SOLVE How To Manual

Getting Started with SOLVE (Company
and Provider only)

ABOUT SOLVE ........................................................................................................................................................ 2
INTRODUCTION ..................................................................................................................................................... 2
THE SOLVE SYSTEM ................................................................................................................................................ 4
SOLVE ONLINE ....................................................................................................................................................... 5
SOLVE HOMEPAGE .........................................................................................................................................................5
ADMIN LOGIN SCREEN ....................................................................................................................................................5
ADMINISTRATION SCREEN ................................................................................................................................................5
Company Tab ........................................................................................................................................................6
Survey Tab .............................................................................................................................................................6
Respondents Tab ...................................................................................................................................................7
Report Tab.............................................................................................................................................................8
SOLVE SURVEY ..................................................................................................................................................... 10
LOGGING ON THE SURVEY ..............................................................................................................................................10
TAKING THE SURVEY .....................................................................................................................................................10
SOLVE SERVICES ................................................................................................................................................... 17
CONFIDENTIAL
ALL COPYING &
DISTRIBUTION
PROHIBITED
ABOUT SOLVE
The purpose of SOLVE is simple SOLVE exists for the purpose of improving the performance and
comfort of workers at work to improve profit for employers and job security for employees.
SOLVE resolves emergent work problems before they become costly the kind of problems likely to
erode profitability, productivity, quality, morale, job security, and peace-of-mind.
Simple solutions require an understanding that surpasses complexity solutions based on science and
experience, not theory and opinion, with deep understanding of human performance, biomechanics,
Applied Functional Science, injury prevention, pathology, work environments, ergonomics,
rehabilitation, training and conditioning.
The SOLVE System represents the confluence of state-of-the-art internet technologies, two decades of
global research and development in Applied Functional Science, and three decades of innovation in
occupational health and ergonomics with companies ranging from local entrepreneurs to Fortune 500.
SOLVE lives up to its name. For additional information visit www.SolveGlobal.com
INTRODUCTION
Employers are constantly challenged by the demand to produce more goods and services, of better
quality, for less cost, with greater profits in an environment of ever increasing global competition.
Business has never been tougher; the stakes have never been higher; and the business environment less
forgiving. It has been said that, People are a companys most valuable asset. At SOLVE we would
disagree. We believe that, Loyal, healthy, productive people are a companys most valuable assets. It is
with that understanding that SOLVE brings value to the workplace.
This is the context in which work and non-work related injuries and illnesses occur.
Copyright 2001-2009 Performance Builders LLC All Rights Reserved. Used by SOLVE LLC with permission.
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Artificial divisions between work and non-work related health conditions are beginning to erode across
many business sectors. This is driven by the reality that it is difficult to differentiate between conditions
that are caused by work and those that are aggravated at work. When the additional liability of worker
compensation indemnity (wage replacement) is considered, most employers are more than happy to
have employees use group health benefits rather than worker compensation benefits. While such
strategies have the potential to reduce indemnity costs, work related medical costs are still incurred and
may be hidden and overlooked. Additionally, employers are beginning to recognize that medical costs
While the incidence of worker compensation cases have decreased over the last 3 decades the
associated expenses have increased, particularly those that are medically related. The decrease in cases
can be attributed primarily to the reduction of traumatic injuries due to better occupational safety
requirements and programs. Today the focus and expense has shifted from traumatic injuries to
cumulative trauma illnesses involving the arm, wrist, hand, back, and neck. Such conditions require new
understandings, strategies, and tools that go beyond traditional occupational safety and health.
for worker compensation cases exceed that of similar cases treated under group health benefits its an
industry fact.
Most employers have systems and resources to manage traditional safety issues those that cause
traumatic injuries related to accidents. Traumatic injuries are relatively easy to manage. There is obvious
cause and effect. There is a time and a place for the event that occurred. There are usually witnesses.
Injury is usually obvious. Treatment commences immediately and the bodys healing capacity is
generally complete in about six weeks. Most traumatic injuries are resolved in a matter of weeks.
Repetitive strain injuries/ cumulative trauma illnesses are different. Cause and effect are not usually
obvious. There is no specific event with time and place. There are no witnesses. Injury is commonly not
visible thus motivation, validity, and trust issues arise. Treatment may not begin for weeks or even
months, meanwhile the condition worsens and may even spread within the body. Such conditions are
persistent and often difficult to diagnose and treat. Thus, intervention is costly and too often
disappointing.
Employers are less well equipped to manage cumulative trauma / repetitive strain illnesses such as
carpal tunnel, tendonitis, rotator cuff, back, and neck conditions that evolve gradually over time.
Employers have occupational safety programs, accident reporting, and emergency response capabilities
in place. Most, however, lack knowledge, resources, and systems in such matters and are financially at
the mercy of healthcare providers who are prone to practice defensive medicine and who have limited
expertise and experience in biomechanics, function, and ergonomics. As an example some 30% of
medical imaging costs are the result of defensive medical practices.
When it comes to workplace injury prevention Employers have a host of state and federal safety
regulations, standards, and guidelines promulgated by state and federal Departments of Labor (DOL),
the federal governments Occupational Safety and Health Administration (OSHA), National Safety
Council, and worker compensation insurers or Third Party Administrators (TPAs) to guide them.
However, when it comes to cumulative trauma conditions most employers lack the systems and
professionals to efficiently resolve them. Cumulative trauma conditions routinely cost tens of thousands
of dollars in direct costs (medical and indemnity) per case. When indirect costs (lost time, labor
replacement, training, legal, etc.) are considered the actual costs may run into the hundreds of
thousands of dollars per case.
The problem of work related cumulative trauma has been a growing problem for the past half century
and continues to worsen as productivity demands, average worker age, and obesity increases and
general health declines.
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There is a significant business opportunity for motivated Practices to differentiate their offerings to
employers through the integration of biomechanics, chain reaction function, human performance, and
TM
ergonomics what SOLVE calls Functionomics
. Practices have the opportunity to forge loyal
relationships with employers, expand service offerings, and secure competitive advantage in a market
segment that has considerable community influence and unregulated reimbursement. Relationships
with employers often expand to other employers (follow-the-leader is big in business), group health
Physical therapists have long provided treatment in worker compensation cases but most have been
reluctant or ill prepared to tackle work related stressors in the workplace that cause them. That
reluctance is usually rooted in the lack of familiarity with work related production processes, tools,
environment, culture; and relevant strategy, experience, resources, business models necessary for
intervention.
insurance (worker and family), payers, and health providers. Business relationships with employers
denote efficacy, credibility, integrity, and influence.
These training materials are intended to provide qualified professionals with the understandings and
tools to prosper in a new and expanding market.
THE SOLVE SYSTEM
The SOLVE System consist of six elements:

1. Education for Providers and Employers
2. Internet tools
3. A qualified network of local SOLVE Providers
4. The SOLVE Survey
5. Interpretive Reports
6. SOLVEs consulting team of experienced corporate health experts
Comprehensive SOLVE training materials provide critical workshop information that business leaders
need to understand in order to make informed decisions about their most important business
challenges - keeping good people productive producing quality products and services at competitive
prices.
SOLVE is structured on a virtual business model. Business resources and tools are online. An
independent Provider Network provides local marketing and client support. Expert SOLVE support
professionals are never more than an online click away with email and video conference calling.
The SOLVE Survey takes just a minute or so to complete online safe, secure, and confidential. The
Survey collects insightful information from each worker about their personal performance and comfort
at work. The responses are automatically aggregated, analyzed, and summarized in an interpretive
report presented with priorities and recommendations.
Solve Surveys are conducted on a periodic basis - usually monthly. Survey access is also available to
workers to report emergent problems on an ad hoc basis allowing for real time intervention.
The SOLVE Survey is all about the early identification of emerging problems the kind that
systematically erode performance and comfort over time and predictably result in costly cases involving
medical intervention, worker compensation, and lost time expense.
When appropriate SOLVE Network Providers deliver customized intervention services to employers and
employees. Such services may include one-on-one interventions with employees and at-risk employee
groups, regular onsite consultation/intervention services, and trusted offsite community based
rehabilitation and conditioning services.
The net result is seen in enhanced productivity, reduced risk, fewer recordable injuries/illnesses, lower
premiums; less lost time, greater employee morale, and improved profitability.
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Every SOLVE engagement incorporates a proven system and responsive service for right-sized
interventions and reliable results.
SOLVE ONLINE
Key URLs: www.SolveGlobal.com | www.SolveGlobal.com/AdminLogin | http://solveglobal.com/batchentry

Solve Homepage
The SOLVE Homepage at www.SolveGlobal.com provides several functions:
1. A brief Welcome and Introduction to SOLVE (main text)

2. A Learn More link that brings up a pdf summary of the SOLVE strategy and system (left
navigation links).
3. A prominent Take Sample Survey button (left navigation links) brings up an interactive SOLVE
SURVEY and access to interactive report samples. No passwords are required, survey answers
are not saved, and reports data is illustrative (i.e. not linked to the sample survey responses).
4. A second prominent My Company Survey button (left navigation link) brings connects to the
login screen for SOLVE Survey respondents. In actual usage, respondents will be taken directly to
the login page via links in their email invitation from their employer.
5. An Admin LogIn Link (footer menu) takes SOLVE Providers to the Admin LogIn screen
6. A Contact Us link (top menu) provides email contact with SOLVE.
7. Top and Footer navigation provides both redundant and supplemental links.
The My Company Survey Button is used by employee respondents. The Admin LogIn is used by SOLVE
Providers. Client companies work through SOLVE Providers but do not access the Solve System directly.
SOLVE Providers have access only
to their companies. SOLVE has
access to all companies.
Admin Login Screen
It requires ID and Password and
restricted to registered SOLVE
Providers. Each SOLVE Provider
will be issued a Username and
Password by SOLVE. Providers can
access only their own account. It
is very important to protect IDs
and
Passwords to prevent unauthorized access to corporate clients, surveys, and data. SOLVE Providers must
carefully limit and manage their SOLVE account access. SOLVE accepts no responsibility for misuse of
login credentials by Providers.
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1. Company Profile Register new client

companies
Administration Screen
Provides functionality for all administrative
tasks pertaining to establishing and managing
Surveys for all of a Providers clients.
Functionality is organized around 5 Menu
items on the left side of the screen that are
context sensitive (i.e. only shown when
relevant). Select the appropriate Tabs to
perform the desired administrative tasks:
2.
3.
4.
5.
Survey Schedule create and implement surveys and survey templates

Respondents Register qualified survey respondents
Reports Filter, review and download reports
Batch Entry
Company Tab
Captures demographic information about each
company that participates in SOLVE Surveys.
The Company List drop down menu, in the left

column, is used to add and delete companies or
modify previously entered company data.
The Company ID and Client Password is
automatically generated by the SOLVE System.
The company ID will be used by Respondents
when logging in to take a Survey. The Client
Password is used by the Provider when the batch file input option is used.
The NAICS entry is for the companys 6 digit classification code as defined by North American
Industrial Classification System. Many companies will know their code otherwise it can be looked up
online at http://www.census. gov/eos/www/naics/ or on other websites. This information will
eventually provide confidential industry specific comparative performance data.
The remaining demographic information on the Company Management Tab is self-explanatory. At the
bottom of the screen are Save and Delete buttons to complete the task.
Survey Tab
Used to structure specific Surveys. The
relevant company for which a Survey is
being created is selected from the
Company List (left column). Only
companies that have been registered on the
Company Management Tab will be listed. If
the desired company is not shown in the
Company List on the Survey Tab, it will first
need to be entered on the Company Tab.
Two tasks are completed on the Survey Tab

a new Survey can be created and existing
Survey can be modified.
To modify a Survey, choose the appropriate Survey from the Survey List on the left side of the screen.
Use the Save button to complete the task.
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The Survey Opening Date and Active Period will determine how long the survey will be active each
month. Generally a 5 - 10 day period will be suitable. If the Survey is to be conducted less frequently
than monthly, simply skip Respondent Notification for the months to be skipped.
To create a new Survey, complete the Survey Information section. The Description is simply the name
that will be used for the Survey choosing a descriptive name will add convenience.
The Survey Type can be Anonymous or Confidential and is selected with the radio buttons. An
Anonymous Survey is one in which the respondent is not identified with the response. Its use is
appropriate when a profile of comfort and performance is desired without identification of individuals. It
is useful when employees fear retribution, when a company is simply interested in accessing the
magnitude of a potential problem, or when demonstrating the SOLVE Survey to a prospective client. A
Confidential Survey is one in which the respondent by linking individual employee with specific Survey
responses and identifying individual employees in reports. It is useful when there will be follow-up with
specific individuals for the purpose of further accessing the complaint or providing intervention services.
Respondents Tab
Used to manage who
participate in the Survey.
is allowed to
Use the Company and Survey List dropdown

menus (left column) to select the desired
completed or active Survey for viewing
Respondent participation information and
for preparing to upload new or updated
Respondents for Surveys.
The Import CSV file function (top
right table header) is used to import
the list of approved Respondents
the CSV file is created using the Excel
spreadsheet downloaded from the
Download Tab.
The
Respondent
table
lists
employees validated for the selected
Company
and Survey. Employees
who have not yet responded to the
Survey are shown in Bold Red while
those who have completed the
Survey are shown in Green. The
color coded count of Open and
Completed Respondents
appears
just above the table.
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1. Validated Surveys limit participation to specific individuals who are prequalified/validated to

respond once to the Survey by logging in using their employee identification number (as stated
in the Excel file) as their password. Validated participants are determined by the company and
are identified by employee number, Name, and Groupings. Each employee can be associated
with up to three affinity Groupings for drill down filtering for data analysis and reporting (e.g.
building, position, shift, department, work team, etc). Within each Grouping, an unlimited
number of subgroups can be created (e.g. buildings 1-99). Groups are user defined. A list of
qualified participants is created using Microsoft Excel spreadsheet, downloadable from the
Download Tab. It is recommended that the Employer enter the employee information in the
Three types of Surveys are possible Confidential (Validated), Anonymous (Non-validated), and Hybrid
(Validated Anonymous).
Excel spreadsheet the employer may be able to export their employee list to Excel to avoid the
need for data entry of the individual names. The spreadsheet will accept up to 2500 employee
names. It is important that the employee list begin on row 11 of the spreadsheet DO NOT
LEAVE EMPTY ROW ABOIVE THE FIRST ENTRY! After the Excel file has been completed and saved
by the employer it can be emailed to the SOLVE Provider. Upon the Providers receipt of the file,
it is opened and the Remove Punctuation button is selected (located in the gray box in the
upper left corner of the spreadsheet). The Remove Punctuation button automatically removes
all apostrophes, commas, and hyphens within the spreadsheet; and will only work if Macros
have been enabled in Excel refer to Microsoft Help for instruction if needed. After punctuation
has been removed, the Excel file must be saved as a coma delimited (CSV) file from the Save as
type dropdown menu located at the bottom of the Excel save dialog box. The CSV file is then
uploaded to the SOLVE website using the Import CSV button shown under the Survey
Respondents heading. Each Validated Survey Respondent will be required to Login using their
Company and Employee IDs. The validation process assures that only preapproved employees
can respond and allows them to only respond one time. It also enables statistical tracking as to
participation/response levels.
2. Non-validated Surveys eliminate the need to pre-qualify participants. Thus there is no validation
of participants and no employee Groupings are possible. Non-validated Surveys do not require
the uploading of participant lists using the downloaded Excel spreadsheet as in the Validated
Survey. Using a Non-validated Survey means that an individual could potential respond more
than once to the Survey, that bogus data could be submitted, and that Grouping functionality
cannot be identified within the data set. The benefit of non-validated Surveys is that it
eliminates administrative work/time, assures absolute anonymity for respondents, and provides
a simple and efficient way to offer Survey demonstrations. Non-validated Surveys do not require
an employee ID at login.
3. A Hybrid Validation Survey is also possible. In such Surveys, the above instructions for the
Confidential (Validated) Survey should be followed. But, instead of each employee receiving a
unique individual ID number, multiple employees from various groupings are all assigned the
same ID Login. Doing so will allow data filtering by Groupings without identifying individual
employees.
Report Tab
Used to access Survey data in both online and downloadable (Printer Friendly Version) report formats.
There are three types of reports Survey Summary, Respondent Summary and the Trend Line Report.
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Report functionality provides the ability to filter responses by Groupings to facilitate analysis and the
scope of reports. Multiple filtering iterations enable multiple reports to be created.
The left column provides options to query the database and

structure reports. The relevant data set is selected through
the Company and Survey drop down menus on the left side
of the screen and the selection of checkboxes in the Groups
List. Each time a Grouping box is checked or unchecked, the
report automatically recalculates.
Printer Friendly Reports can be printed by selecting that
option near the top of the Report Tab.
The Respondent Summary and the Trend Report can also be
filtered using the checkboxes in the left column to generate
respondent lists who have participated in Confidential or
Hybrid Surveys a respondent list is not available for
Anonymous Surveys so that anonymity is protected. This
report enables specific employees to be identified for
confidential follow-up by the SOLVE Provider.
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Both the Summary and Respondent Reports can be further

customized and prioritized using the blue font column
headers. The Index column is particularly useful when
prioritizing the need for interventions amongst a large
employee population.
Summary Report
SOLVE SURVEY
Logging on the Survey
The Survey Login Screen provides Respondent access to their companys SOLVE Survey. The Survey Login
can be accessed in any of three ways.
1. Click on the My Company Survey link in the left column of the SOLVE homepage.
2. Click on an Invitation Link placed embedded in an email sent directly to them by the company.
This method provides the benefit of being able to provide simple instructions/support to the
recipient and eliminate the need to navigate to the Login screen.
3. Computers specifically for use in responding to the Survey can be setup within the worksite and
set to display the Login screen. This again eliminates the need to navigate from the SOLVE
homepage and is a good option for workers without internet access. This approach can be
tweaked by providing an open welcome (MS-Word, notepad, etc.) with instructions and a link to
the Survey LogIn screen.
The SOLVE LogIn Screen requires two ID codes to gain access to the Survey A Company ID and an
Employee ID. It is important to provide employees with the appropriate ID information to prevent LogIn
problems. LogIn IDs can be distributed by email or given to employees by other means. The Company ID
may be found by the Provider at the top of the Company Tab in the Admin area. The Employee ID comes
from the first column of the Excel Upload worksheet or the Respondents Tab in the Admin area once the
CSV file has been uploaded. To begin taking the SOLVE Survey the employee simply enters their
Company and Employee IDs and selecting Login or pressing the Enter key.
If an Anonymous (un-validated) Survey is
used, the Company ID and a single
Universal Employee ID will be required.
After Login, the respondent will be taken
to the first Survey question.
Taking the Survey
The Survey takes just a minute or two to
complete and requires minimal computer
literacy i.e. simply use mouse to point
and click. There are 8 questions/screens
in the Survey. The first 7 questions
provide check box or radio button
responses; the last question invites
additional unstructured comments.
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Upon completion of each question the respondent clicks on the Next Button (lower right) to move on to
the next question. Eight numbered bubble icons representing the eight Survey questions are located
in the upper right of the screen they show the Respondents progress and selecting them will take the
Respondent to the respective question if needed for corrections or changes.
Question/Comments
1. Do you experience problems of
physical discomfort or difficulty
associated with your normal job
activities?
Screen shot
If the respondent answers No to the first

