The document discusses targeted programs to reduce back injuries. It notes that back pain is a problem at a workplace and outlines various causal factors like employee ergonomic errors, prolonged positioning, and sudden movements. The document summarizes spine anatomy including bones, joints, discs, and muscles. It emphasizes the importance of both stability and mobility in the spine. The document recommends a targeted exercise program that includes stretching tight muscles, strengthening weak muscles, and learning to activate local spinal stabilizer muscles before larger trunk movers to help reduce the incidence of back pain and injuries. It discusses resource needs for implementing such a program.
Muscle energy technique, a manual therapy technique with a long term history and 8 variations which can be used in various condition to treat muscle as well as joints. This slide show consists of detailed history, variations/types and summary of MET in detail.
Neurodynamics, mobilization of nervous system, neural mobilizationSaurab Sharma
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
Brian Mulligan described novel concept of the simultaneous application of therapist applied accessory mobilizations and patient generated active movements
Muscle energy technique, a manual therapy technique with a long term history and 8 variations which can be used in various condition to treat muscle as well as joints. This slide show consists of detailed history, variations/types and summary of MET in detail.
Neurodynamics, mobilization of nervous system, neural mobilizationSaurab Sharma
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
Brian Mulligan described novel concept of the simultaneous application of therapist applied accessory mobilizations and patient generated active movements
A type of manual therapy in which the muscle or the joint is altered and placed in a position of comfort for certain duration after which the pain disappears completely or gets reduced. this slide show explains about the principles, mechanism and Phases of PRT
Controlled use of sensory stimulus.
Specific Motor response
Normalization of muscle tone
Use of Developmental sequences.
Sensorimotor development = from lower to higher level.
Use of activity to demand a purposeful response.
Practice of sensory motor response is necessary for motor learning.
This presentation give an upto date insightful information on balance/postural assessment and key domains of Occupational Therapy during assessment of balance using different scales.
Identify common imbalance patterns and potential causes, learn key assessments, approproate action plans, and exercises to help improve/control imbalanced patterns.
Gymnastics Shoulder and Hip Flexibility Essentials DavidTilley17
PDF slides to "Essentials of Gymnastics Flexibility" a lecture given by Dr. David Tilley. Topics center on shoulder and hip flexibility to increase performance and reduce injury risk.
A type of manual therapy in which the muscle or the joint is altered and placed in a position of comfort for certain duration after which the pain disappears completely or gets reduced. this slide show explains about the principles, mechanism and Phases of PRT
Controlled use of sensory stimulus.
Specific Motor response
Normalization of muscle tone
Use of Developmental sequences.
Sensorimotor development = from lower to higher level.
Use of activity to demand a purposeful response.
Practice of sensory motor response is necessary for motor learning.
This presentation give an upto date insightful information on balance/postural assessment and key domains of Occupational Therapy during assessment of balance using different scales.
Identify common imbalance patterns and potential causes, learn key assessments, approproate action plans, and exercises to help improve/control imbalanced patterns.
Gymnastics Shoulder and Hip Flexibility Essentials DavidTilley17
PDF slides to "Essentials of Gymnastics Flexibility" a lecture given by Dr. David Tilley. Topics center on shoulder and hip flexibility to increase performance and reduce injury risk.
The World Health Organization has recommended the goal of promotion of Independent Function for programs addressing musculoskeletal pain. Pain sources, functional goals, biomechanical obstacles to recovery and the LASS strategic approach is described.
Muscle monitoring for optimal rehabilitation & sports performancePetri Lehikoinen
How to use MBody muscle monitoring system to optimize knee rehabilitation and sports performance training.
MEDICA Medicine + Sports Conference 12.-13.11.2014.
Evolving Priority in Developing Nations: to Prevent Personal Bias in Social W...inventionjournals
Health remains an important goal for society.‘Health for all’ is the motto of the world health organization. All hospitals spend only on allopathic drugs &modernization despitethe benefits of exercise medicine being well proven Actually, If there is a single remedy which can prevent & treat a host of lifestyle diseases like hypertension, diabetes, cardiac disease,osteoporosis, depression,etc it is only 30 minutes of exercise a day. More so it is free., Probably realizing these benefits there was a move to introduce a holistic exercise Suryanamaskar by the Indian government in year 2015 in all schools. After resistance from few organizations this path breaking decision was unfortunately withdrawn.This paper focuses on the importance of simple, economical health inventions& exercises like Suryanamaskar&the need to remove personal choices & viewpoints from theirintroduction for benefit of all.For large & populous countries like India which can barely afford to spend 3 % of GDP on health, disease prevention by exercise medicine is a good solution.To allow personal bias of a few people to hamper progress of the majority is an alarming & regrettable trend.As is said “one can count the seeds in an apple but not the apples in a seed “Only time will tell the far reaching losses & effects of these myopic & vote bank appeasing decisions.
