WorkSmart Ergonomics and Healthy Lifestyle Habits IMPACC Program Injury Management Prevention and Cost Containment

By Erik Nieuwenhuis MS, PT Employee Health and Wellness 712-279-1842 erik.nieuwenhuis@unitypoint.org The Industrial Athlete WorkSmart Ergonomics and Healthy Lifestyle Habits IMPACC Program Injury Management Prevention and Cost Containment

Prepared by: Erik N. Nieuwenhuis, MS, PT WorkSmart Ergonomics Injury Prevention Specialist, Wellness Consultant Employee Health and Wellness Faye Tompkins, RN, BS, COHN-S, CWCP Manager of Employee Health and Wellness UnityPoint Health- St. Luke s Updated June, 2013

Disclaimer: This program is intended to provide general instruction on the Industrial Athlete WorkSmart Ergonomics program at UnityPoint Health- St. Luke s. Items discussed include the following; WorkSmart ergonomics and personal ergonomics for the workplace, and home to reduce risks of musculoskeletal injury to your lower back, shoulders, knees, hips, neck and body. At work dynamic stretches to avoid workplace muscle fatigue and injury, and at home exercises to improve flexibility and strength, and self-care techniques for your working, aging body. These types of exercises may not be appropriate for all individuals. Before beginning this or any other type of exercise program, consult with your physician and/or physical therapist to determine what exercise program is suitable for you. If at any time while performing these exercises you experience any pain, numbness, and/or tingling, discontinue performing these exercises and contact your physician immediately.

The Industrial Athlete WorkSmart Mission To Create a Culture of Working Smart and Living Well Industrial Athletes at UnityPoint Health - St. Luke s

Benefits of Working Smart and Living Well (Industrial Athlete) 1) To Improve Employee Safety and Health 2) Improve Energy!! 3) Reduce Stiffness and Pain 4) Reduce MSD Injury Risk 5) Reduce Stress and Muscle Tension 6) Improve Quality of Life

What is Ergonomics? It is the Science of designing the layout and organization of the workplace, The tools and equipment used-- 1) To Reduce Musculoskeletal (MSD) injury risks, 2) Improve Employee Safety and Wellness and 3) Improve Workplace Productivity Ergonomics= Fitting the job to the worker

What is Personal Ergonomics? Personal Ergonomics is the Science of YOU Working Smart and Choosing Healthy Lifestyle Habits daily!! Learning to MOVE and Position (Staggered Stance posture when lifting, reaching) your working body daily to reduce fatigue, stress, and reduce MSD injury risk factors Healthy Lifestyle Habits; Eating a healthy breakfast, Physical activity 30+ min/ day, Sleep 7-8 hrs/ day, and Drinking 40+ ounces of water Your Body s Health is YOUR Responsibility!

WorkSmart Daily with a Staggered Stance, the Athletic Ready Posture When you to Lift, Push or Pull, or Reach away from your body at Work, Play, or at Home ALWAYS use a Staggered Stance (athletic ready) posture to PROTECT your Lower back, Shoulders, Knees, and Neck Benefits of Using a Staggered Stance or Athletic Ready Posture DAILY 1) Improved BALANCE and STABILITY 2) PREVENT your Lower back, Shoulders, Knees, and Neck from injury 3) Improve your Quality of LIFE at St. Luke s, and Home with family!

Why is Your Health Important to YOU?? Why is it, that when we travel on airplanes, we are instructed to place the oxygen mask on ourselves first, in cases of danger, instead of our children, spouse or anyone else? This is the same reason, that paying attention to your daily choices and Lifestyle Habits, is important to your health and quality of life so we may be the best parents, spouse, workers, and Be at our best daily for our patients we serve, BOFEPET!

POWER of Your Daily CHOICES and Lifestyle Habits

What are Musculoskeletal Disorder (MSDs) Risk Factors 1) Awkward Postures (Both Repetitive and Sustained) Reaching with arm almost fully extended or above shoulder level; Head or Lower back flexed of extended / side bent/ or twisted > 30 degrees; Wrist flexed or deviated > 30 degrees; and extended > 40 degrees; Knees flexed > 90 degrees; Sitting awkward postures; Crossing your legs, sitting on your feet, pulling legs back underneath chair, and slouching 2) Forceful Exertions (Grip/ Pinch, Lifting (above shoulder level and below knee level), Push/ Pull, Kneeling) 3) Repetitive Motions (Repeating the same motion every few seconds, 2 to 4 hrs/ day, with little to no variation) 4) Contact Stresses to the Wrist, or Elbow to the sharp edge of a desk or on top of steering wheel while driving, or Knees when kneeling hard, or vibrating surface 5) Vibration (Tools and equipment used and operated) Without Mechanix type gloves 6) Personal Ergonomics are the Lifestyle Habits of Industrial Athletes (At Work, Home, and Play) Examples include; Posture habits and Body Mechanics and Self-Cares, Smoking, Drinking water, Attitude, Past medical history, Fitness level, Nutrition, and Rest habits

