Ergonomics…From Another Perspective Background and case histories

Petti Redding, OTRP.R.I.D.E. Wellness

Systems, Inc.

RSI statisticsRSI statistics

OSHA studies show that…

• RSI’s account for 34% of all lost workdays due to injury

• RSI’s claim $1 out of every $3 spent for Workers’ Comp

• Total annual RSI costs exceed $60 billion

• RSI’s are the fastest growing workplace injuries in the U.S.

• RSI's result in the highest median days away from work

• RSI's have the highest average Workers’ Comp cost-per-case from $14,000 to $29,000

Lost Work Days Per RSI(Median # of Days)Lost Work Days Per RSI(Median # of Days)

• Carpal Tunnel Syndrome – 27 days• Repetitive Motion Injury – 19 days• Shoulder – 16 days• Upper Arm – 15 days • MSD – 14

days• Wrist – 14

days• Tendonitis – 14 days • Tenosynovitis – 14 days • Hand & Fingers – 10 days• Hand & Wrist – 11 days• Bursitis – 7 days

Bureau of Labor Statistics - 2006

Primary problems of RSI’sPrimary problems of RSI’s

• Pain (burning, sharp, dull, achy, etc.)• Parasthesia (numbness and tingling)• Weakness• Fatigue of body part

Can we find a common link?

Muscles: the lowest common denominator of injuryMuscles: the lowest common denominator of injury

The concept of structural integrity of the musculoskeletal system

The concept of structural integrity of the musculoskeletal system

Structural integrityStructural integrity

Axis line:

Earshoulder-hip-knee-ankle

Unbalanced

Typical, dysfunctional postures leading to musculo-skeletal pain, vertebral dysfunction, arthritic conditions, etc.

Root cause of dysfunction…MusclesRoot cause of dysfunction…Muscles

Bones are pulled out of alignment by muscles that are generally :

1. Weak and overstretched on 1 side

2. Tight & stronger on the opposite side

Primary cause of RSI Pain- the trigger pointPrimary cause of RSI Pain- the trigger point

• Mechanisms of injury include muscle that work overstretched, overshortened or overloaded

• Based on energy crisis and dysfunctional motor endplates

• Most often overlooked in the diagnostic process by the medical community- Why?

Muscle anatomy and functionMuscle anatomy and function

A different view of a sarcomereA different view of a sarcomere

At the cellular level…the sliding mechanism theoryAt the cellular level…the sliding mechanism theory

Muscle sarcomere in actionMuscle sarcomere in action

Dysfunctional muscles…the trigger pointDysfunctional muscles…the trigger point• Muscles contracting in over-stretched, over-

shortened or over-worked positions• Muscles holding a static, isometric contraction

for extended periods of time

… lead to a in blood flow and resulting energy crisis

Trigger Point FormationTrigger Point Formation

1st Actin and myosin proteins fail to disconnect in multiple sarcomeres

2nd Leading to increased tension throughout the entire muscle

Relationship of trigger points and nerve entrapmentRelationship of trigger points and nerve entrapmentTight muscles

Lack of nerve glide

Nerve compression

Nerve damage

Scalenes trigger point and referred pain patternScalenes trigger point and referred pain pattern

Gluteus minimus trigger point and referred pain patternGluteus minimus trigger point and referred pain pattern

Infraspinatus trigger point and referred pain patternInfraspinatus trigger point and referred pain pattern

Trigger point deactivationTrigger point deactivation

• Locate trigger point• Apply firm, moderate pressure• Hold about a minute• Stretch muscle afterward• Repeat 6-8 times a day• Usually takes 1 day to 1-2 weeks (depending how long it’s been there)

But what does that have to do with posture and lack of structural integrity?

