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

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The problem of sitting too much...

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  • 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.