Train-the-Trainer Injury Prevention & Workplace Warm-up Program

You will learn about… • Basic anatomy and posture

• Common clinical conditions/injuries

• Physical risk factors identified in the field: • Awkward/Static Postures

• Repetitive Motion & Overuse

• Forceful Exertions & Poor Body Mechanics

• Contact Stress

• Global injury prevention tips

• Benefits of a workplace warm-up programs

• Safe stretching techniques

• A practical introduction to the workplace warm-up program

Anatomy of the Spine

The Spinal Disc

• Separates the stacked bones

• Similar to a jelly-filled donut: • The jelly center is high in water content

and held together by a tough outer ring of fibers

• Outer fibers have a criss-cross (X) pattern

• Acts as a shock absorber

• Provides flexibility – The jelly center moves with movement of

our spine

The Spinal Disc - Mechanics BACK FRONT

Neutral

Forward

Bending

Backward

Bending

Trunk Muscle Anatomy

Trunk Muscle Anatomy

• Run full length of the spine and overlap

• Provide support to the spine • Act as the cables adding support to a bridge; or

• Act as the guy wires on a ship’s mast

• Abdominal muscles and low back tissue create a “corset” – nature’s back belt

• All muscles work together to: • Support postures

• Create movement

• Provide spine stability, protecting the back against injury

Posture

• Alignment of the body and body parts

• Good posture = balanced alignment with minimal stress

• Bad posture = unbalanced alignment with increased stress

• Side view: line of string running from crown down through earlobe, shoulder, hip and ankle

• Front view: line of string running from chin down through breast bone, belly button and between feet

Working Posture

• The “Neutral Zone” describes body positions that are natural and comfortable – minimizes stress

• Best zone: • Width of shoulders

• Between heart and waist level

• As far forward as wrist when elbows bent

• Preferred zone: • One foot on either side of shoulders

• Between shoulder level and finger tips when arms rested at sides

• As far forward has hand with outstretched arm

Shoulder Anatomy

• Shoulder: ball and socket joint

• Has the largest range of mobility = lack of stability

• Must rely on muscles and ligaments to add stability

• Rotator cuff: group of 4 muscles and their tendons that attach to top, front and back

• Allows multi-directional movement of our arms

Forearm Anatomy

• Elbow: hinge-type joint

• Two directional movement

• Ligaments add stability

• Muscles/tendons allow elbow to bend, straighten, and turn palm up and down

• Most muscles that move the wrist and fingers are located in the forearm

Common Clinical Conditions

• Back injuries are the most common reported injury in the workplace

• Linked to sedentary lifestyles and stressful activities

• Majority caused by an accumulation of things we do everyday involving: • Incorrect sitting/standing posture

• Using improper body mechanics and movement

• Staying in one position for a long time

• Poor physical fitness (lack of strength, endurance, and flexibility)

Common Clinical Conditions • Back Strains

• Most common cause for back pain

• Inflammation of tissue

• Involved muscles can weaken

• Cervico-Thoracic Junction pain: straining of upper back tissue due to poor posture

• Can lead to loss of movement

• Herniated Discs & Nerve Impingements

• Bulged disc = jelly center gets pushed out but remains inside disc

• Herniated disc = jelly center leaks outside of disc

• Can cause pressure on nerves

• Majority caused by wear and tear due to

improper body mechanics and posture.

Common Clinical Conditions • Rotator Cuff Tendonitis

• Inflammation of shoulder tendons

• Wear and tear from poor posture, repeated lifting and working with arms overhead

• Tennis/Golfer’s Elbow • Inflammation of tendons attaching to outer/inner bump

• Caused by repeated wrist motion/overuse

• Carpal Tunnel Syndrome • Repetitive wrist movement and positioning

• Tendons become inflamed and compress median nerve = tingling, numbness, pain

Common Spine Conditions

INJURY PREVENTION =

REDUCING KNOWN RISKS So let’s take a look at the physical risk factors that were

identified during field observations

Physical Risk Factor:

