As a field hockey player, Julie Collins (SAR’12,’14) knows how debilitating repetitive stress injuries can be—she’s seen plenty of student-athletes with knee, wrist, and back pain. But it was her friendship with a locker room custodian named Mary (name changed for privacy) that sparked her interest in preventing such injuries.

“As a physical therapy student, I loved analyzing people’s movements,” Collins says. “The more I saw Mary working in our building, the more I was breaking down her movements and trying to think of better working positions for her. I became interested in the idea of giving people suggestions about how to use their bodies properly to decrease the risk for injury.”

In 2013, as part of the practicum requirement for her doctor of physical therapy (DPT) degree, Collins joined Kelly Pesanelli, a senior physical therapist and lecturer in the Department of Health Sciences, and Lee Marinko, a clinical assistant professor and physical therapist, at the Ryan Center for Sports Medicine & Rehabilitation. Together, they developed an intervention program for BU Facilities Management & Planning.

While back and knee problems are prevalent among BU custodians, their most common injuries are to the shoulder. Between 2002 and 2009, approximately 14 percent of custodial workers’ shoulder injuries were caused by repetitive motion and overuse, and those injuries alone cost the University more than $160,000 a year. “A lot of our workers were being injured doing overhead work,” says Pesanelli. “They would reach up as high as they possibly could, and just from doing that for years and years, eventually they would reach up and feel excruciating shoulder pain.”

“I’m not trying to teach [the custodians] how to do their job. I’m teaching them small things they can do to make their job pain-free.”—Julie Collins

As part of the intervention program, Collins shadowed the custodians, including Jessica (name changed for privacy), who cleaned Rich Hall’s 34 bathrooms every day. “Even after cleaning just one bathroom, she would shrug her shoulders to try and loosen them up,” Collins says. By assessing Jessica and her colleagues at work and videotaping their movements for further study, Collins found that many of their injuries could be prevented through small changes, such as investing in step stools and mops with extended handles. She also encouraged the custodians to place their buckets on desks to minimize crouching, and bend their knees instead of their backs when lifting objects from the ground.

At the end of the spring semester, Collins gave 45-minute ergonomics presentations during every custodial shift. She incorporated the videotapes into her talks to show the custodians how their work practices were straining their shoulder muscles and tendons, and explained the changes they could make to prevent pain. “I’m not trying to teach them how to do their job,” Collins says. “I’m teaching them small things they can do to make their job pain-free.”

The results were striking. Since 2010, costs for shoulder injuries among BU custodians have dropped 85 percent to approximately $25,500, and, as of 2014, custodians no longer report shoulder injuries caused by repetitive motion and overuse. Collins presented the results of her program at the 2014 Combined Sections Meeting of the American Physical Therapy Association in Las Vegas, and Marinko notes, “It’s really impressive that a student in the DPT program was able to contribute to a large institutional change.”

While Collins is pleased that the intervention has achieved such far-reaching influence, she is most gratified by its impact on BU’s custodians. “We care about them,” she says. “It’s not just about saving money, it’s about preventing injuries. I met almost every custodian while giving these presentations,” and when she later ran into them on campus, they exclaimed, “Don’t worry, I’m cleaning right. I’m using what you taught me!”