Presentation on theme: "A Team Approach to Managing Physical Stress in the Workplace"— Presentation transcript:
1A Team Approach to Managing Physical Stress in the Workplace Presented by:Timothy A. Duke, D.C.Amy Heckman, M.P.T.Ellen Stoute, M.P.H., R.D., L.D.N.
2Presentation Outline Timothy A. Duke, D.C. Amy Heckman, M.P.T. Biomechanics Associated with Common Workplace Injuries, and Anticipated Conservative (Chiropractic) Treatment After They Occur.Amy Heckman, M.P.T.Appropriate Stretching and Strengthening to Prevent Injuries in the Workplace.Ellen Stoute, M.P.H., R.D., L.D.N.Obesity Trends and Worksite Wellness to Maintain Optimal Health and Minimize Workplace Stress and Injury.
3Presented By: Timothy A. Duke, D.C. Biomechanics Associated with Common Workplace Injuries and the Anticipated Conservative (Chiropractic) Treatment After They OccurPresented By: Timothy A. Duke, D.C.
4Learning Objectives Discuss common workplace injuries Strain/sprainDiscuss the biomechanics of common workplace conditionsLiftingSittingExpected conservative treatment associated with common occupational injuriesActive vs. Passive
5Common Workplace Injuries Strain/Sprain (S/S)Most common (40%)Special considerationOther InjuriesMusculoskeletal disorders (29%)“Ergonomic Injuries”Cuts/lacerations (8%)Fractures (7%)* All stats provided by
6Strain/Sprain (S/S): A Special Consideration Why a special consideration?PreventableHow/why do these occur?Acute vs. repetitiveOverexertionImproper liftingSlip and fallEtc…
7Grading a Strain/Sprain All S/S are not created equalLiterature accepts three gradesGrade IGrade IIGrade IIIInjury grade and timing are going to lay out the frequency, duration, and appropriate type of treatmentPassive to Active
8Lifting Biomechanics Why discuss lifting biomechanics? EducationWhy does improper lifting cause so much injury?SPINE study 2006Measured the change in load to the lumbar spine with external weight, as flexion occursAt 30 degrees the force was approx. four times greaterTakahashi et al. Mechanical Load of the Lumbar Spine During Forward Bending Motion of the Trunk-A Biomechanical Study. SPINE vol 31, number 1, pp
9Lifting Biomechanics Journal of Occupational Rehabilitation Low back loads vs. positions resulting in low back painPrevious studies have looked at body position in regards to causation of LBP, resulting in mixed results.Looked at cumulative low back loads and their relation to LBPResults up to 49% experienced pain in at least one of the follow-up years (3 years of follow-up performed)Coenen et al. Cumulative Low Back Load at Work as a Risk Factor of Low Back Pain: A Prospective Cohort Study. Journal of Occupational Rehabilitation. Online 21 June 2012.
10Lifting Biomechanics SPINE Study 2000 Compared both cumulative lifting AND trunk position while liftingCorrelated time spent in a flexed position, rotated position, and also compared various load weights and frequency of lifting.Results:Increased risk of LBP were noted with workers working in a 60° flexed position at least 5% of the day, working in a 30° rotated position 10% of the day, and lifting a load of 25kg more than 15 times/day.Hoogendoom et al. Flexion and Rotation of the Trunk and Lifting at Work Are Risk Factors for Low Back. SPINE. Vol 25, number 23, pp , 2000.
11Postural Biomechanics Why be concerned by postural biomechanics?Second leading cause of occupational injury (“ergonomic injury”)Very preventableWeight considerationsWhat is considered “good” postural biomechanics/ergonomics?
13Manual Therapy Journal Studies 2005 StudyCompared various muscle activities in “postural” muscle groups through EMG (electromyography), in people performing monotonous keyboard work.Even with proper ergonomics the studies subjects noted not only pain, but increased muscle activitySzeto et al. A comparison of symptomatic and asymptomatic office workers performing monotonous keyboard work-1: Neck and shoulder muscle recruitment patterns . Manual Therapy 10 (2005) pp2009 StudyCompared muscle activity levels through EMG in resting positions vs. task specific positions.Muscle activity increased approximately three times with task specific positions as compared to resting positionsSzeto et al. Neck-shoulder muscle activity in general and task-specific resting postures of symptomatic computer users with chronic neck pain. Manual Therapy 14 (2005) pp
14Conservative Treatment Options What is considered a good trial of Chiropractic care?Mercy GuidelinesHow should improvement be measured?If a person is not responding what should be done next?Chronic care considerations
15Passive vs. Active Treatment Passive TreatmentWhat is considered passive treatment?ManipulationModalitiesActive TreatmentWhat is considered active treatment?Rehabilitation
16Soft Tissue Healing: What to Expect? Phases of soft tissue healingAcuteRemodelingRepairTiming plays a key role in the appropriate treatment of soft-tissue injuriesAggressive treatment early on can lead to chronic ongoing problemsToo much passive treatment later on can lead to a lack of progress.