Awkward & Static Postures

Awkward & Static Postures

• Posture = alignment of the body

• Goal is to stay within the neutral zone while working

• Awkward Posture = any posture requiring the body to move

out of the neutral zone • Muscles have to work harder fatigue • Burns greater energy

• Static Posture = a position that is held for a long period of

time • Muscles remain active fatigue • Strength decreases

Examples Observed Across Trades

• Neck Twisting • Motion of neck away from neutral by looking to right/left • Observed when accessing components in confined spaces • Pulling electrical cable

• Neck Flexion • Motion of neck away from neutral by looking down • Observed with any low level work • Working from heights and observing work below

• Neck Extension • Motion of the neck away from neutral by looking up • Observed with high level work and observing work above • Passing up materials

Examples Observed Across Trades

• Trunk Twisting • Motion of trunk away from neutral by twisting right/left • Back injury associated with >20 twisting • Observed when accessing components in confined spaces • Pulling electrical cable, feeding along tray located to side

• Trunk Flexion • Motion of trunk away from neutral by bending forward • Rounding of back = increased strain on tissues and discs • Mild bending (21 to 45) and severe bending (>45) associated with

back injury • Observed with low level work below chest height • Working from heights and observing work done below • Lifting improperly

Examples Observed Across Trades

• Overhead Reaching • Motion of shoulder and elbows away from neutral by extending arms

above shoulder level • Observed with any high level work

• Elbow Flaring • Positioning of elbows outward and away from trunk sides • Observed pulling cable using hand-over-hand method • Performing above shoulder level work

• Wrist Bending • Motion at the wrist away from neutral by bending up/down • Observed performing fine, detailed hand work • Holding components in place

Force on the spine is increased by 50% when standing upright vs. bending

forward

Physical Risk Factor:

Repetitive Motions & Overuse

Repetitive Motions & Overuse

• Repetitive Motion= performing same movement over and over again with rest time for recovery • Stress builds in overused tissue • Leads to fatigue and decreased strength • Increases risk of developing a RSI

Made worse by these factors: • Combining high repetition with awkward posture or forceful exertion • Having lack of recovery/rest or task variety • If worker is new to job/activity

Examples Observed Across Trades

• Repeated Forearm Rotation • Motion away from neutral by rotating the forearm so the palm faces

upward (to ceiling), or downward (to floor) • Observed when performing fine detailed hand work • When torqueing and wrenching using tools to tighten/secure/loosen

components • Hammering involves repeated wrist movement similar to a hand shake

motion

Physical Risk Factor:

Forceful Exertions & Poor Body

Mechanics

Forceful Exertions & Poor Body Mechanics

• Forceful Exertion = overloading of muscles and tendons

caused by working beyond their limits • Goal = minimize the force applied to our body • Often occurs during material handling

• Body Mechanics = the way we move our body or body parts

during activity • Goal = move in a way that prevents unbalanced or added

stress to our body • Using poor body mechanics is a risk for back injury

Body Mechanics When Lifting

Forces on the spine increase as the distance between the load and spine increases

Keep load close to your trunk to reduce forces on the back

The Hidden Load: a lifting example

20”

A worker is bending over to lift a 30lb load. They have to reach 20in. in front of lumbar spine to grasp load. Centre of mass of upper body lies 10in. in front of lumbar spine.

FORCE = Object Weight x Object Distance Force from weight of load = 30lbs x 20in. = 600 lbs-in Force from weight of upper body = 90lbs x 10in. = 900 lbs-in Total force = 1500 lbs-in This is a lot of unexpected pressure on the lumbar spine!

