Stretching and CumulativeStretching and CumulativeStretching and Cumulative Stretching and Cumulative Trauma PreventionTrauma PreventionDr. Andrew Murro DC, DABCODr. Andrew Murro DC, DABCODr. Andrew Murro DC, DABCODr. Andrew Murro DC, DABCO

PresidentPresidentBusiness Health ResourcesBusiness Health ResourcesBusiness Health ResourcesBusiness Health Resources

(972) 547(972) 547--98379837amurro@ergoamurro@ergo power compower comamurro@ergoamurro@ergo--power.compower.com

What is Cumulative Trauma?What is Cumulative Trauma?What is Cumulative Trauma?What is Cumulative Trauma?

Sound familiar?????Sound familiar?????Employee tears a knee meniscus rising from Employee tears a knee meniscus rising from a squat position?a squat position?CTS develops in OH Linemen or plant CTS develops in OH Linemen or plant

h i f t ?h i f t ?mechanics for no apparent cause?mechanics for no apparent cause?A Rotator cuff tears when pulling a wrench?A Rotator cuff tears when pulling a wrench?A lumbar disc herniates while picking up a A lumbar disc herniates while picking up a wrench from the floor?wrench from the floor?

Cumulative Trauma is a slow wear and Cumulative Trauma is a slow wear and tear process:tear process:pp

No symptoms initiallyNo symptoms initiallyPoor Working Habits cause the damage…..Poor Working Habits cause the damage…..Poor Working Habits cause the damage….. Poor Working Habits cause the damage….. Not merely doing physical workNot merely doing physical workBelief systems of employees / management Belief systems of employees / management y p y gy p y gdrive the behaviors that create the problem.drive the behaviors that create the problem.CT damages muscles and jointsCT damages muscles and jointsg jg j

Strain and Sprain PreventionStrain and Sprain PreventionStrain and Sprain PreventionStrain and Sprain Prevention

Utilize Good BodymechanicsUtilize Good BodymechanicsErgonomic ImprovementsErgonomic ImprovementsMicroBreak StretchingMicroBreak StretchingMicroBreak StretchingMicroBreak StretchingStrengthening / RehabilitationStrengthening / RehabilitationS lf CS lf CSelf CareSelf Care

St t hi Eff tiSt t hi Eff tiStretching…….Effective Stretching…….Effective or Ineffective inor Ineffective inor Ineffective in or Ineffective in Preventing Injury??Preventing Injury??g j yg j y

Problems with research cited in articles Problems with research cited in articles claiming stretching has no significantclaiming stretching has no significantclaiming stretching has no significant claiming stretching has no significant

effect in injuryeffect in injury prevention:prevention:

Sports injury is not like industrial injurySports injury is not like industrial injuryLab research not transferable to etiologyLab research not transferable to etiologyLab research not transferable to etiology Lab research not transferable to etiology of industrial injuryof industrial injuryShort term versus long term effects ofShort term versus long term effects ofShort term versus long term effects of Short term versus long term effects of stretchingstretchingStretch alone not as effective as Stretch alone not as effective as combined approachcombined approachDouble blind studies impossibleDouble blind studies impossible

What do we Know?What do we Know?What do we Know?What do we Know?

Fatigued MusclesFatigued MusclesFatigued MusclesFatigued MusclesBecome hypertonic (spasm)Become hypertonic (spasm)reduced bloodflowreduced bloodflowreduced bloodflowreduced bloodflowmay cause painmay cause painDecreased ork capacitDecreased ork capacitDecreased work capacityDecreased work capacity

Muscle DegenerationMuscle DegenerationDiminished capacity to regenerateDiminished capacity to regenerateweaken (structurally and physiologically)weaken (structurally and physiologically)Scar tissue adhesionsScar tissue adhesions

Loss of Flexibility associated with risk forLoss of Flexibility associated with risk forLoss of Flexibility associated with risk for Loss of Flexibility associated with risk for cumulative trauma injurycumulative trauma injuryStudies support use of stretching forStudies support use of stretching forStudies support use of stretching for Studies support use of stretching for healing / rehabilitation of joint and musclehealing / rehabilitation of joint and muscle

R dR dReduce spasmReduce spasmIncrease blood flowIncrease blood flowR d i i dh iR d i i dh iReduce microscopic adhesionsReduce microscopic adhesionsReduce pain levelsReduce pain levels

What else do we Know?What else do we Know?What else do we Know?What else do we Know?

Muscle spasm causes painMuscle spasm causes painScar tissue adhesions create painScar tissue adhesions create pain

Myofascial trigger pointsMyofascial trigger pointsScar tissue adhesions alter joint mobilityScar tissue adhesions alter joint mobilityScar tissue adhesions alter joint mobilityScar tissue adhesions alter joint mobility

Speeds joint degeneration / arthritisSpeeds joint degeneration / arthritisMuscle spasm weakens muscleMuscle spasm weakens muscleMuscle spasm weakens muscle Muscle spasm weakens muscle Muscle spasm alters joint stabilityMuscle spasm alters joint stability

Stretching Accomplishes ?Stretching Accomplishes ?Stretching Accomplishes…..?Stretching Accomplishes…..?

Reduces scar tissue adhesionsReduces scar tissue adhesionsReduces scar tissue adhesionsReduces scar tissue adhesionsIncreases blood flowIncreases blood flowN li ROMN li ROMNormalizes ROMNormalizes ROMPromotes healingPromotes healingReduces painReduces painImproves strength and work capacityImproves strength and work capacityImproves strength and work capacityImproves strength and work capacity

What do employees believe What do employees believe b S hi ?b S hi ?about Stretching?about Stretching?

