““Back to Work”Back to Work”

Corporate Health CareCorporate Health Care

Dr. Helen WorthingtonDr. Helen Worthington

Presenting Chiropractor:Presenting Chiropractor:

Dr. Helen WorthingtonDr. Helen Worthington

BSc (BSc (HonsHons) Chiropractic) Chiropractic

DC DC PgCertPgCert

Special interest areas:Special interest areas:

�� Occupational healthOccupational health

�� Disc injury & sciaticaDisc injury & sciatica

�� Spinal rehabilitationSpinal rehabilitation

�� Stress ManagementStress Management

�� Paediatrics and Pregnant ladiesPaediatrics and Pregnant ladies

What is health?What is health?

�� ““A complete state of physical, mental and A complete state of physical, mental and social wellsocial well--being and not merely the being and not merely the absence of disease or infirmity.” (1)absence of disease or infirmity.” (1)

�� “A dynamic state of well“A dynamic state of well--being being characterised by a physical and mental characterised by a physical and mental potential which satisfies the demands of potential which satisfies the demands of life.” (2)life.” (2)

What is pain?What is pain?

�� Pain is defined as “an unpleasant sensory and Pain is defined as “an unpleasant sensory and

emotional experience associated with actual or emotional experience associated with actual or

potential tissue damage” International potential tissue damage” International

Association for the Study of Pain (IASP).Association for the Study of Pain (IASP).

�� Pain can serve as a warning to protect the body Pain can serve as a warning to protect the body

from further damage (purposeful pain). Pain is from further damage (purposeful pain). Pain is

usually classified as acute or chronic (over three usually classified as acute or chronic (over three

month’s duration).month’s duration).

What is Chiropractic?What is Chiropractic?

�� Chiropractic is a primary healthChiropractic is a primary health--care profession care profession established in 1895. established in 1895.

�� Chiropractors specialise in the diagnosis, Chiropractors specialise in the diagnosis, treatment, prevention and overall management treatment, prevention and overall management of musculoskeletal conditions that are due to of musculoskeletal conditions that are due to mechanical dysfunction of the joints and muscles mechanical dysfunction of the joints and muscles and the effects of these disorders on the and the effects of these disorders on the function of the nervous system and general function of the nervous system and general health.health.

Education and trainingEducation and training

�� Chiropractors are regulated by the General Chiropractors are regulated by the General Chiropractic Council (GCC).Chiropractic Council (GCC).

�� The title of chiropractor is protected by law and The title of chiropractor is protected by law and it is illegal to practice in the UK without being it is illegal to practice in the UK without being registered with the GCC. registered with the GCC.

�� To register, chiropractors must have completed To register, chiropractors must have completed an honours degree or undergraduate masters.an honours degree or undergraduate masters.

Is back pain real?Is back pain real?

PHYSIOLOGICAL ADAPTIVE RANGE (PAR)PHYSIOLOGICAL ADAPTIVE RANGE (PAR)BIRTHBIRTH

INJURY

COMPENSATION

ADAPTATION

STRESS PHYSICAL

EMOTIONAL

DIETARY

TRAUMA

ENVIRONMENT

MAXIMUM ADAPTATIONMAXIMUM ADAPTATION

ESTABLISHED CONDITIONESTABLISHED CONDITION

HEALTHHEALTH MAXIMUM TOLERANCEMAXIMUM TOLERANCE

A

S

Y

M

P

T

O

M

A

T

I

C

MINIMUM TOLERANCEMINIMUM TOLERANCE

DISEASE PROCESSDISEASE PROCESSTOTALLY SYMPTOMATICTOTALLY SYMPTOMATIC

S Y M P T O M A T I CS Y M P T O M A T I C

What causes back and neck What causes back and neck

pain?pain?

�� Poor posture:Poor posture: spending hours a day sitting at a desk/computer; spending hours a day sitting at a desk/computer; sleeping in a bed that is too hard/soft; slouching in front of asleeping in a bed that is too hard/soft; slouching in front of a TV; TV; hunching your back and shoulders in stressful situations.hunching your back and shoulders in stressful situations.

