Presented by: Timothy A. Duke, D.C. Amy Heckman, M.P.T. Ellen Stoute, M.P.H., R.D., L.D.N.

Presented by:Timothy A. Duke, D.C.Amy Heckman, M.P.T.

Ellen Stoute, M.P.H., R.D., L.D.N.

Presentation OutlineTimothy 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.

Presented By: Timothy A. Duke, D.C.

Learning ObjectivesDiscuss common workplace injuries

Strain/sprainDiscuss the biomechanics of common

workplace conditionsLiftingSitting

Expected conservative treatment associated with common occupational injuriesActive vs. Passive

Common Workplace InjuriesStrain/Sprain (S/S)

Most common (40%)Special consideration

Other InjuriesMusculoskeletal

disorders (29%)“Ergonomic Injuries”

Cuts/lacerations (8%)Fractures (7%)

* All stats provided by www.OSHA.gov

Strain/Sprain (S/S): A Special Consideration

Why a special consideration?Preventable

How/why do these occur?Acute vs. repetitiveOverexertionImproper liftingSlip and fallEtc…

Grading a Strain/Sprain All S/S are not created equalLiterature accepts three

gradesGrade IGrade IIGrade III

Injury grade and timing are going to lay out the frequency, duration, and appropriate type of treatmentPassive to Active

Lifting BiomechanicsWhy 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 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 18-23 2006.

Lifting BiomechanicsJournal of Occupational

RehabilitationLow 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.

Lifting BiomechanicsSPINE Study 2000Compared 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 3087-3092, 2000.

Postural BiomechanicsWhy be concerned by

postural biomechanics?Second leading cause of

occupational injury (“ergonomic injury”)

Very preventableWeight considerations

What is considered “good” postural biomechanics/ergonomics?

“Good” Ergonomic Position

Manual 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) pp 270-280.

2009 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 positions

Szeto 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 338-345.

Conservative Treatment OptionsWhat 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

Passive vs. Active TreatmentPassive Treatment

What is considered passive treatment? Manipulation Modalities

Active TreatmentWhat is considered active treatment?

Rehabilitation

Soft Tissue Healing: What to Expect?Phases of soft tissue healing

AcuteRemodelingRepair

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.

Presented by: Amy Heckman, M.P.T.

Learning ObjectivesImportance of core musclesImportance of stretchingCommon core and stretching exercises

Importance of Core StrengthWhat 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 motionCoordinate muscle actionsKeep up stable

How 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

Basic Core ExercisesDiaphragmatic 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

Basic Core ExercisesPosterior 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

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

Basic Core ExercisesCurl-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

Benefits of StretchingDecrease Muscle Strain/SprainDecrease Tendonitis/Tendonosis conditionsAllow Joints to move properly through their

range of motion

How to Stretch EffectivelyDo not stretch a cold muscleWarm 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 muscleScar tissue leads to less flexibility

How to Stretch EffectivelyHold each stretch about 30 secondsRepeat each stretch 3 to 4 timesStretch until you feel tension, not painStretch on a regular basis

Static verse Dynamic StretchingStatic stretches effect the collagen fibers of

your musclesStatic stretches help reduce injury by

maximizing flexibility and improving biomechanics

Static stretches help increase and maintain a muscle length and flexibility

Static verse Dynamic StretchingDynamic 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 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

Important 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 ahead

Cervical Retraction - Slowly draw your head back so that your ears line up with your shoulders

Important Day-To-Day StretchesPectoralis 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


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


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


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


Gluteal Stretch While Lying on your back, hold

your knees and gently pull them up towards your chest


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


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

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.

Presented by: Ellen Stoute, M.P.H, R.D., L.D.N.