It’s probably good, but I don’t need to……It’s probably good, but I don’t need to……Physical work causes the problem anywayPhysical work causes the problem anywayI’m getting olderI’m getting olderI m getting older……I m getting older……It’s not that bad…… It’s not that bad…… A l it d ’t tA l it d ’t tAs long as it doesn’t get worse……. As long as it doesn’t get worse…….

How do you get people to stretch How do you get people to stretch f h i kd ?f h i kd ?as a part of their workday?as a part of their workday?

They have to decide they want toThey have to decide they want toMust understand Cumulative traumaMust understand Cumulative traumaMust identify it is happening to themMust identify it is happening to themMust recognize the consequencesMust recognize the consequences

Must provide a process to stretchMust provide a process to stretchDaily in morning / Job briefingDaily in morning / Job briefingMicroBreak Stretching during the dayMicroBreak Stretching during the day

Task / Body part specificTask / Body part specific

Must reinforce all concepts regularlyMust reinforce all concepts regularlyMust reinforce all concepts regularlyMust reinforce all concepts regularly

Cumulative Trauma of MuscleCumulative Trauma of MuscleCumulative Trauma of MuscleCumulative Trauma of Muscle

Is it Happening to You?Is it Happening to You?Is it Happening to You?Is it Happening to You?

Are there symptoms from that body part?Are there symptoms from that body part?y p y py p y pIs there loss of Range of Motion (ROM)?Is there loss of Range of Motion (ROM)?Is there discomfort or pain with ROM?Is there discomfort or pain with ROM?Is there discomfort or pain with ROM?Is there discomfort or pain with ROM?

What are the Consequences?What are the Consequences?What are the Consequences?What are the Consequences?

Loss of Quality of lifeLoss of Quality of lifeLoss of Quality of lifeLoss of Quality of lifePain and discomfortPain and discomfortIncreased risk of acute and chronic injuriesIncreased risk of acute and chronic injuriesIncreased risk of acute and chronic injuries Increased risk of acute and chronic injuries and conditions: and conditions:

Carpal Tunnel SyndromeCarpal Tunnel SyndromeCarpal Tunnel SyndromeCarpal Tunnel SyndromeRotator cuff tearsRotator cuff tearsHerniated discsHerniated discsMeniscus tearsMeniscus tearsDegenerative arthritisDegenerative arthritis

Does stretching help when incorporated as Does stretching help when incorporated as t f h i ?t f h i ?part of a comprehensive program?part of a comprehensive program?

6 WTE Plants with approx 550 employees6 WTE Plants with approx 550 employeesStrains / Sprains were the leading type of injuryStrains / Sprains were the leading type of injuryStrains / Sprains were the leading type of injury Strains / Sprains were the leading type of injury representing 34% of all injuriesrepresenting 34% of all injuriesSignificant costs including in workers’ compensation Significant costs including in workers’ compensation of $168K and over $100K per year in nonof $168K and over $100K per year in nonof $168K and over $100K per year in nonof $168K and over $100K per year in non--occupational injuries occupational injuries Most injuries occur to the BACK followed by the Most injuries occur to the BACK followed by the SHOULDER KNEE d NECKSHOULDER KNEE d NECKSHOULDER, KNEE and NECKSHOULDER, KNEE and NECKMost injuries occur while PUSHING/PULLING or Most injuries occur while PUSHING/PULLING or LIFTING LIFTING

We found 84% of employees had significant loss of ROMWe found 84% of employees had significant loss of ROMA loss of ROM is a sign of cumulative traumaA loss of ROM is a sign of cumulative traumaRegular stretching and proper body mechanics will help improveRegular stretching and proper body mechanics will help improveRegular stretching and proper body mechanics will help improve Regular stretching and proper body mechanics will help improve and/or maintain normal ROMand/or maintain normal ROMPre and post ROM measurements to evaluate program Pre and post ROM measurements to evaluate program effectivenesseffectivenesseffectivenesseffectivenessMeasured the neck, shoulder, hands, back and kneesMeasured the neck, shoulder, hands, back and knees18 18 –– 24% of employees were working with pain at moderate to 24% of employees were working with pain at moderate to severe levels on a daily basis depending on the plantsevere levels on a daily basis depending on the planty p g py p g p26 to 60% of employees were working with pain at moderate to 26 to 60% of employees were working with pain at moderate to severe levels several times a week or more oftensevere levels several times a week or more oftenWorking in pain affects productivity, morale, and turnover ratesWorking in pain affects productivity, morale, and turnover rates

9 Months Later:9 Months Later:9 Months Later:9 Months Later:

Reduction in strain and sprain injuries:Reduction in strain and sprain injuries:Reduction in strain and sprain injuries:Reduction in strain and sprain injuries:Zero OSHA recordable injuries for 5 of 6 facilities Zero OSHA recordable injuries for 5 of 6 facilities Zero workers’ compensation cases for 4 of 6 facilitiesZero workers’ compensation cases for 4 of 6 facilitiesppReduction in workers’ compensation costs from Reduction in workers’ compensation costs from $12,700 to $474 per case$12,700 to $474 per case

ROM measurementsROM measurementsAn average of 71% of measurements met An average of 71% of measurements met improvement targetsimprovement targetsimprovement targets improvement targets Improved symptomatologyImproved symptomatology

Questions?Questions?