Contents / Links
Introduction: Exercise Physiology & Workplace Injury
Priority Injuries in the Workplace
Evidence to support the efficacy for the use of Exercise in Musculoskeletal Rehabilitation
Prolonged bed rest is bad for chronic musculoskeletal conditions and pain
Overview: Why are Exercise Physiologists so important in returning injured workers to work?
Clinical problem solving tools for the applied science human movement exercise physiologist
The Musculoskeletal Rehabilitation Program
Types of musculoskeletal conditions that can be treated by an exercise physiologist
Effect of exercise on Lower Back Pain
Sleepy tired workers are as bad a Alcohol users
Why we really don’t like Monday’s
Concept of the Industrial Athlete
Additional benefits of a functional based exercise intervention
Exercise Physiology and Work Place Injury.
The following package will provide you with an outline of what exercise physiology is and how we can assist WorkCover & WorkCover Agents, the differentiation of service between exercise physiologists and physiotherapists, the types of injuries exercise physiologists can make positive contributions towards for key stakeholders when promoting safe – quick – and effective return to work (RTW) outcomes.
Exercise Physiology
Exercise Physiology is the identification of physiological mechanisms underlying injury, physical activity, the comprehensive delivery of treatment services concerned with the analysis, improvement, and maintenance of health and fitness, rehabilitation of heart disease and other chronic diseases and/or disabilities, Musculoskeletal Rehabilitation of Work Place Injury and the professional guidance and counsel of athletes and others interested in athletics, sports training, and human adaptability to acute and chronic exercise and rehabilitation.?
The exercise physiologist with musculoskeletal specialization is able to provide autonomous rehabilitation services to people who have suffered an injury at work and also work hand in hand with treating chiropractors, physiotherapists and medical practitioners in achieving effective RTW outcomes. At Functional Training Perspectives Group we have a passion for health promotion and fostering client education to establish swift and safe exercise programs through a systemic approach to early intervention and Musculoskeletal Rehabilitation. This approach results in appropriate RTW outcomes for both the insured and the client.
Our dedication, high work ethic, and a “do-more-not-less” attitude, can influence how quickly a person can improve their health, well-being and muscle strength. Please feel free to peruse the information provided in this package and I look forward to the possibility of discussing our profession to you and your team.
If you have any further questions regarding this please do not hesitate to contact me.
Matthew Fittolani: Grad Dip in Exercise for Rehabilitation. AEP; AMS; MAAESS.
eMail: info@ftpghealth.com.au tel: 1300 20 20 27
WHAT ARE THE PRIORITY INJURIES IN THE WORKPLACE?
• Low Back Pain (LBP)
• Occupational Overuse Syndrome (OOS)
• Sprains and Strains (fingers, hands, wrists, elbows, shoulders, knees, back & neck).
• Epicondylitis (Inflammation and micro-rupturing of the soft tissues of the epicondyles of the distal humerus)
(Anderson, Hall & Martin, 2005).
The Human body is designed as a system of third order rigid levers in which the effort lies between the axis and the load; this is an extremely common arrangement in the human body. The human bodies preferred mechanism of action to reduce the risk of injury is in what can be termed a neutral position; maintaining correct biomechanical techniques and posture within its own base of support when performing tasks at work, home, and play which is critical in minimizing Musculoskeletal Disorders (MSD).
Here lies the exercise physiologist’s area of expertise. Considering the whole person to rehabilitate MSD and Incorporating Effective Strategies to Minimise Reoccurrence.
Point 1: How do we stop reoccurrence of injury?
• Exercise Physiologist: Muscular Strength and Endurance, Postural Awareness and Body Mechanics,
CORRECT LIFTING TECHNIQUES, holistic health and wellbeing.
• Ergonomics: Education and re-training.
Point 2: It is all about Skill Acquisition and Postural Awareness!!
• Exercise Physiologist is best placed to fulfill this role through our studies of functional anatomy and biomechanics.
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EVIDENCE TO SUPPORT THE EFFICACY FOR THE USE OF EXERCISE IN MUSCULOSKELETAL REHABILITATION.
Conclusive research supports the effectiveness of physical conditioning programs which incorporate a cognitive behavioral approach, supervised physical training, and are done at work or in co-operation with employers in reducing work absence for individuals with chronic low back pain.
* Schonstein E, Kenny DT, Keating J, Koes BW. The Cochrane Database of Systematic Reviews 2002, Issue 4.
