Editor's Note: I forwarded the 12 questions SafetyXChange members submitted to Michael with the following note: “It wouldn't be fair of us to expect you to answer more than half of these.” But Michael went above and beyond the call and answered all 12. So, thank you Michael. And thank you, members, for your questions.
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USING STRETCH BREAKS TO PREVENT MSIs

QUESTION

Our company set up stretch breaks for its employees several years ago. Many positions have repetitive movements and this was part of an initiative to prevent MSI's, such as carpal tunnel. Management is now questioning the value of these breaks and would like to terminate them to allow for increased productivity. They do not feel that the employees are taking them seriously and feel it costs production. How can I defend the program? Are there any Canadian statistics available?

Name withheld

ANSWER

Check out some of the information about stretching below (in the fourth question). The bottom line is that both sides likely have some merit. Stretching, if done in an ambiguous and non-coordinated way can be a waste. If however, planned movements based on work tasks/functions are performed regularly and with correct technique, they are VERY, VERY VALUABLE. The benefits of stretching are numerous – but on the job one of the most important benefits is increasing the local circulation to the tissues. Beyond that, it is flexibility (the end result of proper stretching) that is most important. Probably the most effective thing you can do is to go back and “make the case” looking at injury logs and severity calculations pre and post stretching.

Unfortunately I'm not aware of any statistics that are easily available in Canada. I will keep your information on file and should I come across anything worthwhile I'll happily send it. Good luck.

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 EXPERIENCE WITH UTILITIES

QUESTION

I was wondering: which utilities has Mr. Eisenhart worked with and what were his results? What exactly is a Risk Scoring Protocol?

Name withheld

ANSWER

I'm not 100% sure if our clients would be OK with me using them by name so I won't. About the best I can do is to tell you that if you looked at the top 10 utilities in America on the Fortune 500 list we work with 3 of them all located in the Northeastern part of the US. Notes on the risk scoring protocol are listed further down. I would, of course, be happy to talk further as needed; I can be emailed at meisenhart@pro-activity.com. Also some of the more important results are listed down the page.

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POLICE OFFICERS & FIREFIGHTERS

QUESTION

Many of my clients are police departments. Their officers spend most of their time in very sedentary activity--sitting in a car, standing talking to citizens, etc. Then, after several hours of inaction, with no opportunity for warm-up or stretching, they must suddenly burst into activity, running, climbing, jumping, wrestling, etc. You can imagine the amount of sprain and strain injuries. Firefighters have a similar situation, though their non-response time is generally more physically active than that of police officers.

I know that overall flexibility programs can be of benefit, but do you have any suggestions for these specific situations?

C. Alec MacLean
EH & S Specialist
Du-All Safety

ANSWER

This type of work can be quite complex to deal with and overall – conditioning is extremely important. Many police and fire departments have minimum physical standards on entering but get quite lax as time progresses. My gut says that similar to military operations, maintaining policies for minimal physical abilities based on essential job functions with annual testing would probably be the most effective means available, however it's likely a very tense issue to pursue. As far as programming goes – work-conditioning programs (I can certainly provide more detail as needed) can be one of the most effective means at ensuring the abilities match the requirements. This allows a regular check-point against steady norms and then conditioning as appropriate.

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MORE ON THE EFFECTIVENESS OF STRETCHING PROGRAMS

QUESTION

I've heard many opinions on the effectiveness of stretching programs to prevent soft tissue injuries. What does the latest scientific research show?

Josh DeBroux
Environmental, Health & Safety Director
Northern Star Industries

ANSWER

Here's the most important take home message: people who are flexible have fewer injuries. Not necessarily people who stretch – people who have good flexibility. Now, I realize it seems like semantics but there's a fine line: stretching is about the best way to gain flexibility – but it's the end result that helps, not the act of stretching per se.

One catch – it's important to understand that the act of stretching does have A LOT of benefits, such as increasing local circulation. So in the case that there are several repetitive tasks – increasing circulation by stretching can be quite effective. One of the best research studies on this was done to reduce carpal tunnel symptoms – AND IT WORKED!!

It's important not to “just stretch” but to pick up on the specific movements that need to be done to counteract forces and risks of the job tasks and spend the time doing those specific movements.
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SCORING PROTOCOL

QUESTION

We operate a large grocery warehouse and encounter large number incidents involving of strains and sprains. We do have prevention programs in place to deal with this recurring problem but it seems to never go away. I was wondering if the scoring protocol was available for the asking. If it is, please send me a copy to my attention, at your convenience. Thank you for your time and consideration.

