By David Tuller, MPH
Janice Williams worked for more than two decades as a cashier at an Oakland, California supermarket without sustaining a single injury. But shortly after the store installed electronic scanners in 1993, she began feeling twinges of pain in her right hand and arm.
"On the older machines, you could rest your hands," recalls Williams, a shop steward with the United Food and Commercial Workers union (UFCW), which represents grocery store employees. "But with the scanner your hands were totally suspended, with the constant motion of pulling groceries across it. And you could tell right away there was a problem. My neck had gotten real stiff, and I started to drop things at work and at home as well. It hurt up to my shoulders."
The company doctor treated her with massage and ultrasound, but she didn't seem to improve. She was finally diagnosed with both carpal tunnel syndrome and nerve damage in her neck. She still undergoes treatment and often has trouble gripping items. And when she raises her right arm a pain shoots through it. "It's like someone's sticking you with a pin," she says.
Williams estimates that close to half of the cashiers in her store have experienced similar problems. To ease the physical strain, she now works on the checkout line only half the time; the rest of the day she helps staff the store bakery, although sometimes she has to ask coworkers to lift heavy items for her. She doesn't feel she can leave her job, because, after three decades with the company, she is just two years away from retirement.
Decades ago, the supermarket checkout counter wasn't a dangerous place to work. But ever since supermarkets turned to productivity-boosting electronic scanners, the number of injuries has risen dramatically. According to data compiled by the federal Bureau of Labor Statistics, grocery stores rank fifth among all industries in number of repetitive stress injuries. Studies indicate that cashiers may flick their wrists back and forth up to 600 times per hour. In an eight-hour shift, it's not unusual for a grocery clerk to handle more than 6,000 pounds -- three tons -- of groceries. Worse, it can take two or three attempts to drag the product across the scanner before the bar code registers.
Scanners were introduced into supermarkets in the mid-1970s. By 1982, a survey of supermarket cashiers in British Columbia indicated that 30 to 50 percent of the workers were reporting arm, shoulder, neck, wrist, or back pain, often requiring medical treatment and time away from work. A subsequent Canadian study placed the figure at 35 percent. Studies in England, Japan, Sweden, Spain, the United States, and other countries have since confirmed a widespread problem. Numerous studies conducted in the 1990s and onward document an ongoing workplace health problem for checkstand workers using scanners.
Despite considerable improvements in the technology, studies indicate the scanners still contribute to worker injuries. A 1995 study by the National Institute for Occupational Safety and Health looked at several scanner work station designs used by cashiers. The study states that no matter what the design of the workstation, the rate and probability of worker injury was directly related to worker stature, order size, and product type. The report went on to say that "fundamental changes in cashier work may be required to fully eliminate hazards for musculoskeletal disorders from this job."
"There are a lot of risk factors," says Laura Stock, associate director of the Labor Occupational Health Program at the University of California at Berkeley. "It's a repetitive task with awkward movements like reaching and stretching, and then in the scanning process they have to twist their wrists to scan properly."
Before scanning, explains Stock, the checkout process was significantly slower and was broken up by more varied activities. With scanning, employers seek to monitor productivity by the number of items scanned per hour. Some stores even award prizes to those who scan the fastest. The occupational health program at Berkeley, which frowns on such contests, holds training seminars in ergonomics for checkout workers to teach them how to adjust their posture and motions to minimize the possibility of injury.
And as with many jobs involving repetitive motion, people aren't vigilant enough about taking breaks. "At one training," says Stock, "people joked that if everyone would write more checks, it would slow the pace down. They said the union should start a campaign -- 'Write Checks!'"
No thanks to Uncle Sam
Part of the problem is that, to date, the Occupational Safety and Health Administration (OSHA) of the US Department of Labor developed ergonomic standards, but they were rejected by Congress in 2001. Since then, OSHA has issued voluntary ergonomic guidelines for various industries, including some for retail grocery stores, which were released in May 2004.