question, they are taken to a transition
screen that thanks them for their
participation and the Survey is complete. If
the answer is Yes, then the respondent is
advanced
sequentially through the If No...
remaining 7 questions.
This question has implications relative to
employer/employee exposure to work
related risk and expense related to lost
productivity.
2. How long have you experienced your

problem?
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2 weeks At 2 weeks most minor Note that circular response options (radio buttons) allow for
musculoskeletal (MS)
strains
and only one response square response options (check boxes)
sprains are normally well on their way allow multiple responses.
to resolution. Problems less than 2
weeks in duration warrant passive
monitoring and perhaps simple first aid
(ice, compression,
NSAIDs
and
avoidance of over exertion). Problems
remaining at 2 weeks warrant a brief
biomechanical assessment to rule out a
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There are 5 possible responses only one

can be selected. The time frames are
intended to be approximations appreciating
that many respondents will lack precision in
recalling actual unset of the problem. Each
time frame option has specific strategic
connotations associated with it.
serious condition and to assess the

potential benefit of therapeutic
intervention.
4 weeks At 4 weeks, most minor MS
conditions are resolved. Those that are
not should be evaluated and
therapeutic intervention implemented
to facilitate healing, reduce stressors,
and
prevent
biomechanical
compensatory complications.
6 weeks At 6 weeks all acute symptoms
should
be
resolved. Remaining
problems should receive evaluation and
therapeutic intervention including
rehabilitation as appropriate.
12 weeks At 12 weeks, rehabilitation
should typically be complete and full
normal function restored. Remaining
problems may warrant outside
consultations to assess potential
complications and other factors.
>12 weeks Problems remaining longer
than 12 weeks have higher potential for
chronicity and associated long term
impairment/disability and should be
managed aggressively.
3. What is the primary physical activity

that seems to contribute to your
problem?
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11
This question seeks to identify the single

most problematic functional activity
associated with the reported problem.
There are 24 possible responses including
an Other category that is user defined.
This provides initial hints as to underlying
biomechanical causes and contributors,
relevant transformational zones, possible
interventions, and urgency.
4. Where do you experience your

problem?
This question provides 53 possible
individual responses. Multiple body areas
can be selected by clicking on the body
diagram doing so shades the portion of
the body selected. To unselect simply click
an area a second time.
Responses that include large areas of the
body or anatomically remote areas warrant
assessment and may be indicative of nonsomatic and non-biomechanical conditions.
5. What kind of problems do you

experience?
This question provides 10 possible
individual responses including an Other
category that is user defined. Multiple
selections are permitted. Responses are
suggestive of the severity of the problem.
Response options increase in severity
moving from left to right on the screen.
Responses including weakness, numbness,
or tingling warrant priority consideration.
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This question provides 8 possible individual

responses.
Multiple
selections
are
permitted. It assesses the impact of
comfort/function on an individuals daily
activities.
Responses
including
concentration, safety while working and
sleep warrant priority consideration.
Responses including mood, quality,
intensity, and quantity of work have
immediate productivity implications.
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6. How great is your problem?
7. How frequently does your problem

occur?
This question provides 4 possible individual
responses. Multiple responses are not
permitted. Responses suggest the severity
of the problem. The more frequent the
problem the higher its potential priority.
8. Please add any additional information

or comments below:
This question is an unstructured textbox
that allows respondents to add information
regarding any of the questions, elaborate
on their problem, or raise worries, concerns,
and questions, etc. It provides a failsafe
option to capture unclassified problems.
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13
Upon completing the last question and

selecting the END button, the respondent is
taken to a transition page that thanks them for
their participation. After 10 seconds the page
automatically closes and again presents the
SOLVE homepage.
In some situations employees may not have access to a computer. In such situations a SOLVE Paper
Survey can be used. It can be downloaded as a pdf file from the SOLVE website > Admin LogIn>
Download Tab. There are two Paper Survey options Anonymous and Confidential. In such situations,
the Provider should set up the Survey online as usual. Each employee would then complete a SOLVE
Paper Survey and return it to the Employer who would then forward the completed Paper Surveys to
the SOLVE Provider. In the case of Validated Surveys, the completed Paper Survey would be returned in
a sealed envelope (to assure anonymity) and given to the Provider for data inputting using the SOLVE
Survey online. In the case of Non-validated Surveys where the employee is not identified in any way, the
Paper Surveys can simply be collected in a container, and forwarded to the Provider for processing. The
Provide should use the Batch Entry URL (http://solveglobal.com/batchentry) for data entry.
A few comments about the Survey
...
The SOLVE Survey is a simple and highly effective tool for discovering emerging musculoskeletal
problems that may affect performance and comfort. From an employer perspective, risk of
claims and performance is usually of greater priority than comfort. For employees the reverse is
generally true. When talking with various stakeholder audiences, care should be taken to get the
priority right with the various audiences. Employers care about quantity, quality, and intensity of
work matters of performance. Employees care about feeling good at work, home, and in
leisure matters of comfort. Employees also care about job security, pay, and advancement
matters of performance that many people have a tendency to overlook.
The Survey can provide an indication as to the magnitude of Performance and Comfort issues in
the workplace and it can also be used to identify specific individuals that would benefit from
follow-up (if confidential rather than anonymous).
A Demonstration/Pilot SOLVE Survey can provide an effective marketing tool to help employers
understand the SOLVE process and to determine whether they have an unrecognized problem
or not. In such cases, it is generally best to do a Sample Survey with a high risk portion of
employees rather than the entire employee population. Not doing the entire employee
population provides incentive for employers to move from demonstration to purchased services
and reduces the complexity and time required to conduct a pilot.
Some employers will be concerned that a Survey will discover problems they didnt know about,
and would in fact rather not know about. The concern is that in asking awareness might be
elevated and a new problem created. There is also the concern that in surfacing a hidden
problem someone with responsibility and accountability might be exposed and embarrassed.
These are real possibilities and appropriate responses should be prepared to defuse the issue to
the extent possible.
Like the ostrich many companies would rather bury their head in the ground than confront
issues. The point they need to understand is that the Survey simply measures what is. Ignoring
or denying what is will not resolve problems, protect employees, or make the company
stronger. Dealing with issues will. Help them keep in mind that many problems that are
identified will not require costly intervention. Those that do will have better outcomes at less
expense than allowing matters to worsen over time.
Drawing parallels between the investment and value of monitoring, maintenance, and early
repair of machinery and people is often useful. Companies invest considerable resources
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(money and people) into maintaining the mechanical performance of facilities and equipment
but much less into maintaining the biomechanical performance of employees.
Employers should understand that anytime new questions are asked a certain backlog of
problems will be present. It is common for the number of problems discovered by Survey to
decrease over the first year as old issues are eliminated and only truly emergent issues are
identified. Unrecognized repetitive strain conditions are a ticking time-bomb.
For optimum benefit it is recommended that employers conduct monthly Surveys. Doing so
allows problems to be identified and resolved in the most cost effective and expedient manner.
For various reasons (often short term economics) some employers will be tempted to opt for a
quarterly or even annual survey. In such cases the benefits of monthly Surveys should be
discussed. A key consideration is that emergent problems lasting more than 4 weeks represent
employees at-risk for evolving into full-blown muscular-skeletal disorders (MSDs); and problems
not resolved within 12 weeks (one quarter) are at increased risk for expensive worker
compensation claims and potential disability.
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15
The Survey is a critical component of a comprehensive loss management strategy / system. The
smooth and thoughtful meshing of SOLVE Surveys, injury reports, first aid, safety, engineering,
maintenance, occupational health/medicine/rehabilitation, worker compensation, group health,
insurance, and fitness and wellness resources are essential to providing credible and sustainable
value.
Providers should be exceptionally conservative when engaging in interventions for employees

particularly those of new clients. Failure to do so invites relational erosion and loss of credibility.
Do not over-treat. Do not waste resources on those who dont need it. Do all and only what is
necessary for each individual. Triage carefully to optimized resource stewardship. Differentiate
between those that need monitoring, instruction, encouragement, and intervention. Calibrate
your interventions. Spend the clients money as you would spend your own be patient,
prudent, and conservative. It is just as important to know when not to provide intervention as it
is to know when to do so.
Awareness of regulatory compliance issues is important. Providers operate under certain

practice act constraints just as companies operate under certain OSHA, IRS, ADA and insurance
constraints. Creative solutions associated with managing worker access, employer risk, and
reportable cases should never compromise compliance.
SOLVE SERVICES
The SOLVE Survey is one portion of the SOLVE System that includes related consultation and support
services for employers. Support services can be onsite, offsite, or virtual and may include:
Consulting (employees, management, operations, engineering, ergonomics, safety & health)

Screening and assessment
Educational and training
Job assessment and modification
Therapeutic intervention
Fitness and conditioning
Case management and referrals
Of course these services are delivered in the context of a deep professional expertise in human
performance and Neuro-muscular-skeletal pathology.
It is important to package service offering to meet the unique needs and resources of each client
company. One size does not fit all. Cost justification is crucial. It is important to take the time to
understand each companys unique situation and then right-size the offering. What is offered will vary
significantly between companies.
The value of onsite services is that it provides convenience, reduces employee travel and waiting, and if
structured correctly reduces cost.
The value of offsite services is that of resource availability and economy when a small subset of
employees might need such services.
The value of virtual services (internet, email, phone, etc.) is convenience, the elimination of travel and
the enhancement of productivity.
A well-structured service to employers will:
Reliably identify emerging problems
Resolve problems fast, cheap, and effectively
Make appropriate referrals to the right professionals at the right time for the right reasons
Provide evidence of effectiveness, satisfaction, and value.
The primary emphasis of SOLVE related services is not physical therapy! Physical therapy is perceived as
part of traditional health care services that are equated with the high cost of health care. Physical
therapy will not differentiate a service Provider. SOLVEs fresh approach will provide the desired
differentiation. While physical therapy is an important offering to have available in the service mix, it is a
TM
philosophy of First Aid, Functionomics and Ergonomics that should be emphasized.
SOLVE ROLES
The SOLVE Role

The customer is the company
Define countermeasure strategies
Page
The Clinician Role

The customer is the worker
Define a plan of care
16
It is critical that professionals assume the role of consultant rather than that of clinician if they are to be
successful onsite with employers. Consider these differences.
Focused on an individual
Advocate for worker performance
Clinical Services
Focus on worker potential
Process oriented
Work within health systems
Credentialed by licensure
Covered by malpractice insurance
Focused on a worker population

Enhance company performance
Workplace services
Focus on worker performance
Results oriented
Work within corporate systems
Validated by results and value
Covered by business insurance
The problem solving process however is fundamentally similar in both the clinician role and the
consulting role
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Marketing creates customers

A chief complaint provides the basis for the engagement
Symptoms are identified i.e. the evidence of the complaint
A history is taken to understand context, circumstances, onset, and sequential events
A physical examination / assessment is conducted
Data is analyzed and interpreted
Intervention options are identified and considered
Options are discussed with the customer
A plan is agreed upon activities, timelines, and deliverables
The plan is implemented, modified as appropriate, and completed
The process and outcome is documented
Follow-up may be arranged
There is also strong similarity in the strategies that are used think Functional Testing and Tweaking!
We will come back to those considerations later.
The focus of the consultant is on a seven step process:
1.
2.
3.
4.
5.
6.
7.
Identify root causes of the problem and likely contributing factors through analysis.
Quantify the causes, contributing factors and systems through measurements and testing.
Stratify issues and opportunities by importance and develop intervention strategies.
Modify the environment, equipment, processes, and individuals to resolve the problem.
Verify that the intended results are achieved.
Satisfy all stakeholders (management and labor) in the solution.
Indemnify the parties to mitigate unnecessary potential risk exposure.
Page
An important word of caution is appropriate. As a consultant the professional has an ethical

responsibility and duty to safeguard and conserve the clients resources. There is an inherent potential
for conflict of interest that exits whenever the clinician and consultant are one. Any misuse or abuse of
the consultant role by making unnecessary referrals for clinical service represents a self-serving ethical
breach of conduct that will invariably undermine the credibility and integrity of the consultant / client
relationship at some point in time. Employers often view health care providers as part of the problem
and not part of the solution they may be naturally suspicious. That suspicion is well earned and cannot
17
This seven step process provides a convenient framework for considering and organizing ergonomic
engagements and an efficient way to communicate process and progress to employers.
be overlooked or brushed aside as offerings are marketed, relationships formed, and services are
delivered. Providers will be held accountable and reputations are at stake. It is important to approach
problem solving from a strategic resource perspective at all times.
A few thoughts about resource allocation, intervention strategies and case management...
Historically, health professionals have come to employers
offering either clinical services or education. Both are
generally seen as either expensive or inefficient. The
adjacent Corporate Resources Strategies illustration makes
the point if only 2.5% of cases (25/1000) account for 90%
of the cost, where is the value of training the remaining 975
employees and taking them away from production while the
training is taking place! And, a large and growing percentage
of the 90% of cost goes toward medical treatment.
Further, it is medical professionals who take employees off
work for extended periods of time, thus increasing the
likelihood for indemnity payments (wage replacement),
legal fees, and failure to ever return to work.
It is critical that financial resource use be optimized. That
means identifying emergent cases to resolve them quickly
and inexpensively. It also means optimal intervention and
case management for the few cases that represent the
greatest critical risk. Strategic resource allocation management is a critical SOLVE strategy.
The adjacent Corporate Resource Strategies graphic suggests distinct strategies for the various groups of
employees. The 1000 Employees can be routinely monitored via the SOLVE Survey to detect emerging
problems before they become problematic. The 75 Simple Cases are best served with triaging advice
and simple Functionomic interventions as necessary. The 25 Involved Cases are likely to respond to
conservative biomechanical treatment. The remaining Problem Cases will be best served with active
support and aggressive case management to assure optimal medical care and avoidance of unnecessary
testing and consults.
Page
18
There are 8 predictive factors related to identifying

employees who are at risk during time-away-from-work
(illustrated in order of importance in the adjacent graphic).
These are matters that should be considered when
managing high risk cases i.e. any that involves more than a
few days away from work.
In addition, there are

matters of overall job
satisfaction to consider.
The Gallup Organization
has
done
extensive
research on factors that
determine job satisfaction
that are revealing
factors that recognize the
nonphysical side of the
work environment. The
adjacent Measuring Job
Satisfaction graphic tells
an important story. It is
not unusual that physical
complaints
are
manifestations of larger
non-somatic issues. While
the SOLVE System does
not claim expertise in
managing such issues, it is
important to recognize
non-somatic contributors
to physical problems.
FUNCTIONOMICS
TM
Functionomics is a systematic approach to enabling people to better perform (efficiently and

comfortably) functional activities (physical tasks) at work. Because Functionomics targets only those
people who are experiencing problems it is financially very efficient. Because it identifies those people
as their problem emerges it prevents worker compensation losses and facilitates employee
accommodation. The result is favorable financial value for employers concerned with productivity,
quality, and loyalty.
Functionomics involves the subtle management (manipulation/adjustment) of work related movement,
forces, and time the DNA building blocks of physical function and performance. Functionomics
reduces the physical demands of work while enhancing the physical capacity of the worker.
Functionomics and ergonomics are complementary. Where ergonomics is oriented toward universal
engineering solutions to generic work stressors; Functionomics is oriented toward biomechanical
solutions to specific subtle work stressors. Simply stated, Functionomics effectively and efficiently
positions employers and employees for success at work.
(* Note: Managing involves the subtle management of physical variables associated with tasks, environments, and
individuals in order to enhance functional performance by building on success at the threshold of success. Tweaks
TM
primary involve aspects of position, movement, force, and time. In Applied Functional Science , Gray Institute, the
term use is Tweaking).
Page
19
TM
A distinctive competency of Functionomics is Applied Functional Science * (AFS) which uniquely

integrates the physical, biomechanical, and behavioral sciences. AFS brings a deep understanding of how
the human body physically functions / performs in work, sport and leisure activities. The optimization
and management of biomechanical chain reactions in the body is its core competency. By tweaking
critical biomechanical demands of a task, Functionomics improve the biomechanical response that is
elicited. The result is better performance and greater comfort.
(*Note: AFS evolved out of over two decades of research and development by Gary Gray PT; and is taught through
the Gray Institute www.GrayInstitute.com)
TM
Functionomics is the missing element / gene in most corporate health initiatives. It is the Rosetta
Stone that translates potential into performance. It complements engineering, ergonomics, production,
quality control, human resources, employee training safety & health, , wellness, fitness, first-aid, urgent
care, specialty care, rehabilitation, case management, and return-to-work. It is holistically concerned
with stable, scalable, and sustainable performance of work by workers in the workplace.
TM
Functionomics is investigative, integrative, innovative, and interventive. It does not seek one-size-fitsall or silver-bullet solutions. Rather it recognizes and resolves pre-emergent, emergent, acute and
chronic conditions involving repetitive stress/strain and cumulative trauma. The need for Functionomic
intervention is indicated by discomfort, functional impairment, and compromised productivity.
Functionomic interventions are simple and sophisticated.
(The term FunctionomicsTM originated with Performance Builders, LLC and its use is trademarked. It is used by SOLVE
with Permission. All other use not associated with the SOLVE Survey is strictly prohibited without written permission.)
The term takes its meaning from the Latin functio meaning performance execution; the Greek nomos
meaning principle or law; the Greek oikonomos meaning manager/steward; and the Greek iokos
meaning habitation. Functionomics then is about the management of performance principles and the
stewardship of performance resources in the workplace. Inherent in the term are connotations of
efficiency, effectiveness, quality, sustainability, and value.
TM
The influence of Functionomics