Robert Booth

ANSWER

I would love to share our protocol. Unfortunately my partners would string me up!! Our risk scoring protocol is proprietary and so I can't share the specifics – but the idea is quite simple: healthy, well functioning, well-balance people tend to get injured less and when they do, it's less severe; but what exactly does healthy, well-functioning and well-balanced mean? We take a person through an assessment that looks at all areas of risk and compares them to norms for their age and gender. At the personal level – this gives the person an objective way to understand where they're at and what they need to work on to lower their risk. At the business and/or organizational level – this gives guidance on what areas should be focused on. For example, it doesn't make sense to work on flexibility (stretch programs) if it's not a problem. We've had great success in using this methodology.

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SHOULDER SPRAINS & STRAINS

QUESTION

Please share the evidence vs the gimmicks for prevention of sprain/strain injuries, specifically of shoulder sprain/strain injuries.

Ralph D. Farr, CSP, CHMM
TVA Safety Operations

ANSWER

Shoulder injuries are very common and (as is well documented) high force work, especially prolonged overhead positioning accelerates the breakdown process. One of the more important mechanisms to understand in shoulder injuries is the finely tuned balance between the deltoid muscles and the rotator cuff muscles. One group lifts the humerus (arm-bone) and the other group “seats” the two bones together for stability. The major take home point here is that the two groups have to be balanced and working together synchronously. As you work in hands above shoulder (and even worse elbow above shoulder) position, the balance between the muscle groups gets worse and worse and the humerus begins to pinch (called impinge) the soft tissues. This is often noted with a “catching” as the arm moves above the head and sometimes goes with a clicking sound. The more these tendons rub against bones the more friction, the more irritation, the more inflammation and the more pain and most unfortunately the greater likelihood of more serious breakdown.

By far the best way to prevent sprains and strains (shoulder, back and just about everywhere else) is to have strong, flexible tissues with good balanced strength throughout. I realize this sounds very general – but truthfully that's the gold standard – people who have greater flexibility get injured less often. People who have strong muscles (AND ARE FLEXIBLE) get injured less often. The evidence is resounding here – balanced bodies (strong AND flexible). Combine this with good ergonomics (strategies to lower force, lower reps, control ambient temperatures, and lower duration) and you have a home run. Lots of gadgets exist that claim to be ergonomically sound and to reduce ergonomic stressors but I think it's important to understand how specifically it's going to reduce one of the risks that you face in your particular organization. With that in mind, it's probably most important to understand what the highest risk tasks are and then work from there.

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MSIs & OLDER WORKERS

QUESTION

We work in the construction industry. We are faced with an ageing workforce and a high frequency of musculoskeletal injuries. Can you offer any insights ,success stories or strategies to help us?

John Mathis
Manager of ES&H, BSII

ANSWER

With ageing comes (among others) decreased flexibility, decreased strength, slower reaction time and slower healing/recovery – these all sound bad. It CAN also mean: more life experience, better understanding of personal limitations and the wisdom to practice safe behaviors – so maybe not all bad. From the MSD standpoint (accounting for 35-50% of injuries in most cases) most companies cannot afford to have some mechanism for dealing with this and reactive care has not shown enough to be relied on solely.

The stats that we've seen sometimes compound the problem – not only is the workforce ageing, but there seem to be fewer young-workers entering the field to back-fill. To me this screams  tip of the iceberg. Injury prevention initiatives, when done right, can yield significant results. These can be measured in better safety records, less severity of injuries, cost-savings, greater availability of workers and increased productivity. Every company and industry are different, but the common factor is the human body – it functions in patterns, responds in patterns and breaks down in patterns – change those patterns and the problem can be controlled.

I would love to go into the successes that we've had in detail, but at risk of sounding like an infomercial let me just give some of the high points: In dealing with a population of several thousand in 50+ locations we've seen a drop in lost time due to MSD of 20% and a drop of 15% in average medical costs per case. Although our system is used in conjunction with more traditional safety measures (which we obviously cannot assume credit for) we've seen injury incidence and severity at lows year to date. The insights and successes are too many to list – I would be delighted to chat in more detail off-line or in San Diego (Nov 6/7) or if there's enough interest maybe a webcast for the group – it's our passion and our work!