It is estimated that each year musculoskeletal injuries cause children to miss 21 million days of school and American workers to miss more than 147 million days. Musculoskeletal disorders cost the United States $215 billion each year.
Early diagnosis and proper?treatment of musculoskeletal disorders is critical to reducing pain, eliminating instability and getting people return to active lives. Rehabilitation through exercise is of critical importance when musculoskeletal disorders are taken into consideration.
Musculoskeletal disorders (i.e. disorders affecting muscles and joints) associated with manual handling cause significant human suffering and significant decreases in productivity. From recent statistics strains and sprains affecting shoulder, neck, arm, hand or back, account for 55% of all WorkCover claims; 62% of all WorkCover costs and 70% of long term WorkCover claims *.
* Manual handling and the risks of musculoskeletal disorders Issued: November 1999
Hazardous manual handling can cause serious musculoskeletal disorders.
Supervised exercise programs are strongly recommended in the treatment of chronic LBP.
Summary of Evidence: There is strong evidence to suggest that supervised exercise benefits people with acute and chronic LBP leading to a reduction in recurrence rates over 2 years. Additionally supervised exercise programs leads to less sick leave, faster and safer RTW rates, less pain and disability than usual medical care (control and passive therapies in chronic LBP) 4/5 reviewed – 16/16 Randomized Controlled Trials (RCT’s) .
* Level of Evidence = I and II (7/8 systemic reviews, 19 RCT’s guideline support: 11/11 (APA/MPA 2003 LBP Review 2003).
Pain does hurt but this does not mean it harms, and exercise is recommended and safe despite pain symptoms to increase function and ADL’s *.
* Staal & Almed, 2004.
The is mounting evidence to suggest that spinal fusion is not significantly better than intensive exercise rehabilitation. This supports the demand for insurers private or commensurable to fund treatment.
* Fairbank BMJ, 2002.
Social and behavioral support alone does not improve health outcomes. Reductions in pain are greater for patients who adhere to exercise programs.
* Thomas et al, BMJ, 2002.
Early active treatment including advice, re-assurance and exercise with a cognitive behavioral approach are effective treatments for sub-acute low back pain.
* Mayer C, Latimer J, Refshauge K. Australian Journal of Physiotherapy. 1999; 45(2): 121-132
PROLONGED BED REST IS BAD FOR CHRONIC MUSCULOSKELETAL CONDITIONS & PAIN
Inactivity hampers recovery from chronic musculoskeletal pain. Physical exercises are an integral part of the functional restoration approach. It is important for patients having chronic musculoskeletal pain to understand the harmful effects of prolonged bed rest. It has been proven that prolonged bed rest is not only a bad option in the treatment of chronic back pain but that it also aggravates other medical conditions.
Complete bed rest is a highly un-physiologic and definitely hazardous form of therapy; it should be ordered only for specific indications and discontinued as early as possible. That was the conclusion of an article published in 1944 in the Journal of the American Medical Association. Nevertheless, only a decade ago, prolonged bed rest was in many countries the treatment method of choice for lower back pain. Similarly, various forms of rest or support were often recommended for recurrent pain in the neck or shoulder. Since then there has been a complete change in the way of thinking.
Now it is widely recognized that rest and traditional physical therapies in which patients receive treatments passively are not very effective in chronic musculoskeletal conditions. Physical inactivity has several harmful effects:
• Muscles, ligaments and bones weaken
• The spine stiffens and loses control and coordination
• Overall physical fitness deteriorates
• Patients become prone to depression and sensitive to pain
• Resumption of normal activities & daily routines becomes more & more difficult as time passes.
• In a Nutshell further Deconditioning occurs!!
The current consensus is that inactivity is the wrong response to chronic back pain, chronic neck pain and chronic shoulder pain. In acute pain, it is advisable for patients to continue daily activities as much as possible. In chronic pain, physical exercises can bring about some relief gradually, and the best results are obtained when carefully designed functional restoration approaches are followed and provided by an approved Musculoskeletal Exercise Physiologist.
OVERVIEW
Why are Exercise Physiologists so important in returning injured workers to work?
Physical exercise therapy has been and is continuing to be an integral part of both the clinical and scientific domains of rehabilitation. Inherent in the Exercise Physiology profession are three educational components which makes it a particularly suitable addition: human movement science, pathology, and functional analysis. Exercise Physiologists are active in each of the primary areas of Musculoskeletal rehabilitation encompassing treatment, injury prevention/education, functional capacity evaluation/s, restorative exercise programs, work conditioning, and ergonomics.
