1. Motion is Lotion: Protecting your Long-term Health in the WorkplaceAmy Flory PT 05/19/2010 NAU Employee Development Day

2. The workplace pain problem:

12.7% of the workforce lost productive time in a 2-week period due to a common pain condition. 1

• Headache: 5.4%

• Back pain: 3.2%

• Arthritis: 2.0%

• Other musculoskeletal pain: 2.0%

3. The workplace pain problem:

Average of 4.6hr/wk lost in productive time 1 .

Lost productive time due to health-related reduced performance on days at work account for 4 times more lost time than absenteeism. 1

Of 23,287 annual estimated reduced effectiveness workday equivalents [related to headache], 64% were due to tension-type and other headache types, and 36% were due to migraine. 2

4. The role of sitting in pain conditions at the workplace

Flattening of the lumbar curve increases stresses 3,4on the intervertebral discs and is associated with accelerated disc degeneration 5 .

Contemporary seating designs aim to decrease disc pressure, but more recent studies indicate that pressure is not the likely culprit in development of LBP 6 .

5. Lumbar disc pressure in different positions 6. The problem of recommendations based on disc pressure

Disc pressure measurements actually measure pressure as well as other stresses (shear forces, for example).

Activities in which disc pressure is also high are not associated with increased disc degeneration or low back pain.

Perhaps the lack of activity is the reason sitting accelerates disc problems as well as back pain.

7. Disc fluid dynamics 8. Disc fluid dynamics

There is no direct blood supply to the disc.

The disc receives nutrition from the fluid flow within the disc material 10 .

Motion may pump fluid through disc material.

9. The role of sitting in pain conditions at the workplace

Neck pain is associated with prolonged sedentary postures at work 7 .

Office workers with neck pain adopt even more of a forward head posture when distracted 8 .

The forward head posture is strongly associated with chronic headaches 9 .

10. Prolonged and imbalancedmuscle contraction PAIN! And scartissue lay-down Muscle guarding (tension) to protect the affected area Lactic acid build-up 11. The end result

Knots or trigger points in neck and back muscles

Shortening in the muscles at the skull base, the forearms, the shoulders, the low back and the hips

Weakening of the abdominal muscles, deep back and neck muscles, and buttocks

Pain in hips, neck, back, wrists, etc.

12. 13. Computer workstation caveats

While the seat should be adjustable to allow reclining up to 15, this position should not be used to keyboard or look at the monitor.

It should go without saying, butthat really expensive chair wont help you if you dont actually sit in it correctly

14. Computer workstation caveats

Avoid using bifocal lenses while working at the computer more than 5 minutes at a time.Keep a separate pair of glasses for near vision at your workstation.

15. Computer workstation caveats

If you are using the phone AND doing something else with your hands, you MUST use the speakerphone or a headset.

16. Computer workstation caveats

Laptops save electricity, but are ergonomic nightmares!

If reclining, the chair must have a headrest

Use laptop stands

Use separate keyboard, and mouse, if necessary.

17. The chair quandary

No one chair is perfect for every body and every job

Armrests are essential if at your desk more than 15 minutes (must be adjustable!)

Experiment with lumbar placement before buying a new chair

Sit on a fitness ball 15 minutes out of every hour

Spinalis chair: $900 18. The antidote for the chair:

DO NOT USE THE CHAIR!!

Get out of the chair every 20 minutes

• Do some stretches

• • http://ehs.concordia.ca/ih/ergonomics/exercises.html

• Stand up on your tiptoes or march in place while talking on the phone

• Stand instead of sit at the conference table

19. Stretch break 20. The obesity epidemic

Obesity rates are rising globally 11 .

2/3 of the US population is overweight and 1/3 of the US and UK population is obese 12 .

Overweight and obesity are preventable causes of death and many chronic health conditions: type II diabetes, stroke, high blood pressure, arthritis, cancer 11 .

Medical research and efforts to curb obesity in the past have focused on exercise physiology and calories burned by increasing recreational exercise intensity.

21. The obesity epidemic

The incidence of obesity is increasing despite all the resources devoted to increasing recreational exercise intensity.

People who exercise recreationally at a moderate to vigorous intensity are still at higher risk for health problems if their non-exercise time is spent sitting.WHY???

Sales of labor-saving devices parallel rising obesity rates, whereas food intake does not 13 .

22. Total daily energy expenditure 14 23. Activity thermogenesis

Energy expenditure of exercise

PLUS

Non-exercise activity thermogenesis

24. Non-exercise activity thermogenesis (NEAT)

Labor-saving devices, mechanical transportation do not decrease exercise time, but they do decrease non-exercise activity 14 .