Learning ObjectivesCalculate and interpret Body Mass IndexIdentify Health Risks Associated with ObesityRecognize the Benefits of a Worksite

Wellness ProgramStrategies to Implement a Health Promotion

Initiative

Definition of Overweight and Obesity

Body mass index (BMI)Math formula used to assess overweight and

obesityMultiply weight in pounds by 703

Then divide result by height in inchesThen divide that result by height in inches

again

BMI TableBMI

Underweight < 18.5

Normal 18.5 - 24.9

Overweight 25.0 - 29.9

Obese I 30.0 - 34.9

Obese II 35.0 - 39.9

Obese III ≥ 40

Limited because it doesn’t measure body fat or muscle directly

Health RisksObesity is more than a cosmetic problemOverweight 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

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

Type II DiabetesHigh blood sugar levelsMajor 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

Coronary Artery DiseaseArteries 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 cholesterol

Losing 5-10% of your weight can lower your chances for developing coronary heart disease

Cancer2nd 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

Sleep ApneaStop breathing for short

periods during the nightCan 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

OsteoarthritisExtra 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

Psychological and Social EffectsEmotional suffering may

be one of the most painful parts of obesity

Obese often face prejudice or discrimination in job market, at school, and in social situations

Feelings of rejection, shame, or depression may occur

BMI 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

Study 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

American 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.

InjuriesMost 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

Obesity TrendsDramatic increase in

obesity in U.S. over past 20 years

More than 64% of U.S. adults are either overweight or obese

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%


No Data <10% 10%–14% 15%–19%


No Data <10% 10%–14% 15%–19% ≥20%


No Data <10% 10%–14% 15%–19% 20%–24% ≥25%


No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

What Causes Obesity?Energy Imbalance

The same amount of energy IN and energy OUT over time = weight stays the same

More IN than OUT over time = weight gain More OUT than IN over time = weight loss Overweight and obesity happen over time

when you take in more calories than you use

What 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 reasons Spending 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 obesity Relying on cars instead of walking to places Fewer physical demands at work or at home because modern

technology and conveniences reduce need to burn calories Lack of physical education classes in schools

What Causes Obesity?Environment

Lack of neighborhood sidewalks and safe places for recreation

Long hours at work and time spent commuting

Oversized food portions Lack of access to healthy

foods Neighborhoods without

supermarkets Healthy foods often cost more

Food advertising

What Causes Obesity?Genes and Family

HistoryGenes have strong

influence on weightYour chances of being

overweight are greater if your parents are overweight

Children adopt the habits of their parents

What 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 hours

People who sleep fewer hours seem to prefer eating foods that are higher in calories and carbohydrates

Hormones released during sleep control appetite and body’s use of energy

Weight Loss GoalsLose 5-10% of your current weight over 6

monthsWill lower your risk for heart disease and other

conditionsBest way to lose weight is slowly

1-2 lbs a week is doable, safe, and will help you keep off the weight

Measuring SuccessLook at many factors to

gauge success with weight loss effortsNumber on scaleHow clothes fitBlood pressureCholesterolHbA1CFitness levelEtc.

Worksite 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 more

Worksite wellness is an investment in your most important asset—your employees.

Top 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

Reason #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

Reason #3 – The Work Week is Expanding

Typical American works 47 hours a week 164 more hours than only 20 years ago- If trend continues average person will be on

the job 60 hours a week Technology has erased traditional work

boundaries

Reason #4 – Technology Revolution

Reliance on technology has caused new health concerns including: repetitive stress injuries, low back problems, and compromised vision

One-third of the workforce spends their day seated at their desks plugged into workstations

Sedentary lifestyles major concern

Reason #5 – Employee Stress Levels Are Rising

Information explosion—more information has been produced in the last 30 years than during the previous 5,000

78% of Americans describe their jobs as stressful

Vast majority indicated their stress levels have worsened over the past 10 years

Benefits of Workplace Wellness Programs

Healthier EmployeesFewer InjuriesImproved ProductivityLower AbsenteeismReduced Medical CostsIncreased Job SatisfactionDecreased Employee Turnover

Journal 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.

Where Do We Begin?Establish a Wellness Committee

Employee involvement is vitalAssess Employee Needs and Interests

Employee interest surveyConduct a Worksite Organizational Health

Survey.

Physical 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?

Physical 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?

NutritionCan 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?

NutritionDo 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?

SmokingDoes 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?

Other 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

In SummaryMost popular worksite wellness programs are

ExerciseSmoking Cessation ClassesBack Care ProgramsStress Management

There are numerous compelling reasons why every organization should consider developing a worksite health promotion initiative.

Presented by: Timothy A. Duke, D.C. Amy Heckman, M.P.T. Ellen Stoute, M.P.H., R.D., L.D.N.

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Transcript of Presented by: Timothy A. Duke, D.C. Amy Heckman, M.P.T. Ellen Stoute, M.P.H., R.D., L.D.N.