The WorkCover accredited exercise physiologist comprehends the basic and applied strength and conditioning principles and how they pertain to an injured worker. Exercise Physiologists are able to provide autonomous rehabilitation services to people who have suffered an injury at work and also work hand in hand with treating chiropractors, physiotherapists and medical practitioners in achieving effective RTW outcomes for all key stakeholders.
Additionally we possess an ability to perform workplace task analysis; have thorough understanding of joint and muscle structure and function; provide expert movement analysis of isolated and combined movement/s; have an acquired minimum of 1000 hours of clinical experience with common musculoskeletal pathologies and exercise intervention/s; and are the expert professionals in designing and implementing effective exercise programs to maximise the potential functional gain of patients with musculoskeletal pathologies.
CLINICAL PROBLEM SOLVING TOOLS FOR THE APPLIED SCIENCE HUMAN MOVEMENT EXERCISE PHYSIOLOGIST
1. Knowledge: Ageing process – Anatomy – Inflammatory Process. Exquisite detailed anatomical and biomechanical knowledge.
2. Biomechanics: Establishes the mechanism of injury.
3. Functional Anatomy: Prevention of the injury when combined with biomechanics they go hand in hand.
4. Inflammation: Information regarding healing and rate of recovery. Acute verse Sub-Acute.
5. Observation Skills: Ability to identify mechanisms of injury (walking pattern; posture, incorrect techniques, etc).
6. Communication Skills: Ability to adapt our communication to whom we are interacting with (other medical professionals through to clients)
7. Teaching Skills: Combination of communication, demonstration and effective feedback to client about their rehabilitation and performance. Feedback should be given in a General – Specific – General basis).
THE MUSCULOSKELETAL REHABILITATION PROGRAM.
A musculoskeletal rehabilitation program is designed specifically to meet the needs of the individual patient, depending upon the specific problem, disease or injury.
The goal of musculoskeletal rehabilitation is to help the patient return to the highest possible level of function and independence, while improving the overall quality of life – physically - emotionally and socially.
In order to help reach these goals, musculoskeletal rehabilitation programs may include the following:
• Exercise programs to improve range of motion, increase muscle strength, improve flexibility and mobility, and increase endurance.
• Gait (walking) retraining and methods of safe ambulation (including the use of a walker, cane, or crutch).
• Help with obtaining assistive devices that promote independence.
• Pain management.
• Stress management and emotional support.
• Nutritional counseling.
• Ergonomic assessments and work-related injury prevention.
• Provide the injured worker with the knowledge to achieve effective self management strategies in preserving / improving their injury and health.
TYPES OF MUSCULOSKELETAL CONDITIONS TREATABLE BY AN EXERCISE PHYSIOLOGIST
includes but is not limited too:
• Back Injuries
• Occupational Overuse Syndrome (OOS). (Carpal Tunnel Syndrome)
• Tendon Lesions
• Lateral Epicondylitis
• Medial Epicondylitis
• Shoulder Injuries
• Tendonitis and Bursitis
• Stress leave
• Depression
EFFECT OF EXERCISE ON LOW BACK PAIN
People who do not exercise regularly face an increased risk for low back pain, especially during times when they suddenly embark on stressful unaccustomed activity, such as shoveling, digging, or moving heavy items at work or play. Although no definitive studies have been done to prove the relationship between lack of exercise and low back pain, sedentary living is probably a primary non-medical culprit contributing to this condition. Lack of exercise leads to the following conditions that may threaten the back:
• Muscle inflexibility can restrict the back’s ability to move, rotate, and bend.
• Weak stomach muscles can increase strain on the back & can cause an abnormal tilt of the pelvis.
• Weak back muscles may increase the load on the spine and the risk for disc compression.
• Obesity puts more weight on the spine and increases pressure on the vertebrae and discs. Studies report only a weak association between obesity and low back pain.
Benefits for Chronic Back Pain. People with sudden and severe back pain may be required to limit their exercise. However, exercise can play a beneficial role in chronic back pain management. In one study, patients with back pain lasting for an average of 18 months were assigned eight one-hour exercise sessions over four weeks. They showed greater improvement in nearly every area, including reduced pain and increased capacity, compared to patients who did not exercise.