�� Trauma:Trauma: car accidents; falls; sporting; lifting heavy weights.car accidents; falls; sporting; lifting heavy weights.

�� Stress/emotional disturbancesStress/emotional disturbances

�� Repetitive Strain Injury (RSI):Repetitive Strain Injury (RSI): repetitive daily activities such as repetitive daily activities such as bending, twisting, lifting (e.g. manual work); RSI of working atbending, twisting, lifting (e.g. manual work); RSI of working atcomputer keyboards.computer keyboards.

�� Wear and tear/arthritic changesWear and tear/arthritic changes

�� Chemical causes: Chemical causes: poor diet/nutrition; lack of fluid (water) intake; poor diet/nutrition; lack of fluid (water) intake; excess caffeineexcess caffeine

... consequently... consequently

• Without treatment people with severe low back

pain or RSI may have to leave their jobs and

even with milder symptoms they may be in

constant pain or have to take large numbers of

days off every year – or work inefficiently.

•• Not providing an adequate service for the Not providing an adequate service for the

workforce may prove a false economyworkforce may prove a false economy

Conditions suitable for Conditions suitable for

treatmenttreatment

Chiropractors treat patients from newborn to elderly. Chiropractors treat patients from newborn to elderly.

95% of back pain is mechanical in origin and can be treated by a95% of back pain is mechanical in origin and can be treated by a

chiropractorchiropractor

Chiropractors treat mainly:Chiropractors treat mainly:

�� Back pain, neck pain (including whiplash)Back pain, neck pain (including whiplash)

�� Repetitive strain injuriesRepetitive strain injuries

�� Disc injuryDisc injury

�� Leg pain and sciaticaLeg pain and sciatica

�� Headaches (migraine, tension type)Headaches (migraine, tension type)

�� Shoulder and arm painShoulder and arm pain

�� Sports injuriesSports injuries

�� Pain during pregnancyPain during pregnancy

�� Childhood disorders (e.g. postural problems, sprains/strains) Childhood disorders (e.g. postural problems, sprains/strains)

Faculty of occupational medicineFaculty of occupational medicineOccupational guidelines for the management of Occupational guidelines for the management of

low back pain low back pain

Time off work depends on complex individualTime off work depends on complex individual

psychosocial and work organisational factors. Principalpsychosocial and work organisational factors. Principal

recommendations: recommendations:

A.A. PrePre--placement assessmentplacement assessment

B.B. Workplace preventionWorkplace prevention

C.C. Assessment of worker with back painAssessment of worker with back pain

D.D. Management Management strategies strategies for worker with back painfor worker with back pain

E.E. Management of worker with difficulty returning to Management of worker with difficulty returning to

normal duties at 4 normal duties at 4 -- 12 weeks12 weeks

New benchmark of appropriate New benchmark of appropriate

carecareDiagnostic triage

Patient reassurance/education

Pain relief (manipulation/analgesics)

Active rehabilitation to restore function

(Clinical Standards Advisory Group CSAG,)

Chiropractic TreatmentChiropractic Treatment

AimsAims

�� Alleviation of distress and control Alleviation of distress and control of painof pain

�� Restoration of normal function Restoration of normal function and activityand activity

�� Preventing recurrence of the Preventing recurrence of the problemproblem

What does treatment entail?What does treatment entail?

�� Emphasis on manual treatments Emphasis on manual treatments appropriate to the patient and appropriate to the patient and his/her condition including his/her condition including spinal spinal manipulation manipulation oror adjustment.adjustment.

�� Manipulation is designed to Manipulation is designed to improve the function of the joints, improve the function of the joints, relieving pain and muscle spasm.relieving pain and muscle spasm.

�� Manipulation is safe, very specific Manipulation is safe, very specific and directed at individual joints in and directed at individual joints in the spine or other areas of the the spine or other areas of the body.body.

