PREAMBLE
When it comes to searching for the cause of the
personally-generated musculo-skeletal dysfunctions there appears
to be a gap in both literature and practice about what to look
for and where to look for it.
The gap extends from medical research, through radiology
departments, into surgeries and from there fans out through the
broad range of therapeutic modalities.
There is a cause (in fact it is usually more than one cause) of
most of the personally-generated musculo-skeletal dysfunctions,
particularly lower back pain; you just have to know where to
look for it.
There are clues that are not difficult to detect. Think about
it, we’re dealing with body mechanics here. If we were motor
mechanics we’d be out of a job if we didn’t know what to look
and listen for when someone brought their car in for repair.
A frequent cause of back pain is a herniated disc. The radiology
report focuses on 'what is', not what's caused 'what is'.
‘ … there is a central disc protrusion with a
focul annular tear …’
The important question of what's caused the ‘central disc protrusion with a focul annular tear,' is not addressed.
Whilst this may be a generalization, in the manipulative therapy
industry there is always the temptation to rub, crunch, heat,
vibrate and shock the spot where it hurts and not treat the
underlying cause(s) of the problem. This is understandable; it’s
what the customer expects. Along with a pain killer, it at least
feels like it's doing some good.
How good it is in the long term is debatable,
particularly if the problem is generated by a lack of strength
and flexibility in parts of the body quite removed from the place
where it hurts.
As a rule of thumb, if the problem is generated by a lack of
strength and flexibility then failure to prescribe strength and
flexibility exercises falls short of the mark of best practice.
THE MEDICAL RESEARCH
The (Australian) National Health and Medical
Research Council (NH&MRC) points out in its report on
musculo-skeletal pain;
‘The majority (approximately 95% of cases) of acute low back
pain is idiopathic; serious conditions are rare causes of acute
low back pain.’
The word 'idiopathic' means 'the cause is not known'. For a
robust medical research organisation their findings do not
provide useful advice for those who treat people in pain.
(It could be good news for workers compensation insurers eager
to avoid compensation claims. The incident may not be to blame
at all. It could be 'idiopathic'!)
THE FITNESS RESEARCH
In the majority of cases, lower back (or any
musculo-skeletal pain) is not a medical problem, it’s a fitness
(strength and flexibility) problem and it's not often that a fitness
problem can be solved with a medical solution. Fitness problems
can only be solved by people themselves.
Most people don’t understand that musculo-skeletal pain is the
body’s way of telling them to get back into alignment and to
become stronger so the body can be supported in its correct
alignment.
Pain is not a call to merely deaden the pain.
It’s a warning sign, like the light that flashes on the
dashboard of your car telling you that you’ve run dangerously
low on oil. There are two ways to turn the light off - put more
oil into the engine, or cut the wire.
The results of the Miller Health 2009
musculo-skeletal health survey provide powerful evidence of the
need for people to keep themselves strong and flexible. In fact
you can close up all the musculo-skeletal research institutes
and put down the glasses. Just start training.
The results of The Miller Health
2014 Musculo-skeletal Health
Survey in which 1236 people completed in the musculo-skeletal
risk profile show that people who rate the condition of their
musculo-skeletal system highly are people with a regular and
systematic strength and flexibility training program.
An analysis of the results of a survey of
1236 people who have attended our musculo-skeletal
health seminar over the last 7 years, shows that around
70% of people are at risk of making a claim on their
employer's workers compensation insurance.
Here's the
link
to the results spreadsheet.
If you save the spreadsheet to your computer you'll be able to
manipulate the data to gain a better understanding of what the
information means.