17Stretching and Strengthening to Prevent Injuries in the Workplace Presented by: Amy Heckman, M.P.T.
18Learning Objectives Importance of core muscles Importance of stretchingCommon core and stretching exercises
19Importance of Core Strength What is your “core”?Girdle of muscles that surround the midsection of your bodyWhat is the purpose of your core muscles?Support posture (static and dynamic)Create motionCoordinate muscle actionsKeep up stable
20How does the core help reduce injury? Helps limit stress of movementHelps prevent laxity of joints of your spineExcess movement of the bones in your spine due to weak core can result in damage to the joints
21Basic Core Exercises Diaphragmatic Breathing Start lying on your back with feet shoulder width apart and your hands on your lower abdomen (Be aware of the position of your back on the floor)Take a breath in through your nose for a count of 4 and feel how your back gently arches off the floorSlowly blow out through pursed lips like you are blowing a balloon for 8 seconds and think of "releasing" your back and notice how it moves closer to the floorAfter each cycle rest and breathe normally, but notice how your back feels. Do this before and after your other exercises. To start you may have to do shorter breathe cycles until your diaphragm is trained
22Basic Core Exercises Posterior Pelvic Tilt Lie on your back on a firm surface with knees comfortably bent (top picture)Then flatten back against the table while contracting abdominal muscles as if pulling belly button toward ribs (bottom picture)
23Basic Core Exercises Plank Side Plank on Knees Start face down with elbows on a mat directly below your shoulder and pull your core up, creating a plank position on your toes and elbows. Hold until you feel a shake then hold for ten more secondsSide Plank on KneesPut your weight on the bottom knee and elbow. Keep neck straight and abdominals in. Hold position until you feel your body shaking then hold for ten more seconds
24Basic Core Exercises Curl-Up (Reverse) While lying on your back with your knees bent, raise up your legs and lift your buttocksMaintain the same leg position the entire time
25Benefits of Stretching Decrease Muscle Strain/SprainDecrease Tendonitis/Tendonosis conditionsAllow Joints to move properly through their range of motion
26How to Stretch Effectively Do not stretch a cold muscleWarm up 5 to 10 min. prior to stretching (or stretch after activity)Do not bounceBouncing can cause small micro tears in muscleTears produce scar tissue in muscleScar tissue leads to less flexibility
27How to Stretch Effectively Hold each stretch about 30 secondsRepeat each stretch 3 to 4 timesStretch until you feel tension, not painStretch on a regular basis
28Static verse Dynamic Stretching Static stretches effect the collagen fibers of your musclesStatic stretches help reduce injury by maximizing flexibility and improving biomechanicsStatic stretches help increase and maintain a muscle length and flexibility
29Static verse Dynamic Stretching Dynamic stretching effect the golgi tendon organs of a muscleThe golgi tendon organs measure muscle tension to protect it from injuryThe structures can over react if not properly prepared for activityThe golgi tendon organs can stimulate a protective/reflexive muscle contraction at a time of rapid accelerationDynamic stretches can decrease the reactiveness of the golgi tendon organs and limit number of muscle strains experienced during quick acceleration activities common in sports
30Important Day-To-Day Stretches Neck StretchesUpper Trapezius - Tilt your head towards the side, then return back to looking straight ahead. (Be sure to keep you eyes and nose pointed straight ahead the entire time)Levator Scapulae - Turn your head towards the side, then return back to looking straight aheadCervical Retraction - Slowly draw your head back so that your ears line up with your shoulders
31Important Day-To-Day Stretches Pectoralis Major/Minor StretchWhile standing at a corner of a wall, place your arms on the walls with elbows bent so that your upper arms are horizontal and your forearms are directed upwards as shownTake one step forward towards the corner and bend your front knee until a stretch is felt along the front of your chest and/or shouldersYour arms should be pointed downward towards the ground.NOTE: Your legs should control the stretch by bending or straightening your front knee
32Important Day-To-Day Stretches Wrist Flexor StretchUse your unaffected hand to bend the affected wrist down as shownKeep the elbow straight on the affected side the entire timeWrist Extensor StretchUse your unaffected hand to bend the affected wrist up as shown
33Important Day-To-Day Stretches Standing Quad StretchWhile in a standing position, bend your knee back behind and hold your ankle/footNext, gently pull your knee into a more bent position
34Important Day-To-Day Stretches Hamstring StretchWhile lying down on your back, hook a towel or strap under your foot and draw up your leg until a stretch is felt under your leg calf areaKeep your knee in a straightened position during the stretchCan also be done in standingKeep knee in straightened position and flex forward at hipsRemember to keep your back straight
