“it’s affecting my job”

Workplace injuries tend to arise from;

  1. an acute event
  2. repetitive strain

Acute injuries are best avoided through a workplace risk assessment. Lifting technique is one of the most well-known, but poorly understood, ways of reducing injury, with the most common advice being “lift with your legs, not your back”. The majority of lifting situations are better suited to a hip hinge than the squat technique. Learning to brace through the core and generate force from the hips is a fundamental skill that your physio can advise you on.

Repetitive strain injuries (RSI) can affect any part of the body depending on the nature of the job. They are usually the result of accumulating tissue fatigue from which the body doesn’t have time to recover and adapt. This fatigue can go unnoticed for weeks, months or years. The pain from RSI is most likely a combination of microtrauma (microscopic tissue damage that accumulates with time), increased sensitivity of nerve endings in the body part, and a protective response from the brain to prevent further damage.

Tissue fatigue can be reduced by managing workload or improving ergonomics and technique. Repetitive tasks should be identified and assessed for efficiency and symmetry. Some common strategies are technology-based (such as conveyor belts in a factory, hoists in a hospital, voice-dictation software for typists and drill pedals for dentists) while some involve human change (such as checkout clerks at a Supermarket rotating every 2 hours so they are reaching both to the left and right).

Take a hairdresser for an example. They are on their feet all day, arms continually elevated to about shoulder height, wrists and fingers continually working the scissors.

The best way for a hairdresser to reduce the risk of RSI is:

Workload
– gradually increase the number of weekly haircuts (set a limit when first starting work)
– don’t work 7 days a week! (many do)
– take holidays and, if returning from an extended period away, set a limit to your total weekly haircuts before building back up

Ergonomics
– wear well-supported shoes
– pump the seat up or down to avoid either stooping or lifting the arms too high
– using well-made, well-maintained scissors of the right size for your hands
– learn to cut with both hands

This last one is not just for bonus points. It’s a real consideration for any occupation involving fine motor skills or anything one-sided. Many hairdressers regret not taking the time to learn this skill early on. We often recommend office workers to teach themselves to use the mouse with both hands too.

The body responds best to variety in movement, where the tissues are challenged from a variety of angles. However easy a task may seem, if repeated over a long enough period it can cause problems. With sufficient time to adapt, however, and a steady progression of workload, our bodies are capable of remarkable specialisation.

The same principles of preventing and managing RSI apply to tasks as simple as sitting and standing, which are outlined in more detail below.

Seated occupations & Standing occupations

Spinal and hip conditions that present to physiotherapy can often be traced back to seated occupations, while being on your feet all day comes with its own set of overuse conditions, particularly in the lower back, hips, knees and feet.

The 2 most commonly injured, inflamed or irritated structures in the lower back are the

  1. intervertebral discs
  2. facet joints

Generally speaking, prolonged sitting builds pressure on the intervertebral discs of the lumbar spine, while prolonged standing builds pressure on the facet joints. This is due to the position the pelvis tends to fall into with each posture. For this reason, it is beneficial to alternate sitting and standing postures regularly throughout the day (for comparison, lying down decompresses the spine, which is why you are taller first thing in the morning). Many institutions have begun providing sit-stand desks for their employees to reduce postural stress.

Office based occupations

The risks of a sedentary job can largely be offset with appropriate ergonomics in place:

– Stand up every 15 minutes
– If using a computer, gaze at a further distance (such as out a window) regularly
– Take longer breaks every hour to walk around or stretch. A few calf raises, backbends and shoulder rolls address the main areas. Ask your physio if you want more ideas on a workplace routine.
– At home at the end of the day, have a more thorough stretch. You may want to include some foam rolling for the upper back, or some self-traction (there are a few ways to do this to decompress the spine, such as lying over a large swiss ball or hanging from a bar – give us a call if you’re not sure).
– Still try to reach 10,000 steps by walking before/after work or at lunch.
– Reduce sitting time at home / on weekends

There may be specific exercises that we recommend you perform throughout the day, especially if you have current lower back pain or a history of recurrent back pain. These exercises may depend on your individual movement patterns or joint restrictions, or may aim to offload an irritated joint or nerve in your back.

Driving occupations

Let’s use a truck driver as an example.
As well as all the issues caused by prolonged sitting mentioned under office-based occupations, driving has its own risks of acute injury, especially whiplash injuries.

The issues relating to sitting can be amplified when driving for a few reasons:
– you can’t get up for a walk as readily
– you may hold more muscle tension depending on traffic conditions
– your gaze must remain relatively focused
– constant low-load contraction of the leg muscles is required to maintain speed
– seats and pedals may not be suitable for all body types and are rarely as well supported as office chairs.

In fact, driving is a close approximation to the “slump test” used to identify neural tension in back pain patients.

Standing occupations

Let’s use the example of a chef. Not only may they be on their feet for long periods, they are constantly leaning forwards over the stove or bench. As their mind is consumed by the task at hand, perhaps with an element of stress to beat the clock, they may be unaware of the positions they are working in, or of the muscle tension they may be holding. While an acute back injury from a heavy lift is unlikely, the repetitive or prolonged nature of the tasks makes cumulative tissue damage a bigger consideration. Sometimes what may seem like an acute back injury is the manifestation of years of overuse.

Footwear becomes very important in standing occupations. High heels put unnatural stress on the feet and ankles, and also tend to increase the forward tip of the pelvis, potentially leading to knee, hip and back issues. Hard footwear including boots or some business shoes can cause plantar heel pain, especially when coupled with an unforgiving surface such as concrete or floorboards. If you work a standing occupation and are suffering from foot pain, we can assess your foot posture, including how well the natural arches are supporting you when weightbearing, and recommend the appropriate orthotics if needed.

Trade and physical occupations

Both acute injuries and overuse conditions are part of the nature of more physical work.

Lower back strain is again the most common condition we see, whether from a one-off heavy lift or accumulated fatigue. Painters are at the highest risk of neck pain, but there are usually ways around it. Generally speaking, if you work a physical job, maintenance spinal treatment is an investment to consider to protect your career in the long-term.

Tennis elbow or golfer’s elbow, both of which are forearm tendon overuse injuries, plague construction workers due to the combination of heavy gripping and tool use. There are useful manual therapy techniques we can do to provide a “grease and oil change” of your elbow, and there are elbow straps you can wear, but usually a period of rest from the aggravating activity is required to fully resolve symptoms. Depending on the severity and duration of your elbow symptoms, you may need to start on a rehab exercise program before or during your return to work.

The shoulder would round out the most commonly injured joints in physical occupations. Give us a call if you’re suffering from shoulder pain or weakness and you’re not sure what may be injured. We can usually tell you over the phone if a physio examination will be beneficial, or if you should first get some scans.

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