�� This restores This restores optimaloptimal joint and joint and muscle function.muscle function.

Additional techniquesAdditional techniques

Chiropractors may support their treatment using additional technChiropractors may support their treatment using additional techniquesiques

including:including:

�� Ice/heatIce/heat

�� Soft tissue/massage techniquesSoft tissue/massage techniques

�� Spinal tractionSpinal traction

�� Muscle stretching techniquesMuscle stretching techniques

�� UltrasoundUltrasound

�� Dry needlingDry needling

Patients are also given advice on:Patients are also given advice on:

�� Lifestyle/workLifestyle/work

�� Activity/rehabilitative exerciseActivity/rehabilitative exercise

�� Diet/nutritionDiet/nutrition

Chiropractic and Chiropractic and

Occupational HealthOccupational Health

�� Back pain is the biggest cause of health Back pain is the biggest cause of health problems in the workplace and the leading cause problems in the workplace and the leading cause of sickness absence from work. (4)of sickness absence from work. (4)

�� Sickness absence due to back and neck pain Sickness absence due to back and neck pain alone accounts for a loss of 1.2 million days, at a alone accounts for a loss of 1.2 million days, at a cost of £100 million a year, in small and medium cost of £100 million a year, in small and medium sized businesses.sized businesses.

((Clinical Standards Advisory Group, Department of health 2004Clinical Standards Advisory Group, Department of health 2004))

The realityThe reality: : Back pain is the largest single reported Back pain is the largest single reported

cause of absence from work cause of absence from work andand leading cause of leading cause of

disability.disability.

Each yearEach year::

�� 40% of the population are affected by back pain40% of the population are affected by back pain(16(16 millionmillion))

�� 2.5 million people ha2.5 million people haveve back pain every day of the back pain every day of the yearyear

�� 50 million working days are lost50 million working days are lost

�� Overall burden to industry = £5 billionOverall burden to industry = £5 billion

�� 1.2 million people are affected by musculo1.2 million people are affected by musculo--skeletal pain and 500,000 by workskeletal pain and 500,000 by work--related related stressstress

How it affects your company How it affects your company –– cost cost

of sickness absenceof sickness absence

�� Average total sickness absence (S/A) in a Average total sickness absence (S/A) in a company of 3000 is 150 employees (5% of company of 3000 is 150 employees (5% of the workforce) each year, for, on average, the workforce) each year, for, on average, two working weeks at a cost of £100 per two working weeks at a cost of £100 per day day

�� Of the total 5% S/A, 30% is due to Of the total 5% S/A, 30% is due to musculoskeletal problems and 60% of these musculoskeletal problems and 60% of these are back and neck related.are back and neck related.

... or, put another way... or, put another way

�� At any given time 1.5% of the work force At any given time 1.5% of the work force

will be off due to a musculoskeletal will be off due to a musculoskeletal

problem and 1% due to back and neck problem and 1% due to back and neck

related injuries only.related injuries only.

�� Two or three employees off work at any one Two or three employees off work at any one

time at £100 per day each, plus any time at £100 per day each, plus any

production disruption or litigation.production disruption or litigation.

How much does your company lose each year to back pain andHow much does your company lose each year to back pain and

neck pain?neck pain?

Do you offer your employees a referral system for fast andDo you offer your employees a referral system for fast and

effective treatment?effective treatment?

�� Chiropractors have worked with numerous companies to reduce Chiropractors have worked with numerous companies to reduce significantly sickness absence costs and costs due to lost significantly sickness absence costs and costs due to lost productivity.productivity.

