A Team Approach to Managing Physical Stress in the Workplace

1. A 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.

2. Presentation Outline • Timothy A. Duke, D.C. • 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.

3. Biomechanics Associated with Common Workplace Injuries and the Anticipated Conservative (Chiropractic) Treatment After They Occur Presented By: Timothy A. Duke, D.C.

4. Learning Objectives • Discuss common workplace injuries • Strain/sprain • Discuss the biomechanics of common workplace conditions • Lifting • Sitting • Expected conservative treatment associated with common occupational injuries • Active vs. Passive

5. Common Workplace Injuries • Strain/Sprain (S/S) • Most common (40%) • Special consideration • Other Injuries • Musculoskeletal disorders (29%) • “Ergonomic Injuries” • Cuts/lacerations (8%) • Fractures (7%) • * All stats provided by www.OSHA.gov

6. Strain/Sprain (S/S): A Special Consideration • Why a special consideration? • Preventable • How/why do these occur? • Acute vs. repetitive • Overexertion • Improper lifting • Slip and fall • Etc…

7. Grading a Strain/Sprain • All S/S are not created equal • Literature accepts three grades • Grade I • Grade II • Grade III • Injury grade and timing are going to lay out the frequency, duration, and appropriate type of treatment • Passive to Active

8. Lifting Biomechanics • Why discuss lifting biomechanics? • Education • Why does improper lifting cause so much injury? • SPINE study 2006 • Measured the change in load to the lumbar spine with external weight, as flexion occurs • At 30 degrees the force was approx. four times greater Takahashi et al. Mechanical Load of the Lumbar Spine During Forward Bending Motion of the Trunk-A Biomechanical Study. SPINE vol 31, number 1, pp 18-23 2006.

9. Lifting Biomechanics • Journal of Occupational Rehabilitation • Low back loads vs. positions resulting in low back pain • Previous 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 LBP • Results 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.

10. Lifting Biomechanics • SPINE Study 2000 • Compared both cumulative lifting AND trunk position while lifting • Correlated 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 3087-3092, 2000.

11. Postural Biomechanics • Why be concerned by postural biomechanics? • Second leading cause of occupational injury (“ergonomic injury”) • Very preventable • Weight considerations • What is considered “good” postural biomechanics/ergonomics?

12. “Good” Ergonomic Position

13. Manual Therapy Journal Studies • 2005 Study • Compared 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 activity Szeto 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) pp 270-280. • 2009 Study • Compared 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 positions Szetoet al. Neck-shoulder muscle activity in general and task-specific resting postures of symptomatic computer users with chronic neck pain. Manual Therapy 14 (2005) pp338-345.

14. Conservative Treatment Options • What is considered a good trial of Chiropractic care? • Mercy Guidelines • How should improvement be measured? • If a person is not responding what should be done next? • Chronic care considerations

15. Passive vs. Active Treatment • Passive Treatment • What is considered passive treatment? • Manipulation • Modalities • Active Treatment • What is considered active treatment? • Rehabilitation

16. Soft Tissue Healing: What to Expect? • Phases of soft tissue healing • Acute • Remodeling • Repair • Timing plays a key role in the appropriate treatment of soft-tissue injuries • Aggressive treatment early on can lead to chronic ongoing problems • Too much passive treatment later on can lead to a lack of progress.

17. Stretching and Strengthening to Prevent Injuries in the Workplace Presented by: Amy Heckman, M.P.T.

18. Importance of core muscles Importance of stretching Common core and stretching exercises Learning Objectives

19. Importance of Core Strength • What is your “core”? • Girdle of muscles that surround the midsection of your body • What is the purpose of your core muscles? • Support posture (static and dynamic) • Create motion • Coordinate muscle actions • Keep up stable

20. How does the core help reduce injury? • Helps limit stress of movement • Helps prevent laxity of joints of your spine • Excess movement of the bones in your spine due to weak core can result in damage to the joints

21. Basic 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 floor • Slowly 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 floor • After 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

22. 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) Basic Core Exercises

23. Basic Core Exercises • Plank • 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 seconds • Side Plank on Knees • Put 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

24. Curl-Up (Reverse) While lying on your back with your knees bent, raise up your legs and lift your buttocks Maintain the same leg position the entire time Basic Core Exercises

25. Benefits of Stretching • Decrease Muscle Strain/Sprain • Decrease Tendonitis/Tendonosis conditions • Allow Joints to move properly through their range of motion

26. How to Stretch Effectively • Do not stretch a cold muscle • Warm up 5 to 10 min. prior to stretching (or stretch after activity) • Do not bounce • Bouncing can cause small micro tears in muscle • Tears produce scar tissue in muscle • Scar tissue leads to less flexibility

27. How to Stretch Effectively • Hold each stretch about 30 seconds • Repeat each stretch 3 to 4 times • Stretch until you feel tension, not pain • Stretch on a regular basis

28. Static verse Dynamic Stretching • Static stretches effect the collagen fibers of your muscles • Static stretches help reduce injury by maximizing flexibility and improving biomechanics • Static stretches help increase and maintain a muscle length and flexibility

29. Static verse Dynamic Stretching • Dynamic stretching effect the golgi tendon organs of a muscle • The golgi tendon organs measure muscle tension to protect it from injury • The structures can over react if not properly prepared for activity • The golgi tendon organs can stimulate a protective/reflexive muscle contraction at a time of rapid acceleration • Dynamic stretches can decrease the reactiveness of the golgi tendon organs and limit number of muscle strains experienced during quick acceleration activities common in sports