is subconscious and natural. It facilitates what the human body
instinctively seeks but often does not achieve effectiveness, efficiency, and economy.
Pag
e
1. Antecedent (Stimulus) Antecedents are the stimulus/provocation that sets the stage for a
biomechanical chain reaction to occur. The provocation is neurologically processed in a complex
interaction involving prior learning, experience, conditioning, and real-time environment,
positioning, subconscious proprioceptive input, and conscious will.
2. Behavior (Action/Reaction) Behaviors are what a person physically/functionally does.
Behaviors are where value is either found or lost. Behavior is purposeful. It is influenced by the
antecedent and drives the consequence. Behaviors are evoked by their subtle interplay between
the Antecedent and the Consequence.
3. Consequence (Result) Consequences are influenced to varying degrees by the effectiveness,
efficiency, and quality of the behaviors performed. Consequences produce a functional feedback
loop that either increases or decreases future behaviors via positive reinforcement, negative
reinforcement, punishment, or penalty.
20
Human function / performance are the product of Biomechanical Chain Reactions (BCRs). A BCR involves
the recruitment, distribution, sequencing, and integration of the bodys biomechanical resources
(neuro-muscular-skeletal) to perform functional tasks for particular purposes. BCRs are made up of 3
elements rooted in the scientific method and a robust neurologic feedback system:
All BCRs always have either positive or negative consequences impacting the quantity and quality of
work performed and the comfort, health, and sustainability of the body to perform work. BCRs are
learned motor skills acquired, developed, and modified by repetition over time. BCRs are
accommodative and may vary significantly between individuals and within individuals in response to
habits, training, changing conditions, and injury.
BCRs are temporal events (TEs) having spatial and time dimensions. BCRs can be anticipated, measured,
modified, and enhanced. There are three variables associated with all BRC TEs motion, force, and time:
1. All human movement simultaneously occurs in three planes of motion (sagittal, frontal, and
transverse) within three dimensional space.
2. That movement is subconsciously and dynamically managed by the neuro-muscular-skeletal
systems production and absorption of forces in real time.
3. Time introduces the dimension of intensity and dosage to functional tasks through repetition,
pacing, and duration.
BCR TEs are task specific and involve complex interplay between gravity, momentum, ground reactions,
center of gravity, leverage, and compression, tensile, shear, and torsional forces. Such interplay
influences performance variables such as speed, accuracy, power, endurance, balance, agility, comfort,
and vitality.
Keep in mind that the poverty of movement can be just as demanding as its excess; the forces of nature
are never at rest even in sedentary work; and time marches on.
When these three variables are optimized performance soars. When they are compromised
performance suffers.
Performance has both a quantitative and a qualitative dimension. Physical performance is objectively
measured in work (e.g. she was 85% productive) and in sport (e.g. he jumped 6 3). But performance is
also subjectively perceived (e.g. he felt off, he didnt look on). Subjective perceptions of
performance over time can be highly credible and useful particularly when they include the qualitative
dimension of comfort. These understanding are the foundation for the SOLVE Survey.
Page
The bodys 206 bones, 360 joints, 639 muscles, and over 1 billion nerves engaged temporally in three
dimensional movements through the production and absorption of complex forces enable functional
diversity beyond comprehension. BCRs are weakest link phenomena. Intolerance associated with one
task involving one joint in just one portion of one plane of motion can disrupt the efficiency of an entire
BSR. That disruption could easily extend from the fingers to the toes (e.g. try balancing on one foot
while reaching out to turn off a light switch watch the finger and feel the toes). In such situations, the
body effectively compensates and adapts but at the cost of incurring repetitive strain. Efficiency,
21
Work and sport is comprised of repetitive BCR TEs repetitive movement patterns repetitive strain.
When things are going well and repetitive strain is balanced with repetitive recovery then performance
is sustainable. When recovery exceeds strain over time, performance feels good, looks good, and is
good. When strain exceeds recovery over time (i.e. recovery is exhausted) performance and comfort
predictably and progressively erodes. That difference is readily apparent when a similar task results in a
callus vs. a blister; or when it results in muscle hypertrophy vs. tendonitis. Repetitive tasks facilitate
either a conditioning or de-conditioning response in the body. It all depends on whether BCR are on or
off, and that varies individually by person, task, and time. We see it so vividly every day in the
competitive field of sport but we overlook the same phenomena on the competitive field of work.
comfort, and productivity all suffer. While the weakest link may disrupt a BCR and result in a costly
worker compensation case, the smallest biomechanical tweak can restore the BCR and eliminate the
TM
cause of the strain it instantaneously. This is why Functionomics is so potent and profitable.
A key reference point in the performance of all BCRs is the Transformational Zone (TZ). TZs represent
the position, time, and space in which BCRs structures transform between loading and unloading
functionality. Loading and unloading patterns may be driven from the top-down or the bottom-up; and
may cover or expose weak links in the BCR. TZs may facilitate or impair the recruitment and integration
of the bodys biomechanical resources. Managing TZs are key to managing performance and comfort.
TM
Functionomics provide principles, strategies, techniques, process, and discipline for optimizing human
performance, health, and wellbeing by managing BCRs, TEs, and TZs within the context of workplace
design, production operations, performance training, and health intervention.
TM
Functionomics is essentially industrial strength manipulations of motion, force, and time variables
that affect the performance of activities / tasks that people do every day at work.
TM
Professionals engaged in Functionomics are uniquely trained and experienced in the physical, health,
and behavioral sciences. They have acquired sophisticated skills in the prevention, intervention, and
rehabilitation of neuro- muscular-skeletal conditions and the enhancement of human performance in
individuals ranging from the disabled to elite athletes.
High frequency, high cost worker compensation injuries / illnesses (cumulative trauma) predominately
involve the neuro-muscular-skeletal system and are usually caused by repetitive tissue strain of
biomechanical origins the primary domain of physical therapists (PTs). PTs who understand
biomechanical chain reaction principles and intervention strategies have much to contribute to that
which presents the greatest worker compensation risk and expense to employers.
Human performance and comfort is a dynamic
balancing act that is ever changing. There are
four elements at play the demands of the
work, the capacity of the worker, the behaviors
through which the worker engages the work,
and administrative systems including intended
policies, procedures, and processes and
unintended culture, habits, and practices.
Page
There are actions, reactions, and compensations that constantly interact over time. Some achieve
balance (temporary or sustained) others do not. There are many potential balance point configurations.
For every balanced situation there are multiple tipping points. Thus, there are multiple solutions for
restoring balance when it is lost. Balance is more to achieve than imbalance. Apparent equilibrium may
be only temporary. Optimization of performance and comfort requires the sustained avoidance of
tipping points. In some instances sustained balance may require ongoing tweaking to accommodate
evolving situations (getting better or worse). When avoidance is not possible a timely recovery, with
22
Changes in work performance and comfort

result from the interplay amongst these four
elements. A change in any one element affects
all elements for better or worse.
perhaps a certain amount of overcorrection, is all important. Risk is associated with the absence of
detection systems to identify ones proximity to tipping points.
TM
The implementation of Functionomics within the SOLVE System is uniquely differentiated in four
ways:
1. Its holistic worker-centric perspectives
2. Its focus on emergent issues and intervention efficacy
3. Its functional orientation on human performance and comfort
4. Its cost effectiveness and return on investment.
TM
Page
23
Functionomics combines a can -do attitude, innovation, efficient problem resolution, and
relational integrity between management, labor, and external stakeholders.
INTEGRATIVE FUNCTION MODEL

TM
Functionomics is about making work more workable by building comfort, productivity, and reward in
its doing. Its about building human performance around the human factor. Its about positioning people
and companies for greater success, security, and sustainability.
The physical function of work
consists of 7 core elements
Position, Excursion, Locomotion,
Propulsion,
Distribution,
Manipulation, and Transformation.
Within each of the functional core
elements are multiple functional
skills.
Those
functional
skills
are
subconsciously
assembled,
modified, disassembled, integrated,
and accommodated on-the-fly to
enable the completion of an infinite
range of functional tasks at work,
home and play. They are learned
motor skills that build on past
experience, current challenges, and
real-time proprioceptive feedback.
Workers essentially manufacture
their functional capacity to work
while actually performing the work;
i.e. the work trains them to perform
it just like the mouse trains the cat
to catch it. Its kind of like building an airplane while flying it with the airplane providing the instructions.
The human motor system is hard wired to learn and adapt by doing.
The Core Element is Transformation. Transformation is the bodys capacity to integrate core functional
skills efficiently and economically in the performance of work. It involves the subconscious management
of biomechanical resources through coordination, balance, power, and agility while responding
dynamically to ever-changing internal and external forces. Transformation is influenced by motion, force
and time. It incorporates three-dimensional movement in the sagittal, frontal, and transverse planes;
the biomechanical forces of gravity, ground reaction, and momentum; and the temporal variables of
repetition, rate, and duration. When function goes well there is gracefulness, elegance, and capacity
building. When function goes poorly there is inefficiency, awkwardness, and capacity erosion as tissues
breakdown due to tensile, compressive, shear, torsional, and yield forces.
Page
1. Engage alternative functional skills e.g. push instead of pull

2. Enhance functional skill levels e.g. enhance pushing capacity
3. Enhance transformational skills i.e. enhance coordination, balance, power, and agility
24
An understanding of this integrative model provides some big rock strategies that can be effectively
exploited to tweak the work environment.
4. Reposition the body i.e. change Transformational Zones to re-triangulate starting and ending
points
5. Redistribute movement within the three plains of motion e.g. more/less movement in select
planes
6. Redistribute movement within the body i.e. recruit and integrate resources rather than
remove and isolate resources
7. Modify internal force generation e.g. more or less loading or unloading
8. Modify external force absorption e.g. more or less loading or unloading
9. Modify temporal exposure e.g. increase or decrease repetition, speed, frequency, or duration
Page
25
Such Tweaking of work demands/capacity will alter performance and comfort. Since the effect of tweaks
are immediately visible and measurable the value of Functionomic tweaks are immediately apparent
with functional testing. Tweaking is an iterative process. Use and repeat that which works and discard
that which doesnt. Build on success and work at the threshold of success.
ERGONOMICS
Functionomics and ergonomics are complimentary.
Ergonomics is an interdisciplinary body of knowledge that extends well beyond the scope of most PT
practitioners. It encompasses the entire worker/work system including: industrial engineering,
physiology, anthropology, psychology, computer science, mathematics, and more. The sweet spot for
physical therapists lay in: biomechanics, applied functional science, anthropometrics, training,
conditioning, injury prevention, rehabilitation, human performance, and disuse/overuse syndromes of
the neuro-muscular-skeletal origins.
Professionals
engaged
in
ergonomics come from many
disciplines and each tends to
specialize within their particular
knowledge domain. Ergonomics is
a team sport with each team
member contributing within their
scope
of
knowledge
and
experience.
In the US, there are two primary
certification bodies for the
ergonomist. The first is Board for
Certification
in
Professional
Ergonomics and the second is
Oxford Research Institute. Keep in
mind however that even without
ergonomic certification, particular
areas of ergonomics are well
within the professional domain of
the physical therapist as illustrated in red in the adjacent graphic.
The term ergonomics originated with Wojciech Jasrzeboski (1857), who defined and used the concept.
He described it as: The Science of Work. The term ergonomics comes from the Greek words ergon,
meaning to work, and nomos, meaning principle or law.
The Board of Certification in Professional Ergonomics (BCPE, 1997) defines Ergonomics as: a body of
knowledge about human abilities, human limitations and other human characteristics that are relevant
to design. Ergonomic design is the application of this body of knowledge to the design of tools,
machines, systems, tasks, jobs, and environments for safe, comfortable and effective human use.
Page
Ergonomics is worker-centric that is, work is designed around the worker to optimize performance
and comfort. Ergonomics focuses on the interface between the worker and the work (machine, tool,
26
Ergonomics is sometimes used synonymously with human factors particularly in Europe. In the US
human factors includes both physical and cognitive attributes of human performance. The Ergonomist
typically has expertise in human performance, biomechanics, and anthropometrics. They typically work
in the design and implementation of work spaces, processes, and tooling in manufacturing and office
environments with the intent of promoting safety and productivity.
control, product, etc.). Ergonomics makes work accommodative focusing predominantly on permanent
engineering solutions that change the nature of the work such that most workers could perform it safely
and successfully.
The reference standard for ergonomic design is human performance not average performance and
not individual performance, but rather the range of achievable performance by 95% of the population
th
th
who would potentially be engaged in the work (2.5 %tile 97.5 %tile). Thus statistically speaking,
ergonomic design is concerned with designing work that fits the size, strength, mobility, speed, and
perceptual capabilities of a population group that includes everyone within two standard deviations of
the mean.
By contrast, Ergonomic accommodation uses a single worker
or a specific work group as the reference standard. In such
situations the intent is not to design the most inclusive
ergonomic solution for an entire population, but rather to make
the necessary modifications to adequately accommodate a
portion of the population. Such solutions are about economy,
and expediency rather than optimal inclusiveness. Thus
functionally speaking, ergonomic accommodation is concerned
with modifying work to fit the size, strength, mobility, speed,
and perceptual capabilities of an individual or group of
individuals whose comfort or productivity may be enhanced.
The functional orientation of a clinical therapist is distinctly different from that of an ergonomic
consultant. This can be illustrated by the following example. In a jumping task, if one cannot jump over
the bar there are two options. The jumper can be trained or the bar can be lowered. Therapists are
clinically oriented toward training the jumper / worker through exercise, training and conditioning
strategies.
In ergonomics, the orientation is on lowering the bar, i.e. reducing work stressors through ergonomic
design and countermeasures. Ergonomics is not about competition it is about participation. Its not
about who can jump the highest, its about modifying the challenge so it is possible for everyone to
jump over the bar (think Special Olympics). This is a fundamental difference between human
performance in sports and in the workplace. In the practice of ergonomic accommodation, the best
solution may be a combination of both strategies.
This brings up three critical understandings for those trained in clinical practice who engage in
ergonomic related activities.
Page
Ergonomics is a natural extension of the biomechanical expertise of a functionally orientated therapist.

However, ergonomic practice is also distinctly different from clinical practice. Ones appreciation of and
attention to such differences are significant and have implications on the acceptance and potential
27
1. Ergonomics is focused on changing the work not the workers.

2. Ergonomics may change work for a population of workers or individual workers.
3. While both the performance of the worker (comfort, health, and job security) and the
performance of the company (productivity, quality, and profitability) are equally important
considerations; ergonomically speaking, company performance is what almost always justifies
the ergonomic related decisions made by companies! This understanding is essential!
success of ergonomic service relationships with companies. The professional always needs to be
cognizant of which hat is being worn patient advocate or corporate advisor!
ECONOMICS
As a corporate advisor, the economics of matters is what matters.
Economics is all about the creation, use, and management of assets (financial, physical, and human) for
the primary purpose of earning profits of course more is better. Yes there are other priorities but they
fall far behind profitability.
Profit is the ultimate measure of the decisions made by management and those that advise
management.
Through work, assets are put to use and value is created. There are only four ways to improve financial
performance:
1. Improve revenue
2. Improve expense
3. Improve asset utilization
4. Improve risk
Functionomics and ergonomics primarily impacts expense, asset utilization, and risk. Unless services can
demonstrate a measurable return on investment in less than a year, companies will likely show little
interest. Economic performance demands accountability. Accountability demands active management
toward definable goals.
Return on investment is about enhancing value. It can be measured in multiple ways:
Functionomics is only justified by its positive financial impact, thus economic impact need always be
addressed i.e. What is the net positive value that is intended and achievable? When the economic
impact is understood client interest can be high. More positive impact in less time is always good.
28
Output
Productivity
Quality
Employee morale/loyalty
Waste
Errors
Management time and worry
Medical expense
Lost time
Labor replacement costs
Labor and customer retention
Revenue
Expense
Asset utilization
Risk exposure
Insurance costs/liabilities
More
Page
Determining the economic impact usually requires an insiders understanding of the clients business. It
is always worth engaging such an insider when economics will be considered. A simple return on
investment calculation is priceless.
ESTABLISHING CONTEXT
How does one know that there are likely issues in the workplace that could/should be addressed? What
should cause suspicion?
Consider these metrics as the Dirty Dozen indicators
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Worker compensation incident data incident rates and risk ratings (Mod Rate)
Worker compensation expenses medical, wage replacement, premiums
Work restrictions, job rotation, and absenteeism
OSHA, Department of Labor, or work comp insurer involvement / citations
Deteriorating employee morale
Employees complaints about comfort and resources
Employee turnover
Deteriorating productivity
Increased waste or rework
Quality related issues
Employee modified tools and equipment
Frequent and intensive use of medical or rehabilitation services
These are topics that need to be discussed during exploratory interviews with employers the
discussion is not dissimilar to taking a patients history. Its a time to: get to know the client, establish a
relationship, understand issues and context, discuss and shape expectations, define the scale and scope
of opportunity, and understand budgetary resources. Upon completing such a discussion there should
be an understanding of the following:
Foundational information that is generally helpful for such discussions includes the following:
29
What is the clients perception of the problem?

