Motion is Lotion: Protecting your Long-term Health in the Workplace  Amy Flory PT 05/19/2010 NAU Employee Development Day
The workplace pain problem: <ul><li>12.7% of the workforce lost productive time in a 2-week period due to a common pain co...
The workplace pain problem: <ul><li>Average of 4.6hr/wk lost in productive time 1 . </li></ul><ul><li>Lost productive time...
The role of sitting in pain conditions at the workplace <ul><li>Flattening of the lumbar curve increases stresses 3,4  on ...
Lumbar disc “pressure” in different positions
The problem of recommendations based on disc pressure <ul><li>Disc “pressure” measurements actually measure pressure as we...
Disc fluid dynamics
Disc fluid dynamics <ul><li>There is no direct blood supply to the disc. </li></ul><ul><li>The disc receives nutrition fro...
The role of sitting in pain conditions at the workplace <ul><li>Neck pain is associated with prolonged sedentary postures ...
Prolonged and imbalanced  muscle contraction PAIN! And scar  tissue lay-down Muscle guarding (tension) to protect the affe...
The end result… <ul><li>“Knots” or trigger points in neck and back muscles </li></ul><ul><li>Shortening in the muscles at ...
 
Computer workstation caveats… <ul><li>While the seat should be adjustable to allow reclining up to 15°, this position shou...
Computer workstation caveats… <ul><li>Avoid using bifocal lenses while working at the computer more than 5 minutes at a ti...
Computer workstation caveats… <ul><li>If you are using the phone AND doing something else with your hands, you MUST use th...
Computer workstation caveats… <ul><li>Laptops save electricity, but are ergonomic nightmares! </li></ul><ul><li>If reclini...
The chair quandary… <ul><li>No one chair is perfect for every body and every job </li></ul><ul><li>Armrests are essential ...
The antidote for the chair: <ul><li>DO NOT USE THE CHAIR!! </li></ul><ul><li>Get out of the chair every 20 minutes </li></...
Stretch break
The obesity epidemic <ul><li>Obesity rates are rising globally 11 . </li></ul><ul><li>2/3 of the US population is overweig...
The obesity epidemic <ul><li>The incidence of obesity is increasing despite all the resources devoted to increasing recrea...
Total daily energy expenditure 14
Activity thermogenesis <ul><li>Energy expenditure of exercise </li></ul><ul><li>PLUS </li></ul><ul><li>Non-exercise activi...
Non-exercise activity thermogenesis (NEAT) <ul><li>Labor-saving devices, mechanical transportation do not decrease “exerci...
Energy expended from exercise in addition to NEAT 16
Walk and work desk 18 <ul><li>http://www.mayoclinic.com/health/treadmill-desk/MM00706   </li></ul>
Inactivity physiology <ul><li>The “act” of sitting results in specific cellular signals, not simply the lack of the signal...
2 birds with 1 stone—what a deal! <ul><li>Many of the recommendations for decreasing musculoskeletal stresses will also st...
Talk is cheap <ul><li>Changing habits is never easy. </li></ul><ul><ul><li>Use of technology (walk over to your co-worker ...
Jump around!
References <ul><li>1.  Stewart W; Ricci J; Chee E; et al. Lost Productive Time and Cost Due to Common Pain Conditions in t...
References, cont’d <ul><li>4. Keegan JJ. Alterations of the lumbar curve related to posture and seating.  J Bone Joint Sur...
References, cont’d <ul><li>7. Ariens G, Mechelen WV, Bongers PW, Bouter LM, van der Wal G .  Physical risk factors for nec...
References, cont’d <ul><li>10.Adams MA, Hutton, WC. The effect of posture on the fluid content of lumbar intervertebral di...
References, cont’d <ul><li>13.Lanningham-Foster L, Nysse LJ, Levine JA. Labor saved, calories lost: the energetic impact o...
References, cont’d <ul><li>16.Hamilton MT, Hamilton DB, Zderic TW. Role of low energy expenditure and sitting in obesity, ...