What are Musculoskeletal Disorders (MSD s) Disorder (Injury or Pain) of; Muscles, Nerves, Tendons, Ligaments, Joints, Cartilage, Blood vessels, or Spinal discs Most Common are Sprain (ligament or joint)/ Strains (muscle) Affecting the Lower Back, and Shoulders Neck, Elbows, Knees, Wrists/ Hands at UnityPoint Health- St. Luke s Other Common MSDs are Tendonitis of the Shoulder, Elbow, Wrist, Knee and Thumb; Carpal Tunnel Syndrome, DeQuervains Tenosynovitis Blackberry Thumb (Texting, Video games, and Pinching mouse with fingertips are risk factors for this pain) Self-Care Techniques: Ice Massage, Snakebite Technique, 90/90 position, WorkSmart Dynamic Stretching, Friction Massage, and others

Early Warning Signs & Symptoms of MSDs Persistent Fatigue, Discomfort or Pain Back, Shoulder, Neck, Knee or Wrist Pain (any other joint pain) Tingling/ Numbness in Arms, Hands or Legs Shooting or Stabbing Pains Swelling and/ or Inflammation Decreased Grip Strength Decreased Range of Motion Stiffness and/ or Muscle Cramping Disrupted Sleep, or Waking up at night with pain, numbness or tingling is very common with tendonitis and carpal tunnel syndrome Industrial Athletes report these Signs and Symptoms EARLY to your Supervisor, and Employee Health/ Wellness x3530 is VERY IMPORTANT for your bodies health!

Lower Back, Neck and Shoulder MSD Injury Risks Factors Performing Patient Care without the use of Gait Belts and the proper Safe Patient Handling Equipment (SPHE) such as; Sara Plus, Hoyer Lifts, Stedy, HoverMatt, Slide boards, and Maxi-slides Lifting heavy/ awkward loads and assisting with Patient Care Transfers with a narrow base of support, and without the proper help Use a Staggered Stance (athletic ready posture), and Always use a Gait Belt and the proper SPHE to WorkSmart to Prevent Injury!

4 WorkSmart Dynamic Stretches for a Healthy Back, Neck, and Shoulders

4 WorkSmart Shoulder Stretches for Healthy Shoulders

Forward Head and Shoulders Awkward Postures Habits Most Common Awkward Posture Habit Increases Risks for Neck pain (Headaches, Trigger Points), Shoulder, Arm (Elbow, Wrist, Thumb and Hand) Pain or Tendonitis Lower Back Pain Why?? Industrial Athletes Reverse these Postures, & Stretch Daily Strengthen Upper back, and Shoulder Rotator Cuff (RTC) muscles 2-3 times each week

Stretches to Reverse Forward Head Posture, Headaches, STRESS, and Neck, Upper back and Shoulder Stiffness and Pain, OR Elbow, Wrist, Hand Tendonitis & Carpal Tunnel

Wrist Stretch with Rotation to Reduce Forearm Stiffness/ Pain & Reverse Tendonitis, & Carpal Tunnel Syndrome --Snakebite Technique, and Ice Massage Self-Cares Which Side Do Industrial Athletes Stretch More?

Elbow Stretch without and with Overpressure to Reduce Back of Forearm Stiffness/ Pain, and Reverse Tennis Elbow --Self-Care s of Snakebite Technique and Ice Massage

UnityPoint Health - St. Luke s Safe Patient Handling Equipment (SPHE) Program St. Luke s has a Safe Patient Handling Equipment (SPHE) program to improve the patient handling and movement ergonomics, and safety for St. Luke s employee s lower back and shoulders, and to improve patient mobility, safety, and patient outcomes (BOFEPET). SPHE Used at St. Luke s - Gait belts in each patient room, and on the patient care floors we have MaxiSlides, Hover Matt, Total Lift II, Stedy, Sara Plus, MaxiLite, 3 Hoyer Type Lifts, and the Tenor Bariatric Lift are used at UnityPoint Health - St. Luke s. This SPHE has all been purchased with Employee Grant s since December of 2006. Thank you for all who donate to this effort to keep our patients and workers healthy and safe at St. Luke s by Working Smart!