Who does it involve? What is its scope people, dollars, locations?
Where is it occurring?
When did it begin? How has it progressed?
What work demands, policies, and procedures impact the problem?
What attempts have been made to resolve the problem? What have been the results?
What does the client worry about happening?
What is the net financial impact of the problem? (Consider economic, operational, quality,
productivity, relational, and competitive impact.)
What are the clients expectations as to process, special concerns, timeline, outcome, and cost?
Note, its worth asking if a budget for the project has been established this save a lot of guess
work as to project content and pricing. Also inquire as to how a decision will be made Who will
be involved? How many steps will be required? How long will it take? How will you need to
participate in the process?
If intervention is successful, how will things change and how will those things be measured?
Who from the company will champion the project and expedite resources?
What is the process and timeline for making a decision concerning the matter?
Page
OSHA Form 301 Injury and Illness Incident Reports*

OSHA Form 300 Log of Work Related Injuries and Illnesses*
Insurer or Third Party Administrator (TPA) periodic reports**
Industry specific loss data***
Health services provider data****
*Occupational Safety and Health Administration For OSHA information: www.osha.gov.com
For information on OSHA Forms: www.osha.gov/recordkeeping/OSHArecordkeepingforms.pdf
** Insurer reports vary widely but generally provide a summary of cases and financial expenditures and reserves. The
companies Mod Rating is an insurers ranking of the companies risk rating within its industry (e.g. <1.0 = better than
average, 1.0 = average, > 1.0 = worse than average)
*** Pertinent loss data can be obtained from:
OSHA (http://www.osha.gov/oshstats/work.html),
States OSHA List http://www.osha.gov/dcsp/osp/states.html
US Bureau of Labor Statistics (http://www.bls.gov),
State Bureaus of Labor Statistics List http://www.bls.gov/bls/ofolist.htm
US Department of Labor http://www.dol.gov/
State Departments of Labor List http://www.dol.gov/esa/contacts/state_of.htm,
State Worker Compensation Agencies List (http://www.ic.nc.gov/ncic/pages/all50.htm),
National Safety Council (www.nsc.org).
**** Most employers have little if any data from providers. Its absence makes a strategic point.
Having reliable information as a foundation is critical to assuring that interventions and investments are
strategic in nature and able to produce reliable and meaningful results. Not taking a project is better
than taking one and failing for any reason! Business operates on data. Dont be caught short!
PERSPECTIVES
Traditional ergonomics, like traditional clinical practice, has been too long focused on cook book
solutions, protocols, and tools that are habitually applied to common classes of problems. They have
tended to be tactical interventions rather than strategic solutions, thus resources have often been
wasted and results compromised.
TM
In Functionomics , the focus shifts to understanding underlying

biomechanical causes that impact the biomechanical chain reactions that
are work. Interventions are strategic, custom, and efficient.
Traditionally ergonomics has been driven by academics, researchers,
engineers, and tool manufacturers, none of whom typically understand
subtle functional chain reaction biomechanics. This is not to say the
solutions and products they design are wrong. What it does suggest is that
many ergonomic designs are poorly applied due to errors in selection or
implementation. It also means that traditional ergonomics has a blind spot
that leaves unexplored and underexploited opportunities. Ultimately, it means that something
important is missing. Work related data proves it year after year!
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MSDs are the result of repetitive stress caused by work interrelated forces and motions over time that
exceed the bodys strain tolerance/adaptability threshold.
30
If off-the- shelf ergonomic solutions were the answer, the problems of muscular-skeletal disorders
(MSDs) in the workplace would not persist as they do. The problem is that MSDs are of biomechanical
origins. Ergonomic solutions may be necessary but are often not sufficient. Functionomics provides an
added dimension to ergonomic and engineering solutions and enhances their potency.
Repetitive stress can be relieved by altering one or more of these three

contributing factors. An analogy to fire makes the point. In the case of fire, three
elements are needed: fuel, temperature, and oxygen. A fire can be extinguished
by eliminating any one of the three elements. So too, MSDs can be extinguished
by eliminating or even modifying one or more of its three elements. Like fire,
MSDs are more easily extinguished when caught early before they intensify and
spread!
When workers engage their work it is accomplished through physical efforts of one type or another.
Thus, if work tolerance and performance is to be enhanced it too will need to be accomplished through
physical means!
TM
Functionomics is a vital component of a comprehensive strategy for safeguarding the performance

contribution of human assets in a uniquely designed, operated, and managed business environment.
TM
The principles and strategies of Applied Functional Science provide a systematic and replicable
framework with which to reliably assess workers and work for stable, scalable, and sustainable
productivity.
When it comes to function, one can approach the assessment and management of work stressors the
same way one approaches functional interventions in the clinic i.e. with Tweaking. The principles and
strategies are identical! Its like working in a mirror.
In the clinic, one works with the client from a work performance perspective
to enhance functional capacity. In the workplace, one works with functional
tasks from a work demands perspective to improve functional
requirements. Functional tweaking from both the capacity and demands
side of the equation provides an unlimited variety of potential solutions and
enhancements.
Tweaking is used to modify testing and exercise demands in the clinic and
work demands in the workplace. Functional capacity and functional
demands can be Tweaked up or down and in or out with subtle, or not
so subtle, changes in motion (positions, joints, direction, and displacement), force (gravity, reactive
forces, mass and momentum) and time (rate, cycles, frequency, duration). This is the essence of
TM
Functionomics .
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1. Solutions are uniquely individualized to a particular situation there are no one-size-fits-all offthe-shelf answers.
2. For every problem there are multiple potential solutions and combinations of solutions the so
called silver bullet solution often sells but seldom satisfies.
3. Solutions may be found:
At points of transformation i.e. where biomechanical loading and unloading and
neuromuscular proprioceptive training occur.
With multi-joint tri-plane motion i.e. where integrated isolation is avoided and
neuromuscular recruitment occur.
In timing where speed, duration, frequency, rates, rhythms, and repetitions are managed.
4. Identify and modify biomechanical causes, not compensations and symptoms.
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There are 6 functional principles that establish the framework for Functionomics
5. Better questions drive better solutions answers are inherent in the problem. Questions are
both verbal (ask for information and listen) and physical (ask for activities and watch).
6. Behaviors contribute to either the problem or the solution. Behaviors are reactive. Solutions are
found in subconscious behavioral recruitment.
PRINCIPLES
TM
The biomechanical domain of Functionomics

revolves around the interaction of three variables
force, motion, and time. Understanding those relationships is the foundation for all biomechanical
strategies. These are the same three relationships that establish the foundation for Tweaking in the
clinic. With an understanding of force, motion, and time, the worker-work interface can be tweaked
both on the side of the work and the side of the worker to provide an almost unlimited range of
opportunities to improve work performance and comfort.
Lets begin with a brief consideration of mechanics (force and motion) by considering Newtons three
laws with an emphasis on force considerations.
Newtons First Law An object at rest tends to stay at rest and an object in motion tends to stay
in motion with the same speed and in the same direction unless acted upon by an unbalanced
force.
Newtons Second Law The acceleration of an object as produced by a net force is directly
proportional to the magnitude of the net force, in the same direction as the net force, and
inversely proportional to the mass of the object.
Newtons Third Law - "For every action, there is an equal and opposite reaction."
Applications:
1. Introduce mass between work and worker to absorb impact and vibration forces
that originate from external sources and are transferred to, and dissipated
through, the worker.
2. Introduce mechanized force production and control systems to assist workers to
celerate (accelerate or decelerate) loads.
3. Introduce objects with reduced mass to enable workers to celerate loads
manually.
4. Introduce leverage to reduce forces transmitted to and from workers.
5. Introduce counter-forces to achieve equilibrium and reduce manual force
requirements.
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Newton reminds us that the physical nature of work involves force related actions and reactions.
Worker generated actions produce work reactions; and work generated actions produce worker
reactions the result is a dance between work and worker constant give and take. Depending upon
32
6. Introduce neutral or mid-range postures, biomechanical alignment, and external

support for static postural tasks to minimize leveraged forces of gravity.
biomechanical and physiologic variables, these dances may either build-up or break-down workers. The
difference could be a callus or a blister, a bulging biceps or an inflamed tendon, a strong core or a bad
back. The only difference being the dosage and relative interplay between motion, force, and time.
Within biomechanics there are four important types of forces to consider Tensile, Compressive, Shear,
and Torsion.
Tensile forces occur within a structure and are related to elongation forces (e.g. attempting to stretch or
load a muscle/tendon/ligament). Think, tendency to tear.
Compressive forces occur within and between structures and are related to compacting forces (e.g.
external pressure applied perpendicularly to soft tissue or internal pressure due to compartmental
swelling). Think, tendency to bruise.
Shear forces occur between structures and are related to frictional forces (e.g. finger flexor tendons
sliding past each other under the carpal ligament at the wrist). Think, tendency to abrade.
Torsion forces occur within structures and are related to twisting around an axis (e.g. spinal column and
discs undergo torsion forces with rotational, transverse plane, body movements). Think tendency to
derange.
From a biomechanical perspective, force management brings up three considerations.
The first is the matter of resiliency a workers ability to absorb forces. While the body is reasonably
capable of absorbing transient external forces, as is demonstrated in athletic events involving contact,
soft tissue breakdown can result from sustained external force exposure of sufficient frequency and
duration (i.e. cumulative micro-trauma). Two patterns are common - muscle / tendon breakdown
(inflammation) can occur with repetitive strain and vascular compromise can result from vibration
exposure in the frequency range of 5 - 36 m/s. (For more information on vibration and cumulative
trauma visit www.cdc.gov/niosh/homepage)
The second is the matter of neuromuscular force generation by the worker. Force generation and
coordination is influenced by four variables learned motor patterns in the central nervous system,
proprioceptive input from the peripheral nervous system, peripheral neural-motor performance, and
muscle composition / bulk.
The third is the matter of econ-centric muscle loading. Concentric muscle contractions are more
powerful and effective when they are immediately preceded by sufficient eccentric loading. Efficiency
can be gained through facilitating biomechanical cycles of eccentric loading-transformation-concentric
unloading-transformation-eccentric loading that enhance efficient performance.
Applications:
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2. Introduce biomechanical task designs that prevent integrated-isolation of muscles

i.e. tasks where force generation is demanded of isolated and relatively weaker
muscles while larger more distributed muscle groups are prevented from being
recruited due to joint positioning.
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1. Introduce biomechanical task designs that engage muscle groups involving multijoint chain reactions.
3. Introduce biomechanical task designs that facilitate force transfer between work
and worker in mid-ranges of joint motion.
4. Introduce biomechanical work patterns that naturally recruit powerful muscle
groups such as the buttocks, quads, core, and shoulder girdle.
5. Introduce and enhance multi-plane eccentric muscle loading immediately preceding
demands for concentric muscle force generation.
6. Introduce body mass, momentum, gravity, leverage, as internal substitutes for
muscle generated force.
Next lets briefly consider motion as it occurs in the body by
considering four variables. The first three variables are quantitative
while the last variable is qualitative.
Functional motions are tri-plane. That is, they involve the
sagittal, frontal and transverse planes. Even though one
plane may be dominant all three planes are involved to
some extent.
Functional motions are multi-joint. That is, motion is distributed across multiple joints, thus
multiple motion and force distribution alternatives always exist. Even though one joint may be
dominant, multiple joints may participate in varying degrees at different times or under
different circumstances.
Functional motions are multi-dimensional. That is, motion occurs with direction, height,
displacement, and velocity.
Direction Relative to anatomical neutral or relative to external references (i.e. a 360

degree range of possible bearings in the transverse plane).
Height Relative to vertical (i.e. a range from maximal reach down to maximal reach
up).
Displacement Relative to a starting point or relative to external references (i.e. a linear
or angular measurement of distance).
Velocity Relative to displacement over time (i.e. distance per second)
Functional motions are synergistic. That is, motions occur within a coordinated and integrated
chain reaction contributing to the quality of motion whose attributes include balance, agility,
efficiency, and flow / gracefulness / artistry.
Applications:
1. Introduce subconscious planes of motion modifications to tasks to facilitate,
enhance, or limit required / desired motor patterns or alter the range of potential
user options.
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2. Introduce task placement and/or orientation to facilitate multi-joint participation

thus enhancing the recruitment of motor resources and better distributing
biomechanical loads.
3. Introduce alternative dimensional variables to modify work demands -Work Tweaks.
Alter direction to modify stance, orientation, and alignment.
Alter height to modify postures, joint involvement, and motor recruitment.
Alter displacement to modify the physical demands of walking, reaching and
lunging.
Alter velocity to modify accuracy, efficiency, productivity, and motor patterns.
4. Introduce alternative staging, positioning, sequencing, timing, flow, combination,

and assignment of work tasks to choreograph and enhance the efficient and natural
quality of biomechanical reactions.
Finally, lets consider the element of time as it influences biomechanical work
tasks.
The variable of time has 3 dimensions that need to be considered in the context
of work and functional ergonomics. They are Cycle, Frequency, and Duration
each is typically a ratio (e.g. units per minute, cycles per hour, and hours per
day). Taken together they provide a terminology for describing exposure time (or
dosage) to work tasks / activities / stressors.
Cycle time is the time taken to accomplish a particular task (e.g. 90
seconds per part or 2 minutes per inspection).
Engineers and operators commonly refer to the Cycle dimension as tach time.
Rhythm has to do with an interval during which a regular sequence of events occurs and
reoccurs (i.e. the timing of the things). Work rhythms can be regular or irregular.
Frequency is the number of Cycle occurrences within a period of time (e.g. 30 cycles per hour).
Note that the Department of Labor also uses frequency as a descriptor to classify task
participation time within a work shift. Frequency can be occasional (6 33% of work
time), frequent (34%-66% of work time), or continuous (67% - 100% of work time).
Duration is the time during which Cycle time and Frequency occur (e.g. per day).
So for example, a task could have a cycle time of 90 seconds, occurring at a frequency of 10
cycles per hour for duration of 8 hours per day. Thus the task would occur for 2 hours per day
(25% of shift). The Department of Labor would classify that exposure as Occasional.
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Rate is a ratio. It measures the number of occurrences within a specified time span. It suggests
pacing and productivity (e.g. units per minute) . In the manufacturing environment rate is about
cycle time and is driven by time studies and engineering work flow. Rate can be self-paced or
system paced.
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(i.e. 90 seconds per cycle x 10 cycles per hour x 8 hours = 7,200 sec or 2 hours)
Repetition is a matter of occurrences that are time independent. When time factors are
introduced (i.e. repetitions completed within a defined span of time) repetitions could be stated
either as an absolute quantity per unit of time or as a rate for a certain duration or time.
Applications:
1. Introduce a regular rhythm to tasks to enhance motor learning, efficiency, and
consistency.
2. Introduce an irregular rhythm to tasks to enhance motor variability in task execution
and relieve boredom.
3. Introduce system rate controls and rate enhancements to facilitate productivity.
4. Introduce personal rate controls and rate reductions to reduce physical and
psychological stress.
5. Introduce cycles, frequency, and duration reductions to enhance soft tissue
recovery.
6. Introduce cycle, frequency, and duration increases to enhance productivity.
7. Introduce job rotation to reduce exposure time to high demand tasks.
PATHOLOGY
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When acute traumatic injuries occur they are generally associated with accidents where one may expect
clearly defined events, witnesses, locations, causes, and onset dates and times. The cause of the injury
and the resultant anatomical damage are generally well linked. Structural damage is usually apparent
36
There are two primary types of work related Muscular-skeletal Disorder (MSD) conditions - acute
traumatic injury events and cumulative trauma illness (by OSHSA definition) processes. Each has a
distinct temporal profile and implications.
and recovery times predictable within periods of weeks (primary healing is usually accomplished in a
period of 2 6 weeks).
When exposures of force, motion, and time are adequate intensity and duration to cause cumulative
trauma and subsequent pathology, Functionomic and ergonomic countermeasures should be
considered. Lets briefly consider the pathology to better understand potential countermeasures.
Work induced cumulative trauma with related pathology and resulting economic cost is the most
common reason for seeking workplace solutions.
Biomechanical breakdown in the body is not dissimilar to the mechanical breakdown of a tire. Road
forces, compression, friction, and rotational motion combine to create heat and tire wear. That wear
may be increased or decreased based on road conditions, tire size, travel speed, air pressure, vehicle
load, and tire alignment. Its all about force, motion, and time.
The sequence of tissue breakdown occurs like
this:
1. Repetitive force (load) and motion
(friction) over time (fatigue) causes
biomechanical stress friction, heat,
and swelling
2. That stress causes soft tissue strain and
micro-trauma
3. If tissue strain levels are sufficiently
low and intermittent, the body
accommodates via callus formation,
muscle/tendon
hypertrophy, bone
hypertrophy,
and
enhanced
vascularization
If tissue strain levels are sufficiently high and sustained, the body tissue damage occurs in the
form of blister formation, muscle/tendon inflammation, stress fractures, and vascular
compromise
4. Progressive tissue breakdown and inflammation occurs
5. Progressive signs and symptoms appear
6. Progressive loss of physiological function occurs
7. Progressive loss of functional performance occurs
9. Secondary breakdown occurs due to compensation overuse
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8. Substitution and compensation occurs
10. The cycle may repeat and expand to involve additional soft tissue structures and biomechanical
mechanisms.
When physiological homeostasis is maintained or reestablished, cyclical tissue strain with micro-trauma
and physiologic recovery occur below the threshold where signs, symptoms and chronicity occur.
Cumulative soft tissue micro-trauma is caused by chronic soft tissue strain resulting from biomechanical
chain reactions to three dimensional work stressors (force, motion, and time). When complex forces and
motions become focused on susceptible soft tissues the result is overload, inadequate load distribution,
or impaired recruitment of biomechanical resources. Individual work capacities, behavioral patterns,
tolerances, and responses vary greatly.
Integrated isolation is often the underlying biomechanical cause. Integrated isolation may occur when
chain reaction biomechanics position select joints and muscles at a relative disadvantage and overload
due to the inhibition of other joints and muscles that could but are unable to contribute to a functional
action.
For example, test grip strength with wrist
flexed (weak) vs. wrist neutral (strong). With
finger flexors in a shortened position less grip
output can be exerted. Additionally, friction on
the flexor tendons as they pass through the
carpal tunnel is increased due to mechanical
positioning and the additive effect of
compressive and shears forces. Over time with
repetition these mechanics could contribute to
tendon sheath swelling, and loss of functional
strength.
A second example - test squat depth with
forefoot unsupported over edge of step and arms reaching overhead (weak) vs. entire foot supported on
floor and hands reaching anterior laterally at knee height (strong). The weak position prevents the ankle
and hip from participating in the squat, thus isolating the knee which takes the full load while operating
under a mechanical disadvantage.
A third example of integrated isolation observe workers who reach a waist height while standing in
front of a work bench, which does not allow foot access under the bench; thus blocking a sagittal plane
stance (RXX). The resulting frontal plane stance limits forward shifting of center of gravity (located in the
pelvis) and forces increased sagittal plane compensation to occur in the lumbar spine while
simultaneously accentuating leverage forces.
Such repetitive patterns of exertion in integrated isolation are a common finding where biomechanical
muscular-skeletal problems exist.
HUMAN PERFORMANCE
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Functionomics , like ergonomics, is worker-centric, however, Functionomics offers a more granular

approach and enhanced scope to problem solving than ergonomics. If one is to modify work/worker to
reduce stressors it is necessary to have a human performance frame of reference as a starting point. The
intent is to functionally position the worker and the work for success i.e. to encourage them. To that
end, the following human performance concepts need to be understood.
There are three things to keep in mind
concerning muscle output.
1. Muscles have a normal excursion
length that correlates with the
range of motion of the joints they
power. Maximum muscle force
output occurs in the middle third of
that excursion/range. Thus tasks
that require strenuous effort
related to force or repetition are
most efficiently performed around
mid-range.
2. Muscles are driven proprioceptively from practiced behavioral patterns. New tasks and new
motor patterns take time to learn. Thus a proprioceptive patterning allowance should be
factored into productivity standards for new production tasks or processes, new worker
assignments, and workers returning post injury.
3. Concentric muscle contractions (force production) are optimized with eccentric muscle loading.
The greater the eccentric load (i.e. end range) the greater the potential concentric output.
Where, when, and how transformation between eccentric and concentric occur affects muscle
recruitment and output. Three dimensional loading recruits more biomechanical resources.
Specificity in eccentric loading affects concentric unloading and performance. Thus muscle
efficiency and effectiveness during high force/power demand tasks can be enhanced with
strategic eccentric loading. Such loading may also contribute to enhanced circulation during
lower force repetitive tasks.
about muscle fatigue.
1. Muscle
exertion
duration is
inversely proportional to muscle
exertion effort.
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3. Tasks demanding higher muscular effort should be designed for shorter duration. And, longer
duration tasks should be designed for lower intensity muscle effort.
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2. Muscle endurance is circulatory

dependent - to supply energy
resources
and
to
remove
metabolites. Thus, when circulation
is compromised by external forces
or by vascular collapse, due to
internal muscle contraction, endurance erodes, soft tissue recovery is compromised, and tissue
healing may be delayed.

