Lecture 1 : Occupational Health in Physiotherapy Flashcards
8 proposed risks for LBP
- Manual handling
- Lifting
- Pushing/pulling
- Extreme postures (forward flexion)
- Cyclic loading (whole body vibration)
- sitting postures (in occ areas with no lifting or manual handling)
- Work related psychological stress
- Lifestyle factors
functional interactions in the spine
all trunk muscles together provide muscular stability to trunk
- subconsciously - relative to environment
- against external forces
- establish a base for limb movement
spinal stability - combination of intrinsic and extrinsic stabilisers
- large overlap between intrinsic and extrinsic in contributing to both static and dynamic stabilisation
Intrinsics - spinal stability
intrinsic stabilisers include
- transversospinal group - multifidus
- short segmental group
- deep abdominal muscles - TrA
- Diaphragm
segmental stability - control precise alignment and stiffness of one or few intervertebral junctions at a time
provide fine control of vertebral column to avoid
- excessive spinal curvature
- excessive interspinal movement
- and/or painful instability
Extrinsic stabilisers
provide gross movement, high torque generators for trunk and hip movement with coarse stability
important in stabilising, particularly at the lower trunk, against external forces
Forces that impact on the trunk are effectively transferred across SIJ, through hips and through lower extremities
clinically - strengthening exercises for stability in LBP patients should challenge both trunk and hip muscles in all 3 planes of motion
Why is LBP such a focus
LBP is a considerable issue because 80% of australians experience it. The spine overall receives a lot of attention from health professionals and is the cause of the greatest loss of work time
“IT KEEPS COMING BACK” recurrence is a big issue
Functionally
most functional activities require concurrent activation of the trunk and hip muscles
eg. combined movement durin activities such as throwing, bending down, sit to stand, sweeping, performing a situp
don’t forget to address muscles beyond the spine
-targeted and functional exercises
ways to reduce force while lifting
to reduce force required of extensor muscles
- decrease the magnitude of the external load
- decrease speed of lifting
slow and smooth to maximise motor unit recruitment
-decrease the length of the external moment arm
keep object close to the spine
-increase the length of the internal moment arm
stabilise your spine and core to maintain neutral curves (esp Lx lordosis) while recruiting the prime mover muscles
ways to reduce force while lifting cont’
make full use of hip and knee extensors - squat lift
minimise vertical and horizontal distance load must be lifted
choose frontal plane movements
push or pull in the same plane, direction and height
- avoid twisting
increase base of support - wider stance
ensure good contact and foot support
Use double handed techniques
Have no physical objects to free movements
Use mechanical device or get assistance
get someone else to do it..
WMSDs stands for
work related MSK disorders
attributes that impact on your risk of WMSDs
in addition to all the factors listed above
your attributes
- some of which you can change
- some you can’t
your patients attributes- most of these are fixed
Personal attributes that increase risk of WMSDs
gender
- females higher incidence of reporting W
age
- decrease in strength, power, balance
level of fitness, coordination and condition
- consider where you sit on the spectrum
stature
- it sucks to be tall
Recent illness or prolonged holidays
- deconditioning
previous injuries
expectant mothers and post natal
- hormonal and conditioning impact
limited experience
- <5 years in profession
casual and rotating staff
non-compliant behaviour wrt manual handling and lifting guidelines
Patient attributes that increase risk
there are many factors but perhaps consider patients are becoming
- heavier
- more aged - fragile
- comparatively weaker
- have greater number of comorbidities
all these trends are on the rise
How do we reduce occupational risk
practice good ergonomics and lifting practice
one of the bests ways to reduce risk is to exercise
-evidence to support benefit of various forms of exercise for MSK conditions
SST- flexibility, strength, endurance, aerobic
-know your target wrt different presenting conditions
applies to both you and your patient
level of fitness, coordination and condition
-consider where you sit on the spectrum
