miller Health Occupational Health and Fitness

2. OSDM 85 - MARCH 2009

John Miller conducted the CrookBack Clinic musculo-skeletal health program for The Group in February and March 2009.

85 people, 76 men and 9 women took part in the program and completed the following profiles: -

■ Health, Fitness and Wellbeing

■ Musculo-skeletal risk

The results are presented in graphic format, with commentary.

Click here to read what the assessments are all about

HEALTH, FITNESS AND WELLBEING PROFILE

The Health, Fitness and Wellbeing profile provides people with a very good idea of how well the various systems of the body are functioning, particularly the

• the mind

• autonomic nervous system

• immune system

• digestive system

• circulatory system

• elimination system

• musculo-skeletal system.

	Symptom	None		Not much			A fair bit			A lot
1.	Headaches including migraines	0	1	2	3	4	5	6	7	8	9	10
2.	Lack of energy and vitality	0	1	2	3	4	5	6	7	8	9	10
3.	Candida - jock itch, thrush, tinea ...	0	1	2	3	4	5	6	7	8	9	10
4.	Poor sleep. If on tablets score 10	0	1	2	3	4	5	6	7	8	9	10
5.	Snoring &/or sleep apnoea. Score 10 if using a mask	0	1	2	3	4	5	6	7	8	9	10
6.	Crook back, stiff neck, sore shoulders, dicky knee RSI ...	0	1	2	3	4	5	6	7	8	9	10
7.	Frequent colds, flu, sinus	0	1	2	3	4	5	6	7	8	9	10
8.	Unsettled stomach, reflux (Score 10 if on medication)	0	1	2	3	4	5	6	7	8	9	10
9.	Overweight - 1 point for every 2Kg	0	1	2	3	4	5	6	7	8	9	10
10.	Irritable bowel, constipation	0	1	2	3	4	5	6	7	8	9	10
11.	Asthma	0	1	2	3	4	5	6	7	8	9	10
12.	Low level of aerobic fitness	0	1	2	3	4	5	6	7	8	9	10
13.	Chest pain, palpitations	0	1	2	3	4	5	6	7	8	9	10
14.	Rashes, itchiness, skin outbreaks, psoriasis ...	0	1	2	3	4	5	6	7	8	9	10
15.	Mouth ulcers, cold sores	0	1	2	3	4	5	6	7	8	9	10
16.	Elevated blood pressure. Score 0 on pills	0	1	2	3	4	5	6	7	8	9	10
17.	Elevated blood cholesterol. Score o if on pills	0	1	2	3	4	5	6	7	8	9	10
18.	Elevated blood glucose. Score 0 if on medication	0	1	2	3	4	5	6	7	8	9	10
19.	Shakes, nervous ticks, mannerisms	0	1	2	3	4	5	6	7	8	9	10
20.	Grinding teeth	0	1	2	3	4	5	6	7	8	9	10
21.	Alcoholic drinks per day (2 pts/drink)	0	1	2	3	4	5	6	7	8	9	10
22.	Smoking. (1 pt/cigarette/day)	0	1	2	3	4	5	6	7	8	9	10
23.	Caffeine (1 pt/cup per day)	0	1	2	3	4	5	6	7	8	9	10
24.	Anxious about life, insecure, apprehensive	0	1	2	3	4	5	6	7	8	9	10
25.	Sad or depressed (On medication, score 0)	0	1	2	3	4	5	6	7	8	9	10
26.	In wrong job for now	0	1	2	3	4	5	6	7	8	9	10
27.	Under-appreciated at work	0	1	2	3	4	5	6	7	8	9	10
28.	Have poor work/life balance	0	1	2	3	4	5	6	7	8	9	10
29.	Unhappy with family life	0	1	2	3	4	5	6	7	8	9	10
30.	Unhappy with financial status	0	1	2	3	4	5	6	7	8	9	10

Score

The score of a normal, fit and healthy human being is less than 20. A reasonable score is less than 50.

Higher scores are symptomatic of dysfunction of one or more body systems.

People with high levels of stress usually score well over 100.

We know a fit and healthy group when we see the majority of scores below 40. This was not the case with this group. By and large higher scores are usually a reflection of

• low levels of fitness

• an inability to deal with what life and work are serving up to people.

Remember, it is not what happens, but how we deal with what happens that determines our level of stress.

Classification of average scores: Excellent - less than 40. Good - 41 - 50. Fair 51-60. Poor - over 60.

This profile is described as poor. The average score was 72.

For people with a score of more than 80, the ‘background noise’ of their life is becoming louder and louder. It is hard to concentrate on your work when body systems are dysfunctional.

What surprised us about this score is the higher than normal number of people scoring less than 20 on the profile. In that respect it's a good result.

