1. ALLIANCE OCCUPATIONAL MEDICINE 1 Preventing Repetitive Motion Injuries Lucy Austin Physical Therapist Asst. Alliance Occupational Medicine

2. ALLIANCE OCCUPATIONAL MEDICINE 2 RMI/CTD Many names Many symptoms - Pain in the neck & shoulders - Pain in the forearms & elbows - Tingling in the hands - Headache, etc.

3. ALLIANCE OCCUPATIONAL MEDICINE 3 Poor Posture Position

4. ALLIANCE OCCUPATIONAL MEDICINE 4 Posture at the Computer Head forward Rounded Shoulders Slouched low back Forearms/wrists resting on surface

5. ALLIANCE OCCUPATIONAL MEDICINE 5 Results of That Posture Tightness & shortening of the chest muscles, sub occipital muscles, and anterior neck muscles Over stretching and weakness of the back & posterior shoulder muscles

6. ALLIANCE OCCUPATIONAL MEDICINE 6 Results of Working at the Computer for Extended Periods of Time Static contraction of the forearm muscles Ischemia/decreased fresh blood supply to the forearm muscles Abnormal forearm, wrist & hand positions – causing repetitive stress, wear & tear of the tendons

7. ALLIANCE OCCUPATIONAL MEDICINE 7 Muscles used to move our fingers & wrist are in the forearm Muscles taper down to form tendons Tendons are long fibrous cords – strong but not elastic Tendons have long & at times angled pathways

8. ALLIANCE OCCUPATIONAL MEDICINE 8 Note the 2 nerves that are around the wrist – the median nerve at the carpel tunnel and the ulnar nerve near the pisiform bone Median and Ulnar Nerves

9. ALLIANCE OCCUPATIONAL MEDICINE 9 Note the synovial sheaths

10. ALLIANCE OCCUPATIONAL MEDICINE 10 Note the band at the wrist joint. A common location for friction. Friction at the Wrist

11. ALLIANCE OCCUPATIONAL MEDICINE 11 Tendons are most commonly affected They are the weak link; they transmit forces generated by the muscles They are enclosed in the lubricating synovial sheaths which can get inflamed Tendons have limited blood supply, hence delayed repair & recovery RMI is the result of the repeated & prolonged tensing of the muscles At times combined with excessive “rubbing” on nearby structures Tendons

12. ALLIANCE OCCUPATIONAL MEDICINE 12 Other Structures Affected Muscles – due to sustained contractions affecting circulation, causing tenderness, tight knots – in the forearms, shoulders & upper back Nerves – due to direct pressure or compression in the tight muscles or swollen tissue

13. ALLIANCE OCCUPATIONAL MEDICINE 13 Muscular Activity Falls under 2 categories: Static & Dynamic Static contraction – length and tension generated by the muscle stays the same. Inhibits circulations, causing fatigue & increasing risk for injury. Also increases stress on the tendons. Dynamic contraction – length & tension change, muscle acts as a pump promoting circulation

14. ALLIANCE OCCUPATIONAL MEDICINE Ergonomics

15. ALLIANCE OCCUPATIONAL MEDICINE 15 Risk Factors Involved Force – pushing/pulling/gripping Awkward posture – head forward, rounded shoulder Repetition – continual typing/mousing Duration – long days Contact Stress – resting forearms or wrists affecting circulation

16. ALLIANCE OCCUPATIONAL MEDICINE 16 Other Factors Aerobic fitness Muscular strength Flexibility Coordination Excessive volume of activity Inadequate recovery time Advancing age Chronic Illness (diabetes, low thyroid) Smoking

17. ALLIANCE OCCUPATIONAL MEDICINE 17 Create an optimal work station to improve posture & pressure Micro stretch breaks – to enhance circulation Correct typing & mousing techniques – to lower abnormal forces What Can You Do?

