Preventing Repetitive Injuries & Office ErgonomicsRichard Chau, D.C. Q.M.E. Certified Ergonomic Assessment SpecialistAlliance Occupational Medicine

AGENDA•Preventing Repetitive Motion Injuries

•Office Ergonomics

•Stretches

•Workstation Adjustments

•More Stretches

PREVENTING REPETITIVE MOTION INJURIES

RMI/CTD

•Many names

•Many symptoms

- Pain in the neck & shoulders

- Pain in the forearms & elbows

- Tingling in the hands

- Headache, etc.

Poor Posture Position

POSTURE AT YOUR WORKSTATION

•Head forwards

• Rounded Shoulders

• Sitting position in chair

• Slouched low back

• Forearms/wrists resting on surface

RESULTS OF POOR POSTURE

Tightness & shortening of the chest muscles, sub occipital muscles, and anterior neck muscles

Over stretching and weakness of the back & posterior shoulder muscles

RESULTS OF WORKING FOR EXTENDED PERIODS OF TIME

• Static contraction of the forearm muscles

• Ischemia/decreased fresh blood supply to the forearm muscle

• Abnormal forearm, wrist & hand positions – causing repetitive stress, wear & tear of the tendons

● Tendons are most commonly affected● They are the weak link; they transmit forces generated by the muscles● They are enclosed in the lubricating synovial sheaths which can get inflamed● Tendons have limited blood supply, hence delayed repair & recovery● RMI is the result of the repeated & prolonged tensing of the muscles● At times combined with excessive “rubbing” on nearby structures

STRUCTURES AFFECTED

OTHER STRUCTURES AFFECTED

● Muscles – due to sustained contractions affecting circulation, causing tenderness, tight knots – in the forearms, shoulders & upper back

● Nerves – due to direct pressure or compression in the tight muscles or swollen tissue

RISK FACTORS INVOLVED

• Force – pushing/pulling/gripping/pinching • Awkward posture – head forward, rounded shoulder• Repetition – continual typing/mousing• Duration – long days• Contact Stress – resting forearms or wrists affecting circulation

OTHER FACTORS

• Aerobic fitness

•Muscular strength

• Flexibility

• Coordination

• Excessive volume of activity

• Inadequate recovery time

• Advancing age

• Chronic Illness (diabetes, low thyroid)

• Smoking

SOLUTIONS

• Optimal work station to improve posture & pressure• Micro stretch breaks – to enhance circulation• Correct typing & hand held tool techniques – to lower abnormal forces

OFFICE ERGONOMICS

What can you do?•Create an optimal work station to improve posture & pressure

•Micro stretch breaks – to enhance circulation

•Correct typing & mousing techniques – to lower abnormal forces

Office Ergonomics

Office Ergonomics

Ergonomics• Most frequently used items closest

• Keyboard tray with space for mouse

• Headset

• Curved or split keyboards

At Your Workstation

Document Holder Placement

Headset and Split Keyboard

Mouse Position

Awkward Positions

Awkward Sitting Positions

Awkward Writing Positions

Awkward Leg Positions

UPPER BODY STRETCHES

What Can You Do? – Get Up and Stretch!

• Take small breaks to stretch

• Find a stretching buddy!

Tendon Glides

Wrist Extensor Stretch

Keeping elbow straight, grasp

left hand and slowly bend wrist

forward until you feel a gentle

stretch. You may curl your

fingers as necessary to increase

the stretch.

Hold 10-15 seconds. Relax.

Repeat on the right side.

Wrist Flexor Stretch

Keeping elbow straight, grasp right hand and slowly bend wrist back until youfeel a gentle stretch. KEEP FINGERS POINTINGDOWNWARDS. Hold 10-15 seconds. Repeat on the left side

Neck Stretches

PULL YOUR CHIN BACKand bend head backward.Do this only if it is pain free.

Upper Trapezius Stretch

DO NOT USE YOUR HANDS. Gently bend your head towards theleft shoulder while grasping your seat with your right hand or while bending your right arm behind you. You should feel a gentle stretch in your upper shoulder.

Hold for 15-20 seconds.

Posterior Capsule Stretch

Gently pull on right forward elbow with other hand until stretch is felt in shoulder.

Hold 10-15 seconds.

Inferior Capsule Stretch

Gently pull on right raised elbow with other hand until stretch is felt in shoulder.

Hold 10-15 seconds.

Chest and Shoulder Stretch

Lace fingers behind backand squeeze shoulderblades together. Slowlyraise and straighten arms. Hold 10-15 seconds.

STRETCH BREAKS•Every 20-30 minutes; never less then hourly •Stand up•Take several deep breaths•Rotate Stretches•Do your favorites more often•Walk at least 10 minutes at lunchtime •Once a day, do all exercises in one session•Exercise 20-40 minutes most days

WORKSTATION ADJUSTMENTS

Chair Adjustments

1) Stand in front of chair with height below knee cap

2) Sit tall in chair with feet flat on floor and chair ending 1-3 inches from knee

3) Adjust back rest to push hips slightly forward

4) Bent elbows at side of body should not contact armrests

Adjust Your Monitor

Monitor Height – Eye Level

Proper Distance – Fingertip Distance

Do You See Anything Wrong with the Following Pictures?

Good or Bad?

Good or Bad?

Good or Bad?

Good or Bad?

Good or Bad?

Good or Bad?

Good or Bad?

Good or Bad?

Proper Location of Document Holder

Mousing Examples

Mousing Examples

Mousing Examples

Keyboard Tray – Proper Typing Techniques

BACK AND LOWER BODY STRETCHES

Lumbar Extension

Supporting your low back bend backwards to make the hollow of the low back deeper.

Hold 2-3 seconds.

Quadricep Stretch (Standing)

Pull right heel towards buttock

Hold 5-10 seconds.

PNF Strengthening Resisted

Stand with resistance band around each hand, bring right arm up and ways, thumb back

Strengthening Chest Pull

Stand with resistance band around each hand, with arms straight out, stretch band across chest.

PNF Strengthening Resisted

Stand with resistance band around each hand, bring right arm up and ways, thumb back

Additional Stretches

PNF Strengthening Resisted

Stand with resistance band around each hand, bring right arm up and ways, thumb back

Bridging

Slowly raise buttocks from floor, keeping stomach tight.

Hold for 5-10 seconds if possible.

Partial Sit Up for lower abdominals

With legs over chair and arms clasped behind neck or folded across chest, tilt pelvis to flatten back.

Raise head and shoulders from floor.

Partial Sit Up for lower abdominals

With legs over chair and arms clasped behind neck or folded across chest, tilt pelvis to flatten back.

Raise head and shoulders from floor.

Hip/knee/back/legs

Stand with right foot back, leg straight, forward leg bent. Keeping heel on floor, into wall until stretch is felt in calf.

Hold 15-25 seconds. Repeat on other side

Double arm side bend

With hands clasped, reach over head and reach over to side. Repeat on other side.

Hold for 10-15 seconds.

Hip/Knee stretch

With leg crossed over other thigh, place elbow over outside of knee. Gently stretch buttock muscles by pushing bent knee across body.

Hold for 15-20 seconds.

Upper trapezius stretch

Gently grasp right side of head while reaching behind with the other hand.

Hold 15-20 seconds.

Upper back corner stretch

Standing in corner with hands just above shoulder level, lean forward until you feel a comfortable stretch.

Hold 10-15 seconds.

Thank You

Any Questions?

By Richard Chau, D.C.

Alliance Occupational Medicinewww.allianceoccupationalmedicine.com