�� They have shown and documented that employees are often able to They have shown and documented that employees are often able to remain at work, or return to work within eight treatments. remain at work, or return to work within eight treatments. ((BloklandBloklandet al 2005 Journal et al 2005 Journal NeuromsculoskeletalNeuromsculoskeletal System)System)

�� Chiropractic treatments (manipulation in particular) have been Chiropractic treatments (manipulation in particular) have been shown consistently in reviews to be more effective than the shown consistently in reviews to be more effective than the treatments to which they have been comparedtreatments to which they have been compared. (UK BEAM Trial 2006, . (UK BEAM Trial 2006, Meade et al 2007 BMJ) Meade et al 2007 BMJ)

Factors for quicker return to workFactors for quicker return to work

(Institute for Work & Health, 2009)

1.1. Steady symptomatic improvementSteady symptomatic improvement

2.2. Job securityJob security

3.3. Supportive workplaceSupportive workplace

4.4. Supervisor supportSupervisor support

5.5. Accommodate gradual return to full Accommodate gradual return to full

capacitycapacity

Changes in the WorkplaceChanges in the Workplace

�� 70% of the working population is made up of 70% of the working population is made up of

seated workersseated workers

�� The average working week is now 46 to 50 The average working week is now 46 to 50

hourshours

�� More women than men maintain and manage More women than men maintain and manage

home and family home and family –– essentially 2 jobs.essentially 2 jobs.

�� Technology & Information changes have created Technology & Information changes have created

considerable job stress.considerable job stress.

Human Relation RolesHuman Relation Roles

�� Human resource departments are shifting, Human resource departments are shifting,

with a focus on human relations.with a focus on human relations.

�� Shift from matching the right people with Shift from matching the right people with

the right jobs the right jobs –– to overall “people to overall “people

management”management”

�� Relying on HR services to increase direct Relying on HR services to increase direct

profits.profits.

Human Relations/People Human Relations/People

ManagementManagement

�� Injury preventionInjury prevention

�� Nutritional ProgramsNutritional Programs

�� Stress ManagementStress Management

�� Physical ExercisePhysical Exercise

�� Back pain Management policiesBack pain Management policies

Current Business MantraCurrent Business Mantra

“Do More With Less”“Do More With Less”

�� Pressures created by the profound Pressures created by the profound

shifts in the business economy have shifts in the business economy have

made life hard not only for the made life hard not only for the

unemployed, but also for those who unemployed, but also for those who

still have jobs.still have jobs.

�� Business objective is to cuts costs Business objective is to cuts costs

without sacrificing Qualitywithout sacrificing Quality

Implementing a Corporate Health Implementing a Corporate Health

Care ProgramCare Program

�� Injury & Illness PreventionInjury & Illness Prevention

-- Ergonomics i.e. workstation/liftingErgonomics i.e. workstation/lifting

-- Stress ManagementStress Management

�� Address lifestyle considerations :Address lifestyle considerations :

-- Diet Diet

-- Nutrition Nutrition

-- Physical fitness and exercise programsPhysical fitness and exercise programs

What can we offer your injured What can we offer your injured

employees?employees?

�� Fast track/emergency appointmentsFast track/emergency appointments

�� Determine the level of urgencyDetermine the level of urgency

�� Render a diagnosisRender a diagnosis

�� Priority referral to appropriate therapist (e.g. massage Priority referral to appropriate therapist (e.g. massage therapist) if necessarytherapist) if necessary

�� OccupationOccupation--specific postural and ergonomic advicespecific postural and ergonomic advice

�� Tailored, occupationTailored, occupation--specific rehabilitation/ exercise specific rehabilitation/ exercise programmes to prevent recurrence of the problemprogrammes to prevent recurrence of the problem

�� Ongoing support Ongoing support

Why Chiropractic?Why Chiropractic?

�� A Chiropractic health care provider is a A Chiropractic health care provider is a

reliable and cost effective health care reliable and cost effective health care

choice.choice.

�� Employers can implement a cost efficient Employers can implement a cost efficient

solution by sending an injured person solution by sending an injured person

directly to the right form of care, rather directly to the right form of care, rather

than routing him/her through a series of than routing him/her through a series of

providers.providers.

Surviving A Shifting EconomySurviving A Shifting Economy

�� With our nation’s economy in a state of With our nation’s economy in a state of

uncertainly, employers must search for uncertainly, employers must search for

new ways to survive.new ways to survive.

