Preventing Repetitive Motion Injuries

ALLIANCE OCCUPATIONAL MEDICINE

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Preventing Preventing Repetitive Repetitive

Motion InjuriesMotion InjuriesLucy Austin

Physical Therapist Asst.Alliance Occupational

Medicine


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RMI/CTDRMI/CTD• Many names• Many symptoms

- Pain in the neck & shoulders- Pain in the forearms & elbows- Tingling in the hands - Headache, etc.


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Poor Posture PositionPoor Posture Position


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Posture at the Posture at the ComputerComputer

•Head forward•Rounded

Shoulders•Slouched low back•Forearms/wrists

resting on surface


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Results of That Posture

• Tightness & shortening of the chest muscles, sub occipital muscles, and anterior neck muscles• Over stretching and weakness of the back & posterior shoulder muscles


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Results of Working at the Computer

for Extended Periods of Time

• Static contraction of the forearm muscles• Ischemia/decreased fresh blood supply to

the forearm muscles• Abnormal forearm, wrist & hand

positions – causing repetitive stress, wear & tear of the tendons


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• Muscles used to move our fingers & wrist are in the forearm

• Muscles taper down to form tendons

• Tendons are long fibrous cords – strong but not elastic

• Tendons have long & at times angled pathways


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Note the 2 nerves that are around the wrist – the median nerve at the carpel tunnel and the ulnar nerve near the pisiform bone

Median and Ulnar Nerves


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Note the synovial sheaths


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Note the band at the wrist joint. A common location for friction.

Friction at the Wrist


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• Tendons are most commonly affected• They are the weak link; they transmit forces generated by the muscles• They are enclosed in the lubricating synovial sheaths which can get inflamed• Tendons have limited blood supply, hence delayed repair & recovery• RMI is the result of the repeated & prolonged tensing of the muscles• At times combined with excessive “rubbing” on nearby structures

Tendons


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Other Structures Affected

• Muscles – due to sustained contractions affecting circulation, causing tenderness, tight knots – in the forearms, shoulders & upper back• Nerves – due to direct pressure or compression in the tight muscles or swollen tissue


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Muscular ActivityMuscular Activity• Falls under 2 categories: Static &

Dynamic

• Static contraction – length and tension generated by the muscle stays the same. Inhibits circulations, causing fatigue & increasing risk for injury. Also increases stress on the tendons.

• Dynamic contraction – length & tension change, muscle acts as a pump promoting circulation


Ergonomics


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Risk Factors InvolvedRisk Factors Involved• Force – pushing/pulling/gripping• Awkward posture – head forward,

rounded shoulder• Repetition – continual

typing/mousing• Duration – long days• Contact Stress – resting forearms or

wrists affecting circulation


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Other FactorsOther Factors• Aerobic fitness • Muscular strength• Flexibility • Coordination• Excessive volume of activity • Inadequate recovery time • Advancing age• Chronic Illness (diabetes, low

thyroid)• Smoking


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• Create an optimal work station to improve posture & pressure

• Micro stretch breaks – to enhance circulation

• Correct typing & mousing techniques – to lower abnormal forces

What Can You Do?


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OFFICE OFFICE ERGONOMICSERGONOMICS


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ErgonomicsErgonomics• Most frequently used items

closest• Keyboard tray with space for

mouse • Headset• Curved or split keyboards


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At Your WorkstationAt Your Workstation


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Headset & Split KeyboardHeadset & Split Keyboard


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Awkward PositionsAwkward Positions

http://oldpeoplelol.com/files/2011/06/Old-People-Stretching.jpg


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Awkward Sitting PositionAwkward Sitting Position


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Awkward Mouse PositionAwkward Mouse Position


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Awkward Writing PositionAwkward Writing Position


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Leg PositionLeg Position


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What can you do? What can you do? Get up and… STRETCH!Get up and… STRETCH!

• Take small breaks to stretch

• Find a stretching buddy!


