A Sports Medicine Approach to Overuse Injuries in the Workplace Presented by Jeffrey Pearson, D.O. San Marcos, California .

A Sports Medicine A Sports Medicine Approach to Overuse Approach to Overuse

Injuries in the WorkplaceInjuries in the Workplace

Presented byPresented by

Jeffrey Pearson, D.O.Jeffrey Pearson, D.O.

San Marcos, CaliforniaSan Marcos, Californiawww.medicine-in-motion.comwww.medicine-in-motion.com

SportsmedicineSportsmedicine

Medicine in motionMedicine in motion

The “Industrial Athlete”The “Industrial Athlete”

Applying the principles of Applying the principles of sportsmedicine to the evaluation sportsmedicine to the evaluation and treatment of injured workers.and treatment of injured workers.

The “Industrial Athlete”The “Industrial Athlete”

AdvantagesAdvantages Faster, more efficient return to Faster, more efficient return to

participationparticipation enhances self-esteem of injured enhances self-esteem of injured

workerworker Team physician conceptTeam physician concept

Humans are machinesHumans are machines

Underlying structureUnderlying structure electrical systemelectrical system plumbingplumbing pulleyspulleys energy plantenergy plant thermostatthermostat

Review of anatomyReview of anatomy

bonesbones joints/synovial liningsjoints/synovial linings

ligamentsligaments muscles/tendonsmuscles/tendons

synovial sheathssynovial sheaths

The Cycle of OveruseThe Cycle of OveruseOverloading

Tissue injury

Inflammation Continued activity

Pain

Rest - healing

Overuse: force vs. timeOveruse: force vs. time

Effects of Effects of forceforce (intensity) (intensity) jumping from jumping from

chair to floorchair to floor jumping from jumping from

significant heightsignificant height acuteacute overuse overuse

Overuse: force vs. timeOveruse: force vs. time

Effects of Effects of timetime (duration) (duration) walking around the walking around the

blockblock hiking the Continental hiking the Continental

DivideDivide

chronicchronic overuse overuse cumulative traumacumulative trauma

Common types of overuse Common types of overuse injuriesinjuries Tendons Tendons

de Quervain’s tenosynovitisde Quervain’s tenosynovitis extensor tendonitis/lateral epicondylitisextensor tendonitis/lateral epicondylitis rotator cuff impingementrotator cuff impingement

Nerves Nerves carpal tunnel syndromecarpal tunnel syndrome cubital tunnel syndromecubital tunnel syndrome

Common types of overuse Common types of overuse injuriesinjuries Bone and joints Bone and joints

stress fracturesstress fractures degenerative arthritisdegenerative arthritis

Connective tissuesConnective tissues plantar fasciitisplantar fasciitis

Grading overuse injuriesGrading overuse injuries

Grade I (most mild)Grade I (most mild) symptoms occur generally symptoms occur generally only after only after

activity or at night.activity or at night. May keep hands under pillow.May keep hands under pillow.

Grading overuse injuriesGrading overuse injuries

Grade IIGrade II symptoms occur symptoms occur

during activity, during activity, but but do not interfere do not interfere with performance with performance of tasks.of tasks.

Grading overuse injuriesGrading overuse injuries

Grade IIIGrade III symptoms occur symptoms occur

during activity during activity and do interfere and do interfere with performance.with performance.

Grading overuse injuriesGrading overuse injuries

Grade IVGrade IV symptoms so bad symptoms so bad

unable to use the unable to use the affected part.affected part.

Treatment of overuse Treatment of overuse injuriesinjuries General principlesGeneral principles

flexibilityflexibility strengthstrength enduranceendurance

Treatment of overuse Treatment of overuse injuriesinjuries Acute phaseAcute phase

PPRICERICESS ProtectionProtection RRestest IIcece CCompressionompression EElevationlevation SupportSupport

Ice is Nice!

Treatment of overuse Treatment of overuse injuriesinjuries Grade IGrade I

Reduce intensity or duration of activity by Reduce intensity or duration of activity by 25%. More diligent stretching. Ice following 25%. More diligent stretching. Ice following activity.activity.

Follow the 10% per week rule.Follow the 10% per week rule. Sudden, excessive overtime is a sure-fire recipe Sudden, excessive overtime is a sure-fire recipe

for overuse complaints because the workers do for overuse complaints because the workers do not have an opportunity to build up their not have an opportunity to build up their endurance prior to the extra work.endurance prior to the extra work.

Treatment of overuse Treatment of overuse injuriesinjuries Grade IIGrade II

Reduce intensity or duration of the activity by 50%.

NSAIA’s Counterforce bracing Consider physical therapy

flexibility, endurance, eccentric strengthening

Treatment of overuse Treatment of overuse injuriesinjuries Grade IIIGrade III

"Active" rest: the worker should stop performing the offending tasks, but is allowed to move the affected part for his daily activities.

Physical therapyPhysical therapy Consider steroid injectionConsider steroid injection

Treatment of overuse Treatment of overuse injuriesinjuries Grade IVGrade IV

Complete rest of the affected part, usually involving the use of some sort of sling or splint

If all else fails, consider surgical If all else fails, consider surgical options.options.

Sports Medicine PearlsSports Medicine Pearls

Healthy people perform better Healthy people perform better than sick people.than sick people. Difficult to win Super Bowl with team Difficult to win Super Bowl with team

of injured athletesof injured athletes Athletes perform better when Athletes perform better when

using the right equipmentusing the right equipment Difficult to run marathon if shoes too Difficult to run marathon if shoes too

big or too smallbig or too small

Sports Medicine PearlsSports Medicine Pearls

Training/conditioning Training/conditioning Should progress graduallyShould progress gradually Example: return to running Example: return to running

programprogram cycling 45 minutescycling 45 minutes walk 2 miles in 30 minuteswalk 2 miles in 30 minutes alternate jogging/walking alternate jogging/walking gradually increase gradually increase

speed/intensity/distancespeed/intensity/distance– increase by 10% per week maximumincrease by 10% per week maximum

Sports Medicine PearlsSports Medicine Pearls

Training/conditioning Training/conditioning In the workplace, consider:In the workplace, consider:

Increase duration of a specific task Increase duration of a specific task gradually, e.g. an hour/day/week.gradually, e.g. an hour/day/week.

alternating tasks/departments every alternating tasks/departments every few hours.few hours.

Sports Medicine PearlsSports Medicine Pearls

Work smartly with proper Work smartly with proper ergonomicsergonomics concept of neutralityconcept of neutrality

Sports Medicine PearlsSports Medicine Pearls

Maintain flexibility Maintain flexibility stretches every 2 hours stretches every 2 hours

(approximately)(approximately) slow and controlled movementsslow and controlled movements

Sports Medicine PearlsSports Medicine Pearls

Decrease unnecessary forces to Decrease unnecessary forces to bodybody footwear footwear

Vibram rubber solesVibram rubber soles shock matsshock mats

SummarySummary

We have only one body/machine We have only one body/machine that needs to last us for our entire that needs to last us for our entire lifetime.lifetime.

Taking good care of the machine Taking good care of the machine helps to ensure that it will not helps to ensure that it will not break down as much and last a break down as much and last a long time.long time.

Thank you!(And enjoy your stay in San Diego!)