NEAT is the energy expenditure of all activity other than volitional sporting-like exercise (going to work, grocery shopping, driving).

NEAT varies widely in different occupations and in leisure-time activity (seated office worker = low NEAT, mail carrier = moderate NEAT).

Non-exercising, lean sedentary adults stand/walk 2.5 hours more than obese sedentary adults 15 .

25. Energy expended from exercise in addition to NEAT 16 26. Walk and work desk 18

http://www.mayoclinic.com/health/treadmill-desk/MM00706

27. Inactivity physiology

The act of sitting results in specific cellular signals, not simply the lack of the signals resulting from exercise 16 .

Non-exercise activity (and sitting time) are associated with elevated rates of metabolic syndrome, type 2 diabetes, cardiovascular disease, and obesity 17 .

There is much research to be done!

There are no specific recommendations yet, however

28. 2 birds with 1 stonewhat a deal!

Many of the recommendations for decreasing musculoskeletal stresses will also stimulate large muscle contractions that appear to be important in thermogenesis and modulating scary cellular signals.

29. Talk is cheap

Changing habits is never easy.

• Use of technology (walk over to your co-worker instead of using email?)

• Type of footwear!

Changing workplace culture is certainly not easy.

• Standing meetings?Walking meetings?Will someone feel too short?Too slow?Left out?

Change requires consistent cuing from outside ourselves.We can cue others, but we also need cues from them.

30. Jump around! 31. References

1.Stewart W; Ricci J; Chee E; et al. Lost Productive Time and Cost Due to Common Pain Conditions in the US Workforce.JAMA2003;290(18):2443-2454

2. Schwartz, B; et al. Lost workdays and decreased work effectiveness associated with headache in the workplace.JOEM1997;39(4):320

3. Adams MA, McNally DS, Chinn H, et al. Posture and the compressive strength of the lumbar spine.Clin Biomech1994;9:514.

32. References, contd

4. Keegan JJ. Alterations of the lumbar curve related to posture and seating.J Bone Joint Surg Am1953;35:589603.

5. Farfan HF, Huberdeau RM, Dubow HI. Lumbar intervertebral disc degeneration.J Bone Joint Surg Am1972;54:492510.

6. Claus A, Hides J, Moseley GL, Hodges P. Sitting versus standing: does the intradiscal pressure cause disc degeneration or low back pain? J Electromyogr Kinesiol 2008 Aug;18(4):550-8.

33. References, contd

7. Ariens G, Mechelen WV, Bongers PW, Bouter LM, van der Wal G .Physical risk factors for neck pain.Scand J Work Environ Health2000;26(1):7- 19.

8. Szeto GP, Straker LM, OSullivan PB. A comparison of symptomatic and asymptomatic office workers performing monotonous keyboard work.Man Ther2005;10:281291.

9. Watson DH, Trott PH. Cervical Headache: an investigation of natural head posture and upper cervical flexor muscle performance.Cephalalgia1993;13(4), 272-284

34. References, contd

10.Adams MA, Hutton, WC. The effect of posture on the fluid content of lumbar intervertebral discs.Spine1983;8(6)

11.World Health Organization. Obesity: preventing and managing the global epidemic. Geneva, Switzerland; 1997.

12.Wyatt SB, Winters KP, Dubbert PM. Overweight and obesity: prevalence, consequences, and causes of a growing public health problem.Am J Med Sci2006;331:166-74

35. References, contd

13.Lanningham-Foster L, Nysse LJ, Levine JA. Labor saved, calories lost: the energetic impact of domestic labor-saving devices.Obes Res2003;11:1178-1181

14.Levine JA, Vander Weg MW, Hill JO, Klesges RC. Non-exercise activity thermogenesis: the crouching tiger hidden dragon of societal weight gain.Arterioscler. Thromb. Vasc. Biol.2006;26:729-736.

15.Levine JA, Lanningham-Foster LM, McCrady SK, et al. Interindividual variation in posture allocation: possible role in human obesity.Science . 2006;307(5709):584-6

36. References, contd

16.Hamilton MT, Hamilton DB, Zderic TW. Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease.Diabetes2007;56:2655-67.

17.Manini TM, Everhart JE, Patel KV; et al. Daily activity energy expenditure and mortality among older adults.JAMA2006;296:171-179.

18.Levine JA, Miller JM. The energy expenditure of using a walk-and-work desk for office workers with obesity.Br J Sports Med2007;41:558-61.