WOlDen: (N ot) The Weaker Sex at Work? SUSAN J. ISERNHAGEN Isernhagen & Associates, Inc., Duluth, Minnesota

Women~ role has developed and changed dramatically in the last twenty years. Women now are prevalent in the work Jorce and assuming work tasks not in their traditional pattern. Society and work injury managers are beginning to come to terms with women as a gender (different Jrom men), women~ specific strengths and weaknesses, andJemale oriented work injury problems. Science and logic blend to produce a clearer picture oj women~ physical parameters related to work.

Keywords: Maximum voluntary capacity; Strength; Endurance; Anthropometrics; Myofascial

In traditional animal and human roles, the female possessed the nesting instincts, bore the young, raised the family, and nurtured the family group. The male traditionally foraged for food, protected against other species or wild animals, and directed the family unit, strongly taking the leadership role linked with life-saving, life-protecting missions. As modern society developed, the female continued to be the nurturer, the child raiser, and the family organizer, keeping all detailed aspects of the family unit in order. The male continued to be the breadwinner, the decision maker, and the authority figure. Within the last 20 years there has been a tremendous shift, with both anthropological and cultural changes in the roles of men and women. While this shift has taken on many social meanings, it also is relevant for the new role of the woman as "the industrial worker."

Women are now seen as breadwinners, often as single parents who are responsible for all aspects of the family's well-being. In addition, some women have gravitated to jobs formerly held by men, including those involving heavy manual labor. Many women have continued to do traditional women's work of the "nurturing" type, such as sewing, assembling, keyboarding, communicating, and managing details on an organizational level. How has this recent thrust of women into the workplace changed the physical demands on women and thus changed the pressures in the workplace with which professionals must now cope? Do women possess strengths and weaknesses that, when taken out of their "home" aspects, create negative pressures? Can women use their positive aspects to bring quality and productivity to the workplace? WORK 1994; 4(2):114-119 Copyright © 1994 by Butterworth-Heinemann

Women: (Not) The Weaker Sex at Work?

WOMEN'S PHYSICAL MATCHING TO THE JOB Women are physically different from men in ways that create mismatches with workplaces that are designed by and for men. In addition, many of the "new" service and light-assembly jobs take advantage of women's abilities and create stress to the point that even these abilities may become less useful. What are some of the physical differences that separate women from men and give them different attributes on the job?

Strength Depending on the muscle groups being tested, women's strength is 60-70 % of men's strength (Cress and Schultz, 1985; Brown and Rose, 1985; Timm, 1988; Payton and Poland, 1983; Kaufman, 1982). This discrepancy allows, in general, a lesser maximum voluntary capacity (MVC) for jobs that require strength. In jobs that require repetitious strength activities, women use a higher percentage of MVC than men. For example: In a lifting task on a loading dock, with 30 pounds frequent lift, average men's capacity on the job is 90 pounds; 30 pounds, therefore, is 33% MVC, which is well within a range for this repetitive work. Women's average maximum strength on the job is 60 pounds, thus creating a load of 50 % MVC. This level may be inadequate or on the low end of tolerance for repetitious activity. Because percent MVC is important in calculating fatigue, susceptibility in injury, and longitudinal strength abilities on the job (Rodgers, 1988), it is clear that average women, placed in a job with strength requirements designed for men will constantly work at higher MVC. They face a significantly higher risk of injury and may be unable to do the job on a continuous basis. The answer to this strength dilemma lies in using simple ergonomics to reduce the load - in other words, using brains rather than brawn. The outcome for both men and women will be a reduction in the stressors on the body.

Endurance Women have traditionally had endurance levels equal to or better than men. In strength testing

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women have excellent endurance levels in lighter repetitious activities (Timm, 1988; Payton and Poland, 1983). These endurance levels may be partially physiologically caused as a means to overcome strength discrepancies between men and women. Women's work has traditionally been continuous, ongoing work rather than activities that require strength. There may be evidence, therefore, that women do as well as, if not better than, men in endurance-related activities. In typical women's jobs, endurance activities are often stressed over strength activities in job application or placement.