Chances are the results from your organisation may be
similar.
| |
Item |
People
scoring 10/10 |
People
scoring 0/10 |
|
| |
Percentage |
Ave current condition score
out of 10 |
Percentage |
Ave current condition score
out of 10 |
|
| |
Squats |
50 |
6.3 |
6.5 |
3.9 |
|
| |
Situps |
16 |
7.0 |
6.5 |
4.6 |
|
| |
Pressups |
23.5 |
6.8 |
11 |
4.0 |
|
| |
Hamstring stretch |
11 |
6.9 |
25 |
4.8 |
|
| |
Functional mobility |
33 |
6.6 |
12 |
4.7 |
|
| |
Squats, situps, pressups |
10 |
7.5 |
2.4 |
3.7 |
|
| |
Body composition |
23 |
6.6 |
10 |
4.2 |
|
| |
Strength training |
13 |
6.5 |
55 |
5.3 |
|
| |
Flexibility training |
8.5 |
7.6 |
60 |
5.7 |
|
| |
Strength and flex training |
6 |
7.0 |
51 |
5.3 |
|
When the spreadsheet was sorted first on total score,
the 554 people (45%) scoring over 60 were placed in the
low risk
group. The 55% of people at risk were categorised
according to their score.
| |
Risk |
Score range |
People |
Percent
(rounded) |
|
| |
1. Low risk |
60+ |
554 |
45 |
|
| |
2. Moderate risk |
50-59 |
237 |
19 |
|
| |
3. Risk |
40-49 |
213 |
17 |
|
| |
4. High risk |
30-39 |
115 |
9 |
|
| |
5. Very high risk |
20-29 |
69 |
5 |
|
| |
6. Grave risk |
less than 20 |
48 |
4 |
|
We then added to the 'at risk' group,
people who had scored less than 4/10 for the following
parameters:
|
l |
Current condition. If a
person is already in poor musculo-skeletal
health (and in pain) there's a risk that they
could be waiting for an incident to happen that
tips them over the edge into your workers
compensation claims basket. |
| |
|
|
l |
Body composition - code for
being over weight. People 20Kg over weight are
at risk. |
| |
|
|
l |
Abdominal strength |
| |
|
|
l |
Leg strength |
| |
|
|
l |
Upper body and trunk strength |
| |
|
|
l |
Hamstring flexibility |
| |
|
|
l |
Functional mobility |
| |
|
|
l |
Shoulder function |
This reduced the percentage of low risk
people to 30%.
| |
Risk |
Score range
out of 100 |
People |
Percent
(rounded) |
|
| |
1. Low risk |
60+ |
365 |
30 |
|
| |
2. Moderate risk |
50-59 |
57 |
5 |
|
| |
3. Risk |
40-49 |
582 |
47 |
|
| |
4. High risk |
30-39 |
115 |
9 |
|
| |
5. Very high risk |
20-29 |
69 |
5 |
|
| |
6. Grave risk |
less than 20 |
48 |
4 |
|
Comparative results
| |
Item |
People
scoring 10/10 |
People
scoring 0/10 |
|
| |
Percentage |
Ave current condition score
out of 10 |
Percentage |
Ave current condition score
out of 10 |
|
| |
Squats |
50 |
6.3 |
6.5 |
3.9 |
|
| |
Situps |
16 |
7.0 |
6.5 |
4.6 |
|
| |
Pressups |
23.5 |
6.8 |
11 |
4.0 |
|
| |
Hamstring stretch |
11 |
6.9 |
25 |
4.8 |
|
| |
Functional mobility |
33 |
6.6 |
12 |
4.7 |
|
| |
Squats, situps, pressups |
10 |
7.5 |
2.4 |
3.7 |
|
| |
Body composition |
23 |
6.6 |
10 |
4.2 |
|
| |
Strength training |
13 |
6.5 |
55 |
5.3 |
|
| |
Flexibility training |
8.5 |
7.6 |
60 |
5.7 |
|
| |
Strength and flex training |
6 |
7.0 |
51 |
5.3 |
|
The 6% of people who scored 10/10 for the
quality of their strength training program scored a
total of 77/100.
The 56% of people who didn't have a
strength training program scored 47/100.
The 8.5% of people who scored 10/10 for
the quality of their flexibility training scored a total
of 78 on the profile.