Jackie Nowell, director of the UFCW occupational health and safety office, says that it took a while for management to recognize the problem. "There was a lot of denial at first," she recalls. "They thought, 'How could this little motion they're making be causing all these terrible problems?' But the main issue with ergonomics is to stop designing work without humans in mind."
As an example, she cites the positioning of checkout-stand scales, which used to be placed above the cash register because that was conveniently out of the way. "That was just the logical place to put it," says Nowell. "Never mind that a human being had to lift a watermelon up there 7,000 times in the summer. So they'd have shoulder problems."
Some cashiers have filed lawsuits against scanning system manufacturers. A supermarket checker who developed "tennis elbow" was awarded $85,000 by a jury in Maryland. And many supermarket chains, recognizing the problem, have taken steps to redesign their checkout counters to reduce the possibility of injury.
Nowell says that scales are now often placed low and near the scanner. Wide conveyor belts have also been a common problem, since they forced cashiers to reach across to grab heavy items. In response, many stores have narrowed the belts and added bars placed at a 45-degree angle to slide the groceries toward the checker. Nowell says that in stores that have implemented changes, injury rates have dropped by about a third.
But changes have come too late to prevent injuries to some workers. In a report released by the UCFW, a cashier wrote about what happened after scanners were introduced to the store: "Within a few months my hands began getting numb," wrote the worker. "The pain and numbness increased, and [soon] I would wake up at night in terrible pain. My entire life, both work and personal, has drastically changed. My hands hurt all the time. Carpal tunnel syndrome can become a permanent and crippling disability, especially if not treated early by a specialist."
As for Janice Williams, she remains philosophical about her injuries. Although her doctors think the pinched nerve in her neck won't improve, they believe her carpal tunnel might, if she is careful not to re-injure the area. And she's happy she still has a secure job. "I've never been a complainer," she says.
Safety tips for grocery clerks
OSHA recommends the following measures be taken to minimize risks to check stand workers:
- Use stop braces on check-stand conveyer belts to reduce the amount of forward reaching that employees have to do when moving merchandise items. Braces should move merchandise and items close to the employee. Generally, OSHA recommends that you should reach no more than 16 to 17 inches.
- To avoid low back injury when loading items into bags, you should be able to adjust the bag loading height when necessary. All employees, regardless of height, must be able to place items in a bag without having to bend forward more than 6 to 10 degrees.
- Use two hands when placing larger items into a bag. Any item that forces the employee to open the hand wider than about 2 to 3 inches (thumb to finger measurement) should be performed with two hands.
- Keep elbows close to your body and keep your work at about elbow height.
- Keep hands straight, in line with the forearms, and avoid twisting them.
- Use a footrest to promote comfort and a good quality anti-fatigue mat to reduce back and leg exhaustion.
It's also a good idea to take frequent breaks, asking another employee to spell you if necessary. If you develop symptoms of RSI, such as pain, tingling, or numbness, in your arms and hands, report it to your employers and seek medical help immediately.
National Institute for Occupational Safety and Health (NIOSH)
Established in 1970 by the Occupational Safety and Health Act, NIOSH is a federal research agency which makes recommendations to help employers prevent job-related injuries and illnesses.
Occupational Safety and Health Administration (OSHA)
Part of the Department of Labor, OSHA develops and enforces safety and health regulations in the workplace.
OSHA's Guidelines for Retail Grocery Stores can be found at: http://www.osha.gov/ergonomics/guidelines/retailgrocery/retailgrocery.html
United Food and Commercial Workers International Union
Occupational Safety and Health Administration. Ergonomics for the Prevention of Musculoskeletal Disorders Guidelines for Retail Grocery Stores. 2004.
P. Harber. Work-Related Symptoms and Checkstand Configuration: an Experimental Stu K.A. Grant An Analysis of Scanning Postures Among Grocery Cashiers and its Relationship to Checkstand Design. Ergonomics. October 1995; 38(10);2078-90.