30. Important Day-To-Day Stretches • Neck Stretches • Upper 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 ahead • Cervical Retraction - Slowly draw your head back so that your ears line up with your shoulders

31. Important Day-To-Day Stretches • Pectoralis Major/Minor Stretch • While 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 shown • Take one step forward towards the corner and bend your front knee until a stretch is felt along the front of your chest and/or shoulders • Your arms should be pointed downward towards the ground. • NOTE: Your legs should control the stretch by bending or straightening your front knee

32. Important Day-To-Day Stretches • Wrist Flexor Stretch • Use your unaffected hand to bend the affected wrist down as shown • Keep the elbow straight on the affected side the entire time • Wrist Extensor Stretch • Use your unaffected hand to bend the affected wrist up as shown • Keep the elbow straight on the affected side the entire time

33. Important Day-To-Day Stretches • Standing Quad Stretch • While in a standing position, bend your knee back behind and hold your ankle/foot • Next, gently pull your knee into a more bent position

34. Important Day-To-Day Stretches • Hamstring Stretch • While 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 area • Keep your knee in a straightened position during the stretch • Can also be done in standing • Keep knee in straightened position and flex forward at hips • Remember to keep your back straight

35. Important Day-To-Day Stretches • Gluteal Stretch • While Lying on your back, hold your knees and gently pull them up towards your chest

36. Important Day-To-Day Stretches • Piriformis Stretch • While lying on your back with both knee bent, cross your affected leg on the other knee • Next, hold your unaffected thigh and pull it up towards your chest until a stretch is felt in the buttock

37. Important 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 leg • Your back knee should be straight the entire time

38. References • 1. "Strength and Conditioning Journal"; Core Stability Training for Healthy Athletes: A Different Paradigm for Fitness Professionals; Jeffery Willardson, Ph.D., CSCS; December 2007 • 2. "NSCA's Performance Training Journal"; Connecting the Core; Paul Goodman, MS, CSCS; November 2004 • 3. "NSCA's Performance Training Journal'; Core Training for Improved Performance; Tracy Handzel, CSCS; December 2008 • 4. Core Muscle Training: Keep Your Abdominal Muscles Strong to Prevent Injuries | Suite101.com http://suite101.com/article/core-muscle-training-a50442#ixzz26PX3C96W • 5. “To stretch or not to stretch: The role of stretching in injury prevention and performance.” Scandinavian Journal of Medicine and Science in Sports. 2010 • 6. ACSM's Primary Care Sports Medicine. 2nd ed. Philadelphia, Pa • 7. Dynamic stretching warm-up intervention elicits longer-term performance benefits. Journal of Strength and Conditioning Research. 2008;4:1286.0.Rancour J, et al.

39. Obesity Trends and Worksite Wellness to Maintain Optimal Health and Minimize Workplace Stress and Injury Presented by: Ellen Stoute, M.P.H, R.D., L.D.N.

40. Learning Objectives • Calculate and interpret Body Mass Index • Identify Health Risks Associated with Obesity • Recognize the Benefits of a Worksite Wellness Program • Strategies to Implement a Health Promotion Initiative

41. Definition of Overweight and Obesity • Body mass index (BMI) • Math formula used to assess overweight and obesity • Multiply weight in pounds by 703 • Then divide result by height in inches • Then divide that result by height in inches again

42. BMI Table Limited because it doesn’t measure body fat or muscle directly

44. Health Risks • Obesity is more than a cosmetic problem • Overweight and obesity are risk factors for • Type 2 diabetes • Coronary heart disease • High blood cholesterol • Stroke • Hypertension • Gallbladder disease • Osteoarthritis (degeneration of cartilage and bone of joints) • Sleep apnea and other breathing problems • Some forms of cancer (breast, colorectal, endometrial, kidney) • Fatty liver disease • Gastroesophageal reflux • Gout • Reproductive problems in women

45. Obesity is Also Associated With… • Complications of pregnancy • Menstrual irregularities • Hirsutism (presence of excess body and facial hair) • Stress incontinence (urine leakage caused by weak pelvic floor muscles) • Psychological disorders, such as depression • Increased surgical risk • Increased mortality

46. Type II Diabetes • High blood sugar levels • Major cause of heart disease, kidney disease, stroke, amputation, blindness • 6th leading cause of death in U.S. • > 85% of people with Type 2 diabetes are overweight • Losing 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

47. Coronary Artery Disease • Arteries become hardened and narrowed • Can cause heart attack • Coronary 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 cholesterol • Losing 5-10% of your weight can lower your chances for developing coronary heart disease

48. Cancer • 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, breast • It is not known exactly how being overweight increases cancer risk

49. Sleep Apnea • Stop breathing for short periods during the night • Can cause daytime sleepiness, difficulty concentrating, heart failure • Risk for sleep apnea higher for overweight people • More fat stored around neck may make airway smaller, which makes breathing difficult • Weight loss usually improves sleep apnea

50. Osteoarthritis • Extra weight places extra pressure on joints and cartilage, causing them to wear away • Weight loss of 5% of your body weight may decrease stress on your knees, hips, and lower back