18. ALLIANCE OCCUPATIONAL MEDICINE 18 OFFICE ERGONOMICS

19. ALLIANCE OCCUPATIONAL MEDICINE

20. 20 Ergonomics Most frequently used items closest Keyboard tray with space for mouse Headset Curved or split keyboards

21. ALLIANCE OCCUPATIONAL MEDICINE 21 At Your Workstation

22. ALLIANCE OCCUPATIONAL MEDICINE 22 Headset & Split Keyboard

23. ALLIANCE OCCUPATIONAL MEDICINE 23 Awkward Positions

24. ALLIANCE OCCUPATIONAL MEDICINE 24 Awkward Sitting Position

25. ALLIANCE OCCUPATIONAL MEDICINE 25 Awkward Mouse Position

26. ALLIANCE OCCUPATIONAL MEDICINE 26 Awkward Writing Position

27. ALLIANCE OCCUPATIONAL MEDICINE 27 Leg Position

28. ALLIANCE OCCUPATIONAL MEDICINE 28 What can you do? Get up and… STRETCH! Take small breaks to stretch Find a stretching buddy!

29. ALLIANCE OCCUPATIONAL MEDICINE 29 ERGO STRETCHES

30. ALLIANCE OCCUPATIONAL MEDICINE 30 ERGO STRETCHES

31. ALLIANCE OCCUPATIONAL MEDICINE 31 ERGO STRETCHES

32. ALLIANCE OCCUPATIONAL MEDICINE 32 ERGO STRETCHES

33. ALLIANCE OCCUPATIONAL MEDICINE 33 ERGO STRETCHES

34. ALLIANCE OCCUPATIONAL MEDICINE 34 ERGO STRETCHES

35. ALLIANCE OCCUPATIONAL MEDICINE 35 WORKSTATION CHAIR ADJUSTMENT 1)Stand in front of chair with height below knee cap 2)Sit tall in chair with feet flat on floor and chair ending 1-3 inches from knee 3)Adjust back rest to push hips slightly forward 4)Bent elbows at side of body should not contact armrests

36. ALLIANCE OCCUPATIONAL MEDICINE 36 Adjust Your Monitor

37. ALLIANCE OCCUPATIONAL MEDICINE 37 MONITOR HEIGHT: Eye Level

38. ALLIANCE OCCUPATIONAL MEDICINE 38 Proper Distance: Fingertip Distance

39. ALLIANCE OCCUPATIONAL MEDICINE 39 Do You See Anything Wrong With the Following Pictures?

40. ALLIANCE OCCUPATIONAL MEDICINE 40 GOOD or BAD?

41. ALLIANCE OCCUPATIONAL MEDICINE 41 GOOD or BAD?

42. ALLIANCE OCCUPATIONAL MEDICINE 42 GOOD or BAD?

43. ALLIANCE OCCUPATIONAL MEDICINE 43 GOOD or BAD?

44. ALLIANCE OCCUPATIONAL MEDICINE 44 GOOD or BAD?

45. ALLIANCE OCCUPATIONAL MEDICINE 45 GOOD or BAD?

46. ALLIANCE OCCUPATIONAL MEDICINE 46 GOOD or BAD?

47. ALLIANCE OCCUPATIONAL MEDICINE 47 GOOD or BAD?

48. ALLIANCE OCCUPATIONAL MEDICINE 48 GOOD or BAD?

49. ALLIANCE OCCUPATIONAL MEDICINE 49 Proper location of a Document Holder

50. ALLIANCE OCCUPATIONAL MEDICINE 50 MOUSING EXAMPLES

51. ALLIANCE OCCUPATIONAL MEDICINE 51 MOUSING EXAMPLES

52. ALLIANCE OCCUPATIONAL MEDICINE 52 MOUSING EXAMPLES

53. ALLIANCE OCCUPATIONAL MEDICINE 53 KEYBOARD TRAY ADDITION: Proper Typing Technique ?

54. ALLIANCE OCCUPATIONAL MEDICINE 54 Stretch Break!

55. ALLIANCE OCCUPATIONAL MEDICINE 55 ERGO STRETCHES

56. ALLIANCE OCCUPATIONAL MEDICINE 56 ERGO STRETCHES

57. ALLIANCE OCCUPATIONAL MEDICINE 57 ERGO STRETCHES

58. ALLIANCE OCCUPATIONAL MEDICINE 58 ERGO STRETCHES

59. ALLIANCE OCCUPATIONAL MEDICINE 59 ERGO STRETCHES

60. ALLIANCE OCCUPATIONAL MEDICINE Thoracolumbar Side-Bend Hands clasped, reach over head and bend to left side until stretch is felt. Then go to the other side. Hold 10 seconds in each position. Relax. Repeat 2-3 times per set. Do 1 sets per session. Do 1-2 sessions per day. ERGO STRETCHES