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Motion is lotion

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Motion is lotion

  1. 1. Motion is Lotion: Protecting your Long-term Health in the Workplace Amy Flory PT 05/19/2010 NAU Employee Development Day
  2. 2. The workplace pain problem: <ul><li>12.7% of the workforce lost productive time in a 2-week period due to a common pain condition. 1 </li></ul><ul><ul><li>Headache: 5.4% </li></ul></ul><ul><ul><li>Back pain: 3.2% </li></ul></ul><ul><ul><li>Arthritis: 2.0% </li></ul></ul><ul><ul><li>Other musculoskeletal pain: 2.0% </li></ul></ul>
  3. 3. The workplace pain problem: <ul><li>Average of 4.6hr/wk lost in productive time 1 . </li></ul><ul><li>Lost productive time due to health-related reduced performance on days at work account for 4 times more lost time than absenteeism. 1 </li></ul><ul><li>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 </li></ul>
  4. 4. The role of sitting in pain conditions at the workplace <ul><li>Flattening of the lumbar curve increases stresses 3,4 on the intervertebral discs and is associated with accelerated disc degeneration 5 . </li></ul><ul><li>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 . </li></ul>
  5. 5. Lumbar disc “pressure” in different positions
  6. 6. The problem of recommendations based on disc pressure <ul><li>Disc “pressure” measurements actually measure pressure as well as other stresses (shear forces, for example). </li></ul><ul><li>Activities in which disc “pressure” is also high are not associated with increased disc degeneration or low back pain. </li></ul><ul><li>Perhaps the lack of activity is the reason sitting accelerates disc problems as well as back pain. </li></ul>
  7. 7. Disc fluid dynamics
  8. 8. Disc fluid dynamics <ul><li>There is no direct blood supply to the disc. </li></ul><ul><li>The disc receives nutrition from the fluid flow within the disc material 10 . </li></ul><ul><li>Motion may “pump” fluid through disc material. </li></ul>
  9. 9. The role of sitting in pain conditions at the workplace <ul><li>Neck pain is associated with prolonged sedentary postures at work 7 . </li></ul><ul><li>Office workers with neck pain adopt even more of a “forward head” posture when distracted 8 . </li></ul><ul><li>The “forward head” posture is strongly associated with chronic headaches 9 . </li></ul>
  10. 10. Prolonged and imbalanced muscle contraction PAIN! And scar tissue lay-down Muscle guarding (tension) to protect the affected area Lactic acid build-up
  11. 11. The end result… <ul><li>“Knots” or trigger points in neck and back muscles </li></ul><ul><li>Shortening in the muscles at the skull base, the forearms, the shoulders, the low back and the hips </li></ul><ul><li>Weakening of the abdominal muscles, deep back and neck muscles, and buttocks </li></ul><ul><li>Pain in hips, neck, back, wrists, etc. </li></ul>
  12. 13. Computer workstation caveats… <ul><li>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. </li></ul><ul><li>It should go without saying, but…that really expensive chair won’t help you if you don’t actually sit in it correctly </li></ul>
  13. 14. Computer workstation caveats… <ul><li>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. </li></ul>
  14. 15. Computer workstation caveats… <ul><li>If you are using the phone AND doing something else with your hands, you MUST use the speakerphone or a headset. </li></ul>
  15. 16. Computer workstation caveats… <ul><li>Laptops save electricity, but are ergonomic nightmares! </li></ul><ul><li>If reclining, the chair must have a headrest </li></ul><ul><li>Use laptop stands </li></ul><ul><li>Use separate keyboard, and mouse, if necessary. </li></ul>
  16. 17. The chair quandary… <ul><li>No one chair is perfect for every body and every job </li></ul><ul><li>Armrests are essential if at your desk more than 15 minutes (must be adjustable!) </li></ul><ul><li>Experiment with lumbar placement before buying a new chair </li></ul><ul><li>Sit on a fitness ball 15 minutes out of every hour </li></ul>Spinalis chair: $900
  17. 18. The antidote for the chair: <ul><li>DO NOT USE THE CHAIR!! </li></ul><ul><li>Get out of the chair every 20 minutes </li></ul><ul><ul><li>Do some stretches </li></ul></ul><ul><ul><ul><li>http://ehs.concordia.ca/ih/ergonomics/exercises.html </li></ul></ul></ul><ul><ul><li>Stand up on your tiptoes or march in place while talking on the phone </li></ul></ul><ul><ul><li>Stand instead of sit at the conference table </li></ul></ul>
  18. 19. Stretch break
  19. 20. The obesity epidemic <ul><li>Obesity rates are rising globally 11 . </li></ul><ul><li>2/3 of the US population is overweight and 1/3 of the US and UK population is obese 12 . </li></ul><ul><li>Overweight and obesity are preventable causes of death and many chronic health conditions: type II diabetes, stroke, high blood pressure, arthritis, cancer 11 . </li></ul><ul><li>Medical research and efforts to curb obesity in the past have focused on exercise physiology and calories burned by increasing recreational exercise intensity. </li></ul>