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ERGO STRETCHES ERGO STRETCHES


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ERGO STRETCHESERGO STRETCHES


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WORKSTATION CHAIR WORKSTATION CHAIR ADJUSTMENTADJUSTMENT

1) Stand in front of chair with height below knee cap

2) Sit tall in chair with feet flat on floor and chair ending 1-3 inches from knee

3) Adjust back rest to push hips slightly forward

4) Bent elbows at side of body should not contact armrests


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Adjust Your MonitorAdjust Your Monitor


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MONITOR HEIGHT: MONITOR HEIGHT: Eye LevelEye Level


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Proper Distance: Proper Distance: Fingertip DistanceFingertip Distance


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Do You See Do You See Anything Wrong Anything Wrong

With the With the Following Following Pictures?Pictures?


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GOOD or BAD?GOOD or BAD?


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Proper location of a Proper location of a Document Holder Document Holder


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MOUSING EXAMPLESMOUSING EXAMPLES


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KEYBOARD TRAY KEYBOARD TRAY ADDITION: ADDITION:

Proper Typing Proper Typing Technique ?Technique ?


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Stretch Break!Stretch Break!


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Thoracolumbar Side-Bend Hands clasped, reach overhead and bend to left side until stretch is felt. Then go to the other side. Hold 10 seconds in each position. Relax.Repeat 2-3 times per set.Do 1 sets per session.Do 1-2 sessions per day.

ERGO STRETCHES


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Chest Stretch

Lace fingers behind backand squeeze shoulderblades together. Slowlyraise and straighten arms.Hold 10-15 seconds.Repeat 3-5 times per set.Do 1 sets per session.Do 2 sessions per day.

ERGO STRETCHES


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Laptop Guidelines

As a general rule avoid working directly on top of your laptop more

than 1hr/day.


The Following are Recommendations for:

• Conference Room • Dining Room Table, • Hotel Desk • Any Non-Adjustable

Surface


Best Practice Overall

• Place the laptop on a laptop stand or books so top of screen is close to your eye level

• Use an external keyboard and mouse and raise the chair so your elbows are level with the keying surface. If the chair does not adjust, use folded towels or pillow to raise yourself. If the seat is too deep, add pillow for back support.

• Use a footrest, books or a pillow to support your feet, if needed.


At Risk Practice

Prolonged sitting without:

• Foot and Back Support• Awkward Neck Position• Awkward Back Posture• Pressure at Wrists


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Computer Stretch Computer Stretch BreaksBreaks

•Every 20-30 minutes never less then hourly

•Stand up•Take several deep breathes•Rotate Stretches•Do your favorites more often•Walk at least 10 minutes at lunchtime

•Once a day, do all exercises in one session

•Exercise 20-40 minutes most days


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What Else Can You Do?What Else Can You Do?Stay Healthy!Stay Healthy!Eat nutritious mealsExercise regularlySleep until you’re

rested (7-8 hours)Manage stressDon’t let hobbies and

work tasks compete for your energy and recovery time


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Common Symptoms of Common Symptoms of Repetitive Motion InjuriesRepetitive Motion Injuries

• Fatigue• Vague aching • Sharp pain• Tenderness• Decreased Range of Motion

– With or without pain• Tingling

•Weakness•Swelling

- Edema - Effusion


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Are RMI’s Treatable?Are RMI’s Treatable?• Our bodies have capacity to

repair themselves. • Injuries will heal if they have

not progressed to the point of irreversible damage (scarring).

• Once inflammation if controlled, then the tendons will recover


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Treatment PlanTreatment Plan•Ergonomics - evaluate & adjust•Improve Technique and Work Habits

•Conditioning - increase strength and flexibility•Improve overall health

•Physical Therapy / Occupational Therapy•Splints•What these "treatments" really do is to provide conditions in which the body's own healing powers can do their job


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RMI SummaryRMI Summary•Common•Gradual Onset•Not a single disease •Severity varies greatly - mild to severe and

incapacitating•No single “correct” treatment for everyone

•“Nothing changes if nothing changes” •Recovery requires teamwork,

consistency and patience•Ergonomics, Technique, Conditioning


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Thank YouThank You

Any Questions?Any Questions?Lucy Austin

Physical Therapist Asst.Alliance Occupational Medicine315 South Abbott Ave., Milpitas2737 Walsh Ave., Santa Clara

Preventing Repetitive Motion Injuries

Healthcare

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