HEALTH CLIMATE SURVEY

Based on scores received in the Health, Fitness and Wellbeing profile we've compiled a Health Climate Survey. Scores on each item have ranked - the higher the score the worse the problem. We added the scores for each item. The results appear in the table below.

Symptoms/issues/concerns	% of people scoring over 5 Total number 85
Crook back, sore shoulders	61
Low level of fitness	48
Overweight	44	16people 20Kg over-wt
Snoring, sleep apnoea	37
Lack of Energy	33
Poor sleep	31
Under appreciated at work	29
Work-life balance	29
Reflux, unsettled stomach	26
Alcohol	25
Elevated cholesterol	20	6 on medication
Wrong job	20
Financial status	20
Elevated blood pressure	19	10 on medication
Caffeine	19
Anxious	19
Headaches	17
Itchy, rashes, psoriasis	17
Shortness of breath from asthma	15
Unhappy family life	15
Irritable bowel, constipation etc	13
Frequent colds, flu, sinus	12
Smoking	12	7 people
Grinding teeth	11
Depressed	11	2 on medication
Elevated glucose	10
Candida	8
Chest pain, palpitations	8
Mouth ulcers	5
Shakes, nervous mannerisms	2

We registered those scores of 5 and over as being a symptom, issue or concern, the most pressing of which have been highlighted.

Perception

Based on people's perception (where they gave a particular symptom a score of 5 or more, and backed up by objective scores) the key issues are

•	Musculo-skeletal dysfunction 61% of people said they had some sort of musculo-skeletal dysfunction. Musculo-skeletal dysfunction goes with low levels of strength and flexibility. Those at greatest risk need encouragement to attend a strength and flexibility training program several times a week.

•	Only 12% of people smoked, several not heavily. This is well below the community average of around 20%. Nevertheless, it's a habit that's killing people and we recommend the company move heaven and earth to assist people to quit. Plus it's costing the smokers a fortune in money that many don't have.

•	Obesity 44% of people said they were more than 10Kg over weight. 5% were more than 20Kg overweight.

•	Snoring 37% of people said they snored loudly enough for it to be a problem. The recipe for a good snore is to be male, be unfit and at least 20Kg over weight, to have high blood pressure, have a few drinks every night, be stressed out of their brain and sleep on their back.

•	Lack of energy 33% of people said they lacked energy. Low levels of energy come from many sources, including: - - lack of a good aerobic fitness training program - a diet high in wheat flour and sugar - dullness - ...

•	Fitness 48% said they were unfit. Fitness has a significant bearing on the scores for low levels of energy, poor sleep, snoring, depression and headaches.

•	Rashes and itchiness Can be caused by a range of things: - - a body that's stressed producing too much cortisol - a toxic diet - a sluggish elimination system - itching to get away from something - ...

•	Headaches 17% of people said they regularly get headaches. Headaches are caused by - a diet high in wheat flour and sugar - caffeine withdrawal - lack of oxygen getting to the head - a sluggish elimination system - a head out of alignment due to tight and weak muscles - beating your head against a brick wall - ...

•	Colds and flu Symptom of a depressed immune system, one which can be strengthened by eating from the top of the Hourglass and getting plenty of aerobic exercise.

•	Under-appreciation at work 29% said they were under-appreciated at work. Managers need to take note and put in train a series of measures to improve this score in say, 3 months time.

•	Being in the wrong job 20% of people said they were in the wrong job. There is usually a high and positive correlation between people being in the wrong job and people saying they are under-appreciated at work.

•	Diet A diet high in flour and sugar and low in fruit, vegetables and fibre leads to irritable and bowel, reflux.

•	Depression and anxiety There is an epidemic of depression in our community and we encourage all organisations to target depression. 11% of people gave themselves a score of 5 or more on the depression question, indicating risk that needs to be dealt with. 2 people were on anti-depressant medication. There is a significant core of depression that relates to poor health generally. All body systems are connected. The epidemic of depression will continue to escalate at the same rate as the epidemic of all other body system dysfunctions. People need to be given encouragement to exercise regularly and vigorous, eat less flour and sugar and imbibe less of the culturally chemicals - particularly nicotine, caffeine and alcohol. Because of the relationship of depression to fitness and diet there is a chance that some people have been misdiagnosed. Some aspects of depression relate to psychologically generated issues. It is important that these people be encouraged to have regular counselling - through the EAP or other counsellors - The best book about depression I've read, and what you can do about it, and one that I recommend highly is by psychiatrist, David Servan-Schreiber, Healing Without Freud or Prozac.

•	Blood pressure 19% of people indicated their blood pressure was elevated. 10 people were on blood pressure medication. Blood pressure is a symptom of body system dysfunction relating directly to - lack of aerobic fitness - being over weight - being stressed.

MUSCULO-SKELETAL RISK FACTOR

Our musculo-skeletal risk factor profile looked at a range of parameters including mobility, strength and flexibility and whether people are training to keep themselves strong and flexible.