Safe Patient Handling Equipment (SPHE) used at UnityPoint Health - St. Luke s

How can I Work Smarter Daily in Patient Care? What Parts of this Nurses Body are at Risk for MSD Injury? These 3 WorkSmart habits protect your Lower Back, Shoulders, Knees, and Neck 1) Raise bed to waist height for Lower Back, Shoulders, Knees, and Neck health 2) Lower same side railing, to allow you to get closer to patient (reduce reaching, and bending forward lower back) 3) Stand with your feet Staggered (one foot in front of the other) to improve balance and protect back, shoulders, knees, and neck from injury!

WorkSmart Techniques for Computer Workstations Keep Feet Flat on the Floor or Footrest Chair Adjusted Properly, and Sit up Tall---KEY Use Upper Extremity Support Keep Elbows Close to Your Sides When Typing or using Mouse Use your Whole Hand to Operate the Mouse Monitor Directly in Front of You Just Below Eye Level, Lower if You Have Bi or Tri-Focals Use Document Holder to Avoid Forward Head/ Shoulder Posture for Paperwork AVOID Holding Phone Between Neck and Shoulder, AND Avoid Contact Stress of wrist to sharp edge of desk Stand and Stretch (MOVE) At least every hour for 1-3 minutes, or Choose 1-3 stretches to perform Your Body is Worth The Effort!

Reduce SUSTAINED SITTING Awkward Posture Habits Large MSD Risk Factor s for Lower Back, Knees, Hips, and Shoulders Pain and Stiffness Industrial Athlete s SIT UP TALL with feet flat on floor or footrest, stand up and move every hour (middle photo), and Limit their time crossing their legs, & pulling legs underneath chair, or sitting on their feet

Your HIP Flexibility is a Key to Reducing Stiffness and Pain and Injury Risks to the Lower back, Knees, Hips, & Shoulders Hip Flexor, Hamstring, Piriformis, and Hip Adductor/ Groin Muscles Perform these WorkSmart Dynamic Stretches 1-2 times daily

How Serious are Slip, Trip, and Fall Accidents? They re the second most common cause of Lost workday injuries in hospitals! Lead to ligament or joint (sprains), and/ or muscle (strains), bruise/ contusions, or fractures They can have a long term impact on an individual s life at work, home, and play They affect multiple body parts, such as Lower back, neck, shoulders, knees, hips, ankles, and wrists and Slip, Trip, and Falls are A leading cause of fractures and Lost Time (Days away from work) MSD Injuries at St. Luke s!

Slip, Trip and Fall (STF) PREVENTION is the KEY!! How can we PREVENT the most common causes of STF s daily? Contaminants on the Floor (Water, grease, oil, fluid, and food) Tripping Hazards such as; Clutter, Loose cords, Hoses, Wires, Medical Tubing, Left open drawer files Weather Conditions (Ice, Snow, and Rain) ---Slow Down! Walking surface Irregularities (indoor and outdoors) sidewalks, cracked tiles, loose gravel, hole in grass Stairs and Handrails Stepstools and Ladders Floor Mats that are folded over or slippery Industrial Athletes SLOW DOWN, Watch where walking, Wear proper shoes with good grip for environment of work, and place signs to give EARLY WARNINGS!

7 Principles of Ergonomics for the Workplace and Home 1) Keep Everything Within an Easy Reach When lifting keep person, or object close to body; Keep elbows close to sides of body using keyboard/ mouse 2) Work at Proper Heights Adjust bed/ cart to WAIST height, and when lifting work to keep heavy and awkward items between knee and shoulder level 3) Reduce Excessive Forces When lifting use a Staggered Stance, and Use whole hand when using your mouse and make sure mouse is proper size for your hand 4) Work in Good WorkSmart Postures - Staggered Stance 5) Minimize Direct Contact Stress/ Pressure of Your Wrist, and Elbows to a sharp edges of your desk, avoid leaning on elbow, or vibrating surface (top of steering wheel) 6) Provide Adjustability and Change of Posture Throughout Your Workday Alternate Sitting and Standing postures, Change chair setup, Vary Staggered Stance posture (How wide, and How deep feet are) 7) Provide Clearance and Access Watch for cords, ICE, and slow down

Benefits of Flexibility and WorkSmart Dynamic Stretching 3 to 5 second hold, 3 to 5 minutes to complete #1 to #10 YOUR FLEXIBILITY is the Foundation of Your Physical Health and Vitality!! Improves Energy Level! Reduces Stiffness and Pain Reduces Stress and Muscle Tension Keeps Joints and Muscles Healthy Reduces MSD Injury Risks Improves Quality of LIFE! Perform 1-3 times daily; OR Choose 1-3 Dynamic Stretches to do every hour Your Body, and Mind will Thank You!

