Oct 25th, 2015

Ergonomics & Workplace SafetyMRSC 10089 Professional Practice of Cardiac Sonography

WARM UP:

What is the exercise Why I chose this exerciseLATERAL TRUNK FLEXION + ARM

Starting from a straight up-right stance, straighten out your back. Keeping one arm straight above your head and the other hanging by your side. Bend at the waist, towards the side with the un-extended until you feel a stretch in your arm and waist. Hold for 20 secs. Repeat with other side (Muscolino, 2010).

Most of my strain is in the lower back and waist region. This exercise allows loosening up my lower back muscles and hip muscles prior to starting to scan and further minimize the strain from any leaning that may occur.

SHOULDER ROLLS:Keeping your elbows straight and arms by your side push your shoulders up towards your ears and then slowly push them back with your arms pointing out and backwards to pinch your scapulae together. Repeat this shoulder rolling motion 3 times and relax. Repeat again in opposite direction.

Being a petite size has its disadvantages when scanning larger patients who would require a larger angle of abduction at the arm. The purpose of this exercise is to help reduce the stiffness and strain on the shoulders, and helps the scapulae to retract and depress. It also helps to prime and give strength to the lower trapezius muscles which in turn helps restore the balance of over worked upper trapezius muscles. This exercise also helps to reduce the chances of thoracic inlet syndrome by stretching and strengthening the shoulder girdle (IPC Physical Therapy,2010).

WRIST CURLS

Clasp both hands with your elbows pointing out horizontally. Slowly start to bring your clasped hands down towards your naval. Hold this position at the level of your waist for 20 seconds (Burnage, 2007).

Holding the transducer with constant pressure in a flexed position for long durations can be tough on the wrist muscles and tendons. This can lead to carpal tunnel and/or tendonitis.This exercise helps to extend and stretch the wrist muscles and reduce stiffness.

Ergonomics & Workplace SafetyMRSC 10089 Professional Practice of Cardiac Sonography

STRETCHES EXERCISES

What is the exercise Why I chose this exerciseWRIST

Hold your arms out from your body. Then using your left hand, bending at the wrist, flex your right hand inward. Hold this position for 10 seconds. Repeat with extending your hand outward.Repeat 3 times per set. Repeat one set every 2 hours (Madden, 2006).

After scanning for 30 – 45 minutes straight, with the wrist holding an inward position, the wrist can get stiff. This exercise helps to stretch out the wrist muscles and reduces the tension and risk of developing carpal tunnel.

TENSION IN NECK, SHOULDERS AND POSTURE:

With a straight posture, place hands on back for support. Push your back inwards and pelvis outward to its fullest extent while pinching your scapula by pushing your shoulders back. Hold position for 10 seconds. Return back to a neutral position (Religioso, 2012).

After returning to a neutral posture, rotate your neck in a circular motion. Then reverse direction (Alina, 2015).

Repeat from above 3 times.

Throughout the day, my posture can start to suffer. I acknowledge the fact that I personally do not have a very good posture and need to remind myself throughout the day to straighten out my spine. The tension in the neck and shoulder area, if progressed, can impinge on the brachial plexus which has branches going down the arm and causes pain and numbness in the wrists. Therefore, it is imperative that this area of the body receives stretching exercises. This exercise helps the upper back, neck and shoulders release tension.

Shoulder tension can cause a misalignment of the upper spine and cause the lower spine to curve outward unnaturally. This shows how pain that originated from the neck and shoulders area, radiate into the arms and lower spine (Rhea, 2013).

SHOULDER

Reach for your back from above your head. Using your other hand, push your elbow further down your back until a stretch is felt. Hold for 30 seconds. Release and rest. Repeat with other arm.

Standing in a neutral position, place your arm behind you and try to pull it in an upward direction with the other arm until you feel a stretch. Hold this position for 30 seconds. Release and rest. Repeat with other arm.

Repeat these exercises at least 3 times a day.

Constant arm abduction can lead to stiffness in the arm and shoulder areas. Being a petite size can make it difficult to find a comfortable position when scanning obese patients. Understanding my physical limitations of having to abduct my arm around obese patient whilst hold that position for can add to arm and shoulder strain.

These exercises will help with developing rotator cuff injuries overtime. It also helps in releasing the tension and stiffness from holding the arm abducted at an angle greater than 30 degrees for long periods of time.

STRENGTHENING EXERCISES

What is the exercise Why I chose this exercise

EXTERNAL ROTATION

Hold one end of the resistance band in each hand. Keep your elbows fixed at the waist and your forearms extended out in front of you holding the resistance bands. Slowly stretch the resistance band laterally on either side along with rotating your arm outward. Hold this position for 3 seconds and slowly relax. Repeat the 5 times and build up to 30. Repeat at least once a day.

This exercise not only helps to strengthen the rotator cuff muscles and prevent shoulder injury, but also promotes proper posture (Admin, 2012).

