how to implement a best practice stretch program

2. Stretching the Limits
at Work
Presented by:
Denise Dumont-Bernier, PT

3. Workplace Stretch Programs
 Many companies have implemented
workplace stretch programs in an attempt
to prevent sprain & strain injuries
 In this session, we will explore the
efficacy and cost effectiveness of these
programs and the literature which exists
 We will also discuss the process of implementing a
successful program

4. Overview
 Low Back Pain, J Occup Med 1990
● Ave cost/claim: $6807
● Indemnity costs: 67.2%
● Medical Costs: 31.5%
 Sprain and strain injuries
 Costs:
● $45-54 billion in costs
● 7 Million physician office visits
● 1 Million people took time from
work in 1999
 Ergonomics
● Work, Worker, Worksite
 Injury Prevention Efforts
Productivit
y
Safety
Labor
Management
Aging
Voluntary
Jobs
ErgoInjuries

5. Unnecessary Strain
Can Be Caused by:
Excessive Reaching
Prolonged Static Positions
Awkward Postures
Repetitive Motions
Bending and Twisting
Faulty Ergonomic Workstations

6. Distribution by Hour of Shift
12.30%
10.20%
10.10%
8.80%
7.30%
6.90%
6.40%
5.60%
7.80%
0% 2% 4% 6% 8% 10% 12% 14%
1st
3rd
5th
7th
9th

7. Nature of Injury
50.90%
8.80%
8.30%
7.70%
3.20%
0.02
1.90%
0% 10% 20% 30% 40% 50% 60%
Sprains, Strains
Cut, Laceration
Contusion, Bruise
Fracture
Multiple Injuries
Hernia Rupture
Nervous System
East

8. What is Flexibility?
 Elasticity and extensibility of
muscle and connective tissue
 Range of movement possible
around a specific joint or
series of joints
 Prevents injury when a
sudden high stress is placed
on the muscle

9. Physiology of Stretching-
(Vocabulary & terms)
Flexibility
● The change in length of a muscle tendon unit brought
about by changes in the viscoelastic properties
Stretching
● Increases the distance tissues can
stretch as well as the force required
to tear the muscle tendon unit
● Prevents Injury-
● Athletes

10. Why Stretch?
Regular stretching will:
 Enhance blood flow and nutrition
to muscle and tendons
 Reduce muscle tension
 Improve coordination
 Improve mobility
 Prevent muscle strain
 Promote faster recovery... better
conditioned muscles heal more rapidly

11. Efficacy Studies of Workplace
Stretching Programs
Pharmaceutical 28 Manufacturing Employees
Genaidy, Ergonomics, (1994)
6 week, 16 subjects, 12 controls
Trunk ROM, dynamic & static strength,
flexibility measured
Increased flexibility measurements
after 2 months of stretching
Greatest in back flexibility and shoulder rotation
Improved perception of physical conditioning,
self-worth, attractiveness and strength

12. Efficacy Studies of Workplace
Stretching Programs
Municipal Firefighters, Hilyer, et. al.,J Occup Med (1990)
 6 months, 469 FFs, aged 24-63, 251 subjects, 218 controls
 Evaluated the incidence, cost and
severity in stretchers vs. non-stretchers
 At 6 Months- participants were significantly
more flexible (LB, Hamstrings & Shoulders)
 At 2 Years-
● no significant difference in incidence of injury (48 vs. 52)
● Lost time costs for stretchers were significantly less than non-stretchers
($45.6K vs. $147.6K)
● Medical costs for stretchers were not significantly different ($39.8K vs.
$87.6K)
● Worker absences and loss time compensation are greater costs than
medial

13. Efficacy Studies of Workplace
Stretching Programs
Manual Handling Workers, Moore, AAOHN J (1998)
 60 employees, aged 23-59, pre/post test design
 Looked at Strength in conjunction with Flexibility
 Flexibility improved in the group who performed
stretches along with strengthening but not
with those who performed strengthening alone
 LB flexibility did not improve in group
who did not stretch
 Static and dynamic strength improved
more in the group who stretched than
with strength training alone*

14. When to Stretch?
 Before or after physical
activity
 Before start of day
 After sitting or standing for
prolonged periods
 When you feel stiff
 When performing repetitive
work
 During long car ride

15. Who Should Stretch?
 Every one regardless of age or flexibility
 4% of Americans are considered physically fit
 80% experience lower back pain
 You do not need to have athletic skills to take
part in stretching program
 The same techniques apply to everyone
! Someone who has had a recent physical problem
or pre-existing condition should consult a health
care professional to help customize stretches

16. Types of Stretching
Static
(hold stretch, simple to perform)
Ballistic
(can cause injury and should be avoided)
PNF
(contract muscle for 20 seconds, relax and
stretch)
Symmetry in ROM is essential for preventing
injury

17. How to Stretch Properly
Static Stretch is scientifically and medically
supported. It is safe and effective.
 Slow, gentle, static stretch
 Force applied is enough to place tension, not cause
pain or injure structures
 Hold for 10-30 seconds
 Breathe slowly and regularly
 Use proper posture and techniques

18. How NOT to Stretch
Do NOT bounce during a stretch
Do NOT cause pain

19. Best time to stretch
Sedentary Work
● Break up static postures
Repetitive Work
● Rest tired muscles
● Enhance blood flow
Manual, heavier work
● Prevent strain
Frequency of stretching
● Depends on type of work and
ability to break

20. Implementing a Successful Warm-
Up and Stretching Program

21. Criteria for a Successful Program
 A preliminary warm up
 Designed by job demands or area most susceptible to injury
 Stretch regularly, 2-3 days/week minimum
 Perform stretches correctly
● Static or PNF stretches
● Hold stretch 10-30 seconds
● 3-4 repetitions per muscle group
● Stretch bilaterally, emphasize tight muscles
 Intensity to position of mild discomfort
 Trained peers should lead and monitor sessions
 Compliance should be monitored
 Company commitment to work time and program overhead costs
 Stretch at appropriate work times during day

22. Planning
 Planning is most important- safety culture
 Details of implementation process
● Specific to your company needs
● Mandatory vs. Voluntary?
● Frequency of stretches during the shift
● Peer training? Incentives?
● Management endorsement and participation?
● Measurement of success?
 Predict the barriers and how they will be addressed
● Employee resistance?
● Shift schedules
● Job demands
● Pre-existing medical problems?
● Injuries claimed as a result of stretching

23. The Program
Warm Up
Stretches
Strengthening
Designed by job demands or
area most susceptible to injury
Baseline Measurements
Symptom Surveys

24. Flexibility Measurements
 Sit and Reach
 Shoulder Rotation  Trunk Rotation

25. Training
Company size and number of employees
Peer Training needed?
Participant Training
Management Training
Posters/ Materials/Promotion

26. Program Success depends on:
Dedicated volunteers to be team leaders
Management demonstrates their endorsement of
the program with regular participation and
support
Regular follow through
Customized to departmental needs

27.  Each participant learns exercises precisely so the
stretches can be carried over at any time of the day
 Each department implements program according to
individual needs
 On site availability of
clinicians and Health
and Safety committee
members to
guide program
Program Goals

28. Value of Stretch Programs
Decreased Worker’s
Compensation Costs
Decreased Injuries
Reduced Severity of
Injury
Increased Productivity
Improved Employee Morale

29. Summary
 Basic science demonstrates that stretching increases
viscolelastic properties which leads to reduction in
sprain & strain injuries
 However, studies focused on working
populations are equivocal with
demonstrating cost reductions
 Stretch programs can be valuable
when implemented properly
 Stretching is only one component
of injury prevention

30. Thank You
QUESTIONS?