about muscle recovery.
1. Muscle recovery time is directly
proportional to muscle exertion
effort.
2. Reducing muscle effort while
maintaining circulatory efficiency is
critical to the sustainability of
performance.
3. Muscle recovery time should be
factored into engineered task selection, cycle times and production quotas.

about aerobic endurance.
1. Aerobic work sustainability is
inversely proportional to the
percent of aerobic work capacity
expended.
2. Worker aerobic capacity can be
enhanced on the job if adequate
task ramp-up pacing and duration is
provided.
3. Tasks requiring one third of aerobic capacity or less should be sustainable over a typical 8 hour
work shift. Aerobic capacity varies markedly amongst workers.
about grip strength.
1. As previously
noted, muscle
strength is optimal in mid-range.
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3. To minimize required grip effort, grip sizes should position each workers hand in mid-range.
This means that multiple grip sizes should be provided for grip intensive tasks; and that tools
should be fitted to individual workers.
40
2. The optimal round grip size for an

individual is
the approximate
diameter of the circle formed by
the thumb and forefinger when
making the OK sign. The optimal
oval grip size for an individual is
the circumference of the circle
formed by the thumb and forefinger when making the OK sign.

about wrist positioning.
1. Effective grip strength is most
effective
in
mid-range.
Although
grip
diminishes
muscle exertion does not! This
means more effort and less
effect.
2. Wrist position is driven by body
size (height), task design, and
tool selection.
3. Wrist positioning is important for repetitive tasks involving the hand, wrist, and forearm.
about gloves.
1. Gloves protect the hands from
work related hazards.
2. Gloves reduce effective grip
strength more effort and less
effect.
3. Gloves may restrict circulation and
wrist / hand mobility if not
appropriately selected or fitted.
2. Workers should be able to perform

repetitive work tasks within a
comfortable and efficient range of
motion (i.e. mid-range) consistent
with each workers body size. Work
environments should conveniently
accommodate workers of any size
via features offering adjustability.
3. Generic work tasks should be
P
a
g
e
1. Motion (range and reach) is

dependent upon a workers physical
body dimensions.
4
1

about anthropometrics.
th
designed to accommodate the physical movement capacities of 95% of workers (2.5 percentile
th
female - 97.5 percentile male).
Note: There are many sources of anthropometric. It can be incredibly useful in objectively assessing and designing
work spaces and tasks. Many are population specific. Good references and resources are available on the internet.
Three books that are very useful are: The Measure of Man & Woman by Alvin Tilley, Publisher Wiley, 2002; Human
Scale 1,2,3 by Niels Diffrient (expensive and hard to find but excellent), and Human Dimension & Interior Space by
Julius Panero, Publisher: Whitney Library of Design, 1979.
OBJECTIVES
TM
Functionomics
demands.
is intended to retain physiologic and functional homeostasis by reducing work
Countermeasures are introduced for the purpose of reducing work related stressors that contribute to
altered biomechanics and subsequent soft tissue strain, pain, and pathology. The intent is to enhance
work performance, comfort, productivity, and sustainability through the introduction of strategic
countermeasures.
There are three broad classes of work countermeasures that can be used to subconsciously improve
work stressor exposure. They are:
1. Engineering where changes are made in work processes, materials, and tooling.
TM
2. Functionomics
where changes are made in worker biomechanics.
3. Administrative where policy and practice changes are made to the work environment and
task exposure.
FUNCTIONAL DRIVERS
The work and the worker are part of an integrated biomechanical chain reaction. Both are linked. Both
act and react. They dance together throughout the day day after day. The dance is function. Each
enables the other. Each restrains the other. They are inseparable. When one leads the other must follow
easily and spontaneously or awkwardly with effort. When the later occurs performance and comfort
problems are prone to occur.
When awkwardness and inefficiency occurs the functional linkages between work and worker should be
considered for Tweaking (forces, motions, time) to alter mechanics and/or biomechanics. That is, the
cause, compensations, contributing influences, and cure needs to be found. That is, the drivers of the
functional task need to be considered and modified appropriately.
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There is a useful clinical analogy that applies here. Tweaking has taught us that there are literally
millions of potential exercises that could be used in the clinic too many to learn, too many to
remember, and too many to manage. Additionally, the biomechanical variations and responses used by
clients are essentially limitless, making cookbook solutions inadequate and irrational.
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There is a nearly infinite range of potential countermeasures that could be applied to any particular
problem. The range of options continually evolves with the introduction of new technologies and
processes. Thus it is better to focus ones understanding on functional drivers, movement response
patterns, and potential strategies, than to catalog endless lists of tactical solutions.
Thus it makes more sense for the professional to work from principles and strategies than tactical
solutions. The professional needs to differentiate between biomechanical patterns that are efficient and
effective and those that are not. To differentiate one must observe. To observe function, one must
systematically ask functional questions and observe the clients functional responses. Functional
questions are asked by giving clients relevant tasks / activities to perform using different Tweaks and
drivers. All the while, the professional assesses the biomechanical responses to determine what helps
and what hinders achieving optimal responses.
Functionomics is an identical process. The worker is the frame of reference. The intent is to Tweak tasks
(force, motion, time) to enhance workers ability to use natural, efficient, and effective biomechanical
patterns within ones capacity to engage the work. Each time work drivers are altered worker reactions
are too. By Tweaking the work and worker functional questions may be asked and refined until an
acceptable solution(s) is found.
When work is tweaked, the reactions of the entire worker population that may be exposed to the work
must be considered. This is a very different perspective than the individualized approach employed in
the clinic. It requires that the anthropometrics and physical performance capacities of 95% of the
workers be considered in formulating a solution. An accommodative solution is desired.
There are 5 critical linkages between the worker and the work that need to be considered. They are the
two feet, the two hands, and the two eyes which effectively function as one.
These 5 linkages are the primary drivers of chain reaction biomechanics. If one understands the
placement, orientation, and actions of these 5 linkage points, one can extrapolate what biomechanics
are likely to be occurring throughout the rest of the body.
By Tweaking work to alter one or more of these linkages the biomechanics of the worker can be
effectively changed. It is the ability to recognize favorable and unfavorable biomechanical patterns and
change them through Tweaking that makes Functional Ergonomics unique.
It is important to remember that judgment needs to be exercised when assessing a situation. How much
is too much and how little is too little? While too much force or motion (i.e. repetitive motion) may over
time contribute to cumulative trauma injuries, so to can too little force, motion (e.g. static postures).
The art of Tweaking is the ability to strike the appropriate balance between activity and inactivity so that
productivity is enhanced while comfort, healthy physiology and functional tolerance are maintained.
Lets consider the work tasks and activities that influence the 5 linkage drivers. The following
illustrations identify many of the key considerations that are repeatedly encountered in the workplace.
They are the work activities that influence the drivers.
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43
These guidelines should not be viewed as rigid standards, but rather as reasonable target
approximations suitable for consideration with high repetition tasks where performance and tolerance
are an issue. These guidelines optimize biomechanical advantage.
NEUTRAL TASK POSITIONS

Neutral positions are not intended to be static. On the contrary, neutral positions should be dynamic,
facilitating frequent movement through neutral. When sustained positions and repetitive tasks are
required they will be best tolerated near neutral.
Neutral Position Considerations Comments
Standing postures are best tolerated when leverage forces
exerted by gravity are minimized. A dynamic upright
posture that frequently moves through neutral facilitates
vertical alignment of head, thorax, pelvic center of gravity,
and feet (base of support). Work comfort and productivity
diminish as flexed postures are assumed and exaggerated.
Shoulder intensive activities are best tolerated with

o
elevation not exceeding about 30 . As elevation increases,
so do leverage forces and potential for structural
impingement within the shoulder.
Arm and hand intensive activities are best tolerated

around elbow height where the elbow and shoulder can
work in mid-range; and where visual acuity is favorable.
Wrist and forearm intensive activities are best tolerated

around a midrange in a thumbs up position and a
neutral to slightly extended wrist. As pronation,
supination, flexion, and extension increase mechanical
advantage diminishes in the forearm muscle groups.
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44
Dynamic standing activities are best tolerated where the

base of support incorporates multi-plane placement. As
stance moves toward single plane positions stability and
comfort is compromised. Elevation of one foot may
facilitate hip and knee recruitment.
WORK TASK HEIGHT

The height of work tasks is important to work performance quality, comfort, and productivity. The
more frequent and sustained a task becomes the more critical it height is.
Work Height Considerations
Applicable when standing or seated
Applicable when standing or seated
Comments
Heavy, awkward, and repetitive material handling
tasks are most efficiently performed near ones
center of gravity (i.e. pelvic height). As one moves
away from that optimal location body movement,
leverage forces, and energy consumption all
increase.
Manipulation tasks demanding hand dexterity are
most efficiently performed near elbow height at a
horizontal distance about equal to, or less than the
forearm length. As one moves away from that
location biomechanical efficiency and task
visualization diminishes.
Precision tasks demanding visual acuity are most
efficiently performed near shoulder height at a
distance about equal to half the forearm length. As
one moves away from that location visual acuity
diminishes and gravity loading into flexed postures
increases.
HAND TASK VARIABLES

The hands are highly susceptible to repetitive strain injuries/illnesses, and thus warrant careful
attention. Small details have large influence.
Comments
Grip intensive tasks can be facilitated by proper
sizing of handles and grips. Linkage points should
accommodate the width of the hand. Linkage
diameter should approximate the diameter
formed when a worker makes the OK sign with
thumb and forefinger. This optimizes surface
contact area and effective grip strength. Rounded
linkage points best distribute loads.
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45
Hand Considerations
Grip intensive tasks can be accommodated by

providing enriched linkage surfaces to enable
more control with less force. Various wraps,
tapes, and materials provide flexible options to
increase friction, reduce abrasions, absorb
vibration, and distribute loads.
Repetitive exertional pinching and gripping is best

avoided since small intrinsic hand muscles fatigue
easily. Hand related tasks should avoid
constriction at the wrist which can compromise
circulation; and compressive forces (e.g.
pounding) to the heel of the hand that may injure
tendons, ligaments, and nerves of the carpal
tunnel. Avoiding pressure points on the sensitive
soft tissues of the forearm and wrist (e.g. hard
square edges of work surfaces) are
recommended.
Grip intensive tasks are very sensitive to wrist
positions. Effective grip strength and precision
diminishes as the wrist moves out of neutral.
Thus the orientation between, task, tool, grip,
and wrist is significant. Pistol and inline grip
options allow simultaneously for task and
biomechanical efficiency.
o
Note the 70 angle inherent to the hand when

gripping tasks are performed.
Tool selection is determined by the orientation of
the task that needs to be completed and the
orientation and efficiency of the associated
biomechanical
chain
reaction
required
performing it.
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46
Grip intensive tasks are also affected by weight

balance of tools. Tasks and tools that introduce
leverage or torque to the wrist and forearm
contribute to muscle fatigue and compromise
tolerance. Consider tool weight, handle
placement, torque control, and counterbalancing
management technologies.
Vibration is present in many work situations. Low

frequency vibration may be problematic in the
spine and is often associated with rough road
conditions during driving. Higher frequency
vibration may be problematic in the hand and is
often associated with use of power tools and
equipment. Vibration may impede circulation,
compromise sensation, and accentuate grip
requirements.
Temperature extremes may be an issue in some
environments. Temperature extremes may result
from ambient temp., tool/handle temperature, or
airflow induced wind chill. High temperatures
may result in fatigue, dermal burns, soft tissue
swelling, and vascular compromise. Low
temperatures may result in hypothermia,
impaired sensation/circulation, and loss of motor
coordination.
Gloves provide important hand protection against
abrasion,
cuts,
punctures,
and
chemical/temperature exposure. Gloves also
typically diminish dexterity and grip/pinch force
output. Glove style, material, and fit significantly
affect biomechanical performance and effort.
Tool and machine maintenance significantly
affects the effort required to use them.
Lubrication,
sharpness,
and
alignment
significantly affect biomechanical demands, effort
and performance.
SEATED SUPPORT CONSIDERATIONS
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Seated support is all about comfort and performance for the task being performed. Seated tasks may be
static or dynamic in nature. Static tasks (e.g. transcription) are more demanding as to alignment and
support; while dynamic tasks (document handling) are more demanding as to freedom from constraints
in mobility. An assembly of seated tasks performed by an individual worker often imposes conflicting
seating demands; task assignments and sequencing, multiple work stations, and situational compromise
are frequent considerations.
47
The topic of seating is immense and prevents an exhaustive discussion here. Instead we will focus on a
few core concepts that will provide a framework for consideration.
Again, the worker is the point of reference as favorable and unfavorable biomechanics and posture are
considered. The work demands the worker reacts. Seating must be assessed with workers working.
Work and seating Tweaks provide the means to improve the motor and postural responses that are
elicited.
Seated tasks are driven primarily by vision, dexterity, and conversation. Each has different implications.
An individual work assignment might involve one or more of these drivers. Those tasks and individual
worker characteristics/behaviors determine the biomechanical chain reactions that will be elicited.
Vision tasks are driven by visual acuity and focal distances. Such tasks require attention to placement
and orientation of visual targets and seat stability.
Dexterity tasks are driven by motor demands. Such tasks require attention to worker positioning and
tool/equipment alignment.
Conversation tasks are generally flexible and are usually the least demanding. Basic support vis--vis
gravity and avoidance of awkward neck postures due to phone use require the most attention.
Primary considerations with seating include the following:
A modest reclining position (~20 ) to prevent gravity induced static flexed postures
Lumbar and pelvic (Ischia and sacral) support to provide a stable foundation and core stability
(functionally similar to the foot when standing).
Height and depth to allow adequate foot and thigh support
Materials that provide appropriate cushioning and prevent undue slippage and flexed postures.
Arm and/or wrist support to relieve static shoulder and neck strain
Personal preference plays an important role in seating selection. That said, most workers are not given
the option of selecting their preference that is usually done for them via a purchasing decision.
Secondly, seating needs are usually considered apart from the work being performed that often means
incompatibility. Finally, most people dont know how to appropriately adjust seating to meet their
personal and work needs.
SUMMARY
Worker performance is complex with a host of potential contributing factors; a sampling of which is
shown in the illustration below. With at least 75 contributing factors in 8 categories, symptoms can arise
from many sources and combination of sources. Those possibilities grow exponentially in the context of
three dimensional biomechanics and related impairments. With this degree of complexity it is useful to
have a strategy for dissecting the problem.
Page
48
The following diagram provides a useful tool when considering potential work stressors and solutions. It
guides one through considerations for a bottom-up approach, considering the problem from a work
variables perspective.
Page
1. Identify the symptomatic complaint to identify potentially involved anatomical structures

(causes and compensations).
2. Observe the work being performed and note mechanical and biomechanical patterns that
potentially correlate with worker complaints. Particularly note loads, postures, and
Transformational Zones.
3. Study worker - work linkages (e.g. feet, hands, and eyes) between work and worker to
understand critical biomechanical drivers.
4. Consider potential Tweaks that could favorably influence linkages and resultant biomechanical
chain reactions. Experiment by tweaking the work / worker linkages to assess and prioritize
alternative options. Tweak all and only those variables necessary to achieve the desired results.
It is not about creating perfect biomechanics or an ideal design. Its just about solving the
problem as efficiently and as effectively as possible keep it simple and subconscious.
a. Modify motion, force, and time variables by tweaking.
b. Pay particular attention to transformational zones where loading (eccentric muscle
contractions) and unloading (concentric muscle contractions) transition. Consider
potential changes in the location or orientation of transformation zones.
c. Tweak the triangulation (angle, distance, or height) of transformation zones.
d. Introduce alternative drivers.
e. Tweak in or out particular biomechanical resources to redistribute loads.
f. Shift loads from smaller tonic muscle groups to larger phasic muscle groups.
g. Enhance proprioceptive feedback.
h. Modify tasks (selection, assignment, methods, means, sequence, timing, volume, etc).
i. Introduce ergonomic countermeasures.
j. Train and condition workers.
5. Determine economic cost and benefits.
6. Implement changes.
7. Monitor results.
49
An alternative top-down approach considers the problem from a worker experience perspective using
biomechanical chain reaction principles. In summary it works like this
8. Tweak further as needed.