Bone While both men and women have calcium and mineral loss (osteoporosis) with aging, women have significant losses earlier than men (Raab and Smith, 1985; Krolner and Toft, 1983). The loss of calcium and minerals, coupled with a decrease in bone density, means that women age sooner than men. Their bones are less strong, with a lower mineral content. Women begin to lose bone minerals beginning at age 40. This osteoporotic condition, which becomes more evident as women reach their 50s and 60s, creates musculoskeletal problems that are not linked with work but that can impact on work when pain, postural positioning, and other issues arise. Men, on the other hand, do not see significant bone mineral loss until around age 70, well beyond their working years.

Coordination In coordination tests of different types, women scored as well as men; in some hand coordination tests they scored better (Nygard, Luopajarvi, and Limarinen, 1988). Basic coordination appeared to be similar among women and men, but women's attention to detail and their good endurance levels may give them the edge in upper-extremity motor coordination. In addition, women tend to have smaller hands that allow them to manipulate small objects competently. Therefore, women have a positive relationship with small hand-coordination tasks. However, if strength and coordination factors are combined, the greater strength of men may mean a higher level of competency than

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women in jobs that require strong hand-tool use. Therefore, for the types of coordination activities that require hand coordination, women may have a physical edge in the lighter, fine hand-coordination tasks compared to men, who are better in the strength-related hand-tool and -coordination activities.

Hormonal Changes Men's hormonal changes related to aging are gradual and do not appear to be a major factor in on-the-job injury rate or in other work aspects. Women, on the other hand, have known hormonal changes that begin beyond age 40 and that escalate beyond age 50. Therefore, some particular risk issues faced by women are linked with hormonal changes. An analysis of risk factors for carpal tunnel syndrome indicate that swelling that can accompany hormonal changes may cause at least temporary symptoms of median nerve compression (Putz-Anderson, 1988). These hormonal changes in women are normal and must not be negatively viewed. Yet they must be acknowledged because women must note changes that are impacted by work. Women who recognize and understand changes in their physical health can lessen the impact these changes have on their work. While not strictly physical in nature, women are often targeted for comment regarding monthly hormonal changes and their effect on decisionmaking abilities. While this mayor may not be true on an individual basis, it is ludicrous to bring this up as a work-related issue. The effects of testosterone on males are well known regarding aggressiveness, confrontation, and other characteristics, which are also hormonal in nature. Hormonal issues for men are almost never discussed in the same way that hormonal aspects of women's behavior are discussed. Therefore, discussion on the hormonal aspects of men and women's behavior does not have a place in workplace evaluation, unless it is done on an equal basis and is handled in a way that also brings an understanding of significant individual ability to cope with these hormonal issues. Therefore, the mood aspect of hormonal work factors is not appropriate for dis-

cussion at this point because this has not been given sufficient research and individual variations are not understood very well.

Balance Good balance is necessary for proper body mechanics and movement safety in the workplace. Women may be at a disadvantage because as they get older they tend to have increased postural sway (Kaufman, 1987). This increased sway, coupled with the normal aging change of slowed reaction time, may lead women in older age groups to be slightly more susceptible to falls or balance loss. In general, decreased balance is noted beyond age 40, and it becomes more pronounced at age 60 and older. While men have decreased balance with aging, it appears later in the aging process and thus may not affect their work. Careful ergonomic planning can be used to overcome this mild difference in gender balance. The implication is one of modification, recognizing that there may be an innate difference between the needs of women and the needs of men.

Aerobic Young women have a lesser maximum heart and lung capacity than young men, and heart and lung capacity will decrease with age. Work in general, however, is not known to require full aerobic capacity, so these differences should not impact work ability for women compared to men. Only those jobs that require extremely high metabolic equivalent-level work may be affected. Women in good condition, however, can reach the necessary levels of aerobic fitness required by a particular job. It is unlikely that this difference in heart and lung capacity will affect job matching.