35Important Day-To-Day Stretches Gluteal StretchWhile Lying on your back, hold your knees and gently pull them up towards your chest
36Important Day-To-Day Stretches Piriformis StretchWhile lying on your back with both knee bent, cross your affected leg on the other kneeNext, hold your unaffected thigh and pull it up towards your chest until a stretch is felt in the buttock
37Important Day-To-Day Stretches Standing Calf Stretch (Gastroc.)While standing and leaning against a wall, place one foot back behind you and bend the front knee until a gentle stretch is felt on the back of the lower legYour back knee should be straight the entire time
38References1. "Strength and Conditioning Journal"; Core Stability Training for Healthy Athletes: A Different Paradigm for Fitness Professionals; Jeffery Willardson, Ph.D., CSCS; December 20072. "NSCA's Performance Training Journal"; Connecting the Core; Paul Goodman, MS, CSCS; November 20043. "NSCA's Performance Training Journal'; Core Training for Improved Performance; Tracy Handzel, CSCS; December 20084. Core Muscle Training: Keep Your Abdominal Muscles Strong to Prevent Injuries | Suite101.com5. “To stretch or not to stretch: The role of stretching in injury prevention and performance.” Scandinavian Journal of Medicine and Science in Sports. 20106. ACSM's Primary Care Sports Medicine. 2nd ed. Philadelphia, Pa7. Dynamic stretching warm-up intervention elicits longer-term performance benefits. Journal of Strength and Conditioning Research. 2008;4: Rancour J, et al.
39Presented by: Ellen Stoute, M.P.H, R.D., L.D.N. Obesity Trends and Worksite Wellness to Maintain Optimal Health and Minimize Workplace Stress and InjuryPresented by: Ellen Stoute, M.P.H, R.D., L.D.N.
40Learning Objectives Calculate and interpret Body Mass Index Identify Health Risks Associated with ObesityRecognize the Benefits of a Worksite Wellness ProgramStrategies to Implement a Health Promotion Initiative
41Definition of Overweight and Obesity Body mass index (BMI)Math formula used to assess overweight and obesityMultiply weight in pounds by 703Then divide result by height in inchesThen divide that result by height in inches again
42Limited because it doesn’t measure body fat or muscle directly BMI TableBMIUnderweight< 18.5NormalOverweightObese IObese IIObese III≥ 40Limited because it doesn’t measure body fat or muscle directly
44Health Risks Obesity is more than a cosmetic problem Overweight and obesity are risk factors forType 2 diabetesCoronary heart diseaseHigh blood cholesterolStrokeHypertensionGallbladder diseaseOsteoarthritis (degeneration of cartilage and bone of joints)Sleep apnea and other breathing problemsSome forms of cancer (breast, colorectal, endometrial, kidney)Fatty liver diseaseGastroesophageal refluxGoutReproductive problems in women
45Obesity is Also Associated With… Complications of pregnancyMenstrual irregularitiesHirsutism (presence of excess body and facial hair)Stress incontinence (urine leakage caused by weak pelvic floor muscles)Psychological disorders, such as depressionIncreased surgical riskIncreased mortality
46Type II Diabetes High blood sugar levels Major cause of heart disease, kidney disease, stroke, amputation, blindness6th leading cause of death in U.S.> 85% of people with Type 2 diabetes are overweightLosing 5-10% of your body weight and doing moderate-intensity exercise for 30 minutes, 5 days a week, may prevent or delay onset of Type 2 diabetes
47Coronary Artery Disease Arteries become hardened and narrowedCan cause heart attackCoronary heart disease is the leading cause of death in U.S.People who are overweight are more likely to develop risk factors for heart disease like high blood pressure and cholesterolLosing 5-10% of your weight can lower your chances for developing coronary heart disease
48Cancer 2nd leading cause of death in U.S. Being overweight may increase risk of developing several types of cancer, including cancers of the colon, esophagus, kidney, uterine, breastIt is not known exactly how being overweight increases cancer risk
49Sleep Apnea Stop breathing for short periods during the night Can cause daytime sleepiness, difficulty concentrating, heart failureRisk for sleep apnea higher for overweight peopleMore fat stored around neck may make airway smaller, which makes breathing difficultWeight loss usually improves sleep apnea
50OsteoarthritisExtra weight places extra pressure on joints and cartilage, causing them to wear awayWeight loss of 5% of your body weight may decrease stress on your knees, hips, and lower back
51Psychological and Social Effects Emotional suffering may be one of the most painful parts of obesityObese often face prejudice or discrimination in job market, at school, and in social situationsFeelings of rejection, shame, or depression may occur
52BMI and the WorkplaceThere is a relationship between higher BMI and workplace injuries, short-term disability, compensation claims and lost man-hours.In 2008, 335,390 cases were reported when someone had to take days off from work due to an ergonomic injury.Average length of absence = 9 days