9. Document operational, financial, and individual impact.
10. Communicate outcome with stakeholders.
Keep in mind that there is rarely a single cause, but rather a confluence of causes. Similarly, there is
seldom one solution. Consider potential causes and solutions broadly. Every solution has its tradeoffs
its pros and cons be sure to understand them fully. Enlist the help of labor, management, and
technical experts to deepen understandings and facilitate buy-in.
When modifying work fix only what needs fixing.
When designing work consider the 30% Rule.
1. Keep repetitive motions within 30% of neutral and
work through neutral whenever possible.
2. Keep strength demands under 30% of strength
capacity and take advantage of eccentric loading.
3. Keep aerobic demands under 30% of aerobic
capacity and provide generous diversity of work
content where possible.
The most common ergonomic issues are related to:
1. Reaching outside of ones base of support.
2. Material handling to and from high or low
positions.
3. Repetitive motions and forces.
4. Static postures and static loading
5. Misalignment of work and worker.
6. Physical loads, pressure, and vibration.
7. Integrated isolation of biomechanical chain reactions.
TM
Functionomics is about establishing a balance between work demands and worker capacities. Like a
bank account there are deposits and withdrawals. Deposits come in the form of nutrition, rest, and
graded activity. Withdrawals are made in the form of force and motion over time. When work related
withdrawals are made at a rate that exceeds that of a persons recovery deposits, soft tissue breakdown
occurs and worsens until such time as homeostasis (the balance) is restored. Pathology, pain and the
loss of performance results when there is an overdraft that is when withdrawals exceed deposits.
TM
Functionomics
is the discipline of auditing, budgeting and rebalancing the account. Rebalancing
improves the demands of the work (withdrawals) and the capacity (deposits) of the worker for the value
and profitability of both.
Withdrawals
Work volume, speed, duration, intensity
Fatigue
Poor fitness
Rumor/ignorance
Page
Deposits
Nutrition
Rest
Physical conditioning
Information/knowledge
50
WORK BALANCE SHEET
Positive relationships
Encouragement
Job satisfaction
Negative relationships
Discouragement
Job dissatisfaction
TM
Functionomics
provides a comprehensive approach to managing work related biomechanical
problems that affect worker health, company profitability, and the competitive advantage of both.
Working is a physical dance between the worker and the work. It involves a continuous give and take. It
involves bidirectional biomechanical chain reactions. Functionomics simplifies the dance and keeps the
Providers off each others toes. When done well the employee and employer are positioned for
success.
RISK M ANAGEMENT
TM
Functionomics is likely to take health professionals beyond their typical roles and introduce them to
new challenges and risks. There are two risks that should be managed proactively.
First, be sure to verify insurance coverage for your new services through your business insurance
underwriter and your malpractice insurance underwriter. Dont assume. Get verification in writing.
If you will be providing significant services to a client consider designating each other as named insured
parties under each others insurance plans. Doing so is very inexpensive (often free) and prevents
potential gaps in liability coverage between companies. Your agent will be familiar with the process.
Be sure your insurance includes coverage for errors and omissions. It is the most common risk of a
consultant.
Second, whenever offering ergonomic advice always include a written disclaimer to mitigate potential
risk exposure this is the fine print. You should of course always obtain qualified legal advice as to
such matters. A basic disclaimer might read something like this
The complex matters of health/comfort and productivity/performance in the workplace are both an art
and a science. Work is a complex interplay of physical, mental and emotional stressors. Risk of potential
injury is inherent in any job and statistically injuries and illnesses will occur over time. As such, there are
seldom easy answers or absolute solutions. Moreover, there are many potential countermeasures and
combinations of countermeasures that could be considered and implemented. Every countermeasure has
its tradeoffs. No solution is perfect. Selection and implementation of countermeasures reflects the
priorities compromises and judgment of management. Any use and application of these recommendations
by the client is done so at its sole discretion. The recommendations offered are the opinions of the
consultant. These recommendations are believed to be reasonable and consistent with common practices,
but the opinion of other consultants may differ. The consultant makes no promises, guarantees or
warranties pertaining to these recommendations and accepts no responsibility for their implementation or
for the results of their implementation.
The bottom line is that it is important to engage appropriate levels of management and labor in
discussions, decisions and interventions and that there be full disclosure of risks and opportunities.
Page
TM
Functionomics is a marketing term that is used for provider differentiation in an entangled and
confusing marketplace one that has been trapped in old paradigms for decades. Participants include:
51
MARKETING
insurers, third party administrators, hospitals, clinics, HR professionals, occupational safety and health
professionals, industrial hygienists, engineers, production leaders, quality specialists, safety consultants,
ergonomists, therapists, physicians, nurses, rehab nurses, case managers, trainers, wellness consultants,
corporate health professionals, performance coaches, and more.
Work related MSDs are a significant problem for many companies and the cost of these conditions
continue to rise annually at an alarming rate. At the same time employee / employer trust has eroded.
Use this reality as a door opener to companies. They will generally be interested in new solutions if one
is sensitive to their needs, circumstances and economic concerns. Reduce the risk for new clients by
offering references, opportunities to try before they buy, and guarantees in the form of risk-sharing.
Never over-promise but always over communicate and over-deliver!
First, prepare yourself. Take time to become comfortable with the concepts, principles, and strategies of
TM
Functionomics and become fluent in discussing its issues, opportunities, benefits, and applications. A
TM
solid understanding of Gray Institutes Applied Functional Science approach is invaluable.
Learn to think like your prospective client put yourself in their shoes. Know and anticipate their needs,
worries, and objections better than they do. Your needs come second. Learn to become their advocate.
Next, define the geographic scope of your target market. Typically it will encompass a radius of about 30
minutes from the practice. Within that area potential client companies should be identified. Criteria for
selecting target companies might include the following:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Companies that have a reputation for being early adopters of innovation.

Companies that are respected trend setters for other companies in the area.
Companies whose interest in safety and health is above average.
Companies with a high degree of concern for employee morale and wellbeing.
Companies that are environmentally conscious.
Companies poised for growth or who are/will be experiencing high employee turnover.
Companies with a moderate to large number of employees (50+).
Companies operating in an industry known to have high incident rates.
Companies with a poor safety record or high worker compensation experience.
Companies whose employees are frequently referred for rehabilitation services.
Companies identified by your referral sources as having a worker compensation problem.
Companies who are self-insured.
The companys products and services.

The companys organizational structure and leadership.
The companys attitude toward employees.
Current business focus and priorities.
Business challenges
The companys occupational health providers.
Comparative incident rates.
How decisions are made.
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52
Once a list of target companies has been formed, and before making contact with them, do some
research on each company. Review their websites. Talk to people who work for the companies or have
had business dealing with them. Useful information might include:
Determine the key messages to communicate
Worker compensation costs are problematic and are expected to continue to worsen.
MSDs are a primary cost driver and are fundamentally different than accidents.
MSDs can be effectively managed with innovative solutions.
Functionomics solves MSD problems by addressing their cause.
The benefits of Functionomics are improved productivity, quality, cost, and morale.
Your services and expertise is uniquely distinctive.
Other
There are basically four structured approaches to making contact with target employers. They can be
used individually or in combination.
The first is to build relationships with leaders and influencers within the community. Go where they go
and do what they do think social, business, and recreational venues. Seek out individuals who can
personally introduce you to leaders within the company. Keep in mind that every clinical patient is a
potential marketing resource. A personal relationship and introduction are the most potent of the
options. You are looking for someone who knows someone at the target company who can personally
introduce you to the right person (the decision-maker or someone reporting directly to the decisionmaker). This approach is based on the concept of six degrees of separation that is, everyone in the
world is no more than six introductions away from everyone else in the world. This approach may take a
little time but the effort will usually be worth it. Once the introduction has been arranged, the goal is to
schedule a personal meeting.
The second approach is to do direct mailings to targeted companies. This usually takes the form of a
letter of introduction that briefly (one page) communicates three points:
1. The key messages previously referenced.
2. Your intent to call the recipient in the next few days to discuss scheduling a meeting with them
to explore the opportunity further.
3. Your appreciation of their time and interest.
It is important that the letter be addressed to a specific individual rather than to whom it may
concern. This usually requires that the company receptionist be contacted by phone to determine the
name, title, address, and phone number of the person you need to make contact with. Depending on
the companys organizational structure and size, the target person could be the president or COO of a
small company, the Director of Human Resources in a medium size company, or the Director of
Occupational Safety & Health in a larger company. Ask who is responsible for occupational health and
safety at the company. In some companies it will be beneficial to target several people.
Page
When meeting with them, keep the meeting on schedule, and to the point. Keep the conversation
focused on their needs, opportunities, and benefits rather than on your services. It is better to have a
conversation than a PowerPoint presentation at your first meeting but it is nice to have a business card
53
After sending the letter, follow-up in a few days as promised with a phone call. Thank them for taking
your call, compliment them about their company, and offer to meet with them for an hour to explore
their situation, your services, and the benefits available to them. Be polite and dont oversell. Success at
this stage is no more than a meeting. Dont over complicate your message. Help them get to Yes, then
thank them and say goodbye.
and a page or two of printed material to leave behind. A more detailed presentation can always be
scheduled later when additional people from the company might participate. Building a relationship and
earning the privilege to consult with a company takes time, patience, and persistence. Its not
uncommon for a sales cycle to last several months.
Your conversation might go something like this
1. Greetings and introductions

Be complimentary about their products, services, reputation, facilities, contributions to the
community, etc
Explain briefly what you understand about their business and ask a few questions to validate
and clarify your understandings.
Provide a brief overview of your company
2. Determine their situation:
What has been their experience?
What are the trends?
What strategies have been/are being used?
Are situations under control at an acceptable level?
3. Determine the problems that result from that situation:
E.g. rising costs, lost time, reduced productivity / quality / employee morale, employee
turnover, growth limitations, etc
4. Determine the implications of those problems - in other words, what is the ripple effect of those
problems upon the vitality and performance of the company (e.g. competitive, sales,
operational, financial ) and upon the individuals responsible for managing those problems (i.e.
job security, promotion, quality of life implications)
5. Determine the net impact of those implications on the company:
What are the financial ramifications? Often the net impact far exceeds the direct costs
associated with the actual injuries sustained!
6. Determine the opportunity to submit a proposal or follow-up with a second meeting.
7. Summarize next steps and say Thank you.
8. Immediately send a written thank you note in follow-up.
The third approach is to get your message out into the business community through presentations to
community service groups, e.g. Chamber of Commerce, trade associations, special interest groups, local
safety directors affinity group, or media news release. In the case of the latter, it is always more
effective to have a news release that features an organization you are helping rather than your business
this is especially the case when the organization being helped is a respected non-profit. Consider
setting up a pilot project with an organization that has problems with MSDs. This approach is intended
to attract a sufficient level of community exposure and interest so as to cause employers to contact you
for more information. The intent again is to schedule a meeting with employers as summarized above.
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54
The fourth approach is to hire a skilled marketing person to systematically make sales calls to employers.
Such an approach might put the marketing person on the road on a full or part time basis for a period
of time. The intent of such sales calls is to open the door for you to have a scheduled meeting as
discussed above. This approach can be particularly applicable for busy practices and for practices that
are uncomfortable with making initial contacts. Getting the right sales person for the job is critical.
A fifth non-structured option is chance meetings that serendipitously occur. Always have a 30 second
and a 3 minute elevator speech ready to share. It need not be comprehensive but it does need to
bracket your offering and leave them with an interest to learn more.
Keep in mind that as you market it is important to offer your new service within the context of your
broader portfolio of services - that might include physical therapy services, pre-employment testing,
functional capacity testing, return to work management, ergonomic services, back or carpal tunnel
prevention training, onsite rehabilitation services, training and conditioning, etc. Employers are
generally more receptive to comprehensive expertise and solutions than they are with narrow program
offerings. Beware however that your new services are not perceived as being a marketing ploy to drive
referrals and increase their costs something commonly done by health providers.
Be alert if an employer brings their worker compensation insurance representative to the table. While
such meetings are generally congenial, the insurance representative will more often than not attempt to
undermine your services behind the scenes in order to keep the insurer front and center. Many
employers will contact their insurer or risk management agent for their opinion about the services you
are offering - assume they will do so and try to get those conversations on the table so you can
address reservations or opposition that might be posed by the insurer. Keep in mind that insurers are
appropriately protective of the relationship they have with their client and will be sensitive to anything
that threatens to undermine that relationship.
Maintain perspective on your marketing efforts. Employers tend to move slowly and cautiously on
making strategic decisions about employee matters. The sales cycle can be several months. A track
record of satisfied clients who you can use as references will help considerably. Consider offering a pilot
or demonstration project under special terms with an influential company in your community to jump
start your service and gain experience.
Expect employer decisions to hinge on return on investment and be prepared for such conversations.
Decisions also hinge on relationships remember they take time to develop and are earned. Expect to
invest time in the relationship outside of formal meeting times and normal business hours. Look for
opportunities for social contact such as lunch / breakfast, a community event, send occasional email or
newspaper clipping about topics of interest, share conversations at church or school functions, play golf,
go boating, etc. Be patient. Be visible. Be responsive. Dont forget to ask for the sale.
FEES
TM
Functionomics consulting fees will vary by market, size of project, deliverables, potential economic
impact for the client, duration of the relationship, and competition. Fees are typically established on
either an hourly rate, unit of service (e.g. visit or session of predetermined duration), or a fixed fee (e.g.
per month, quarter, or year with defined deliverables). Many clients prefer a fixed fee arrangement to
reduce risk and provide predictable budgeting.
Page
That said, there is value in considering certain bonus arrangements that are dependent on certain
deliverables, performance metrics, or outcomes. The nature of the bonus may vary from year to year.
55
Many consultants have attempted to establish gain sharing arrangements whereby they are paid a
percentage of any savings realized over a defined time period. While such arrangements are interesting
to contemplate they have proven difficult to sell, operationalize, track and sustain. Tracking is difficult,
variables are many, special circumstances are the norm, one of the two parties generally find the
arrangement to be unfair, and they are very difficult to sustain over time. Consider them with caution.
Similarly, there could be certain discounts or adjustments provided to the buyer e.g. serving as a
reference for the provider or making introductions that lead to new business for the provider. Potential
arrangements are virtually infinite but always reward value generated.
Multiyear contractual arrangements with companies invariably experience pressure from the buyer on
the provider to reduce costs after a 3-5 of years. Cost reductions (price erosion) are normal in the
competitive sectors of manufacturing and service. It is important to anticipate that reality in initial
pricing. It is imperative that a file be maintained to justify the benefits and value of the service to the
company and to validate how much the service is appreciated by employees. Such an evidence file is
critical at contract renegotiation time.
Appropriate consulting fees can be approximated by benchmarking fees for similar services such as
accounting or legal fees; and current clinical services and making adjustments for travel time,
supplemental staff support, and external fees. Consider an hourly rate somewhere in the neighborhood
of 45 60 minutes of the gross charge equivalent for clinical evaluations (CPT 97001) or therapeutic
exercise (CPT 97110) . Ultimately fees are what the market will bear. The fee may be influenced by
competitors, existing workload, or strategic/competitive value in securing a larger number of corporate
relationships.
In setting fixed project fees make as accurate an estimate a possible as to projected time commitments
and expense; then apply an hourly rate. Consider the opportunity loss/gain associated with such time
commitments. If possible, factor in a cushion of 5- 10% of estimated fees as a contingency fund. Be sure
to define the period of time for which the rate will be offered so that market or competitive adjustments
can be made in a timely fashion without upsetting relationships. Define clearly what the scope and
deliverables of the service will be. In fixed fee arrangements the scale and scope of the project always
grows! Without clear definition it becomes very difficult for the provider to avoid exploitation in the
relationship.
When considering fees it is always a good idea to keep in mind what the buyer considers fair and
reasonable. One way of doing so is to have a conversation about it and determining what kind of an
initial budget is feasible. Once that is known, delivery strategies, methods, and resources can be
adjusted to accommodate the budget.
PROPOSALS
6.
7.
8.
9.
10.
11.
Interactions leading up to the project

Needs/desires of the client
Capability and experience of the consultant
Purpose of the project and intended outcome
Scope of the project (whats included and whats not) e.g. locations, number of people,
deliverables, availability,
Project components, activities, and sequencing
Timeline and milestones
Summary of features and benefits
Point person for client and consultant
Arrangements for structured communications
Fees and terms of payment
Page
1.
2.
3.
4.
5.
56
When engaging a client a proposal should be drafted and presented to accurately define the
engagement. The following items are common to such documents:
12.
13.
14.
15.
Beginning and ending dates with provisions for renewal

Termination and penalties
Statement of appreciation and service commitment
Signatures of acceptance / date
A signed proposal may be the only documentation that is necessary. Depending upon circumstances, it
may be appropriate/desirable to sign a Contract, Letter of Agreement, or Memo of Understanding in
addition to the proposal. In such cases there is value to the provider in drafting the agreement since it
provides greater control of the outcome. Local legal counsel is strongly recommended in drafting
contracts since state laws and local customs vary by region. A poor contract is often worse than no
contract at all. Also keep in mind that contracts engage attorneys which invariably slow the process, add
complexity, and increase scrutiny and cost.
Keep in mind specifically who the audiences will be for your proposal. There is usually a primary
audience and multiple secondary audiences. Be very careful what you choose to put in print (context,
content, tone, voice, balance, objectivity, etc.). What plays to one audience may offend another. Never
assume that a document within an organization will remain confidential.
The primary audience is the people that will directly receive and act on the proposal. Know who they
will be, what they value, and what process they will use to make their decision. Understand that the
interests and issues of a finance person will be different from that of someone from human resources,
safety, medical, operations, or organized labor. So target your message and include all of the necessary
messages in a politically astute way. Consider what to include and not include as well as how and when
to present them.
The secondary audience is those stakeholders who may influence the pending decision. Secondary
audiences seldom have the authority to say yes but do have the opportunity to say no. Secondary
audiences typically get involved when you are not in the discussion and thus have no opportunity to
respond. They can raise objections and concerns, undermine credibility, introduce innuendo and spin,
misunderstand, undermine, and protect self-interests. And, they will do all of that when you are not
present to defend your presentation.
It is important to personally meet with decision makers build a relationship with them, not just send a
proposal present it, discuss it, amend it, and sell it. If multiple presentations are necessary do them
yourself. Avoid situations where you present to a company representative and they then present to
others in your absence. They will never be as effective in presenting and addressing concerns and
questions as you are. There is always value in having the first word and the last word in such dialogs.
ADDITIONAL RESOURCES
Worker Compensation Glossary of terms - http://www.workerscompensationlawfirms.com/Glossary-Terms.cfm

Insurance Information Institute - www.iii.org/
National Council on Compensation Insurance, Inc. www.ncci.com
Worker Compensation Research Institute - www.wcrinet.org
National Safety Council - www.nsc.org/
US Chamber of Commerce - www.uschamber.com/default
Occupational Safety & Health Administration - www.osha.gov/
Bureau of Labor Statistics - www.bls.gov/
Page
1.
2.
3.
4.
5.
6.
7.
8.
57
The following internet websites provide valuable reference resources:
9.
10.
11.
12.
Board for Certification in Professional Ergonomics - www.bcpe.org/info/default.asp