10”

Examples Observed Across Trades

• Pushing & Pulling Forces • Involves exerting a force to move an object • Using awkward postures increases injury risk • Observed with cable pulling - trunk twisting and elbow flaring

postures; single arm pulling • Rigging, manually guiding and installing components • Using a pulley system to move up bundled materials

• Poor Body Mechanics with Lifting

• Rounding of the back rather than pushing back with hips • Lifting with the back rather than the legs

Physical Risk Factor:

Contact Stress

Contact Stress

• Contact Stress = when pressure from a hard surface is directly applied to a body part

• Can cause pinching/crushing of tissue, restricting blood flow to area

Examples Observed Across Trades

• Contact Stress on Shoulders • Transporting materials • No protective padding = compression of tissues and joint

• Contact Stress on Hands • Tool usage with ridges/sharp edges or if too small for user • Striking objects with hand • Crawling on hard surfaces • Holding objects in place, especially if sharp

• Contact Stress on Forearms/wrists • Resting them on hard surfaces

• Contact Stress on Knees • Kneeling/crawling on hard/rough surfaces without padding • Can lead to degenerative changes

Minimizing Your Own Risk:

Injury Prevention Tips for the

Physical Risk Factors Identified

Tips To Control Awkward/Static Postures

• Be aware of how to position the body before starting • Adjust work to allow for a natural body posture – staying

within the “Neutral Zone” • Avoid repeatedly coming out of neutral posture • Move materials closer • Tool use – keep wrist in neutral alignment • Take Micro-breaks

• <1 minute pause, change in position/posture, and stretch • Move in opposite direction of working posture • Helps with working efficiently and pain-free

Tips To Control Repetitive Motions & Overuse

• Use automated devices and tools when possible • Pace yourself by using micro-pauses for recovery • Change positions regularly during repetitious work

• Alternate between hands/sides to avoid overload

• Gage grip forces – unnecessary high grip force adds strain • Power Grip (full palm) used for high forces to be applied • Pinch Grip (thumb and fingers) used for light precision work

• Job variety – rotate between physically demanding and less demanding tasks

Tips To Control Forceful Exertions & Poor Body Mechanics

• Use automated assistive devices when possible • Manual lifting should be done within “Neutral Zone”

• Below shoulder but above waist level • As far forward as finger tips when elbows bent at sides • The body is stronger, more efficient and less prone to injury in this

position

• Handle half the load at one time – use fixed surface • Tilt object up on its side to raise initial lift height • Alternate between lifting and non-lifting tasks • Separate material into manageable loads

Tips To Control Forceful Exertions & Poor Body Mechanics

• Avoid heavy lifting right after long periods of sitting or stooping – take a minute to stand upright and perform a few back extensions first

• Allow brief periods of recovery between heavy or repetitive lifts

• Test the weight before lifting • Plan the lift • Always keep the load close and within your center of gravity

Steps for Proper Lifting

1. Position body to face the load.

2. Get as close to the load as you can.

3. Position feet so that there is a wide and balanced base of support.

4. Gently tighten trunk muscles to increase support.

5. Keep the natural arched curve in low back by pushing butt and hips back when bending knees.

6. Chest should be lifted up and forward. Keep head looking straight ahead.

7. Get a good grip – use a power grip.

8. When lifting up, use your legs not the back.

Steps for Proper Lifting

9. Stand up using a smooth, even motion. 10. The belly button should remain in middle of base of support

(between your feet) when maneuvering a load – pivot with feet with any direction change.

11. Ensure sufficient communication if using the buddy system.

Different Lifting Styles

• Power Lift • Bulky/heavy loads • Slight staggered stance • Move into half-squat position with trunk moving slightly over load

• Deep Squat Lift

• Small/lighter loads • Feet shoulder width apart • Move into full squat position • Watch for knee issues

Different Lifting Styles

• Partial Squat Lift • Small/lighter loads, with knee/back issues • Slight staggered stance • Support hand on thigh or fixed surface • Move into partial squat by kicking back hips

• Golfer’s Lift

• Small/lighter loads, with knee/back issues or if there’s a barrier

• Place hand on fixed object to support trunk • Keep arch of low back and bend at hips while at

same time raising one leg behind body to counterbalance

• Do not lock the standing leg

Different Lifting Styles

• Overhead Lift • Slight staggered stance • Raise load while balancing weight between front and back foot • As load is lifted up towards final destination, shift weight over to front

foot • Retrieving the load = shift weight to back foot • Always walk load in and out to keep close to center of gravity

