Functional Fitness: What is it and How Does it ImpactTotal

Worker Health? By

Jennifer A. Hess, DC, MPH, PhD Labor Education and Research Center

University of Oregon jhessdc@gmail.com

OHSU Spring

Symposium June 5, 2014

Today’s Talk Will…

•  Review why corporate stretching programs are

popular

•  Consider other aspects of “Fitness” and “Health”

•  Introduce the concept of Functional Fitness

•  Discuss issues around implementating corporate

functional fitness programs

Stretching & Fitness are not substitutes for ergonomics

Disc herniation

Tissue damage and injury occur from: ü Over loading structures ü Prolonged postures ü Awkward postures

 What  does  it  mean  to  be  

Physically  Fit?    

• State of physiologic well being that is achieved through a combination of good diet, regular physical exercise, and

other practices that promote good health (med dictionary) • A set of attributes that people have or achieve that relates

to the ability to perform physical activity (USDHHS)

How  are  these  3  people    different  or  the  same  in  terms  of  fitness?  

Lets Start Where We Are in 2014: Workplace Stretching

Programs

What do companies want from a stretching program?

•  Prevents MSDs •  Reasonably Inexpensive to implement •  Able to perform standing & in street clothes •  Appeals to both managers and workers •  Maximizes effectiveness while minimizing risk

to workers (one size fits all) •  Can use workers to lead •  Takes little work time to do •  Good for morale Dream on!

Positive Stretching Program Benefits

ü They improve morale and camaraderie ü They’re fairly straight forward to implement ü They’re economical (?)

•  No such thing as ‘one size fits all’ •  Skilled trainers essential •  Effective with 5-10 minutes or work? Not •  Efficacy of stretching to prevent injuries in

either athletes or workers is unclear and may cause harm

Conflict may lie in type of physical activity

•  Stretching may prevent injury in activities with high intensity moves: frequent bouncing, jumping or quick moves, like soccer or football (Witvrouw et al, 2004)

•  Low intensity activities like jogging, swimming or cycling do not require very compliant (stretchy) tendons so there is no protective effect by stretching and stretching may reduce stability

•  So what about work activities? Are your workers like: football players or joggers?

Effectiveness Also Depends on… • Technique: are workers stretching? • Compliance • Intensity: is it sufficient? • Duration: is 5 minutes enough? • Scope: does it target appropriate muscle

groups for audience?

Stretching Controversy •  Industry takes the lead from sports where

evidence is contradictory

•  Workers are not equivalent to athletes who are usually in their 20’s and train many hours each day

•  It probably depends on type of work intensity

•  Current literature does not define who benefits from stretching –  hypomobile vs hypermobile? –  those with past, present, recurrent, or first

injuries?

OK, so, what elements of physical fitness besides stretching are

important for good health?

Hip replacements increased 123%, knee replacements - 188% in 45-64 y.o. between 2000-2009 (AAOS)

Mediators are interdependent

Attributes of Health & Disease

Fitness levels inversely related to MSDs (Reichelt 1995)

Components of Physical fitness: (President’s Council on Fitness) –  Cardiovascular endurance –  Muscular strength –  Muscular endurance –  Body composition –  Flexibility

Should be amended to include: –  Mobility (flexibility with control) –  Muscle symmetry –  Stability –  Coordination (aka motor control)

Mobility

•  Flexibility is passive, ~ gravity dependent

•  Mobility is the ability to move a limb through full range of motion with control

•  Mobility demands strength and coordination

•  Impossible to have good mobility without strength

•  Better to be somewhat inflexible but with good mobility control

Muscle Endurance •  Tone is the continuous and passive partial

contraction of muscles, helps maintain posture

•  Endurance training important (McGill, 2002) –  Reduced back muscle endurance in workers

related to low back troubles (Nicolaisen, 1985; Alaranta, 1994)

–  Endurance more protective than strength (Luoto, 1995)

•  Imbalances in endurance lead to back pain –  Muscle imbalance from right-left sides associated

with back pain (McGill, 2002) –  Back muscles have less endurance than stomach

muscles in those with back pain

Muscle Symmetry & Balance Consistent muscle patterns: –  Certain muscles tend towards tightness – Others towards weakness – Muscles have to do their ‘fair share’

Stretch tight muscles " Upper trapezius " Levator scapulae " Pectoralis " Lumbar erectors " Psoas " Hamstrings

Strengthen weak muscles " Scapula stabilizers " Abdominals (back

stabilizers) " Gluteus (butt muscles) " Neck stabilizers (deep)

•  Many of us develop movement asymmetries

•  Asymmetries are a risk factor for injury (Kiesel, 2014)

•  Asymmetries lead to dysfunctional movement patterns

•  Fundamental movement ability precedes stellar performance

Muscle Asymmetries

Stability •  Guy wires provide stability &

stiffness to ship’s mast or tall poles

•  Trunk muscles are like guy wires, they disperse forces and stabilize the spine

•  Unequal stiffness decreases ability to bear loads & leads to injury

•  Hypermobility = decreased stability

•  “Body awareness, balance, breathing, posture and mobility all contribute to stability.” (Elphinston, PT, Stability, Sport, and Performance Movement, 2008)

Courtesy of A. Schwartz, 2006

• By developing motor control patterns/programs

• These are neural shortcuts from the brain to the muscles that allow us to move swiftly in a coordinated manner

How did you learn to ride a bike?