WorkSmart Stretching on and off the Job at UnityPoint Health- St. Luke s When should I stretch daily (1-3x/ day)? 1) Before Work/ Start of Workday- Before Start Work Day or At Start of Workday 2) During Work- After Lunch or Mid-Shift Break, and anytime you feel fatigue/ discomfort 3) After Work/ End of Workday- Greatly enhances repair of the Working Aging Body, Improves Sleep, and Recovery of Body and Mind 4) Before Bed- To reduce stiffness and pain before you rest to help body and mind recover from hard and/ or stressful workday and life at home! Every Hour at Work- 3 to 30 sec break during the workday to perform 1 to 3 stretches to specific areas of your body that are stiff, and painful

Benefits of Drinking 40+ ounces Water Daily Adventist Health Study, and Don Colbert MD The 7 Pillars of Health Book Increases Your Energy Level Will help you Lose Weight, and Eat Less Will Reduce Stiffness and Pain Reduces Risks of Muscle Cramping Improves Your Quality of LIFE How much should I drink each day? 40 or more ounces, working towards half of your body weight in ounces 40 to 60% Reduction in High Blood Pressure (HBP), Heart attack and Stroke Risk when drinking 40+ ounces of water daily, slowly working towards half of your body weight in ounces. Now that s an awesome return for your bodies health!

Take Charge of Your Functional Strength! The American Journal of Medicine, April 2011. Biggest Loser and Tiffany Zermeno-Lopez ERGF 13 Based on the latest science, the single most powerful predictor of functionality in older age is strength capacity. Maintaining your muscular strength is the most important factor in maintaining your independence as you age!! Perform Strength Training exercises 2-3 times each week!

Benefits of Strength Training 2-3 times per week+ and Performing Simple Moves at Work, Home Daily Increased Energy Level!! Improved Quality of LIFE at Work, Home and PLAY IMPROVED SLEEP REDUCE FATIGUE Reduced Injury Risks to Lower Back and Shoulders (MSDs), Knees, Wrists LOSE INCHES of FAT at your Waist REDUCE FRACTURE RISKS Best way to Lose Weight and Manage it for LIFE!!

90-90 Position: (To Reduce Low Back Pain) Remain in this position as long as needed (at least 5 to 10 minutes) After work, at breaks, or at home to get rid of your Lower back pain If you sleep on your back, use pillow under legs Relax, and take slow deep breathes Hold this position as long as needed, OR until your back pain is reduced Also, great position to ICE lower back until numb 10 to 20 minutes

Sitting Piriformis Stretch (#16) Key stretch to reverse or prevent Sciatica, OR Reduce Lower back, hip, knee, and shoulder pain or stiffness Sit up TALL in a chair, place right foot on top of your left knee (cross your Right leg). Turn your trunk (upper body) to the right so you are looking over the right knee. Gently pull your right knee with both hands toward your left shoulder. You should feel a stretch in your right buttock/ thigh (typically very uncomfortable/ tight). Hold for 3 to 5 seconds. Repeat each side 1-2 times with slow/ deep breathing, then repeat other side. Do this WorkSmart Stretch 1-2 times Daily, especially on side you tend to cross each day, and spend less time daily crossing your legs (if you are able;)

Self-Care Techniques Do the Standing Trunk Extension (Backward bend #3), 90-90 Position, and Sitting piriformis stretch (#16), or other WorkSmart Stretches at home and/ or at the end of the workday. This restores the flexibility you lost during the day s work (reduce stiffness and pain), allowing your body to heal itself properly during tonight s sleep. Applying moist heat or taking a warm shower/bath before doing the exercises can help increase blood flow and relax your muscles. Take a brisk walk after dinner with family and friends. This can greatly help your neck, back, total body, and mind.

Headache relief: Neck Stretches, and Laying on 2 Tennis balls in a sock Forward head and rounded shoulders awkward postures are one of the key risk factors for headaches. Headaches can be treated naturally by a variety of means such as; Chin tuck stretch (#6 see top photo) performed multiple times followed by chin tuck with head extension (leaning your head backward), stretching the levator scapulae muscle (neck stretch #7B, see bottom photo) and lying on tennis balls. By lying on two tennis balls, tied up tight in a sock, this works to relieve the muscle tension/ tightness at the sub-occipital muscles (which are the cause of most peoples headaches), which are at the base of your skull. Initially this area will likely be very tender or uncomfortable. With time this discomfort should lessen and your headaches will bother you less or be completely relieved.