WRIST CURLS

In a neutral sitting position, place your forearm on your thighs. Place weights in the hand with the palms facing down. Slowly raise the weights in and upward and downward motion using only the joints in your wrist. Repeat this 8 to 10 times in a set. Once comfortable with one set, build up to performing 2 to 3 sets a day.

Repeat this exercise, but modify it by now having your palm faced up.

Wrist injuries such as developing tendonitis or carpal tunnel are concerning to me especially because having developed carpal tunnel in the past, I know how painful it can be. In order to ensure that I don’t run into this problem again, I have put in wrist exercises in my warm-up, stretches and strength developing exercises.

SHOULDER EXTENSION

Wrap resistance band around something stable. Hold the ends of the band with each hand. Keeping your arms extended straight out in front of you, slowly start to pull the band back until you feel a pinch in the scapula. Hold the position for 3 seconds, and then relax slowly. Repeat this 30 times in one set. Build up to 2 to 3 sets daily.

One of my goals has been to build strength in my shoulder and back along with increasing flexibility. This exercise increases mobility and flexibility in the arm and helps to maintain good shoulder health. It also forces you to keep a straight posture while pulling the resistance bands back.

4. Briefly discuss any possible limitations or obstacles you may come across while implementing your personal ergonomic plan.

- Having insufficient time in between patients to perform these exercises on a daily routine. - I am also concerned about the availability of a well-designed room. Having proper imaging equipment, exam tables, sonographer chairs with height adjustability and proper support. - Having to perform scans on extremely large patients.

5. Discuss additional ways to help reduce the risk of WRMSDs. Support this discussion with other references.

- It has been proven that implementing a healthy and active lifestyle by performing strength and flexibility building exercises can reduce WRMSD incidence of low back pain and arthritis (Work-Related Musculoskeletal Disorders (WMSD) Prevention, 2013).- Eating healthy and maintaining a healthy weight also reduces stress on joints in the arm, shoulder, knee (Licameli, 2015). - Ensuring that you receive adequate rest helps your body to relax and recover. Constant straining can build up overtime and lead to tear in muscles, tendons, joints and nerve impingements.- Shoes with good arch support help cushion under the ball of the foot, and help maintain its natural arch, leading to reduced pressure (Craig, 2013).

6. Summarize other safety concerns that sonographers may experience during their career.

- Increased risk of contracting infectious diseases due to close patient contact. - Poor lighting conditions can cause eyestrain. - Poor air quality conditions in the healthcare setting. Airborne particles such as dust, allergens, smoke, pollution and infectious diseases can impact the health of the staff and other patients and lead to increased absenteeism from sick calls.- Overcrowded work spaces can be difficult to work efficiently in, especially in ICUs and emergency departments. These tight spaces can become ergonomically unfit due to awkward maneuvering (Craig, 2013).

Works Cited

Admin. (2012). Healthy Sonographers and Exercise (with Images). Retrieved October 21, 2015, from Ultrasound Technician Center: http://www.ultrasoundtechniciancenter.org/blog/healthy-sonographers-exercise.html

Alina. (2015, July 12). Simple Moves Which Will Help you with Your Back and Neck Pain. Retrieved October 21, 2015, from Daily Fit Hit: http://www.dailyfithit.com/workout/simple-moves-which-will-help-you-with-your-back-and-neck-pain

Burnage, J. (2007, February). Work-related Upper Limb Disorder: A Sonographer’s Survival Guide. Ultrasound, 15(1), 38-42.

Craig, M. (2013). Essentials of Sonography and Patient Care (3rd ed.). St. Louis: MO: Elsevier.

IPC Physical Therapy. (2010). Thoracic Outlet Syndrome. Retrieved October 21, 2015, from IPC Physical Therapy: http://www.ipcphysicaltherapy.com/ThoracicOutletSyndrome.aspx

Licameli, C. (2015, May 13). Workplace Wellness: Tips for Reducing Worksite Injuries. Retrieved October 24, 2015, from HWP Insurance: http://info.hwphillips.com/blog/workplace-wellness-tips-for-reducing-worksite-injuries

Madden, C. (2006). Wrist Sprain And Strain. Retrieved October 21, 2015, from Self Care Navigator: http://selfcarenavigator.com/sports/wrist-sprain-and-strain.html

Muscolino, J. E. (2010, June 21). Feel the Stretch. Retrieved October 21, 2015, from American Massage Therapy Association: https://www.amtamassage.org/articles/3/MTJ/detail/2152

Religioso, E. (2012). 5 GREAT EXERCISES FOR YOUR SPINE. Retrieved October 21, 2015, from Physio Answers: http://www.physioanswers.com/2012/10/5-great-exercises-for-your-spine.html

Rhea. (2013, February 3). Release Neck and Shoulder Tension. Retrieved October 15, 2015, from Heroes Training: http://heroestraining.com/?p=541#

Work-Related Musculoskeletal Disorders (WMSD) Prevention. (2013, October 23). Retrieved October 25, 2015, from Centers for Disease Control and Prevention: http://www.cdc.gov/workplacehealthpromotion/implementation/topics/disorders.html