From Injury to Dysfunction
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From Injury to Dysfunction |
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THE EFFECTS OF MOTION STARVATION The road from - injury to dysfunction - rehab to prehab - under-use to over-use is paved with misguided intention. Let's start with the 80:20 rule. I think that what I'm about to say is probably true 80% of the time. Like most things that go wrong with the body, one cannot be absolutely certain, all of the time, about the cause of the dysfunction.
Syndrome! There appears to be an epidemic of musculo-skeletal dysfunction, the most prevalent manifestations being crook backs, stiff necks, frozen shoulders and sore wrists. Because the medical and OH&S professions doesn’t know the cause of it, it’s been given the dreadful name of OOS, standing for ‘occupational overuse syndrome.’ (Invariably when the medical profession doesn't know the cause of something they call it a 'syndrome' e.g. attention deficit syndrome, irritable bowel syndrome ... And inevitably when you don't know the cause of something you can't prescribe an effective treatment to fix it.)
However, occupational overuse syndrome is not a syndrome, it’s a dysfunction. It has a cause and it can be both prevented and treated. Whilst it may appear to be due to over-use, appearances can be deceptive. It is usually caused by under-use: - lack of a regular and systematic strength and flexibility training program that involves people doing the strength and flexibility exercises that keep them strong and flexible enough to do their jobs.
In people who become dysfunctional, there is a high likelihood that they stopped doing their exercises (laziness and stupidity) – or worse still they never knew they had to do them (ignorance).
It’s a very big ask expecting to avoid musculo-skeletal dysfunction by having someone do something to you. This is because musculo-skeletal dysfunction is not caused by a lack of massage, anti-inflammatory medicine or electric shock therapy!
Of course it you can't pin point the cause then it's very difficult to get rid of the dysfunction and build the person back to normal good health.
(To complicate matters, when it comes to any body system dysfunction, it is likely that some of the reason for the dysfunction is related to something going on inside the mind. That being the case, treatment for any workplace dysfunction needs to have an element of mental rehabilitation - personal development, career development etc etc.)
KEEP FIT AND HEALTHY Whenever I see someone in the workplace with one of the non-life-threatening body system dysfunctions I immediately have the thought that maybe they're not all that fit and healthy. Of course, it's a big ask expecting to keep healthy in our culture if you're not keeping yourself fit - that is especially if you're in a sit down profession. If you're a brick-layer, gardener or farmer it's much easier to keep fitter and healthier because you're being physically active for the 2000 minutes a week the average office worker spends sitting down.
On the other hand, in any occupation where people don’t have a regular strength and flexibility program, musculo-skeletal dysfunction will soon rear its ugly head.
From what I've seen, many organisations that employ people in the sit-down professions have staff who are in poor physical condition - they're disasters waiting to happen, physically and mentally.
In particular they are not strong and flexible enough to do what appears to be a very cushy job, one that appears not to require them to be strong or flexible. That, in my opinion is why many organisations have a large musculo-skeletal problem.
People are just not aware that they need to keep themselves strong and flexible to do what appears to be a cushy job.
I have in front of me a stack of Mind and Body profile scores. Keep in mind that a normal fit and healthy person has a score of less than 20. Many staff have scores over 100. The back ground noise is deafening. Click here to see some Mind and Body profile results.
People have all manner of body system dysfunctions, most of which organisations are not aware. You would be absolutely amazed at the number of people who have crook backs, stiff necks, sore shoulders and sore arms who have not bothered to submit a workers compensation report and/or seek organisation-sponsored treatment.
Poor health also shows in the average number of days off each staff member has a year. 3 days off a year would be a reasonable result. So, if the average number of days of a year for unplanned absences (sickness sickies, workers comp …) is more than 3, then subtract 3 from the average number of days, multiply that number by the number of staff you have, and then multiply it again by the $200 a day it costs to employ them.
For most organisations it’s a lot of money, dead, unproductive money just being eaten up by the effects of poor health, low levels of fitness, indifferent management and people being in the wrong job.
MANAGEMENT On the question of management, there are very few organisations who sheet home the cost of absenteeism and workers compensation claims to particular managers. This is just one of a number of issues that managers are reluctant to manage – or maybe they’ve never been taught how to manage it. The OH&S staff just pick up the pieces after the event and life goes on. Money is drained out of the organisation.
OCCUPATIONAL HEALTH AND FITNESS AUDIT So I recommend is a series of health audits, the Mind and Body (M&B) profile, the musculo-skeletal risk factor profile, stress risk profile and career satisfaction profile being the first ones.
I usually get people to fill in the M&B profile when I run a course, but some time ago another organisation asked me whether I could get people to fill it in online - with anonymity. You can now do that by clicking over to the Mind and Body Profile.