Functional movement is important to reduce injury risk!

What causes dysfunctional movement? –  Prior injuries

–  Repeated natural activities with excessive frequency, intensity and duration (a.k.a. cumulative trauma)

–  Repeated unnatural activities (iron workers bending all day; sitting 40 hrs/week; unilateral movements

(golfing) a.k.a awkward, prolonged postures

Faulty Motor Control •  Delayed onset of tranversus abdominus (stomach

muscle) results in poor stabilization of the low back. (Hodges 1996)

•  Following severe ankle sprain there are delays in activation of gluteus maximus (buttock muscles) during hip extension (walking) Bullock-Saxton, 1994

• Tightness may provide protective muscle tone • Do we really want to stretch these muscles?

Faulty Motor Control •  Multifidus muscles provide

stability and support to the back along the spine.

•  Multifidus recovery from inhibition associated with acute, 1st episode of low back pain does NOT occur automatically with resolution of pain and disability. This may contribute to high rates of LPB reoccurrence (Hides, 1996)

When muscles work together it’s like music, otherwise it’s just noise!

How  are  these  3  people    different  or  the  same  in  terms  of  fitness?  

“There’s somethin happenin’ here…”

•  A paradigm shift is occurring as we speak! •  Dynamic movement exercise is on the rise •  It has caught-on with: –  Some health professionals (PTs, DCs, Athletic

trainers) –  Athletes –  People who are ‘into’ fitness

•  Hasn’t yet diffused across the general population or into the work environment

What is bringing this about?

•  New research tools available (EMG, force plates, accelerometers)

•  More research into how the musculoskeletal system works (McGill, Kiesel, Marras, Hides, to name a few)

•  The mystery of back pain is beginning to be understood as clinicians and researcher look at how the system works rather than focusing on individual tissues

Fitness practices sometime pay too much attention to weakness and tightness

without evaluating fundamental movement patterns (Cook, PT, Functional Movement Systems page 16)

Functional Movement Programs •  Imbalances and limitations within movement

patterns must be identified to ↓ injury risk. Can’t blindly recommend stretching! –  Core strength and functional movement enhancement

programs reduce number of injuries and time loss due to injury in firefighters (Peate et al., 2007)

–  Football players with dysfunctional movement patterns are more likely to suffer an injury (Kiesel et al, 2007)

•  Static posture screens have been around for many years

•  Now screen are dynamic and pinpoint areas of movement-pattern limitations and asymmetry

•  They identify predispositions to compensatory muscle actions that facilitate poor form and increase the risk of injury

Screening Evaluations

Functional Movement Screen (FMS)

Inline Lunge Deep squat

Hurdle Step

§ Several types of functional screens § FMS developed by Gray Cook, PT § http://www.functionalmovement.com § 7 tests evaluate ‘basic movements’ § Scored 0-3, < 14 = ↑ injury risk

Functional Movement Screen

Rotary stability

Shoulder mobility

Active straight leg raise

Trunk stability push-up

Exercise: From Static to Dynamic From This… …to this

More Dynamic Exercises (from  Peate  et  al,  2007)  

Bridging with shoulders on ball

Basic Bridging

Advanced Bridging with weights

Effective/Ideal Injury Prevention & Health Promotion

A comprehensive back injury prevention program resulted in decreased injury prevalence, improved worker morale, and 179% return on investment in muni workers (Shi, 1993)

Components of program were: 1.  Education - weight control, smoking cessation,

nutrition, stress management, etc. 2.  Training - back safety, hazard ID, strength building 3.  Physical fitness – comprehensive and worker

appropriate exercises led by trained professionals 4.  Ergonomics - hazard ID and changes in equipment,

tools and work practices

Where should work-place physical fitness programs to Be

in 10 years? Ideal programs: ü Medical clearance in occupations with above average

exertion ü  Every worker screened by trained evaluator ü  Every worker gets tailored exercise program with

ü Mobility, endurance, strength, stability and motor training components

ü Workers monitored and programs progress and change over time to keep it fresh and demanding

•  Workers re-evaluated periodically •  If injured, worker is re-evaluated and programs

modified/updated

In small groups write down your questions and concerns. Discuss them in your group and then we’ll discuss

them together Where

would we do it?

How do we get management to

pay for a fitness program?

Conclusions •  Paradigm shifting toward more comprehensive,

dynamic physical fitness training – we MUST move beyond work-place stretching

•  Prevention of MSDs and other chronic diseases (stroke, diabetes) interdependent

•  Better strategies to reduce MSDs and increase overall health should include screening, then combinations of mobility, strength, endurance & coordination training, and aerobic exercise, on a regular basis