Strength, Core and Stablity Training for Endurance Athletes. The logic and science behind the need for endurance athletes to get stronger. Exercise examples and workout structure.
3. 10/6/2010 Sharon Sharpe, ScD, ATC
Back Injuries – Incidence
Since January 10, 2010
• Back Pain non-recordable 7
• Back Pain recordable 3
Days Out Alt Duty
– Kitchen 1 4 ?
– Bakery 0
– Packing 1 2
– Sanitation 1 90+
4. 10/6/2010 Sharon Sharpe, ScD, ATC
Causal Factors of Back Pain
• Employee factors (organic)
– Genetics (family History)
– Personal History of previous injury
– Posture
– Muscle imbalances
• Employee factors (performance)
– Ergonomic (technique) errors
• Job Factors
– Prolonged positioning
– Sudden “unprotected” movements
5. 10/6/2010 Sharon Sharpe, ScD, ATC
What goes wrong and Why?
• How is it built?
• How does it work?
• How does it get
injured?
6. 10/6/2010 Sharon Sharpe, ScD, ATC
What does your spine do?
• The base for all
arm/leg activity (“core”)
• Must be both STABLE
and MOBILE
• Each of the 26 joints
contributes to mobility
and stability
• Muscle support is
CRITICAL
8. 10/6/2010 Sharon Sharpe, ScD, ATC
Spine: Like a Tent Pole,
only better (and worse)
• This tent pole is not
straight, and has many
parts – inherently unstable
• Spinal curves allow for
absorption of impact
forces. (Walking, running)
• Not really built for
prolonged positions
9. 10/6/2010 Sharon Sharpe, ScD, ATC
Structure - Bones
Vertebrae
From Anthony CP, Kolthoff NJ: Textbook of anatomy and physiology, ed 9, St. Louis, 1975, Mosby.
Back
Front
Front
Back
10. 10/6/2010 Sharon Sharpe, ScD, ATC
Structure - Joints between bones
Steven M Lobel, M.D. EVMS Dept of PMR
Small movementSmall movement
between any 2between any 2
vertebraevertebrae
There are 26There are 26
jointsjoints……....
Combine forCombine for
Large movements.Large movements.
16. 10/6/2010 Sharon Sharpe, ScD, ATC
Mid Layer –
Trunk Movers
Global Muscles
Inner Layer –
Sensors
Local Muscles
17. 10/6/2010 Sharon Sharpe, ScD, ATC
Local Muscles
–When activated,
position/motion
sensors, not motion
generators.
• How much motion is
occuring between any
2 vertabrae??
• How fast?
18. 10/6/2010 Sharon Sharpe, ScD, ATC
Summarize: a stable spine….
– Stability
• How much motion is occuring
between any 2 vertabrae
when the trunk moves?
– Sensors off
– Sensors on
19. 10/6/2010 Sharon Sharpe, ScD, ATC
Muscle Function Differences
SensorsSensorsTrunk MoversTrunk MoversActivated After
Trunk Movers -
Over activatedOver activated
Sensors – UnderUnder
activatedactivated
Proper activationProper activation
patternpattern
Increased (lessIncreased (less
stable)stable)
Small, safeSmall, safeMotion in local
joint
Trunk MoversTrunk MoversSensorsSensorsActivated First
Past InjuryPast InjuryNever injuredNever injuredPatient History
20. 10/6/2010 Sharon Sharpe, ScD, ATC
Muscle Strength vs Endurance
• Position sensors need to
be ON
– ALL THE TIME, so that
excess movement between
bones can be prevented.
– ENDURANCE
• Trunk Movers need to be
ON
– For stability most of the
time
– Higher level when body
movement is required
– ENDURANCE and
STRENGTH
21. 10/6/2010 Sharon Sharpe, ScD, ATC
Working Example: Posture
• Cause or effect?
– Does the posture cause muscle imbalance or
does muscle imbalance cause poor posture?
25. 10/6/2010 Sharon Sharpe, ScD, ATC
Problem Summary
Employee causal factors
• Prolonged position > muscle fatigue > poor
activation/endurance > poor standing posture >
increased RISK.
• Lack of understanding of the potential
BENEFITS of conditioning and ergo training.