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GETTING INDIVIDUALS TO BUY IN

QUESTION

I have been in the safety industry for years. I was around when the word ergonomics was classified as another scientific tool for safety folks and nobody really new what the word meant. It has been a long time since then and after putting many programs in place and taking schooling to understand all he principles involved I have come to a conclusion: Ergonomics is a great tool to prevent injuries but so much of this science is based on an individual's participation. One of the major factors in making this work is an individual's personal physical condition. I am sure you must know that trying to change a person's attitude is one thing but steering them in a direction to keep them fit is totally different.

Do you have any tips to help me with this type of initiative?

Ross Bellwood CRSP
Utilities Systems Operations
Safety Systems Supervisor

ANSWER

Great insights, Ross – thanks for asking the question – I believe you're very near the mark. MSD prevention is a balance between a lowest-possible-risk (ergonomically sound) environment and optimal human performance (i.e., “HEALTHY PEOPLE”). Too much of one in the absence of the other and there still may be risks to great to overcome. Once a person truly believes they can control their condition and understands that they have the resources to do so – it's really quite easy. In a sentence – the infrastructure for success is far more important than the message of the moment.

Often times, at the business level, the physical conditioning component gets lost in the mix – we hear it all the time: “it's the cost of doing business, it's too personal, etc…..” Generally speaking most business leaders understand that “human-capital” is critical to operational success and therefore stakeholder value. High-turnover, high-injury rates and poor productivity can absolutely kill an organization. However some do not see the link between physical condition and human-capital and this (in my extremely biased opinion) is a major strategic misstep.  This is not to sound distant to the obvious “humanistic” benefits for those that work around us (and ourselves); we sincerely want every person to be safe AND healthy – but rather to point out where you need to be if you really want to gain traction.

The way I've seen this type of initiative work best on the long term (sustainable, bottom-line changing results) is to make sure it permeates the organization – to make it part of the strategic plan – a comprehensive initiative with important goals that senior leaders embrace - only then will it get the championing it deserves. Only then can enough effort and time be given to fostering (removing barriers), tracking (data analysis) and WIDELY-REPORTING (lots and lots of communication at all levels) the success stories enough to get buy-in throughout the organization. There's significant inertia indeed – but it can be done – and the impact is impressive.
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RETURN TO WORK

QUESTION

While I realize that Michael is not a physiatrist he may be able to answer this question, which is asked on a personal (MVA- Car ‘accident') and professional level (RTW – return to work).  

The question: Without a baseline physical how is it possible for a physiatrist to diagnose maximum medical recovery? Specifically, on a return to work basis, all HR directors rely on this factor to base a full return to work status. However, I have observed individuals who are not fully capable of returning to their previous work duties because their maximum medical recovery only meant that they had reached their full injury recovery potential. Boiling this down … what tool or position does HR need for an employee to return to work? (reinjury status?)

Josée M. Morin
Director Health and Safety
Strategic Employee Testing Corporation

ANSWER

Making a RTW determination can be quite difficult and, as you note, I am not a physiatrist. However, we are often involved in making this determination by supplying the critical information so I'll hopefully get you close enough. Most of the recent work that has been done in this area relates to Essential Job Function reports and although I am not familiar with the statutes in Canada, this type of report documents, in great detail the pass/fail requirements for a person to return to work, job class by job class.

For example, a physical therapist (or other qualified evaluator) goes on-site and observes the work, takes measurements of force, strain, repetitions, duration, etc and presents the information to leaders within the organization for comment (generally safety, medical, employee representation and supervision). Once all parties agree that it is an accurate representation of the work it is kept on file (similar to a physical job description). When the return to work decision is to be made the injured party must perform these duties in as closely a simulated environment as possible to demonstrate the physical abilities required. Quite simple really – if a person cannot demonstrate the ability consistently on testing – they are not approved.

 In The States we have the Americans with Disabilities Act that mandates reasonable accommodations be made when applicable so retesting may be done with those in place. (Editor's Note: The same rules apply in Canada under provincial Human Rights laws). Same rules apply pass or fail.  By objectifying the requirements, it makes the RTW call more realistic. Not perfect by any means (there are other data points that certainly are accounted for) – but generally more accurate. In an ideal world HR has such a report for every job class.

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THE SUFFERING OF AN INJURY VICTIM

QUESTION

I have been told by my physiotherapist that I have carpal tunnel and by my doctor, but when sent to the specialist and put through the electronic tests, he said it is not that severe. He said it is carpal but not in need of surgery. My physiotherapist feels differently. I prefer not to have the surgery, but know that the pain is getting worse not better. I have a very high pain tolerance and don't know if that impacted the tests.  Meanwhile, I have gone for physio for 12 weeks now and I had 10 days off from it as I went on vacation to Florida. My arms and wrists and hands hurt more from not using them then when I was still working and using them every day. Right now, the pain is almost excruciating. I have pain in the centre of my palms, shooting up my arm and into my thumbs and my elbows and up through my shoulders and neck.