In the future Miller Health will be able to provide staff with objective and automatic online feedback, or a phone-line counseling service. For instance, what sort of service do you supply to someone who gets a score of 180 on the Mind and Body Profile? This is a person who is experiencing great difficulty with their health and their mental condition. They are the people that need to be referred immediately to the organisations EAP.
What Miller Health does is present a series of two hour seminars, which include completing the Mind and Body profile, followed up by a quick 20 minute personal consultation. A bit of coaching is all it needs for a lot of people to become inspired and motivated to keep themselves fitter and healthier.
MUSCULO-SKELETAL DYSFUNCTION – cop is sweet Only about 10% of the people I see have a regular and systematic strength and flexibility training program.
The rest are getting weaker and tighter by the minute. Click here to look at some Musculo-Skeletal Risk Factor scores.
They get crook backs, sore shoulders, stiff necks and RSI and then blame the employer who, unless they've put in train a regular and systematic musculo-skeletal awareness and training program has to take it on the chin.
However any organisation that wants to avoid the cost of claims for musculo-skeletal dysfunction needs to do a number of things.
BILL OF RESPONSIBILITIES The expectation of all staff to the right of access to workers compensation is attended by the responsibility to keep themselves in the reasonable level of physical condition needed to perform duties in their occupation – whether it be a stand up and move around occupation or a sit down occupation.
I think that with an appropriate education program organisations can quickly get to that position. It requires an Occupational Health and Fitness Manifesto and some training for all managers.
Responsibility of individual managers Managers need to understand that when the costs of absenteeism and workers compensation are tallied up, they will be sheeted home to their budget. The responsibility for health needs to be added to their responsibility for the safety.
This means absenteeism and workers compensation costs need to be apportioned by department and not through the organisation as a whole; otherwise no one is responsible. You can’t run an organisation that way.
No manager I know would want staff to become dysfunctional. Managers have a duty of care to do their level best to see that people don't become dysfunctional on their watch.
I am of course presuming that people don't want to be dysfunctional, and if they are, that they want to get better quickly.
Of course, the responsibility for health rests with the individual. Ignorance is not an excuse when it comes to looking after yourself. However, we know that the workplace is hazardous to health – sitting down, cooped up in a cage for 30 years, without encouragement to do the things needed to stave of dysfunction impacts on both the individual and the organisation. It behooves the organisation to get on the front foot – measure risk, do something about high risk, reward good health and fitness behaviour and generally speaking be proactive in developing a healthy workplace.
Most organisations never bother to measure exactly how fit and healthy their staff are, and there’s the rub. If they don’t measure it, they won’t know if something’s going wrong and they won’t be able to do anything about it.
It’s bad management of the business.
I would go so far as to say that people at risk of musculo-skeletal dysfunction do not have an option to opt out of a program that is recommended by management under the auspices of an occupational health and fitness umbrella.
At the present time, few organisations are looking any further than issues relating to safety. They are, in my opinion abrogating their responsibility in the area of health, and as such are wearing the financial consequences.
STRATEGY
THE INVESTMENT Money spent encouraging people to keep themselves stronger and more flexible is not a cost, it's an investment. Treatment on the other hand is a cost and you can probably get a figure for what it's currently costing your organisation.
The big costs to employing people can be measured.
TRAINING MANAGERS, OH&S STAFF AND CASE MANAGERS Most organisations would benefit by training their OH&S and case-management staff so they can carry out much of this work. In this day and age I would expect anyone working in the OH&S and case management field to have a fitness leader qualification on top of what else they might have.
For those people who are dysfunctional (they're not injured) I believe there needs to be an expectation that they attend organisation-sponsored strength and flexibility classes every day. They can't be allowed to loll around at home, going to someone for a rub down twice a week. That's an expensive nonsense.
MEDICAL SUPERVISION Medical supervision of people with musculo-skeletal conditions in this country is, generally speaking, not good.
General practitioners are likely to encourage people to have time off and to spend organisation money on therapists, rather than having them do something for themselves. In fact it's a very big ask expecting the body to get better by having someone do something to it: sooner or later people have to do something to themselves - like strengthening and stretching weak and tight muscles.
I would recommend to some organisations that they have written into their agreement with staff that any musculo-skeletal dysfunctions that they feel are attributable to work, must be seen by the 'company' musculo-skeletal 'specialist' and not by their own doctor. This means organisations having someone outside the medical loop who is proficient in diagnosing the cause of musculo-skeletal dysfunction. Musculo-skeletal dysfunction is a fitness problem not a medical problem.
Most doctors are not aware of the causes of musculo-skeletal dysfunction; they’re just good at taking a person’s word that they have it. Like their colleagues in general practice they will probably just tell people to pull their knees up to their chest, then send them off to the radiologist, physio and pharmacist, tell them to spend the rest of their time lolling around in front of TV and leave it at that.