  20. 21. The obesity epidemic <ul><li>The incidence of obesity is increasing despite all the resources devoted to increasing recreational exercise intensity. </li></ul><ul><li>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??? </li></ul><ul><li>Sales of labor-saving devices parallel rising obesity rates, whereas food intake does not 13 . </li></ul>
  21. 22. Total daily energy expenditure 14
  22. 23. Activity thermogenesis <ul><li>Energy expenditure of exercise </li></ul><ul><li>PLUS </li></ul><ul><li>Non-exercise activity thermogenesis </li></ul>
  23. 24. Non-exercise activity thermogenesis (NEAT) <ul><li>Labor-saving devices, mechanical transportation do not decrease “exercise” time, but they do decrease non-exercise activity 14 . </li></ul><ul><li>NEAT is the energy expenditure of all activity other than volitional sporting-like exercise (going to work, grocery shopping, driving). </li></ul><ul><li>NEAT varies widely in different occupations and in leisure-time activity (seated office worker = low NEAT, mail carrier = moderate NEAT). </li></ul><ul><li>Non-exercising, lean sedentary adults stand/walk 2.5 hours more than obese sedentary adults 15 . </li></ul>
  24. 25. Energy expended from exercise in addition to NEAT 16
  25. 26. Walk and work desk 18 <ul><li>http://www.mayoclinic.com/health/treadmill-desk/MM00706 </li></ul>
  26. 27. Inactivity physiology <ul><li>The “act” of sitting results in specific cellular signals, not simply the lack of the signals resulting from exercise 16 . </li></ul><ul><li>Non-exercise activity (and sitting time) are associated with elevated rates of metabolic syndrome, type 2 diabetes, cardiovascular disease, and obesity 17 . </li></ul><ul><li>There is much research to be done! </li></ul><ul><li>There are no specific recommendations yet, however… </li></ul>
  27. 28. 2 birds with 1 stone—what a deal! <ul><li>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. </li></ul>
  28. 29. Talk is cheap <ul><li>Changing habits is never easy. </li></ul><ul><ul><li>Use of technology (walk over to your co-worker instead of using email?) </li></ul></ul><ul><ul><li>Type of footwear! </li></ul></ul><ul><li>Changing workplace culture is certainly not easy. </li></ul><ul><ul><li>Standing meetings? Walking meetings? Will someone feel too short? Too slow? Left out? </li></ul></ul><ul><li>Change requires consistent cuing from outside ourselves. We can cue others, but we also need cues from them. </li></ul>
  29. 30. Jump around!
  30. 31. References <ul><li>1. Stewart W; Ricci J; Chee E; et al. Lost Productive Time and Cost Due to Common Pain Conditions in the US Workforce. JAMA 2003;290(18):2443-2454 </li></ul><ul><li>2. Schwartz, B; et al. Lost workdays and decreased work effectiveness associated with headache in the workplace. JOEM 1997;39(4):320 </li></ul><ul><li>3. Adams MA, McNally DS, Chinn H, et al. Posture and the compressive strength of the lumbar spine. Clin Biomech 1994;9:5–14. </li></ul>
  31. 32. References, cont’d <ul><li>4. Keegan JJ. Alterations of the lumbar curve related to posture and seating. J Bone Joint Surg Am 1953;35:589–603. </li></ul><ul><li>5. Farfan HF, Huberdeau RM, Dubow HI. Lumbar intervertebral disc degeneration. J Bone Joint Surg Am 1972;54:492–510. </li></ul><ul><li>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. </li></ul>
  32. 33. References, cont’d <ul><li>7. Ariens G, Mechelen WV, Bongers PW, Bouter LM, van der Wal G . Physical risk factors for neck pain. Scand J Work Environ Health 2000;26(1):7- 19. </li></ul><ul><li>8. Szeto GP, Straker LM, O’Sullivan PB. A comparison of symptomatic and asymptomatic office workers performing monotonous keyboard work. Man Ther 2005;10:281–291. </li></ul><ul><li>9. Watson DH, Trott PH. Cervical Headache: an investigation of natural head posture and upper cervical flexor muscle performance. Cephalalgia 1993;13(4), 272-284 </li></ul>
  33. 34. References, cont’d <ul><li>10.Adams MA, Hutton, WC. The effect of posture on the fluid content of lumbar intervertebral discs. Spine 1983;8(6) </li></ul><ul><li>11.World Health Organization. Obesity: preventing and managing the global epidemic. Geneva, Switzerland; 1997. </li></ul><ul><li>12.Wyatt SB, Winters KP, Dubbert PM. Overweight and obesity: prevalence, consequences, and causes of a growing public health problem. Am J Med Sci 2006;331:166-74 </li></ul>
  34. 35. References, cont’d <ul><li>13.Lanningham-Foster L, Nysse LJ, Levine JA. Labor saved, calories lost: the energetic impact of domestic labor-saving devices. Obes Res 2003;11:1178-1181 </li></ul><ul><li>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. </li></ul><ul><li>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 </li></ul>
  35. 36. References, cont’d <ul><li>16.Hamilton MT, Hamilton DB, Zderic TW. Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes 2007;56:2655-67. </li></ul><ul><li>17.Manini TM, Everhart JE, Patel KV; et al. Daily activity energy expenditure and mortality among older adults. JAMA 2006;296:171-179. </li></ul><ul><li>18.Levine JA, Miller JM. The energy expenditure of using a “walk-and-work” desk for office workers with obesity. Br J Sports Med 2007;41:558-61. </li></ul>

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