53Study ResultsApril 2007 study revealed Worker’s Compensation claims filed by employees with a BMI over 40 were more than double of those by healthy-weight employees.Lost work days for obese group were 12 times as high as the healthy-weight group.Medical costs were almost 7 times higher
54American Journal of Epidemiology 85% of all injured employees in a manufacturing plant were classified as overweight or obese.The odds of injury for employees in the obese group were more than double that of healthy-weight employees.
55InjuriesMost common injury in the workplace suffered by employees with high BMI’s occurred in the leg or knee.Other frequent injuries were in the wrist, hand and back.Common complaints were inflammation, pain, contusions, strains and sprains.One study found patients with a BMI over 29 were 2.5 times more likely to be diagnosed with carpal tunnel syndrome than patients with a healthy BMI
56Obesity Trends Dramatic increase in obesity in U.S. over past 20 years More than 64% of U.S. adults are either overweight or obese
57Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% %–14%
58Obesity Trends* Among U.S. Adults BRFSS, 1986 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% %–14%
59Obesity Trends* Among U.S. Adults BRFSS, 1987 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% %–14%
60Obesity Trends* Among U.S. Adults BRFSS, 1988 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% %–14%
61Obesity Trends* Among U.S. Adults BRFSS, 1989 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% %–14%
62Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% %–14%
63Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% %–14% %–19%
64Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% %–14% %–19%
65Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% %–14% %–19%
66Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% %–14% %–19%
67Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% %–14% %–19%
68Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% %–14% %–19%
69Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% %–14% %–19% ≥20%
70Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% %–14% %–19% ≥20%
71Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% %–14% %–19% ≥20%
72Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% %–14% %–19% ≥20%
73Obesity Trends* Among U.S. Adults BRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% %–14% %–19% %–24% ≥25%
74Obesity Trends* Among U.S. Adults BRFSS, 2002 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% %–14% %–19% %–24% ≥25%
75Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% %–14% %–19% %–24% ≥25%
76Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% %–14% %–19% %–24% ≥25%
77Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% %–14% %–19% %–24% %–29% ≥30%
78Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% %–14% %–19% %–24% %–29% ≥30%
79Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% %–14% %–19% %–24% %–29% ≥30%
80Obesity Trends* Among U.S. Adults BRFSS, 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% %–14% %–19% %–24% %–29% ≥30%
81Obesity Trends* Among U.S. Adults BRFSS, 2009 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% %–14% %–19% %–24% %–29% ≥30%
82What Causes Obesity? Energy Imbalance The same amount of energy IN and energy OUT over time = weight stays the sameMore IN than OUT over time = weight gainMore OUT than IN over time = weight lossOverweight and obesity happen over time when you take in more calories than you use
83What Causes Obesity? Physical Inactivity Less than 1/3 of adults do the recommended amount of physical activity (at least 30 minutes most days)Americans aren’t physically active for many reasonsSpending hours in front of TVs and computers doing work, schoolwork, and leisure activities> 2 hours a day of regular TV viewing time has been linked to overweight and obesityRelying on cars instead of walking to placesFewer physical demands at work or at home because modern technology and conveniences reduce need to burn caloriesLack of physical education classes in schools
84What Causes Obesity? Environment Lack of neighborhood sidewalks and safe places for recreationLong hours at work and time spent commutingOversized food portionsLack of access to healthy foodsNeighborhoods without supermarketsHealthy foods often cost moreFood advertising
85What Causes Obesity? Genes and Family History Genes have strong influence on weightYour chances of being overweight are greater if your parents are overweightChildren adopt the habits of their parents
86What Causes Obesity? Lack of Sleep People who sleep 5 hours a night are much more likely to become obese compared to people who sleep 7–8 hoursPeople who sleep fewer hours seem to prefer eating foods that are higher in calories and carbohydratesHormones released during sleep control appetite and body’s use of energy
87Weight Loss Goals Lose 5-10% of your current weight over 6 months Will lower your risk for heart disease and other conditionsBest way to lose weight is slowly1-2 lbs a week is doable, safe, and will help you keep off the weight
88Measuring SuccessLook at many factors to gauge success with weight loss effortsNumber on scaleHow clothes fitBlood pressureCholesterolHbA1CFitness levelEtc.