Anthropometries Women are generally smaller than men, and the anthropometric dimensions of the workplace may be inappropriately designed for the smaller woman. Table 1 shows some of the anthropometric differences between men and women. When looking at work site design, it is often important to measure the dimensions of the work site. If the work site has been designed by men for men,

Women: (Not) The Weaker Sex at Work?

Table 1. Anthropometric Differences Between Men and Women" Men Height Elbow height Knuckle height Arm span Elbow to fingertip

69" 43.5" 30"

71 " 19"

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orientation" rather than as legitimate complaints of problems relating to work injury.

Women 64"

40" 28.7" 64"

17"

• Stout et al. (1965, 1975)

women may be at an innate disadvantage and the design may be a factor in injury rate or productivity. Therefore, ergonomically designed work sites for women are extremely important and should be taken into consideration in all ergonomic evaluations.

THE MEDICAL SYSTEM'S VIEWPOINT Medical researchers have recently indicated that there has been significantly less research conducted on women than on men. The federal government, particularly the National Institute of Health, realizes that future studies on women's health are important, acknowledging that women react to disease, medications, and treatments in different ways than men. Women currently enter into the medical system in work-injury management scenarios with a decreased likelihood of being treated as accurately as men, because women's physical reactions to diagnostic procedures and treatments have not been as thoroughly studied as men's reactions. This is coupled with information on medical practice, which has brought out the differences in the way that the traditional medical system has related to women. In studies reported in the last 5-10 years, women are often given "palliative" treatment measurements while men are more aggressively diagnosed and given "curative" types of treatment. Valium was one of the most highly abused medications approximately 10 years ago, because it was given to women who complained of various aches, pains, and problems. Women's complaints are often seen as those of a "female

Women's "Epidemics" Other physical issues faced by women that must be addressed include "epidemic" problems such as carpal tunnel syndrome and myofascial- and myositis-related issues. Carpal tunnel syndrome. Carpal tunnel syndrome is escalating as a "women's" illness/injury either because more women are at risk or because more women receive this diagnosis. One pertient reason for an increase in carpal tunnel syndrome diagnosis in women is that there are large numbers of women doing repetitive hand work, which may be a contributory risk factor to carpal tunnel syndrome. The increased incidence of carpal tunnel syndrome in women may be linked to the following factors: 1. Hormonal changes 2. Repetitive hand work 3. Working at higher percentage of MVC in repetitive hand work 4. Use of hand tools designed for men Another issue regarding carpal tunnel syndrome is the overuse of surgery as the main treatment. Conservative care is used far less often than indicated. Ergonomic and medical professionals are working closely with government agencies such as the Occupational Safety and Health Administration (OSHA) to increase the use of conservative care, but the amount of carpal tunnel surgery continues to be a cost to workers' compensation and to the human condition. Myofascial- and myositis-related issues. The medical field recognizes that myofascial problems are significant cumulative trauma issues in the work force. Fibromyalgia, myofascial problems, and other conditions with this common name are more likely to be found in women, and they are among the most difficult workers' compensation problems to treat. Less than 10 years ago professionals debated in arthritis literature about whether or not fibromyalgia or myofascial pain existed. Further research has shown that myofascial pain is a diagnos-

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able physical problem with specific parameters linked to such issues as inadequate sleep patterns, postural stresses, and mild depression. The treatment is often physical therapy, stretching exercises, antidepressants, and sleeping medication. There is nothing in this cadre of treatments to indicate, however, that myofascial pain is a mental problem. Rather, chemical imbalances may create the myofascial pain, sleep disorders, and mild depression. The physical problem appears before the mild implications, not the other way around. It would be a folly at this point to put down this newest of cumulative trauma disorders affecting women as one created by women's psychological issues rather than what it truly is: a physical problem that creates tension reaction to cumulative physical activity and mild stress changes in women. In order to deal with this newly recognized cumulative trauma-type disorder, it must be kept on the medical front, recognizing that women who have these problems are just as deserving of care as those who have fractured ankles. The disorder must be treated as a work-related, ergonomic situation so that people can return to work with the proper medications and treatment modifications. It is imperative that women are properly diagnosed and treated for these problems so that myofascial pain does not become another "women's disease" with a nonmedical connotation.