– Pre-shift stretching
– Micro breaks
– Proper work techniques
– Preventive conditioning program
26. 10/6/2010 Sharon Sharpe, ScD, ATC
Recent Evidence
• Bigos et al. Spine, 2009, High quality
controlled trials on preventing episodes of
back problems: systematic literature
review of working-age adults
– Reviewed studies on effects of exercise,
education, lumbar supports, shoe inserts and
programs to reduce lifted loads
– 17 high quality studies
– ONLY EXERCISE significantly reduced
episodes of back problems
27. 10/6/2010 Sharon Sharpe, ScD, ATC
LiveWell Job Specific conditioning
program
Pre-shift stretches
• Wellness based
exercise programs
28. 10/6/2010 Sharon Sharpe, ScD, ATC
Ongoing Ergonomic Training
X
• Job rotation
• Micro breaks
• Correct lifting
• Proper job technique
• Aug. 2010 Training
•Still have back injuries
29. 10/6/2010 Sharon Sharpe, ScD, ATC
Potential for Risk Reduction
• Evidence shows: back pain incidence could
be prevented with exercise.
• Exercise which impacts…..
Proper muscle activation timing
Hamstring and Hip Flexor flexibility
Abdominal and sensor muscle endurance
30. 10/6/2010 Sharon Sharpe, ScD, ATC
Fix it
1. Reduce Lordosis (restore muscle balance)
Stretch Tight Muscles (Hip Flexors, quads, Hams, calves)
Strengthen weakened muscles (Hip Extensors)
2. Learn muscle control
Activate local sensors FIRST
3. Work on muscle endurance of these systems
4. Report back pain EARLY
31. 10/6/2010 Sharon Sharpe, ScD, ATC
Wellness Based Programs
• Conditioning for all employees
• Preventive Stretching and Exercise, both initial
injury and RE injury.
• In addition to the Core 6 pre-shift exercises
36. 10/6/2010 Sharon Sharpe, ScD, ATC
Learning How to Activate
Draw in Exercise – Activates Inner Abs AND
Position Sensors
Focus on:
Pull belly button DOWN toward the spine
while abs are RELAXED.
37. 10/6/2010 Sharon Sharpe, ScD, ATC
Spine Control Strengthening
Progression - example
• Draw ins
• Pelvic Tilts
• Maintain Pelvic Tilt, raise 1 arm over head
– Both arms
• Maintain Pelvic Tilt, lift single leg bent
– Single leg straight
– “Cycle” legs
• Maintain Pelvic Tilt, Hands and Knees
progression
38. 10/6/2010 Sharon Sharpe, ScD, ATC
Resources Needed:
• Space
• Mats
– 1 yoga mat for each team member OR 1
large floor mat
• Need to be cleaned after each use.
• Committed Leaders
– Trained in the exercises
– Give immediate, ONGOING feedback and
coaching on exercises
• Buy-in, ATTENDANCE/participation by
employees
39. 10/6/2010 Sharon Sharpe, ScD, ATC
Resources Needed
• Supervision/Training
– Initial Training for Leaders
– Ongoing training for Leaders
– Coaching/feedback with teams
– Outcomes measures collected/analyzed
• Ability to control pelvis
• Measures of comfort/discomfort (1 -10)
• Days missed
• Days limited/alternative duty
• Days full duty but with pain
• Others??
40. 10/6/2010 Sharon Sharpe, ScD, ATC
• Time
– Training of Leaders – 2 sessions x 45 min
– Initial Presentation to teams – 30 min
– Time for teams to exercise – 15 min
• Daily - optimal
• 3x/week - minimal
– Ongoing supervision/coaching -1-2 hrs/wk
• Sharon > Leaders
• Sharon > Teams
Resources Needed
41. 10/6/2010 Sharon Sharpe, ScD, ATC
Summary
• Back Injuries are a problem
• Spine needs both stability and mobility
• Exercise programs reduce incidence of LBP
– Stretch tight muscles, strengthen weak muscles
– Prevent excessive local joint motion
• Activate small sensors (“draw in”) BEFORE activating LARGE
MOVERS.
– Control Pelvis (muscle balance)
• Program must have proper resources to be
successful.
43. 10/6/2010 Sharon Sharpe, ScD, ATC
Reference Materials
Bigos, SJ et al. High-quality controlled trials on preventing episodes of back
problems: systematic literature review in working-age adults. Spine Journal.
2009 Feb;9(2):147-68.
Herzog,W., 2000. The Mechanical, Neuromuscular, and Physiologic Effects
Produced by Spinal Manipulation. In: Herzog,W. (Ed.), Clinical Biomechanics of
Spinal Manipulation, pp. 191-207. Churchill Livingstone, Philadelphia.
Margo, M. http://ebm.bmj.com/content/14/4/117
Mendoza, G. “Diagnosis and Treatment in the Lumbar Spine” Powerpoint
presentation, Boston University, Sargent College of Health and Rehabilitation
Science. Feb 2005.