I thought rest is the cure for all!

Lynne Bard, BA (Honours), C.H.R.P.
Principal/Senior Consultant
Beyond Rewards

ANSWER

Given the specificity of this question and the present symptoms – I would likely need to talk a bit further to really have enough information to work with. I'm more than happy to. I can be emailed at meisenhart@pro-activity.com and we can set up a time to talk further.

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DO BACK SUPPORT BELTS HELP?

QUESTION

I work at a large distribution Center and am Chairman of the Safety Committee. My question is: Do Back Support belt prevent injuries or not? NIOSH says they have no evidence that they either help or hurt.

A study in JAMA, (Editor's Note: The Journal of the American Medical Association, one of the world's most respected medical journals) December 6, 2000, Vol 284. No. 21, by James T. Wassell, Ph.D., Lytt I. Gardner, Ph.D., Douglas P. Landsittel, Ph.D., Janet J. Johnston, Ph.D. and Janet M. Johnston, Ph.D., also says that there is no indication that these help.Your opinion would be appreciated.

R.Cecire

ANSWER

This is an excellent question and one that, unfortunately, even the most reputable researchers have not been able to totally wrap their arms around (JAMA Study). The prevailing theory behind back supports is that by adding even/balanced pressure around the abdomen you will increase the internal pressure around the spine and increase the stability. In addition back supports are proposed to have the effect of changing the muscle activity requirements in lifting situations (i.e. let the support do the work) and increasing the “feel” (a.k.a. proprioception) of where the body is in space allowing for better refinements in motor control. There is also a psychological component that goes along with it that may be good or bad “the brace will protect me”: in the previously injured population this might be good to allow greater function with less fear (a big problem with back injuries) in the uninjured population this might not be so good if it means more risk-taking behaviors.

There have been several studies on this topic, some that support the use (UCLA School of Public Health & The Home Depot 1996) others that have shown minimal effect (U of Oklahoma 1994; CDC/NIOSH 2000). All in all, the support of their preventative effect is not great enough and so we typically recommend against them for wide-scale preventative usage.

It has been well documented that after sustaining an injury to the back there is a lag in the muscle timing (for a fairly long time) so if a person is returning from an acute injury an external support may be a good TEMPORARY option until the area is strong enough and stable enough to handle the work demands. Generally I would favor a weaning model – as the body reconditions to the work environment, use less and less until completely gone.

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RECOVERING FROM A BACK INJURY

QUESTION

As I am sure Mr. Eisenhart knows, back injuries plague the gas and electric utility industry. We have a number of people recovering from back injuries. Can he recommend a general exercise program for back injury recovery? I am sure it will also have preventive aspects as well. Thanks.

Michael F. McNeil
Area Manager
We Energies
Milwaukee, WI

ANSWER

Our observation over the years has been consistent with Mr. McNeil's: back injuries (especially lower back as well as knees and shoulders) tend to be an exceptionally common MSD problem area for the utilities that we've consulted with. Unfortunately, there is no universal exercise plan that I am confident enough in to recommend across the board. That said, much research has shown the benefits of exercise, even fairly aggressive exercise in back injury recovery. In several cases the clinical outcome is as good, or better than surgical intervention.

Speaking generally, a low back rehab (or prevention) program generally includes aerobic exercise (to improve blood flow and oxygen efficiency), flexibility (especially of the trunk, hips and hamstrings), strength (muscle endurance more so than classic weight training), and stability & timing (the back loses normal reaction timing after injury) of postural stabilizers and core abdomen. It's important to consider one of the more recent developments in the conservative care literature: a classification system for back injuries – since different underlying causes respond to different treatment. This vantage forces a change in dealing with back injuries since we now know that every back strain is not the same in its presentation or response to care. This for example is why some folks really do well with stretching (tissue tightness) whereas others really need “core-stability” (strength of the lower back and deep abdomen) and others yet have great results from joint mobilization/manipulation. If an injury already exists (or a significant history of one) exercise should of course be geared to the specific underlying cause.

Anecdotally, our observations have been that the vast majority of injuries are in folks who are not flexible, do not have good balance between the low back and the deep-abdomen and are often somewhat heavy for their frame (elevated BMI). If this description is consistent – the exercise framework above will serve quite well, however the best results have been achieved with a more customized plan to meet the specific needs identified.

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