The musculo-skeletal risk factor profile is comprised of a mix of 7 objective and 3 subjective assessments.

• Current musculo-skeletal condition

• Abdominal strength test

• Upper body strength test

• Flexibility

• Functional mobility – the ability to sit down and stand up with ease.

• Shoulder function

• Dominant hand grip

• Non-dominant hand grip

• Flexibility training behaviour

• Strength training behaviour

A score of 70% is attainable by those who have a regular and systematic training program.

Those scoring less than 70 are not doing sufficient in the way of strength and flexibility exercises. They are therefore exposing themselves to a high risk of musculo-skeletal dysfunction. (It would be bizarre for a workplace to offer to pay the rehabilitation costs of people who were not keeping themselves strong enough or flexible enough to do their job without succumbing to musculo-skeletal dysfunction, wouldn't it?)


A fair result. 40% of the participants are experiencing some pain and discomfort. Those scoring less that 5 are experiencing a lot of pain. Those scoring less the 6 need to be required attend a prehab/rehab program, for their own benefit and that of the organisation.		44% were 10 or more kilos over their ideal weight. Being overweight greatly compromises mobility. 25% were more than 15Kg over weight - placing them at extreme risk of musculo-skeletal dysfunction.

Generally speaking a good result. Only 4 people performed poorly.		This is a poor result. 40% of people failed the test. 11 people couldn't do one sit up. This means that the strength of the muscles on the front of their body is not sufficient to keep their pelvis and spinal column in good alignment.

This is a quite a good result. 30% of people failed the test - ie that couldn't do 17 pressups in 30 seconds. 5 people couldn't do one press up. They are leaving themselves open to upper back, shoulder and arm dysfunction.		This is a mediocre result. 21 people couldn't touch their toes at all. 14 people could only just touch their toes. Too many people have tight muscles along the back side of their body - calves, hamstrings, buttock and back. It's caused by two things - sitting down and not having a flexibility program. There is a high risk of lower back and neck dysfunction.

A mediocre result. 8 people are having difficulty getting down on the floor and back up again. 4 people were in such poor shape, or suffering from some sort of dysfunction that they were unable to get5 onto the floor and back up again. Being overweight and having a game leg, bung hip and a crook back dramatically reduces mobility.		A good result. 25% of people had some shoulder dysfunction.

Its always the case, few people have a regular strength and flexibility program. The organisation needs to put in train a regular and systematic training program, on site, that includes 1. specialist prehab and rehab sessions for those at serious risk and those already dysfunctional. 2. daily 10 minute strength and flexibility sessions for all staff.

Average score: 63. Not good. Too many people are not in particularly good shape. The risk of musculo-skeletal dysfunction is high due to low levels of strength and flexibility. There is a strong case for the organisation to implement an obligatory strength and flexibility program for those who scored less than 50 in this profile.

Lack of strength and flexibility is something that the Organisation needs to take seriously and monitor carefully and put in place an organisation-wide strategy to improve musculo-skeletal function. By far and away a high proportion of people do not have a strength and flexibility program. As a result they are getting weaker and tighter by the week, thereby exposing themselves and the organisation to risk.

When push comes to shove and people become dysfunctional, it will be The Organisation that ends up paying the high cost of an avoidable musculo-skeletal complaint. Click here to read the article from injury to dysfunction. Click here to read about swifties and fallacies.

In our opinion musculo-skeletal dysfunction caused by the lack of a regular and systematic strength and flexibility program cannot be classified as an injury. Responsibility for musculo-skeletal dysfunction needs to be sheeted home to individual employees, though it’s unlikely to happen without the establishment of a culture within the organisation that supports, values and understands strength and flexibility.

We recommend a range of strength and flexibility classes that are readily available Australia-wide: -

•	Posture and Flexibility
•	Yoga
•	Crookback Clinic
•	Tai Chi
•	Pontius Pilates

The Organisation would place itself in the forefront of OH&S practice if it took the musculo-skeletal risk seriously and moved heaven and earth to educate all staff about this risk and encourage them to take part in a regular strength and flexibility program. Maybe The Organisation and its worker's compensation insurer could invest in a pilot program to increase staff strength and flexibility!

The lack of strength and flexibility training coupled with poor abdominal strength, upper body strength, flexibility and shoulder function is a cause for concern and needs the attention of individual staff and managers.

Recommendation

We strongly recommend that the people who are in current poor musculo-skeletal condition, and who lack abdominal strength, upper body strength, flexibility, shoulder function and functional mobility, in particular those who scored less than 50 on the profile, be obligated to attend regular, in-house strength and flexibility classes.

The pressure on the organisation's workers' compensation costs is such that to do otherwise would, in our opinion be to abrogate a responsibility for the prudent management of the organisation's finances.