  • Spread the weight around when loading trays, putting the heaviest things closest to the body.

How to feel better

“Severe back pain is debilitating. Employees have to take time off,” says Toriello. “They may have to work with a physical therapist to learn how to treat it, the right ways of lifting and moving on the job. For pain that’s not so debilitating, anti-inflammatory medicines, hot or cold packs, back [and] abdominal exercises and a commitment to a healthy lifestyle should get them back on track. Low-impact exercises like yoga and Pilates can help.” For herniated disks that don’t respond to treatment, surgery may be required.

Back exercises

  • Lie on your back, either on the floor or other firm surface. Bend your knees and keep your feet flat on the surface.
  • Pull your abdominal muscles up and in; this will flatten your back to the floor.
  • Raise one knee up toward your chest, then hold this position for several seconds. Now lower your leg back to the tarting position and repeat on your opposite knee.
  • Raise one knee up toward your chest, then straighten the knee. Hold this position for several seconds, then slowly lower the leg back to the starting position. Repeat on your opposite leg.
  • Raise your leg and keep the knee straight. Hold this position for several seconds, then slowly lower the leg back to the floor. Repeat on your opposite leg.

Feet

The buck stops here. The feet bear the greatest load and take the most abuse. According to a recent survey by the American Podiatric Medical Association, nearly half of Americans experience a foot ailment at some point in their lives. For restaurant employees, that percentage is likely higher.

The foot has dozens of bones, joints, muscles, nerves, blood vessels, tendons and layers of fascia (connective tissue). The bones form arches that are supported by ligaments and muscles. These arches contribute to the strength, stability, mobility and resiliency of the foot by acting as shock absorbers, spreading energy before it’s transferred higher up the leg.

When arches “fall,” or flatten out, their shock-absorbing ability falls, too. This affects not just the feet, but the knees, hips and spine. Fallen arches also change the position of the knee and hip, which makes them more vulnerable to injury from working on your feet, according to the Occupational Health Clinics for Ontario Workers.

It comes down to gravity, which squeezes the protective fluids out of your joints. Without those fluids and circulation, the joints can become malnourished and inflamed, leading to discomfort and possibly other, more debilitating conditions. The Mayo Clinic names plantar fasciitis (burning or stabbing pain in the heel and arch) and metatarsalgia (pain and inflammation in the ball of the foot) as two of the most common foot maladies suffered by people who spend too much time working on their feet.

Fortunately, nagging and even serious foot discomfort can often be linked to one very avoidable cause: low-quality shoes that don’t provide support or don’t fit properly. Managers should insist that their crews are appropriately attired from the bottom up. Those fashionably flimsy little flats the host insists on wearing and the line chef’s worn-out comfy sneakers have simply got to go.

Watch out for ...

Fallen arches, plantar fasciitis and metatarsalgia

Prevention tips

  • Make good-quality, comfortable shoes with good arch support and non-slip soles a required part of the work uniform.
  • Discourage carrying too much at once to reduce stress on the feet and other joints.
  • For employees with foot discomfort, recommend they try over-the-counter, shock-absorbing shoe inserts, heel cups or foot pads to ease the pain.
  • Encourage employee wellness. Excess weight puts excess stress on feet, and smoking exacerbates the problem.
  • Provide a place where employees can get off their feet for breaks.

How to feel better

For nagging foot pain, non-steroidal anti-inflammatory pain relievers should provide temporary relief. For pain that’s more intense, rest, icing and stretching exercises may take care of the problem. Plantar fasciitis, for instance, benefits from simple exercises like rolling the foot back and forth over a large can of frozen juice concentrate. For more severe cases, podiatrists may recommend night splints, orthotics (custom-fitted shoe inserts), athletic tape to support the bottom of the foot, or stretching exercises to strengthen the lower leg muscles and stabilize the ankle and foot.

Can supplements help?

If joint pain is sidelining your crew, dietary supplements specifically formulated for joint problems can sometimes help. The most well-known are Glucosamine and Chondroitin sulfate, each found naturally in cartilage. Studies show they can help make the tissue shock-resistant, and can benefit people with arthritis symptoms. But they don’t go to the heart of the problem—loss of cartilage from overuse, says Penn State’s Clark.

One newer supplement that does is Collagen Hydrolysate (sold as CH-Alpha), which Clark maintains could be a breakthrough for joint-pain sufferers. “Studies show that CH-Alpha actually does regenerate cartilage,” she says. “It gets to the heart of the problem. It takes four to six weeks to start getting results, and you must take it consistently, but all of the studies are very promising.”

CH-Alpha is ingested in liquid, 10-gram doses that can be blended into a drink; it’s sold over the counter or online at www.chalpha.com. Clark cautions that some products may list CH-Alpha as an ingredient, but if they don’t contain the full 10-gram dose, don’t bother.

Eat right and don’t smoke

Experts advocate a healthy lifestyle as the best way to keep job-related joint aches and pains at bay. That means eating a diet rich in fruits and vegetables as well as “good fats,” contained in things like olive oil, avocados and almonds. It means exercising, stretching for flexibility and maintaining a healthy body weight to lighten the load on weight-bearing joints. If your crew members are overweight, snacking on pastries, bread and butter, and grilling off the steak trimmings every day, they’re more susceptible to injury.

And if those same employees are stepping out for a smoke at break, the problem is compounded. Not only does it mess up their lungs, it also cuts the amount of oxygen in the blood and constricts veins, which decreases delivery of blood throughout the body. As such, it robs the body of nutrients, says Penn State’s Clark.  “Smoking greatly increases the risk for nutrient deficiencies, especially vitamin C,” she says. “That’s a very important vitamin for collagen formation, and collagen is the primary ingredient in cartilage.”

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