61. ALLIANCE OCCUPATIONAL MEDICINE 61 ERGO STRETCHES

62. ALLIANCE OCCUPATIONAL MEDICINE Chest Stretch Lace fingers behind back and squeeze shoulder blades together. Slowly raise and straighten arms. Hold 10-15 seconds. Repeat 3-5 times per set. Do 1 sets per session. Do 2 sessions per day. ERGO STRETCHES

63. ALLIANCE OCCUPATIONAL MEDICINE 63 ERGO STRETCHES

64. ALLIANCE OCCUPATIONAL MEDICINE Laptop Guidelines As a general rule avoid working directly on top of your laptop more than 1hr/day.

65. ALLIANCE OCCUPATIONAL MEDICINE The Following are Recommendations for: Conference Room Dining Room Table, Hotel Desk Any Non-Adjustable Surface

66. ALLIANCE OCCUPATIONAL MEDICINE Best Practice Overall Place the laptop on a laptop stand or books so top of screen is close to your eye level Use an external keyboard and mouse and raise the chair so your elbows are level with the keying surface. If the chair does not adjust, use folded towels or pillow to raise yourself. If the seat is too deep, add pillow for back support. Use a footrest, books or a pillow to support your feet, if needed.

67. ALLIANCE OCCUPATIONAL MEDICINE

68. At Risk Practice Prolonged sitting without: Foot and Back Support Awkward Neck Position Awkward Back Posture Pressure at Wrists

69. ALLIANCE OCCUPATIONAL MEDICINE 69 Computer Stretch Breaks Every 20-30 minutes never less then hourly Stand up Take several deep breathes Rotate Stretches Do your favorites more often Walk at least 10 minutes at lunchtime Once a day, do all exercises in one session Exercise 20-40 minutes most days

70. ALLIANCE OCCUPATIONAL MEDICINE 70 What Else Can You Do? Stay Healthy! Eat nutritious meals Exercise regularly Sleep until you’re rested (7-8 hours) Manage stress Don’t let hobbies and work tasks compete for your energy and recovery time

71. ALLIANCE OCCUPATIONAL MEDICINE 71 Common Symptoms of Repetitive Motion Injuries Fatigue Vague aching Sharp pain Tenderness Decreased Range of Motion – With or without pain Tingling Weakness Swelling - Edema - Effusion

72. ALLIANCE OCCUPATIONAL MEDICINE 72 Are RMI’s Treatable? Our bodies have capacity to repair themselves. Injuries will heal if they have not progressed to the point of irreversible damage (scarring). Once inflammation if controlled, then the tendons will recover

73. ALLIANCE OCCUPATIONAL MEDICINE 73 Treatment Plan Ergonomics - evaluate & adjust Improve Technique and Work Habits Conditioning - increase strength and flexibility Improve overall health Physical Therapy / Occupational Therapy Splints What these "treatments" really do is to provide conditions in which the body's own healing powers can do their job

74. ALLIANCE OCCUPATIONAL MEDICINE 74 RMI Summary Common Gradual Onset Not a single disease Severity varies greatly - mild to severe and incapacitating No single “correct” treatment for everyone “Nothing changes if nothing changes” Recovery requires teamwork, consistency and patience Ergonomics, Technique, Conditioning

75. ALLIANCE OCCUPATIONAL MEDICINE 75 Thank You Any Questions? Lucy Austin Physical Therapist Asst. Alliance Occupational Medicine 315 South Abbott Ave., Milpitas 2737 Walsh Ave., Santa Clara