Safe Carrying Tips

• Same principles as lifting can apply • Important: belly button should remain in middle of base of

support (between feet) when moving • Slide, push, or roll objects when able • Turn a carrying force into a pushing force by use of carts,

dollies, etc. • If carrying items on shoulder, alternate between sides

Safe Pushing and Pulling Tips

• Push rather than pull a load when possible • Maintain natural spine curvatures and stay within “neutral

zone” • Use wide base of support - feet shoulder width • Do not lock knees • Use legs/weight of body to help propel • Push/pull an object by directing the line of force through the

low back (belly button level) • Avoid “flaring” of elbows with pulling • Team approach to cable pulls

Safe Pushing and Pulling Tips

• Stationary Cable Pulls: use hand-over-hand method keeping elbows tucked close to trunk sides, wrists straight, and thumbs pointing out

• Walking Cable Pulls: cable rested on padded shoulder while walking forward – keep elbows tucked close to trunk sides, thumbs pointing in, and hands separated by a short distance

Tips to Control Contact Stress • If transporting items on shoulder, ensure padding • Avoid resting forearms, wrists and hands on hard surfaces • Add soft padding to hard surfaces coming in contact with a

body part • Add padding to the body part if the surface can’t be covered • Wear cushioned knee pads with kneeling/crawling • Avoid using the base of the palm or knee as a hammer • Tools: increasing size and width will spread small contact

forces over a greater area

Minimizing Your Own Risk:

Benefits of Workplace Warm-up &

Stretching Programs

Benefits of Workplace Warm-up Programs

• Improves mood, attitude, and employee morale.

• Reduces muscle tension and relaxes the body, reducing stress.

• Improves energy by increasing blood flow to working muscle tissue – “fuel” reduces fatigue.

• Helps to eliminate any waste and toxins that build up in working muscle.

• Lubricates joints.

• Promotes good posture, balance and coordination.

• Improves flexibility of the soft tissue, improving joint mobility.

Benefits of Workplace Warm-up Programs

• Maintains the elasticity of soft tissue which decreases with advancing age.

• Tight/inflexible tissue can make performing certain jobs more difficult.

• Can help prevent muscle strains: strong, flexible muscle vs. strong, stiff and un-stretched muscle.

• Helps to awaken the body and mind in preparation of the physical demands to be placed on them.

It signals the body that it is about to be used!

Workplace Warm-up Programs

• There are two methods or stretching styles:

1. Dynamic “Movement” Stretching

2. Static “Hold” Stretching

Dynamic “Warm-up” Stretching

• Repeated movement that takes the joint through its normal range of motion

• Serves to warm up tissues/joints to be involved in work activity

• Stimulates the nervous system and blood flow

• Replicates body motions performed at work

• Smooth and coordinated movements repeated 5-10x with no significant hold

Static “Hold” Stretching

• Stretches soft tissues while held at rest

• Body part is taken near its end range until mild to moderate stretching sensation experienced

• Held for 20-30secs, repeated 2-3x

• Serves to lengthen tight, shortened tissue

• This method can be used after tissues already warm

• Move in a slow and controlled manner

Safe Stretching Tips

• Stretching should never be painful

• Always warm up first and don’t statically stretch cold muscles.

• Spend 5-10 minutes performing dynamic movements at start of work day and after breaks.

• After muscles have been properly warmed up or following activity, static stretching can be done.

• Relax the muscle while holding the stretch – don’t tense up against the stretch.

• Stretch within your own limitations – everyone is different.

Safe Stretching Tips

• Never bounce, jar or force the stretch – ensure even and controlled movement.

• Don’t forget to breathe – inhale and exhale with slow breaths. Exhale when moving into the stretch.

• Lightly contract trunk muscles for improved stability when stretches are performed in standing.

• Be consistent and stretch regularly to increase the physical and health benefits.

Minimizing Your Risk:

Now let’s get up and move for the

Practical Stretching Session!!!