Rehab providers need some education in this respect as well and need to know what the organisation’s expectations are. I don't think you can presume that all rehab programs, particularly those that are medically supervised are providing staff with what they need to fix themselves up.
A comparison with what athletes do to fix themselves up and what rehab providers recommend to dysfunctional staff in corporate organisations will provide you with clues about the sort of policy guidelines your organisation needs to lay down for its own OH&S staff and external rehab providers. There's no comparison between what athletes do and what your average mug punter does. The treatment for mug punters in the workforce is dreadful in comparison. The return to work rates abysmal. The costs horrendous.
SECOND OPINION I also believe any one with musculo-skeletal dysfunction needs to have someone make an assessment of the cause of the dysfunction.
You can’t determine the cause of a dysfunction by looking at an X-Ray. Whilst an X-Ray can tell you which bones have been drawn out of alignment, it won’t tell you which muscles are responsible. You'd be better off sending a person to a photographer than a radiologist.
We have reached the point where we can no longer rely on the medical profession to tell us the cause of most musculo-skeletal dysfunctions.
If you want a second opinion as to the likely cause of a crook back or a stiff neck, drop me a line.
PRINCIPLES OF MUSCULO-SKELETAL DYSFUNCTION ■ The first principle of musculo-skeletal dysfunction is that Bones do what muscles tell them to do.
■ The second principle is that the cause of the dysfunction is most likely not at the site of the pain.
■ The X-Ray is a useless diagnostic tool. It shows where bones are out of alignment but does nothing to point to the cause of the misalignment. Photographs are usually more effective in pointing out the cause of the misalignment.
■ Most dysfunctions are caused by what doesn't happen at home, rather than what does happen at work - ie, people don't have a regular and systematic strength and flexibility training program. They have weak and tight muscles. The fact that a dysfunction manifests itself, is in most cases not the fault of the employer.
Letting people know the likely cause of their dysfunction is a Miller Health specialty.
For a start it’s easy to determine whether people are strong and flexible. That then gives basic clues as to whether they have been training or not.
Secondly, by running them through a few simple stretching positions and with a bit of probing quickly determine what the cause of the problem is.
■ Invariably the cause of the pain is not located at the site of the pain, so merely giving the site of the pain a crunch, rub down, electric shock therapy and a bit of heat, and swallowing a tablet doesn't fix the cause of the problem.
Miller Health welcomes the opportunity to work closely with corporate organisations, OH& S staff, case managers and insurers to provide them with objective information about the causes of some dysfunctions. Work is being blamed unfairly. Insurers are too lenient. The system is being defrauded.
AVOID SWIFTIES AND FALLACIES People who think that because they have a cushy job sitting down they don't have to keep themselves strong and flexible have a second think coming.
■ Doctor reads X-ray and says, 'Mate/madam you've popped a disc out.' Doctor doesn’t determine the cause of the dysfunction. (Doesn’t and can’t because he or she has got a clue what caused it. It just happened out of the blue! Hello!)
back, then work must have caused it.'
give them a couple of months off, pay for a gross of anti- inflammatory pills, a few rub downs, crunches and electric shocks, none of which do anything to improve strength and flexibility, lack of which was the original cause of the dysfunction.
skeletal dysfunction within the organisation at all well, cops it on the chin, agrees with what the doctor says, signs the claim form and sends it off to the insurer.
get their money back next year when they add another couple of thousand bucks onto the employer's premium.
■ Back never gets better. Person gets a payout and goes up to Queensland and buys a lawn owing franchise.
■ Everyone's happy. Employee happy; payout and a new job in the fresh air has proven to be a miraculous cure. Employer happy; puffs chest out because a problem has gone away (to Queensland) and their costs are less than those of comparable organisations. Doctor happy; patient gone away; hands rubbed with glee due to extra fee that was charged courtesy the compo system.
Insurer very happy - in expectation of next year's premium increase; has difficulty wiping jam off face. Case manager happy because a good result was achieved all round and everyone else is happy. Problem swept under the carpet. Reports have been written up and filed away. Due process has been observed. Congratulations to all the non-participants. Next customer is waiting.
FROM REHAB TO PREHAB Change your outlook on musculo-skeletal dysfunctions within the workplace from rehab to prehab.
Just as staff expect to have access to rehabilitation programs, it behooves organisations to implement compulsory prehab programs for people at great risk of musculo-skeletal dysfunction.
As for the compulsion - it is doubtful that anyone at great risk - and probably already experiencing pain and discomfort would pass up the opportunity to get their musculo-skeletal system back in good nick. They'll feel better.
MILLER HEALTH So what can we do for you.
In a nutshell and on the musculo-skeletal front: -
HOW TO FIX UP A CROOK BACK
John Miller (02) 6288 7703
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