Our most critical VALUE… is we teach workplaces several new, unique, effective approaches to MSD elimination. Many traditional approaches to ‘ergonomics’ and prevention just DO NOT WORK.
There are pioneering new understandings about MSD of the neck-arm and lower back that we exploit to re-define the best practices for preventing and reversing MSD. We are the cutting edge of this effort !
> Repetitive motion is NOT the issue. Repetitive motion, by itself, does not generally cause MSD. Tendinitis is not the result of friction wear damage. MSD is a (key!) NUTRIENT PATHWAY DISORDER. Hardworking musculoskeletal structures consume fuel (sugars, oxygen, nutrients) delivered by blood supply. Tissues burn the fuel, producing acid wastes. Circulation absorbs and removes these wastes. BUT muscle contraction, tendon tension, joint compression all create pressures that exceed perfusion pressures that feed and cleanse working tissues. This causes metabolic wastes to become trapped in tissues… acid irritation… pain… inflammation! It is a blood supply issue. Prevention… restore blood supply to working tissues throughout the work day. We have several tactics for that.
> Posture Loading is the big risk. Sustained sitting, sustained standing, forward head slouching, sustained grip, sustained shoulder elevation. Also: PERFECT POSTURE IS BAD FOR YOU… if you sustain it too long. Too many ‘ergonomists’ will dictate a chair setup and computer setup that places person in ‘perfect’ posture, only to result in pain. If posture is perfect, there is still weight-bearing compression to joints and disc, plus supportive muscle contraction and tendon tension to maintain that posture. The body needs movement to cyclically load-unload tissues to ‘sponge’ them to enable them to mechanically flush with fluids. Posture VARIETY is far more important and healthy than ‘perfect’ posture. I don’t care how someone sets up their chair, as long as the slightly change the height (by only 2″) or tilt every half hour, to re-distribute loading to other structures. Switching between sit versus stand works great! Switch between computer mouse versus trackball hourly to re-distribute loading between digit flexors versus extensors, for variety of loading. Flip keyboard legs in versus out hourly to slightly alter wrist loading. So simple, cheap, effective.
> Forward head posture creates a degree of thoracic outlet-inlet loading... not by much but enough to compress low-pressure lymphatics and veins proximally, allowing fluid backup and stasis distally and within the brachial plexus (altered neurodynamics). This risks neurovascular entrapments such at carpal tunnel, radial tunnel, cubital tunnel, Guyon’s canal, pronator… complicating or mimicing other MSD’s such as tennis elbow, golfer’s elbow, deQuervains. FHP is a major risk factor for a variety of UE MSD’s. Teaching and motivating people to “be an inch taller” (my favorite PT advice) greatly reduces MSD risks.
> Upper extremity support on desk surface… seemingly simple and often overlooked, or even discouraged by outdated ergonomists… adds to forward head posture risks. The upper extremities ‘hang’ from the neck by the neck muscles, adding posture load. Resting arms on padded desk surface greatly reduces this. Gel pad in front of keyboard and mouse allows such support and reduces neck and thoracic outlet loading.
> Lifting is NOT the primary cause of low back injury. Injury usually occurs during lifting to a back that is already compromised and worn. it is a gradual disease process, painless until a final load overcomes what remains of the back structures. Bending; sitting; tight hamstrings; age changes to disc, then joints, then muscles all gradually wear the structures… until a light load collapses something. Posture variety, task variety, micro-stretches that address disc changes and hamstring mechanics can reverse many of these risks, as can after work recovery stretches that reverse degenerative changes in the spine. Lifting ergonomics (wt, frequency, how low, how high, how far away, lift with twist, grip efficiency) are important… but… worker behavior (body mechanics techniques) are equally important.
> BEST PREVENTION TACTICS… 1. work task variety by rotating between two or more job tasks often (see mouse and keyboard tricks mentions above)… 2. frequently switching between sitting versus standing (check out the Vari Desk for computer desks)… 3. hourly Micro-Stretches to certain key muscle-tendon units. Yes, this DOES WORK, especially where ergonomics is stressful but cannot be fixed. See our separate essay on this elsewhere on this site. Also, modifications of these done after work will facilitate much better recovery and repair after work… and reverse much of the age changes that accompany daily wear damage.
> None of these work unless people are professionally educated by an expert on this topic, who can motivate people to accept THEIR responsibility to take care the the ONLY body they have with which to feed their family and live their life.
MSD prevention guide Ebook
The Physical Therapist in the Workplace 