89Worksite Wellness81% of America’s businesses with 50 or more employees have some form of health promotion program.Medical costs can consume half of corporate profits or moreWorksite wellness is an investment in your most important asset—your employees.
90Top 5 Reasons for Worksite Wellness #1--Health Care CostsWe spend over $1 trillion dollars on healthcareAverage annual cost per person exceeds $3,00041 million Americans are without healthcare insuranceMost of these costs are linked to health habits
91Reason #2 - Most Injuries Can Be Avoided Preventable illnesses make up approximately 70% of the entire burden of illness associated costs in the US.Preventable factors include:Tobacco useHigh-risk alcohol consumptionSedentary lifestylesPoor nutritional habits
92Reason #3 – The Work Week is Expanding Typical American works 47 hours a week164 more hours than only 20 years ago- If trend continues average person will be on the job 60 hours a weekTechnology has erased traditional work boundaries
93Reason #4 – Technology Revolution Reliance on technology has caused new health concerns including: repetitive stress injuries, low back problems, and compromised visionOne-third of the workforce spends their day seated at their desks plugged into workstationsSedentary lifestyles major concern
94Reason #5 – Employee Stress Levels Are Rising Information explosion—more information has been produced in the last 30 years than during the previous 5,00078% of Americans describe their jobs as stressfulVast majority indicated their stress levels have worsened over the past 10 years
95Benefits of Workplace Wellness Programs Healthier EmployeesFewer InjuriesImproved ProductivityLower AbsenteeismReduced Medical CostsIncreased Job SatisfactionDecreased Employee Turnover
96Journal of Occupational and Environmental Medicine Study published in 2008 focused on a company with an employee wellness program.Researchers evaluated health care costs during a 4 year period to establish cost-effectiveness.Study found the company had saved over $1.3 million as a result of lower health care costs incurred by program participants.
97Where Do We Begin? Establish a Wellness Committee Employee involvement is vitalAssess Employee Needs and InterestsEmployee interest surveyConduct a Worksite Organizational Health Survey.
98Physical ActivityDoes your worksite have a place for employees to go for a walk?Does your organization have organized physical activities for employees?Access to physical activity facilities for employees?Access to an indoor exercise facility?
99Physical ActivitySubsidize memberships to off-site physical activity facilities?Are there stairs employees can use for physical activity?Incentives or rewards to employees who are physically active?Do you offer a health plan which provides discounts for health club membership?
100Nutrition Can employees obtain food or snacks at the workplace? Where are the food or snacks offered?What types of foods are available through vending machines?Does your organization have written policies or guidelines to ensure that fruit, vegetables and salads are offered at catered meetings?
101NutritionDo you have a place where employees can refrigerate and heat meals?Do you offer nutrition education programs to your employees?Does your organization offer weight control programs?Reimbursement or discounts for dietary counseling?
102SmokingDoes your organization have a written smoke-free environment policy?Are employees who violate the policy penalized in any way?Do you offer programs to help employees quit smoking?Do you offer reimbursement or discounts to employees who enroll in programs to quit smoking?
103Other Health ProgramsHealth education classes, workshops, lectures, or special eventsHealth screening servicesAre employees allowed to use paid work time to participate in health related activities?Solicit feedback from employees on health programs that would be beneficial to them
104In Summary Most popular worksite wellness programs are ExerciseSmoking Cessation ClassesBack Care ProgramsStress ManagementThere are numerous compelling reasons why every organization should consider developing a worksite health promotion initiative.