Primary Cause of Structural DysfunctionPrimary Cause of Structural Dysfunction

Behaviors lead to…

non-balanced, structurally misaligned postures lead to…

muscles statically overstretched and overworked which leads to…

1. Pain

2. Nerve entrapments

3. Misaligned joints that contribute

heavily to degenerative joint disease (Osteoarthritis)

Postural dysfunctionPostural dysfunction

• Muscles adapt to the position that it is put in over time

• Muscles dictate the position of the skeleton

BUT

Muscles can be re-trained, shortened, lengthened, strengthened

To regain structural integrity

Case Histories: Early InterventionCase Histories: Early Intervention• All employees achieved these results

ON THEIR OWN• No employee was “treated”. There were

no modalities, or physical therapy interventions

• No employee visited a physician• No employee became an OSHA

recordable injury or W/C injury.

Sample techniquesSample techniques

• Bumper stretch• Noodle stretch• Cross over girlie knee stretch• Legs up wall stretch• Sit on hand stretch• Supermans

(Petti- play the video!)

Symptoms/frequency

Lower and upper back pain, right sideMost of the timeMedium severity

Trigger point releases

Top and back of shoulder (traps, levator scapula)Booty (gluteus medius/minimus)Chest (pectoralis minor)

Exercises and stretches

Noodle stretch, cross-over girlie knee stretch, legs up wall, sit-on-hand neck stretch

Ergo modifications

Double wedgie, lowered table, raised monitor, wrist rest

Sebastian B. (30’s)EngineerSebastian B. (30’s)Engineer

Symptoms/frequency

Pain in forearms, shoulders, upper back, lower back; most of the time; medium to high severity

Trigger point releases

Neck (scalenes) shoulders (traps, levator scapula) upper back (rhomboids) forearms (extensors)

Exercises and stretches

Noodle stretch w/head press; supermans; cobra; sit-on-hand neck stretch

Ergo modifications

Wedgies, lowered table, wrist rest, HEADSET;

Comments “oh my god! I never knew I could feel this good, even at work!”

Kari H (30’s)HR repKari H (30’s)HR rep

Symptoms/frequency

Pain in low back, shoulders, and neckPain is frequent, and medium in severity

Trigger point releases

Inside of shoulderblade (Subscapularis)Booty (gluteus minimus)Shoulders (upper and middle traps)

Exercises and stretches

Supermans, noodle stretch, cross-over girlie knee stretch

Ergo modifications

Double wedgie, lowered table, raised monitors, added wrist rest65 cm ball

Comments “ I have had shoulder pain for 10 years, and its finally gone”

Aida B. (50’s)IT Specialist (45+ hrs/week) Aida B. (50’s)IT Specialist (45+ hrs/week)

Symptoms/frequency

Neck, shoulders, feetConstant pain, medium in severity(had been seeing podiatrist for 1 year)

Trigger point releases

Neck (scalenes) shoulders (traps, levator scapula, subscapularis) Upper back (rhomboids) calves (soleus)

Exercises and stretches

Noodle stretch, chin tucks, supermans, heel drops

Ergo modifications

Wedgies, lowered monitor A LOT (bifocals)55cm ball, lowered table

Comments “shoulder is wonderful! I’m doing noodle stretch 2x a day! And I love that little ball!”

Deb P. (50’s)IT Specialist 40-45 hrs/weekDeb P. (50’s)IT Specialist 40-45 hrs/week

Additional commentsAdditional comments“I have been seeing a podiatrist for heel pain for several months. I have been to see the doctor 3 times with only sight relief. He said if the last stronger prescriptionMedication didn't work he would inject the heel. Petti was checking up on me and the neck issue last week. I said my neck was fine, but I was going to the doctor to have my foot injected. She got a racket ball and showed me how to find another trigger point in the back of my calf that is causing the heel problem. I felt relied immediately. After less that a week I have less pain than after 6 weeks of medication! I think I can completely resolve the heel issue if I just keep using the ball.”

My Point…My Point…

• Ergonomics is not just about the stuff• Anthropometric data is not the total

picture• The biggest risk factors for injury lie in the

PERSON, not the task (in terms of RSI’s)• Put some effort into helping your

workforce fix their bodies… you’ll be amazed at the results

Questions?

Thank youPetti Redding, OTR