P revent disability R estore movement I mprove function D ecrease pain E nergize life P.R. I.I.I.I.D. E. Wellness Systems, Inc.

Ergonomics… From Another Perspective Background and case histories Petti Redding, OTR P.R.I.D.E. Wellness Systems, Inc.

RSI statistics OSHA studies show that… RSI’s account for 34% of all lost workdays due to injury RSI’s claim $1 out of every $3 spent for Workers’ Comp Total annual RSI costs exceed $60 billion RSI’s are the fastest growing workplace injuries in the U.S. RSI's result in the highest median days away from work RSI's have the highest average Workers’ Comp cost-per- case from $14,000 to $29,000

Lost Work Days Per RSI (Median # of Days) Carpal Tunnel Syndrome– 27 days Repetitive Motion Injury– 19 days Shoulder– 16 days Upper Arm– 15 days MSD– 14 days Wrist– 14 days Tendonitis– 14 days Tenosynovitis– 14 days Hand & Fingers– 10 days Hand & Wrist– 11 days Bursitis– 7 days Bureau of Labor Statistics

Primary problems of RSI’s Pain (burning, sharp, dull, achy, etc.) Parasthesia (numbness and tingling) Weakness Fatigue of body part Can we find a common link?

Muscles: the lowest common denominator of injury

The concept of structural integrity of the musculoskeletal system

Structural integrity Axis line: Ear shoulder- hip- knee- ankle

Unbalanced Typical, dysfunctional postures leading to musculo- skeletal pain, vertebral dysfunction, arthritic conditions, etc.

Postural self tests Up against the wall test Hand-shoulder test Hamstring tightness test Brachial plexus nerve glide test

Root cause of dysfunction… Muscles Bones are pulled out of alignment by muscles that are generally : 1. Weak and overstretched on 1 side 2. Tight & stronger on the opposite side

Primary cause of RSI Pain- the trigger point Mechanisms of injury include muscle that work overstretched, overshortened or overloaded Based on energy crisis and dysfunctional motor endplates Most often overlooked in the diagnostic process by the medical community- Why?

Muscle anatomy and function

A different view of a sarcomere

At the cellular level… the sliding mechanism theory

Muscle sarcomere in action

Dysfunctional muscles… the trigger point Muscles contracting in over-stretched, over- shortened or over-worked positions Muscles holding a static, isometric contraction for extended periods of time … lead to a in blood flow and resulting energy crisis

Trigger Point Formation 1 st Actin and myosin proteins fail to disconnect in multiple sarcomeres 2 nd Leading to increased tension throughout the entire muscle

Relationship of trigger points and nerve entrapment Tight muscles Lack of nerve glide Nerve compression Nerve damage

Scalenes trigger point and referred pain pattern

Gluteus minimus trigger point and referred pain pattern

Infraspinatus trigger point and referred pain pattern

Trigger point deactivation Locate trigger point Apply firm, moderate pressure Hold about a minute Stretch muscle afterward Repeat 6-8 times a day Usually takes 1 day to 1-2 weeks (depending how long it’s been there)

But what does that have to do with posture and lack of structural integrity?

Primary Cause of Structural Dysfunction Behaviors lead to… non-balanced, structurally misaligned postures lead to… muscles statically overstretched and overworked which leads to… 1. Pain 2. Nerve entrapments 3. Misaligned joints that contribute heavily to degenerative joint disease (Osteoarthritis)

The Primary Culprit… Sitting! Our spines are DESIGNED in an “S” Good sitting results in “S” posture, w/ all joints in neutral alignment and muscles relaxed

The “S” curve Good sitting results in “S” posture, w/ all joints in neutral alignment and muscles relaxed

The “C” curve Bad sitting results in “C” posture w/ muscles held statically, non neutral joints and dysfunction happening slowly, over time.

Postural dysfunction Muscles adapt to the position that it is put in over time Muscles dictate the position of the skeleton BUT Muscles can be re-trained, shortened, lengthened, strengthened To regain structural integrity

Gullett Elementary School

Case Histories: Early Intervention All employees achieved these results ON THEIR OWN No employee was “treated”. There were no modalities, or physical therapy interventions No employee visited a physician No employee became an OSHA recordable injury or W/C injury.

Sample techniques Bumper stretch Noodle stretch Cross over girlie knee stretch Legs up wall stretch Sit on hand stretch Supermans (Petti- play the video!)

Symptoms/ frequency Lower and upper back pain, right side Most of the time Medium severity Trigger point releases Top and back of shoulder (traps, levator scapula) Booty (gluteus medius/minimus) Chest (pectoralis minor) Exercises and stretches Noodle stretch, cross-over girlie knee stretch, legs up wall, sit-on-hand neck stretch Ergo modifications Double wedgie, lowered table, raised monitor, wrist rest Sebastian B. (30’s) Engineer

Symptoms/ frequency Pain in forearms, shoulders, upper back, lower back; most of the time; medium to high severity Trigger point releases Neck (scalenes) shoulders (traps, levator scapula) upper back (rhomboids) forearms (extensors) Exercises and stretches Noodle stretch w/head press; supermans; cobra; sit-on-hand neck stretch Ergo modifications Wedgies, lowered table, wrist rest, HEADSET; Comments“oh my god! I never knew I could feel this good, even at work!” Kari H (30’s) HR rep

Symptoms/ frequency Pain in low back, shoulders, and neck Pain is frequent, and medium in severity Trigger point releases Inside of shoulderblade (Subscapularis) Booty (gluteus minimus) Shoulders (upper and middle traps) Exercises and stretches Supermans, noodle stretch, cross-over girlie knee stretch Ergo modifications Double wedgie, lowered table, raised monitors, added wrist rest 65 cm ball Comments“ I have had shoulder pain for 10 years, and its finally gone” Aida B. (50’s) IT Specialist (45+ hrs/week)

Symptoms/ frequency Neck, shoulders, feet Constant pain, medium in severity (had been seeing podiatrist for 1 year) Trigger point releases Neck (scalenes) shoulders (traps, levator scapula, subscapularis) Upper back (rhomboids) calves (soleus) Exercises and stretches Noodle stretch, chin tucks, supermans, heel drops Ergo modifications Wedgies, lowered monitor A LOT (bifocals) 55cm ball, lowered table Comments“shoulder is wonderful! I’m doing noodle stretch 2x a day! And I love that little ball!” Deb P. (50’s) IT Specialist hrs/week

Additional comments “I have been seeing a podiatrist for heel pain for several months. I have been to see the doctor 3 times with only sight relief. He said if the last stronger prescription Medication didn't work he would inject the heel. Petti was checking up on me and the neck issue last week. I said my neck was fine, but I was going to the doctor to have my foot injected. She got a racket ball and showed me how to find another trigger point in the back of my calf that is causing the heel problem. I felt relied immediately. After less that a week I have less pain than after 6 weeks of medication! I think I can completely resolve the heel issue if I just keep using the ball.”

My Point… Ergonomics is not just about the stuff Anthropometric data is not the total picture The biggest risk factors for injury lie in the PERSON, not the task (in terms of RSI’s) Put some effort into helping your workforce fix their bodies… you’ll be amazed at the results

Questions? Thank you Petti Redding, OTR