WHAT ARE THE CHOICES? Women at work, while trying to fit into a formerly male world, must address their uniqueness in the working arena. No longer should the milieu of production be a gender-oriented place. Recent laws, social pressures, and improved medical! functional information (Isernhagen, 1988) reveal that while gender, age, size, and other factors can be categorized "generally," there is a tremendous range of individual variation both in workers and in work practices. The working world is made up of individuals, not groups; evaluation of worker relationship to work should be done on an individual basis. Dis-

cnmmation based on gender has not been allowed, technically or legally, in the past 20 years. However, the new pertinent law, the Americans with Disabilities Act (ADA), brings women's issues to the forefront in a different way. If a worker is "perceived" as disabled and it affects hiring, placement, or promotion, that individual is protect by ADA. If women are perceived as "weak," at "risk," or otherwise not fully able, they may well seek discrimination protection. For women to receive the best medical care in the work-injury system, the following must be done: 1. Further information must be developed about women's physical abilities as they relate to work. 2. More research into ergonomic changes that can be proactive in allowing women to work as safely and productively as possible must be done. 3. There must be better information on diagnosis in order to recognize that projections made from diagnostics are just as applicable for women as they are for men. 4. Treatment regimes may need to be different for women than they are for men. Women's and men's talents blend to bring physical, functional, mental, and motivational strength to the workplace. Women are different from men; men are different from women; young is different from old; big is different from small; fast is different from slow. The truism is that all workers are different, sometimes because of gender, often because of other factors. Each must recognize the strengths and weaknesses of the other. Studies of groups can assist in the promotion of evaluation of underlying work issues. Work solutions lie beyond categorization, however. Individualization (founded on scientifically true generalization) is the answer for safe, productive workers and safe, productive work. Therefore, blending science, functional testing, ergonomics, law, and a desire for optimum productivity can lead to optimum use of all workers.

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REFERENCES Brown, M., and Rose, S. (1985). The effects of aging and exercise on skeletal muscle: Clinical considerations. Top Geriatr Rehab, 1, 20-30. Cress, M., and Schultz, E. (1985). Aging muscle: Functional, morphologic, biochemical, and regenerative capacity. Top Geriatr Rehab, 1, 11-19. Isernhagen, S. (Ed.) (1988). Functional capacity evaluation. In Work injury management and prevention (pp. 184-192). Rockville, MD: Aspen. Kaufman, T. (1982). The hypokinetic model: A new look at the effects of age on neuromuscular functions. Proceedings of the World Confederation of Physical Therapy, Stockholm, Sweden. Kaufman, T. (1987). Posture and age. Top Geriatr Rehab, 4, 13-28. Krolner, B., and Toft, B. (1983). Vertebral bone loss: An unheeded side effect of therapeutic bed rest. Clin Sci, 64, 537-540.

Nygard, C.-H., Luopajarvi, T., and Limarinen, J. (1988). Musculoskeletal capacity of middle aged women and men in physical, mental and mixed occupations. A 3.5 year follow up. Eur j Appl Physiol. Payton, 0., and Poland,J. (1983). Aging process: Implications for clinical practice. Phys Ther, 63, 41-47. Putz-Anderson, V., (1988). Cumulative trauma disorders. Cincinnati, OH: Taylor and Francis. Raab, D., and Smith, E. (1985). Exercise and aging effects on bone. Top Geriatr Rehab, 1, 31-39. Rodgers, S. (1988). Job evaluation in worker fitness determination. InJ. Himmelstein and G. Pransky, (Eds. ), Workerfitness and risk evaluation (pp. 219-240). Philadelphia: Hanley and Belfus. Timm, K. (1988). Isokinetic lifting simulation: A normative data study. jOSPT, 5, 156-166.

Women: (not) the weaker sex at work?

Women's role has developed and changed dramatically in the last twenty years. Women now are prevalent in the work force and assuming work tasks not in...
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