P

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revent disability
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estore movement
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mprove function
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ecrease pain
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nergize life
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D.
E.Wellness Systems, Inc.
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ErgonomicsFrom Another Perspective Background
and case histories

• Petti Redding, OTR
• P.R.I.D.E. Wellness Systems, Inc.

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RSI statistics

• OSHA studies show that
• RSIs account for 34 of all lost workdays due to
  injury
• RSIs claim 1 out of every 3 spent for Workers
  Comp
• Total annual RSI costs exceed 60 billion
• RSIs are the fastest growing workplace injuries
  in the U.S.
• RSI's result in the highest median days away from
  work
• RSI's have the highest average Workers Comp
  cost-per-case from 14,000 to 29,000

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Lost Work Days Per RSI(Median of Days)

• Carpal Tunnel Syndrome 27 days
• Repetitive Motion Injury 19 days
• Shoulder 16 days
• Upper Arm 15 days
• MSD 14 days
• Wrist 14 days
• Tendonitis 14 days
• Tenosynovitis 14 days
• Hand Fingers 10 days
• Hand Wrist 11 days
• Bursitis 7 days
• Bureau of Labor Statistics - 2006

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Primary problems of RSIs

• Pain (burning, sharp, dull, achy, etc.)
• Parasthesia (numbness and tingling)
• Weakness
• Fatigue of body part
• Can we find a common link?

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Muscles the lowest common denominator of injury
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The concept of structural integrity of the
musculoskeletal system
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Structural integrity

• Axis line
• Ear
• shoulder-
• hip-
• knee-
• ankle

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Unbalanced Typical, dysfunctional postures
leading to musculo-skeletal pain, vertebral
dysfunction, arthritic conditions, etc.
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Root cause of dysfunctionMuscles

• Bones are pulled out of alignment
• by muscles that are generally
• 1. Weak and overstretched on 1 side
• 2. Tight stronger on the opposite side

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Primary cause of RSI Pain- the trigger point

• Mechanisms of injury include muscle that work
  overstretched, overshortened or overloaded
• Based on energy crisis and dysfunctional motor
  endplates
• Most often overlooked in the diagnostic process
  by the medical community- Why?

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Muscle anatomy and function
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A different view of a sarcomere
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At the cellular levelthe sliding mechanism
theory
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Muscle sarcomere in action
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Dysfunctional musclesthe trigger point

• Muscles contracting in over-stretched,
  over-shortened or over-worked positions
• Muscles holding a static, isometric contraction
  for extended periods of time
• lead to a in blood flow and
  resulting energy crisis

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Trigger Point Formation

• 1st Actin and myosin proteins fail to disconnect
  in multiple sarcomeres
• 2nd Leading to increased tension throughout the
  entire muscle

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Relationship of trigger points and nerve
entrapment

• Tight muscles
• Lack of
• nerve glide
• Nerve compression
• Nerve damage

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Scalenes trigger point and referred pain pattern
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Gluteus minimus trigger point and referred pain
pattern
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Infraspinatus trigger point and referred pain
pattern
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Trigger point deactivation

• Locate trigger point
• Apply firm, moderate pressure
• Hold about a minute
• Stretch muscle afterward
• Repeat 6-8 times a day
• Usually takes 1 day to 1-2 weeks
• (depending how long its been there)

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But what does that have to do with posture and
lack of structural integrity?
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Primary Cause of Structural Dysfunction

• Behaviors lead to
• non-balanced, structurally misaligned postures
  lead to
• muscles statically overstretched and
  overworked which leads to
• 1. Pain
• 2. Nerve entrapments
• 3. Misaligned joints that contribute
• heavily to degenerative joint
  disease (Osteoarthritis)

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Postural dysfunction

• Muscles adapt to the position that
• it is put in over time
• Muscles dictate the
• position of the skeleton
• BUT
• Muscles can be re-trained,
• shortened, lengthened, strengthened
• To regain structural integrity

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Case Histories Early Intervention

• All employees achieved these results ON THEIR OWN
• No employee was treated. There were no
  modalities, or physical therapy interventions
• No employee visited a physician
• No employee became an OSHA recordable injury or
  W/C injury.

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Sample techniques

• Bumper stretch
• Noodle stretch
• Cross over girlie knee stretch
• Legs up wall stretch
• Sit on hand stretch
• Supermans
• (Petti- play the video!)

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Sebastian B. (30s)Engineer
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Kari H (30s)HR rep
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Aida B. (50s)IT Specialist (45 hrs/week)
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Deb P. (50s)IT Specialist 40-45 hrs/week
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Additional comments

• I have been seeing a podiatrist for heel pain
  for several
• months. I have been to see the doctor 3 times
  with only
• sight relief. He said if the last stronger
  prescription
• Medication didn't work he would inject the heel.
  Petti was
• checking up on me and the neck issue last week. I
  said my
• neck was fine, but I was going to the doctor to
  have my foot
• injected. She got a racket ball and showed me how
  to find
• another trigger point in the back of my calf that
  is causing
• the heel problem. I felt relied immediately.
  After less that a
• week I have less pain than after 6 weeks of
  medication! I
• think I can completely resolve the heel issue if
  I just keep
• using the ball.

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My Point

• Ergonomics is not just about the stuff
• Anthropometric data is not the total picture
• The biggest risk factors for injury lie in the
  PERSON, not the task (in terms of RSIs)
• Put some effort into helping your workforce fix
  their bodies youll be amazed at the results

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Questions?

• Thank you
• Petti Redding, OTR