Exercise should be considered as part of a broader program to return to normal home, work, and social activities. In this way, the positive benefits of exercise not only affect strength and flexibility but they also alter and improve the patient’s attitudes toward their disability and pain.
Repetition is the key to increasing flexibility, building endurance, and strengthening the specific muscles needed to support and neutralize the spine. Some exercise programs used for prevention or treatment of chronic low back pain includes the following:
• Low-impact Aerobic Exercises. Exercises, such as swimming, bicycling, and walking, can strengthen muscles in the abdomen and back without over-straining the back. Programs that use strengthening exercises while swimming may be a particularly beneficial approach for many patients with back pain.
• Lumbar Extension Strength Training Exercises are proving to be effective. Generally, these exercises attempt to strengthen the abdomen, improve lower back mobility, strength, and endurance, and enhance flexibility in the hip and hamstring muscles and tendons at the back of the thigh.
• Flexibility Exercises. Whether flexibility exercises alone offer any significant benefit is uncertain. It is suggested that any benefits derived from flexibility exercises are lost unless the exercise regimens are sustained.
• Retraining Deep Muscles. Studies are finding a link between low back pain and impaired motor control of deep muscles of the back and trunk. According to these studies, contraction exercises specifically designed to retrain these muscles may be effective for patients with both acute and chronic pain.
It is important for any person who has low back pain to have an exercise program guided by an exercise physiologist who understands the limitations and special needs of back pain, and who can address individual health conditions. It has been suggested that patients whoplanned their own exercise did worse than those in supervised exercise therapy.
SLEEPY TIERD WORKERS ARE AS BAD AS ALCOHOL USERS
Key points taken from the article include:
• Hand eye co-ordination diminishes
• Increased fatigue leads to impaired decision making
• Reduced mental alertness
* Kerin, J. (1995). Sleepy workers are as bad as drinkers. Australian, 3.
WHY WE REALLY DON’T LIKE MONDAY’S
Monday is the day people are most likely to be injured at work, a report shows.
CGU Insurance has found workplace injuries are 20 per cent more common on Mondays than on Fridays. The research showed that after Monday, the risk of being injured decreased and Friday was the safest working day.
The study revealed:
• The rate of workplace injuries dropped steadily throughout the working week.
• Sprains and strains were the most common workplace injuries.
• The lower back was the most common body part to be injured.
• Workplace injuries are 20 per cent more common on Mondays than on Fridays.
A safety spokeswoman for CGU in Melbourne, Kristine Haseldine, said Monday was often regarded as the least favorite day, possibly because it was the day when most accidents happened. “This research suggests that many people find it difficult to make the transition from the relaxation and enjoyment of their weekends to starting the working week,” she said.
“Lack of sleep over the weekend and the effects of alcohol and other drugs may be contributing factors to the increased incidence of workplace accidents on Mondays.”
“And given that the majority of public holidays occur on a Monday, if all things were equal Monday should have fewer workplace injuries thanother days of the week. Instead, the rate is 20 per cent higher”.
CONCEPT OF THE INDUSTRIAL ATHLETE…
Work Based Fitness & Functional Restoration Programs.
Consider this! How often have you performed some form of pre-work warm-up, like the pre-competition warm-up that most recreational and all elite athletes often perform in the advent that it reduces the risk of injury? This becomes the concept of the Industrial Athlete.
• No person generally just goes and plays sport “WE PREPARE”.
• Pre-work warm-ups can be tailor made specifically to the task/s performed.
• Assist in increasing the longevity of an employee and decrease the risk of an at work incident.
4 WEEKS OFF WORK = WORKPLACE DE-CONDITIONING…
This therefore increases the potential for injury to occur and also place the returning injured worker at risk of additional injuries and or injury reoccurrence, here a functional restoration program is critical in minimizing the potential of further injury.
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ADDITIONAL BENEFITS OF FUNCTIONAL BASED EXERCISE INTERVENTIONS INCLUDE:
• Increased physical work capacity (one’s ability to perform physical work).
• Reduce stress and anxiety.
• Reduce depression.
• Increase fatigue thresholds.
• Decreased blood pressure.
• Improve or maintain bone integrity.
• Increased joint range of motion or flexibility.
• Improved sense of well being.
• Increased muscular strength.
• Improved glucose regulation (very favorable for diabetics).
• Improved sleep patterns and levels of anxiety.
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