The 60% of people who scored 0/10 for the
quality of their flexibility training program scored a
total of 49.
|
1. |
The 6% of people who scored 10/10
for the quality of their strength training
program scored a total of 77/100. |
|
|
|
|
2. |
The 56% of people who didn't have
a strength training program scored 47/100. |
|
|
|
|
3. |
The 8.5% of people who scored
10/10 for the quality of their flexibility
training scored a total of 78 on the profile. |
|
|
|
|
4. |
The 60% of people who scored 0/10
for the quality of their flexibility training
program scored a total of 49. |
|
|
|
|
5. |
The 15% of people who were more
than 20Kg over weight had an average total score
of 38 |
|
|
|
|
6. |
The 52% people who were less than
10Kg over weight scored an average total score
of 65 |
|
|
|
|
7. |
The 6.5% of people who couldn’t do 1
squat had an average score of 27. |
|
|
|
|
8. |
The 23% of people who couldn’t do 1 situp
had an average score of 38. |
|
|
|
|
9. |
The 11% of people who couldn’t do 1
pressup
had an average score of 31. |
The survey results mirror the results
from a survey we undertook in 2007.
Comparative results
from the 2007
Musculo-skeletal Risk
Survey
|
1. |
Only 5% of people had a
reasonable strength and flexibility training
program. Their average total score on the
profile was 84. |
|
|
|
|
2. |
Only 10% had a reasonable
flexibility training program, Their average
total score on the profile was 75. |
|
|
|
|
3. |
Only 17% of people had a
reasonable strength training program. Their
average total score on the profile was 74. |
|
|
|
|
4. |
The average total score of the
58% of people who had no strength or flexibility
training program at all was a miserable 46. |
|
|
|
|
5. |
Those who were 15 - 19kg over
weight had an average total score of 40 |
|
|
|
|
6. |
Those who were 20Kg or more over
weight had an average score 36 |
|
|
|
|
7. |
People who couldn’t do 1 situp
had an average score of 38. |
|
|
|
|
8. |
People who couldn’t do 1 pressup
had an average score of 32. |
Musculo-skeletal
Risk Summary
Improving the
musculo-skeletal health of your staff is a win-win-win
process.
Your staff win, they feel better.
Your organisation wins
because the risk of workers
compensation claims is lowered and if you happen to
receive an incident claim, you and your insurer have
the risk information to reject claims that are not
genuine work-related accidents.
(You have to protect
yourself from law firms that are encouraging and
actively supporting people (on a no win, no fee basis)
who have set their mind on winning a large workers
compensation payout. If you aren't focused, serious and
attentive to the task of measuring and managing risk,
you'll be taken to the cleaners by a professional group
that, like a pack of roaring lions is stalking poorly
prepared organisations. There are rich pickings in this
business.)
Measuring and managing
the risk of personally-generated musculo-skeletal
dysfunctions entails:
|
1. |
involving your
staff in the
musculo-skeletal health seminar that
includes the
10 point musculo-skeletal health screen.
This is a 'no ticket, no start'
musculo-skeletal health risk program. |
|
|
|
|
2. |
using the
results of the 10 point musculo-skeletal health
screen to identify people with musculo-skeletal
dysfunction and/or those who threaten your
workers compensation arrangements. |
|
|
|
|
3. |
reviewing your
organisation's
musculo-skeletal risk
screen spreadsheet to get a
picture of what your risk profile looks like and
identify people at risk. |
|
|
|
|
4. |
signing the
high risk people up for the
Clinical Assessment. It's
essential that you have a Diagnostic Assessment
report in your files, preferably with an X-ray
attached. |
|
|
|
|
5. |
showing a duty of
concern and care and enrolling your high risk staff
members on a one week
Pro-Active Rehab program. During the program
participants are taught the exercises they need to do to
get their bodies back into better alignment and strong
enough to do every day tasks without breaking down.
The Pro-Active Rehab
program involves clients spending 8 hours a day doing a
range of strength and flexibility exercises, inner
mental training, aerobic exercise, backed up with and an
holistic health education program.
|
|
|
|
|
6. |
enrolling all
your staff in a
daily strength and flexibility exercise
program. |