�� Need for adaptation and changeNeed for adaptation and change

Bottom LineBottom Line

�� Implementing a corporate health care Implementing a corporate health care

program can add direct profits to a program can add direct profits to a

company by cost effective health company by cost effective health

management.management.

�� Generate health and well being for Generate health and well being for

productive happy employeesproductive happy employees

The Workplace Is onlyThe Workplace Is only

as Healthy as its people are!as Healthy as its people are!

North Down Chiropractic ClinicNorth Down Chiropractic Clinic

Our clinic has served the local community for theOur clinic has served the local community for the

past years 5 (Practising for 8 years)past years 5 (Practising for 8 years)

Our Team of Healthcare professionals include:Our Team of Healthcare professionals include:

�� 2 Chiropractors 2 Chiropractors

�� 2 Massage therapists 2 Massage therapists

�� CraniosacralCraniosacral therapisttherapist

�� Rehabilitation trainerRehabilitation trainer

�� ReflexologistReflexologist

�� HomeopathHomeopath

We also have exercise/rehabilitationWe also have exercise/rehabilitation

gym on site.gym on site.

Registered with BUPA, Aviva and all major health care insurersRegistered with BUPA, Aviva and all major health care insurers

ReferencesReferences1.1. WHO 19WHO 19--22 June 1946. Preamble to the Constitution of the World Health 22 June 1946. Preamble to the Constitution of the World Health

Organisation as adopted by the International Health Conference, Organisation as adopted by the International Health Conference, New New York.York.

2.2. BircherBircher J 2005. Towards a dynamic definition of health and disease. J 2005. Towards a dynamic definition of health and disease. Med. Health Care Med. Health Care PhilosPhilos 8:3358:335--41.41.

3.3. Clinical Standards Advisory Group 1994. Epidemiology Review: ThClinical Standards Advisory Group 1994. Epidemiology Review: The e epidemiology and cost of back pain. London, DH.epidemiology and cost of back pain. London, DH.

4.4. Clinical Standards Advisory Group (Department of Health) 1994. Clinical Standards Advisory Group (Department of Health) 1994. Management Guidelines for Back Pain. London, HM.Management Guidelines for Back Pain. London, HM.

5.5. BloklandBlokland MP, Bolton JE, MP, Bolton JE, GrationGration J 2000. Chiropractic Treatment in J 2000. Chiropractic Treatment in Workers with Musculoskeletal Complaints. Journal of the Workers with Musculoskeletal Complaints. Journal of the NeuromusculoskeletalNeuromusculoskeletal System; 8(1):17System; 8(1):17--23.23.

6.6. UK BEAM Trial Team 2004. The UK Back Pain Exercise and ManipulaUK BEAM Trial Team 2004. The UK Back Pain Exercise and Manipulation tion (BEAM) Randomised Trial: Effectiveness of Physical Treatments fo(BEAM) Randomised Trial: Effectiveness of Physical Treatments for Back r Back Pain in Primary Care, BMJ: 329(7479): 1377.Pain in Primary Care, BMJ: 329(7479): 1377.

7.7. Meade TW, Dyer S Meade TW, Dyer S et al et al 1990. Low Back Pain of Mechanical Origin: 1990. Low Back Pain of Mechanical Origin: Randomised Comparison of Chiropractic and Hospital Outpatient Randomised Comparison of Chiropractic and Hospital Outpatient Treatment, BMJ 300: 1431Treatment, BMJ 300: 1431--37.37.

8.8. Meade TW, Dyer S Meade TW, Dyer S et al et al 1995. Randomised Comparison of Chiropractic 1995. Randomised Comparison of Chiropractic and Hospital Outpatient Management for Low Back Pain: Results frand Hospital Outpatient Management for Low Back Pain: Results from om Extended Follow Up, BMJ 311: 349Extended Follow Up, BMJ 311: 349--351.351.