Oxford Research Institute Inc - www.oxfordresearch.org/
Worker Compensation Commissions List by State - www.comp.state.nc.us/ncic/pages/all50.htm
Functional Video Digest Series www.GrayInstitute.com
13. GIFT www.grayinstitute.com
14. Article: Ergonomic Analysis of Work Stressors By Bob Wiersma Orthopedic Physical
Therapy Clinics of North America June 1996 (Reprint available on SOLVE website)
Google is an effective search engine for further resource exploration.
CLOSING THOUGHTS
TM
A Functionomics service provides a revenue opportunity for the practice that is not dependent on
third party payers, and has the potential to bypass the need for physician referrals. It is a tool for
building important strategic relationships and loyalty with employers keeping in mind it is they who pay
for worker compensation benefits and usually also group health benefits. The loyalty of employers can
have significant implications related to participation in insurance provider panels and referral patterns
by local physicians. Competitively Functionomics provides a unique service distinction that makes a
difference.
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58
Functionomics offers innovation and significant value that can be appreciated by employers and
employees. Functionomics is a win / win / win arrangement!
TRIAGE
Triaging and establishing priorities is a critical skill. Having structured process (checklist) enhances
efficiency and consistency while minimizing the potential for mistakes and oversights. The following
graphic has proven to be an effective triage strategy.
Most clinicians are very familiar with the triage / evaluation of individuals. Most are not experienced in
the triage of populations where competing interests and limited budget provide unique challenges.
Whether individual or group triaging, a focus on comfort and performance will be better received than
one of pain and injury, particularly in the workplace.
GROUP TRIAGE
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Discovery
59
Comfort and performance related problems, whether emerging in the workplace or simply impacting
the workplace, require prompt and appropriate resolution that is cost effective and relationally
supportive. An efficient triage methodology for individuals and population groups assures appropriate
and timely intervention. Triage should not be just a passive response to problems that present but
should become an active initiative that discovers emergent issues so they can be resolved.
Discovery is about actively looking for the evidence of unrecognized problems and opportunities
for improvement. In populations, pre-emergent problems are typically discovered in four
primary channels changes in work, OSHA Log, insurance data, and scheduled surveys.
New performance issues commonly accompany changes in work that is performed. Changes
include job assignments, shift/hours worked, processes, tooling, speed, product, materials,
parts, quality, etc. Such change related issues usually resolve themselves in 3 5 days. During
that period situations should be monitored. Situations lasting more than 7-10 days warrant
prompt attention.
Most US employers are required to maintain an OSHA Log and related forms that report and
track work related injuries and illnesses. The type of conditions location where it occurred,
causal factors, and lost/restricted work days are documented within a week of occurrence by
federal and state law. The Log provides a convenient source of information pertaining to
reportable cases. Health and safety personnel, where available can provide supplemental
information. OSHA Forms 300, 300A, and 301 along with instructions in their use are readily
available on the internet.
Worker Compensation Insurance data provides valuable information pertaining to worker
compensation risk exposure and experience. Insurance underwriters, brokers, third party
administrators, and risk and case managers have extensive data on their clients including
company experience, industry specific comparisons, and standardized metrics and trending.
Insurance data is sophisticated and is designed to comply with industry wide standards and
definitions. An understanding of the terminology and structure of the data is important and
does evolve. Keep in mind that while federal requirements and industry standards drive
consistency, state statutes pertaining to employer and worker rights / obligations vary.
Scheduled periodic (monthly or quarterly) SOLVE SURVEYS provide a systematic and disciplined
process for identifying emerging problems. Additionally, ad hoc surveys initiated by workers
when problems emerge provide additional real time discovery opportunities. Periodic surveys
recognize that matters of performance and comfort are ongoing and constantly evolving. The
systematic capture of survey data enables trending and company exposure analysis.
Presentation
Presentation is about responding to problems
and opportunities that have been recognized.
In populations emergent problems typically
present in four primary areas prevention,
productivity and quality, medical conditions,
employee complaints.
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Within operations, issues of productivity and quality within specific work groups, work
processes, and products/services are commonly recognized but often not resolved because
solutions may not be obvious or the magnitude of the problem may not have risen to a level
60
Various safety and health prevention initiatives are ongoing in most companies as required by
regulatory agencies. Those who are involved in the management and implementation of such
initiatives frequently become aware of unaddressed or emergent problems that are present but
routinely get overlooked in the pressing business of day to day operations.
that demands attention. Operational leadership and supervisors are often the first to be aware
of problems lying beneath the surface.
Neuro-muscular-skeletal medical conditions within a worker population are obvious evidence of
problems but only if they are recognized. The lack of recognition, which is common, may be
driven by multiple factors:
The dispersion of cases across worker compensation and group health benefits
The involvement of multiple providers and professionals
Variability in diagnostic terminology and precision
Unavailability of a central database and relevant tracking tools
Confidentiality related to medical conditions
Employers unwillingness/prudence in not getting involved
Employee complaints also provide evidence of problems. The challenge is to gather such
complaints absent an organizational system for doing so. Supervisors, organized labor
representatives can be useful, as can be the recognition of improvised tools, padding, and
support devices in the workplace. Poorly adjusted ergonomic workstations are also indications.
Interview
Interviewing is a key
component of triage. Its
value is dependent on
interviewer skill, people
selected for interview, trust,
questions
asked,
and
effective listening. There
are three elements to
interviewing Show Me,
Context, and Due Diligence.
Please show me provides
an opportunity to see the situation and understand key situational factors such as work
processes, biomechanical variables, and stressors. The purpose is not to complete an exhaustive
analysis but rather to establish context.
In seeing relevant work processes, the purpose is to identify specific aspect of the work process
that those involved believe are/maybe contributing to the problem. The focus is on the
perceptions of those closest to the situation rather than on your own opinions or suspicions. It is
important that the triaging process provide the opportunity for input without judgment or
steerage toward particular conclusions.
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The third part of the show me portion of an interview is to identify known stressors that are
present. It is helpful to establish potential stressors in the context of task(s) and function(s).
Stressors will ultimately link back to potential interactions of motion, force, and time associated
61
In identifying key biomechanics, the purpose is to identify potential biomechanics that

are/maybe contributing to the problem. The focus is on functional tasks and the range of gross
chain reactions engaged in by the work group, rather than a detailed analysis of the specific
biomechanics of individuals. Again, establishing context is the intent.
with suspect tasks and functions. Understanding potential causes and compensations are
valuable. It is critical to keep those closest to the situation involved in this step as a means to
testing assumptions and understandings to confirm realities and subtleties.
The Context portion of the interview is integrative and interpretive. The central understanding is
the GOAL of the process i.e. what does the process need to accomplish by way of
results/outcomes. The GOAL typically has multiple criteria associated with it i.e. volume,
quality, and serviceability. To achieve the GOAL a certain population (group of workers)
performs specific tasks in a particular environment (physical and psychological). By establishing
a contextual understanding, non-negotiables and constraints are defined that will have
implications on potential interventions; and a hypothesis can begin to take form.
Due Diligence is intended to test understandings, assure thoroughness, gain buy-in from
stakeholders, and uncover political and financial sensitivities which are always present. There
are four elements of understanding that should be explored the Situation, the Problem, the
Implications, and the Net impact (SPIN). This methodology is fully discussed in the book SPIN
Selling by Neil Rackham.
For example: Company ABC is having some wrist and hand problems. Can you help?
Upon completion of Due Diligence you have learned that:
Situation (Context): A recent change in government policy has significantly increased
orders for the companys products and services. Production is backing up. The need for
parts has exceeded the production capacity of the company. As result, other parts
suppliers have been engaged but the quality of component parts has declined. Poor
quality parts translate into more variability of fit. Workers are spending more time and
physical effort in assembling the product. The additional effort seems related to hand
and wrist injuries that require medical treatment and increasing lost time. Productivity is
down and things seem to be getting progressively worse.
Problem (Specific Issues) Repetitive strain injuries of the wrists and hands of workers
are a problem for production and workers.
Implications (Business Chain Reaction): If government contracts cannot be fulfilled there
is risk of losing them to competitors. Declining worker morale comes at a time when
workers were beginning to organize and there is a worker vote scheduled in weeks to
decide whether or not to bring in union representation. Meanwhile, shareholders are in
confidential negotiations to sell the company to a Fortune 100 high tech company in a
multi-million dollar deal. If the government contract is lost the potential sale will fail.
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Does any of that have implications pertaining to your recommendations, interventions,

timeline budget, and return on investment considerations?
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Net Impact (Financial, Relational, and Strategic) - If the problem is not resolved soon the
net negative financial impact on the company is estimated to be $7.8 billion including
losses related to contracts, market share, competitive advantage, shareholder value,
increased labor expense, the loss of reputation in the industry, medical expense, and
increased insurance costs.
Intervention
Interventions targeting worker groups often have greater challenges, visibility, and risk than
those targeting individual
workers.
The
work
environment is complex
with competing priorities,
agendas, political, financial
and relational implications,
and scores of tradeoffs, in
addition to a host of
potential
contributing
factors
and
possible
solutions. As such, its
important to be systematic
and thorough since rarely is
everyone satisfied. Gaining
buy-in from opinion leaders
and decision makers is
critical.
It is advisable to identify
multiple solution options,
components or
combinations rather than a single recommendation. Providing options mitigate project risk,
improves results, and stimulates innovation.
It is important to keep both the scope of potential solutions in mind and the core solution
strategies that will be the foundation for most interventions.
When scoping potential interventions, consider all of the options: environmental, design,
process, tools, materials, worker, work-styles, and administration. Appreciate that the best
resolution may only require a 35% solution rather than a 100% solution; and that the 35%
solution could be composed of multiple strategies / interventions, each of which synergizes in
contributing to the desired outcome.
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The criteria for interventions include effectiveness, acceptance, cost, and sustainability. Can
proposed interventions be expected to reliably resolve the problem? Is a testing or pilot phase
desirable for proof of concept or iterative improvement? (Hint: Experiment fast and cheap!) Is it
acceptable to internal and external stakeholders? (Hint: Ask!) Is it technically and socially
possible? What are the short and long term costs (people, knowledge, & time) of planning,
implementing, and maintaining it? (Hint: Model it on a spreadsheet!) What important unknowns
are unknown? (Hint: Ask the experts and those with experience!). How do potential intervention
options compare? (Hint: Developing a comparative matrix and rating scale to compare and rank
potential interventions against defined criteria, features, benefits, and special
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The priority may not necessarily be to eliminate the problem and its cause, which often may not
possible for various reasons. Rather the focus could be to mitigate the problem to an extent that
the negative consequences no longer occur at an unacceptable level. Such approaches require
understanding, judgment, innovation, strategy, and political savvy.
considerations validates process, establishes credibility, develops buy-in, and justifies decisions
up and down the organization!)
TM
Certain Core Functionomics intervention strategies will prove themselves to be useful in

across diverse comfort and performance challenges.
Reduce Work Demands
Assessing the feasibility to reduce work demands should always be a first consideration.
When feasible it is the generally the intervention of choice since it usually addresses the
core of the issue, solves the problem entirely, and is sustainable. Reducing work
demands typically involves either and engineering or ergonomic solution. Such solutions
at their best are simple, elegant, and cost effective. An important benefit is that such
solutions fundamentally change the nature of the work, eliminate worker exposure, and
increases the likelihood for reliable compliance. Engineering solutions are primarily
responsible for the reduction of work related injuries by one half since the 1970s. Their
positive and definitive impact should not be overlooked, under estimated, or
prematurely discounted.
There are 4 strategies that come into play when pursuing engineering/ergonomic core
solutions:
1. Elimination of human effort e.g. robotics and automation
2. Work simplification e.g. design, material, specification, process modifications
3. Modification of physical effort (i.e. movement, strength, power, coordination,
balance, speed, agility, endurance, aerobics) e.g. material handling devices
4. The improvement work to worker alignment (neutral positions and
biomechanical advantage) e.g. work heights and orientation
Note that strategy #1 and #2 are engineering driven with little input required other than
the definition of what human effort needs to be eliminated. Strategy # 3 and #4 can
benefit significantly from input pertaining to human performance considerations such
as:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Anthropometrics
Functional capacity
Selection of postures and stance positions
Pacing and sequencing
Management of biomechanical chain reactions
Modification of Transformational Zones
Integrated Isolation
Use of large muscle groups and joints
Use of mid ranges
Aerobic effort
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Administrative controls do not fundamentally change the work being performed or the
worker performing the work. Instead they influence the psychological / social milieu in
which the work is performed. While administrative controls are often thought of as soft
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Administrative Controls
controls their potential impact can be substantial positive or negative. There are 4
core administrative control strategies:
1. Modify exposure e.g. Work schedules, break, assignments, rotation, etc.
2. Modify culture e.g. Communication, trust, supervision, peer pressure,
independence, respect, etc.
3. Modify policy e.g., Responsibility, accountability, reporting, reviews, support
resources, etc.
4. Incentive / Consequences compensation, bonuses, benefits, recognition,
discipline
Administrative controls are always in play and always have influence whether it is good
or bad. Often they work at cross purposes and have unintentional and undesirable
consequences. Gaming of the System is predictable. The implications of new or
existing administrative controls cannot be ignored.
Enhance Worker Capacity
Workers perform work. The greater the workers capacity the more work they can
perform and the more resilient they are likely to be in the performance of the work.
Capacity is multi-dimensional and has weakest link implications. Ideally work should
play to a workers strengths. When that is not the case, workers can train to the works
demands the military, athletics, and rehabilitation are validation.
The body adapts to demands that are placed on it if those demands are calibrated over
time. The work will effectively train the workers if given the appropriate time and
dosage. Pacing (progressive and intermittent) is a key strategy. While physical training is
highly effective in practice at the individual level, it is not well accepted in most work
cultures where populations are involved. Neither is it necessarily as reliable, sustainable,
or economical as engineering solutions or administrative controls when scaled up across
population groups.
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1. Enhance motion
Manage starting positions, targets, and Transformational Zones
Redistribute relative motion with the three planes
Dynamic stretching to unconstrain, unwind and unload
2. Enhance Strength
Manage proprioception
Recruit / redistribute motor resources
Enhance circulation
Hypertrophy muscles
3. Timing
Warm-up
Pacing
time-out
cool-down
4. Biomechanical qualities
65
When enhanced worker capacity is part of an appropriate intervention three functional

strategies are core:
Coordination
Balance
Speed
Power
Agility
Work Behaviors
Work behaviors are the link between workers and work. Work behaviors are rarely the
intervention of choice for population groups simply because of cost and management
implications. However, there are three core behavioral elements that should be
considered:
1. Provision of education and training
2. Modification of supervision and support
3. Reduction of Risk-taking
TRIAGE INDIVIDUAL
The first step in seeing an individual at a contracted company is discovery of the issue. That issue may be
a concern of the employer or employee. The individual or employer may have a concern based on the
employees difficulty with performing the job or the individual may have discomfort while at work from
work related or home related stressors. Another
trigger of individual involvement may be a reported work
related injury or illness. Lastly the individual may fill out a
survey that will trigger individual follow up.
There are four main drivers for the discovery of needed
intervention. These drivers are the completions of the
following: It hurts when. . . , I cant do. . . . , I want to be
able to. . ., I am afraid that . . . . The completion of these statements establishes a functional basis and
justification for intervention.
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The interview process is also absolutely essential in carrying out due diligence for the employees
wellbeing, and the liability of the therapist and the company. Throughout the interaction with the
individual, the question should be continuously asked, is the employees issue appropriate for
conservative Functionomic intervention? It must be remembered that systemic issues relating to
disease, infection, and cardiovascular disease could be the driver for the pain and performance issue.
Dysfunction of the neuromusculoskeletal system is appropriate for intervention, systemic issues are not.
66
Once it is determined that intervention needs to

occur, the next step is the interview process. The
goals of the interview are to determine the
functional problems, the relevant chain
reactions, and the activities and movements that
reproduce the symptoms. The interview process
also alerts the clinician to the context of the
functional problem realizing that each issue
occurs within the context of a complex interplay
between the worker, the work task, and work environment.
An employee with potential systemic issues needs to be referred to a medical doctor for evaluation and
treatment. Fortunately for the consulting therapist, there are documented red flags that would present
in the history and/or functional exam that would direct the consulting clinician to refer.
After the interview is complete and red flags have been ruled out, the clinician would then proceed to
discover what are the specific functional problems of the employee?
The Show Me portion of the interview provides a first look at potential functional causes. Visual
demonstrations of contributing activities are more informative than verbal descriptions. Real-time
functional tasks are also more informative than clinical tests.
During a functional demonstration the provider is looking for relevant skill characteristics of
Transformational zones:
1. Positioning
2. Stability
3. Safety
4. Coordination
5. Balance
6. Speed
7. Timing
8. Sequencing
9. Effort
10. Efficiency
11. Variability
12. Etc.
While transformational zones are identified by the show me, the clinician is looking for mobile stability
(Mostability) as chain reactions occur within the transformational zones.
All BRCs always have either positive or negative consequences impacting both the quantity and quality
of work performed and the comfort and sustainability of the body to perform work. The question that
the clinician needs to ask is what is the quality of the chain reaction that is occurring as the employee
moves through the transformational zones of work tasks? The movement task can either be observed
on the floor or simulated in a private office setting. If done in the office setting, the movement should
be done with consideration of the force, motion and time requirements of the movement in the work
environment. Is it a safe movement pattern distributing forces in the proper sequence or is it unsafe and
wobbly relying on an isolated joint or muscle. For example, looking at the front leg in a lifting task the
clinician would like to see the following: the calcaneus everts, the tibia internally rotates and translates
forward while the knee moves into a slight valgus direction or abducts while flexing, the hip flexes and
adducts slightly while internally rotating. These movements should occur smoothly without wobbling
and the client should be able to return to neutral without loss of balance. The abilities of the
client would
be
noted
and
graded
as
unable,
suboptimal
or
optimal..
Definitions:
Unable-unable to complete movement or move load.
P
a
g
e
6
7
Sub-optimal-movement isolates joint motion versus integrating multiple joints, the kinetic chain
movement that is expected is not observed, or the movement is poorly controlled.
Example. Lifting task-Load is lifted with knee extension and excessive back flexion, or
when squatting to pick up load the knee moves varus instead of neutral to slight valgus,
or the knee is observed to move into excessive valgus or wobbles.
Optimal-Motion is observed in all relevant joints; the motion occurs in planes as expected and is
controlled well by the musculature.
Movements that are unable to be done or are suboptimal will be focused on with employee training.
The goal is to take each employee to the highest level of function realizing that training the employee to
reach optimal function will allow him/her the best fit to the work needed to be accomplished.
Realizing that being able to analyze a specific three dimensional movement for a successful chain
reaction can be difficult, and that we want to maximize the employees abilities in all three planes of
motion, it is often helpful in the exam to break it down into each dimension separately, analyzing the
chain reactions. Also, the movements would then be done repeatedly to assess if there is a change in
symptoms with the movements. Attention will also be given to whether the symptoms centralize or
peripheralize (McKenzies principals).
Suboptimal or unsuccessful movements would then be tweaked by changing the drivers, speed,
triangulation, etc. to find the threshold for success for the employee. The threshold to success with a
particular movement will be the starting point of the individual's self-help strategy.. The exercise is the
test and the test is the exercise (Gary Gray Chain reaction).
TM
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In summary the evaluation will medically screen the employee for need of a physician referral, it will
assist the therapist in finding the symptom generator, and it will give the therapist information as to
what caused the symptom generator to become symptomatic. If the screen is negative for significant
injury or illness, and when the symptom generator is found or a clinical prediction rule is fulfilled, the
therapist has the information needed to begin to address the pain generator with functional unloading
or unwinding. Functional unloading may be self-traction to unload gravity or to self-manipulate a joint,
or it may be three dimensional movement patterns that allow stressed tissue to recover. After the
symptom generator is addressed with unloading and unwinding to decrease pain, the suboptimal
movement stressing the symptomatic tissue will be addressed. . These are the functional mismatches
identified between the work movement demands and the workers functional abilities to move through
transformation zones with effective chain reactions. These can be addressed with counseling and
training in individual functional exercise/movement to prepare the worker to move efficiently, safely
and sustainably.
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While we realize that integrated function is the cornerstone to the Functionomics program, it must
also be recognized that there is a need for isolated tests to further determine whether the employee
should be referred to an MD for further testing. In addition isolating a joint or a symptomatic tissue can
give the therapist more information why a chain reaction was unsafe. For example, a neurological
screen is necessary to determine whether an employee has severe neurological deficits that would
demand further evaluation by a physician. James Cyriax selective tissue tension testing could alert the
clinician to systemic problems or a complete rupture of a tissue (painless weakness). Special tests, such
as McMurrays and Thessaleys test, can alert the clinician to internal derangement with in a joint. Other
tests can let us know if clinical prediction rules are met for specific interventions. . In addition some of
these isolated tests can identify symptomatic tissue to allow for targeted first aid intervention. Each
clinicians expertise in function and these other tests will determine how much isolated testing is done.
The functional exercise which is a large