Ice Massage to Reverse, Treat, and Prevent Tendonitis Pain, and Carpal Tunnel Syndrome Ice Massage is done by filling a Styrofoam cup with water. Place this cup into the freezer and allow to freeze. Tear off the top portion of the cup and rub the ice directly over the painful area for 2 to 4 minutes or until the area is NUMB. You may also use an ice cube if you can tolerate holding the ice, or use a wash cloth to hold the ice cube. The styrofoam cup works better, due to increased surface area of rubbing ice directly over inflammed tendons, tissues. With cold you should feel the following progression; Cold/ painfulburn-ache and then the area goes numb. The numb sensation is the end point of using the ice. This typically takes only approximately 2-4 minutes. Ice massage can be done daily from 1 to 3 times per day, or as needed to relieve soreness, reduce inflammation, and pain at your wrist, elbow, shoulder, knee, hips, thumb, achilles tendon, or ankles. When to perform Ice Massage; 1) After work 2) Before bed 3) Before work 4) After lunch or Mid-shift break

Snakebite Technique to Reverse, Treat, and Prevent Tendonitis Pain, and Carpal Tunnel Syndrome Steps to Perform the Snakebite Technique Self-Care (just like childhood prank) Have the person with the symptoms of pain, numbness or tingling hold their forearm with palm up, and you start by gripping both of your hands (right next to each other) around their wrist at the end of their forearm. With both hands squeeze to compress the persons forearm, and slowly twist your hands away from each other going in opposite directions for 3 to 5 seconds, and repeat for 1 to 2 repetitions at the same location. While you are doing this squeezing/ compressing and twisting of their forearm The Snakebite Technique, have them slowly open and close their hand. This creates a muscle pumping action and helps the forearm muscles to relax improving blood flow and taking any pressure and stress off of the nerves in the forearm (nerves love good blood flow). Then move both hands up the forearm and repeat again for 1 to 2 repetitions of the 3 to 5 second snakebite, and keep repeating until you get to the elbow. If you notice a more restricted or tight area of the forearm you may want to complete 1 to 2 extra repetitions before moving up the forearm. Typically you complete 6 to 10 repetitions before you are completed. Also do this from the opposite side of the worker or patients forearm with palm up for any wrist, thumb or carpal tunnel symptoms of pain OR if it is Elbow tendonitis (Tennis elbow) than repeat the same process also with their palm down so their elbow extensor muscles are facing up. Perform this Snakebite technique, 2-3 times per week up to daily, OR as needed by your forearm muscle tightness until the pain, numbness and tingling, and stiffness goes away. Make sure to contact Erik Nieuwenhuis MS, PT, your physical therapist, or primary care physician if you have any questions regarding this self-care technique, OR if it doesn t get rid of your carpal tunnel syndrome or tendonitis symptoms

Spenco Arch Supports/ and Cushions HELP for Aching and Painful Feet (Arch/ Heels) Purchase Spenco Arch Supports/ Cushions at Scheels, Rudolph Shoes, and Peak Performance in Sioux City Green in color, $25 to 30, with plastic bottom and ¾ length is BEST for most people with flat feet Those with high arched feet use Arch Cushion Purchase new 1-3x/ year To Reduce Feet (Arch or Heel pain), Knee, Hip, Legs and Lower Back Fatigue or Pain

Health Behaviors 50% Access to Care 10% Genetics 20% Environment 20% Source: Urban Institute The doctor of the future will give no medicine, but will interest his patients in the care of the human frame (your body), in diet (healthy nutrition and drinking water), and in the cause and prevention of disease. By Thomas Edison

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Thank YOU for Working Smart and Living Well as an Industrial Athlete Daily! Industrial Athlete WorkSmart Mission is To Create a Culture of Working Smart and Living Well Industrial Athletes at UnityPoint Health- St. Luke s, so we can truly fulfill our vision (BOFEPET!) daily! For more information concerning any of the topics covered please contact: Erik N. Nieuwenhuis, MS, PT Employee Health and Wellness WorkSmart Ergonomics Injury Prevention Specialist, and Wellness Consultant 712-279-1842 or erik.nieuwenhuis@unitypoint.org