- Detection differentiating piece fits into the context of the
above diagram. The functionomic approach
realizes
that
addressing
only
the
Work
Work
Engineering Demands
Ergonomics
Capacity Conditioning
work/ergonomic side is often not enough, and
early symptom treatment is not the final
Work Behaviors
Training
solution.
What is needed is an approach that
Administrative
addresses ergonomic issues to decrease work
Attitudes / Controls
Policy
demands when needed by addressing issues
related to force, temporal and spatial factors and addresses the physical performance of the worker
with functional exercise to improve the capacity of the worker. If the cause of the problem is not
identified and addressed it is like the clinician is putting a band aid on a fracture and will ultimately be
unsuccessful.
Notice that there other parts to the teeter totter as well. Work behaviors need to be addressed with the
employee. Could they be taking microbreaks in better positions and with functional movement to
unload irritated tissue? Can the technique of the worker be modified? Are they lifting material vs. sliding
it? Are they moving their shoulders through impingement ranges when it is not necessary, etc.?
The context of the problem always needs to be kept in mind. The context of the work is set by
administrative policies and controls. Decisions made by management to rotate jobs, change break times
and number, etc. can have large effects on the balance of the worker to the work load. It is because of
the great potential to improve the balance or severely imbalance the equation, communication with
management is crucial.
What can be communicated with management about individual cases is dependent on whether the
incident was reported to the departmental supervisor or the HR department, whether the employer has
requested information in writing on the case, and on what is relevant to the reported incident. To cover
the provider from violating HIPAA and the employer from receiving information that gives them ADA
liability, the provider should only provide information to the employer related to the work reported
incident after receiving a request for information on the particular claim in writing.
If the employee has not reported the injury, HIPAA applies and information about an individual
employees condition cannot be shared, regardless of whether the cause was work related or not. It is
important that each therapist becomes familiar with the employers reporting requirements and
supports the companys policy. The employee should be informed that reporting an issue to the on-site
provider is not considered reporting of the incident. The employee should be educated that reporting
the incident will allow information to be shared with all parties involved to facilitate a positive outcome.
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When one looks at the process of how to keep the balance, another context needs to be kept in mind,
the context of OSHA guidelines for recordable incidents. What can the therapist do without making an
injury a recordable incident? It is important to note that many companies have an entrenched safety
culture with the goal of reducing recordable incidents even though the main driver of expenses for a
company is not recordable incidents, but instead the number and severity of claims that are filed.
Another part of the context is the laws of the providers and companys state in regards to physical
therapy treatment without referral and treatment with in the states workers compensation? It is very
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The therapist should put forth considerable effort to get buy in to the program from all the key players
at the company by making sure that information flows well on work related cases, but being mindful of
HIPAA and the ADA. Some of the most important key players are company supervisors. The better the
buy in, the more effective the case management, administrative control adjustment, and case outcome
will be. .
important that the therapist is aware of OSHA recordable criteria, state law, and employer sensitivities
because this will determine what the therapist can and will do on site. It should also be noted that laws
may vary depending on whether the company is self-insured or not. To explore record keeping
requirements see definitions of what OSHA states would be a recordable that should be put on the
OSHA log and what provider interventions would make an issue a recordable for the log.
Recordable incidents include work related injuries and illnesses are those that result in one or more
of the following:
1. Death
2. Days away from work
3. Restricted work
4. Transfer to another job
5. Medical treatment beyond first aid
6. Loss of consciousness, or
7. Diagnosis of a significant injury or illness
A case is recordable only if a work event or exposure is a discernable cause of the injury or illness or
of a significant aggravation to a pre-existing condition. This means that the employer must make a
determination whether it is more likely than not that work events or exposures were a cause of the
injury or illness
An injury or illness is also recordable if it results in
Diagnosis of a Significant Injury or Illness A work-related cancer, chronic irreversible disease such as
silicosis or byssinosis, punctured eardrum, or fractured or cracked bone is a significant injury or illness
that must be recorded when diagnosed by a physician or a licensed health care professional.
Restricted Work An employee's work is considered restricted when, as a result of a work-related injury
or illness:
1. The employer keeps the employee from performing one or more of the routine functions of his
or her job or from working the full workday
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Medical Treatment
1. Medical treatment means any treatment not contained in the list of first aid treatments.
2. Medical treatment does not include visits to a healthcare professional for observation and
counseling or diagnostic procedures. First aid means only those treatments specifically listed in
1904.7. Examples of first aid include: the use of non-prescription medications at
nonprescription strength, the application of hot or cold therapy, eye patches or finger guards, and
others. Put in list of First aid treatments from OSHA
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2. A physician or other licensed health care professional recommends that the employee not
perform one or more of the routine functions of his or her job, or not work the full workday that
he or she would otherwise have been scheduled to work. The new rule continues the policy
established under the old rule that a case is not recordable under section 1904.7(b)(4) as a
restricted work case if the employee experiences minor musculoskeletal discomfort, a health care
professional determines that the employee is fully able to perform all of his or her routine job
functions, and the employer assigns a work restriction to that employee for the purpose of
preventing a more serious condition from developing
As stated earlier, it is important in many company cultures to have a low recordable incident rate. While
actual claims incurred is a direct cost driver decreasing recordables is still a worthwhile goal because
each recordable usually has cost associated with it either directly for medical and other costs or
indirectly related to production interruptions, etc for each recordable. Thus employers will be in
agreement with a goal to lower the total number of recordable incidents. To assist employers in this
goal, it is imperative that the onsite therapist understands what can be done onsite for the employee
without making the issue a recordable incident (see above dialogue on use of functional movement
versus therapeutic exercise). The interventions that are first utilized will be first aid interventions and
consultation, not medical treatment. The interventions will be done to help the employee fit the job
better, to improve employee comfort not to medically treat an injury or illness. The above definitions
should be followed closely to assist the employer in lowering recordable rates while working with in
OSHA guidelines. It would be very detrimental to the program to lower recordable rates, but be fined by
OSHA because things that should be recorded arent.
It is important to note that OSHA communication has defined home exercise programs and exercise
given by a licensed professional to be medical treatment (see below from Department of Labor Docket
number R-.02), thus making the work related incident recordable. The unintended consequence of this
communication has been for many employers to steer clear of on-site interventions in fear of the
recordable. This fear has prevented many companies from applying strategies that could significantly
help the employees and the companys bottom line in the long term. The Solve approach does not use
home exercise programs or physical therapy therapeutic exercise, but it counsels and trains employees
in functional movements at new employee orientation and throughout their employment, at company
trainings, and when comfort and performance issues are present. It would be illogical to state that the
movement strategies used for improving job fit and unloading work stressors given consistently
throughout employment would be considered medical treatment simply because the employee has a
reported incident. The movement strategy employed continues to be for job fit not diagnosed
pathology. To support this use of movement and to further distance the intervention from being used
as treatment. Diagnosing of pathology is not done or documented by on-site provider. Functional
movement is used to prepare the employees for work and home tasks and to unload/unwind repetitive
work and home movements. Another consideration is how the on-site provider is documenting the
movements that are trained. They should be documented as the movements done not in terms that are
consistent with prescribed therapeutic exercise, such as AAROM or PROM.
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Yet another consideration in the use of functional movements is the work relatedness of an employees
comfort and performance issue. The majority of issues that employees deal with onsite are related to
cumulative trauma with stress to tissue being contributed to by home and work tasks. Interventions
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Therapeutic exercise does differ from the aforementioned functional movement in that it is intended to
treat a diagnosed pathology and it is one on one supervised performance of exercise with defined
frequency, duration, and intensity over an extended period of time. When an employee is seen for a
comfort and performance issue, red flags for significant injury or illness are ruled out, a diagnosis of
pathology is not made, functional movement is directed at improving employee fit to task as opposed
to treating a diagnosis or pathology, and it is of a relatively short time period. If the comfort and
performance issue does not resolve with first aid and counseling related to condition, preparation and
unloading/unwinding strategies, referral for medical treatment including the use of therapeutic exercise
and other physical therapy treatments may be considered.
directed at non-work related issues do not make the issue a recordable. It is again noteworthy that
instructions given are most often to improve inherent movement inefficiencies with in the individual
for job fit as opposed to movement dysfunction caused by work injury. When considering workrelatedness, one should note their States workers compensation laws. In the State of Wisconsin,
physical therapists are not recognized as a diagnosing provider for work related incidents, as such
physical therapists will not diagnosis causation being work related or not. In addition, OSHA puts the
onus on the employer to determine if work related causation or significant aggravation.
In summary, exercise prescribed for work related injury or illness by a licensed professional, such as a
physical therapist is considered medical treatment. The Solve provider uses functional movement for
job/task fit without making an issue recordable with the following considerations:
Functional movement is used throughout employment, not only for a reported incidentbest practice would document these sessions.
Functional movement is used consistently for job fit not directed at pathology or injury-best
practice would document why a movement is being done to validate this.
Functional movement counseling is implemented, direct supervision of exercise of

prescribed frequency, duration and intensity, as done in the clinic is not-best practice would
not include frequency, duration and intensity on movement handouts
Functional movement is used for comfort and performance; a diagnosis of injury or pathology is
not made by the intervening provider-best practice would not involve giving a diagnosis (ICD 9
or 10) to the patient, employer in written communication, or documented in intervention note.
Functional movement is directed at inherent movement inefficiencies contributing to comfort

and performance problem not pathology induced dysfunction-best practice would use
movement to unload stress to tissue for comfort as opposed to using movement for increasing
ROM in a pathological structure
Functional movement is used for comfort and performance without work relatedness causation
formally determined-best practice would involve documentation of work and non-work related
stressors contributing to condition.
Page
After the therapist initiates working with the employee by applying functionomic strategies to improve
comfort, the therapist needs to keep in mind other contextual items. What is the employers return to
work policy? Will they accommodate workers to keep the recordable incidents from becoming lost time
claims? This has significant importance because once an issue becomes a lost time case, the cost of that
case will increase dramatically. The therapist should work with the employer to encourage them to
aggressively allow light duty and transfer jobs to prevent lost time. It should be noted that the employer
can move a worker to lighter duty work to keep a minor injury from becoming worse without the
incident being recordable. It should be noted that the change in work must be directed by the employer
not the licensed medical professional. If a medical professional writes formal restrictions the issue is a
recordable incident. Thus, if the employee does not improve after the first line intervention
72
Exercise: Several commenters requested adding exercise, performed either at home or at work, to the list
(see, e.g., Exs. 15: 201, 308, 349, 396). For example, Caterpillar suggested that OSHA "add a listing for range
of motion exercises and minor physical therapy performed at home" (Ex. 15: 201). These comments
described exercises that amount to self-administered physical therapy, and are normally recommended by a
health care professional who trains the worker in the proper frequency, duration and intensity of the
exercise. Physical therapy treatments are normally provided over an extended time as therapy for a serious
injury or illness, and OSHA believes that such treatments are beyond first aid and that cases requiring them
involve medical treatment. Department of Labor, OSHA 29 CFR Parts
1904 and 1952[Docket No. R-02]RIN 1218-AB24
the therapist should advise the employer what activities might be hindering progress. The employer can
then move the employee where appropriate.
Adjusting the work will bring about more contextual challenges. The departmental supervisor needs to
have bought in to the program and the importance of light duty for the companys bottom line. If he/she
just sees light duty as something else that makes it more difficult to make the production numbers
he/she is accountable to, work load adjustments will not happen effectively. Communication and
education must be constant and ongoing to make the context of the issue favorable for a good outcome.
Other contextual issues will arise if the employee is not improving with first aid and functionomic
instruction, and the subsequent light duty. When there is not improvement after three to four
interactions, it may be time to consider treatment or to refer the employee to a medical doctor, nurse
practitioner or PA. The first line of treatment to consider is for the onsite provider to treat the condition
(with in practice act constraints and employer sensitivities). If your state allows for direct access and
your employer is agreement with onsite treatment, intervention such as manipulation and trigger point
dry needling may be considered.
If there is a lack of response to on-site interventions referral to a specialist should be considered. Who
refers to the specialist and sets up the appointment? Does it come from the therapist or through the HR
department? Ideally the therapist would make the referral while communicating closely with HR. If the
therapist generates the referral it is likely that the MD will refer the patient back to that therapist if
formal physical therapy is needed. If the HR department refers the patient, and does not the let the
physician know that it is the companys desire to have the onsite therapist involved in the employees
care, the treating physician will likely refer where they have loyalties and perhaps financial interest. It is
essential for cost effective outcomes that the onsite therapist stays involved.
As soon as the physician, chiropractor, physicians assistant, or nurse practitioner (know who your state
recognizes as being able to diagnose under workers compensation) makes a diagnosis and decides that
the employees issues are work related the context of the work to worker balance continues to change.
The issue is now a formal workers compensation claim. Once a claim is filed treatment would have to
be billed through the employers workers compensation carrier (Wisconsin work comp law).
The third party administrator or the workers compensation carrier will become involved. It is important
that the therapist communicates as closely as possible with case workers or claim adjustors from these
companies because they can make it more difficult to maintain balance or they can ease the work to
worker balance. The goal is that the therapist, the HR department, the safety director, the departmental
supervisor, the physician, and the workers compensation carrier are all on the same page to make the
context conducive to positive outcomes with bottom line benefits for the employer. In some companies
this goal may seem illusive, but it should be continually strived for.
Page
disqualification does not occur, providers should focus on providing that which has been previously described as
prevention strategies. If treatment is provided it needs to focus on treatment of minor injury or illness and it
73
Yet other contextual challenges now exist with the current environment. There is even greater potential
now with industrial programs with in the U.S. Marketplace because of the rapid shift to self -insured
plans. These self- insured plans direct any savings related to health care or workers compensation
expenses directly to the companys bottom line. However, with these plans many employers are
offering health savings account or HSA high deductible health plans. The challenge with these plans is
that because of IRS regulations if a significant medical benefit is offered at reduced or no cost, the
employee may be disqualified from using a health savings account. IRC 223(c)(1)(B). To ensure this
should be provided incident to a prevention procedure, an example of which is a musculoskeletal screen. IRS
documents 2004-15 and 2004-33, and 2008-29 should be referred to for more detail.
Page
74
The overarching context in any industry is the bottom line goal of the program for the employer. This
should always be remembered and recognized. The goal is to increase profitability. Profitability is
increased by lowering the risk of claims by improving employee discomfort and by reducing recordable
incidents. It is enhanced by decreasing days away from normal work or on restricted duty (DART rate)
ultimately it is enhanced by less money being spent on workers compensation claims. The language of
profitability should be employed by the therapist when dealing with company management. It should be
remembered that most health care providers are seen as unrealistic employee advocates that will do
the will of the employee without consideration of the company. Speak the language, lower the risk, and
lower the cost and the context of balancing the work to the worker on an individual basis will maximize
program effectiveness.

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Getting Started with SOLVE (Company

and Provider only)

THE SOLVE SYSTEM

The SOLVE System consist of six elements:

Key URLs: www.SolveGlobal.com | www.SolveGlobal.com/AdminLogin | http://solveglobal.com/batchentry

1. A brief Welcome and Introduction to SOLVE (main text)

1. Company Profile Register new client

Survey Schedule create and implement surveys and survey templates

The Company List drop down menu, in the left

Two tasks are completed on the Survey Tab

Use the Company and Survey List dropdown

1. Validated Surveys limit participation to specific individuals who are prequalified/validated to

The left column provides options to query the database and

Both the Summary and Respondent Reports can be further

If the respondent answers No to the first

sequentially through the If No...

2. How long have you experienced your

There are 5 possible responses only one

serious condition and to assess the

3. What is the primary physical activity

This question seeks to identify the single

4. Where do you experience your

5. What kind of problems do you

This question provides 8 possible individual

6. How great is your problem?

7. How frequently does your problem

8. Please add any additional information

Upon completing the last question and

Providers should be exceptionally conservative when engaging in interventions for employees

Awareness of regulatory compliance issues is important. Providers operate under certain

Consulting (employees, management, operations, engineering, ergonomics, safety & health)

The SOLVE Role

The Clinician Role

Focused on a worker population

Marketing creates customers

An important word of caution is appropriate. As a consultant the professional has an ethical

There are 8 predictive factors related to identifying

In addition, there are

Functionomics is a systematic approach to enabling people to better perform (efficiently and

A distinctive competency of Functionomics is Applied Functional Science * (AFS) which uniquely

The influence of Functionomics

Changes in work performance and comfort

INTEGRATIVE FUNCTION MODEL

1. Engage alternative functional skills e.g. push instead of pull

Ergonomics is a natural extension of the biomechanical expertise of a functionally orientated therapist.

1. Ergonomics is focused on changing the work not the workers.

What is the clients perception of the problem?

OSHA Form 301 Injury and Illness Incident Reports*

In Functionomics , the focus shifts to understanding underlying

Repetitive stress can be relieved by altering one or more of these three

Functionomics is a vital component of a comprehensive strategy for safeguarding the performance

The biomechanical domain of Functionomics

6. Introduce neutral or mid-range postures, biomechanical alignment, and external

2. Introduce biomechanical task designs that prevent integrated-isolation of muscles

Direction Relative to anatomical neutral or relative to external references (i.e. a 360

2. Introduce task placement and/or orientation to facilitate multi-joint participation

4. Introduce alternative staging, positioning, sequencing, timing, flow, combination,

9. Secondary breakdown occurs due to compensation overuse

8. Substitution and compensation occurs

Functionomics , like ergonomics, is worker-centric, however, Functionomics offers a more granular

2. Muscle endurance is circulatory

There are three things to keep in mind

There are three things to keep in mind