Injuries are a source of concern for any type of business. Injuries not only cause pain and suffering for employees, they also have direct and indirect (hidden) costs. These hidden costs are reflected in the time lost for an employee who is not available to accomplish his tasks, as well as the cost of training replacement workers and increased insurance costs.
On average, $5 is spent for every $1 of medical expense on a typical injury. One type of injury that is subject to high costs is strains or soft tissue injuries, sometimes called musculoskeletal disorders.
Musculoskeletal disorders and injuries frequently are difficult to diagnose, and it often is difficult to recognize the hazards that cause them. Hazards in the workplace can be controlled by several methods; usually engineering controls, where the hazard is designed out, is the first choice. The second choice is an administrative control, where the use of policies, procedures and job assignment rotation can be used to eliminate the hazard. The last option for eliminating injuries is centered on the worker, whether it's providing task-specific personal protective equipment or providing training in the form of stretching and flexibility exercise programs.
Why Implement Stretching Programs?
A stretching program requires careful planning and thought. The impacts of an ill-conceived and hastily implemented program can result in significant bottom line corrosion and possibly further injuries for employees. Many workplaces look to a stretching program as a simple and quick fix to workplace strain or muscular skeletal injuries, but it is more than that.
A stretching program is a form of physical exercise where specific muscles are elongated to their fullest length to improve the muscles' elasticity. In a paper titled“Do Stretching Programs Prevent Work-related Musculoskeletal Disorders?,” Choi and Woletz described the concept of stretching in this manner: “It is commonly believed that stretching before or after physical activity can reduce the chance of a strain or sprain injury by increasing the flexibility of muscles, tendons and ligaments, which in turn increases the range of motion in a joint or group of joints.”
The three common types of stretches are proprioceptive neuromuscular facilitation (PNF), static and isometric. Most advocates of stretching programs recommend PNF stretching, which allows the muscle to be stretched to a greater degree by increasing the proprioceptor signals through a 5- to 10-second voluntary muscle contraction followed by a 5- to 10-second voluntary muscle relaxation. With the hold-relax PNF method, the muscle is placed into a static stretch. The person is instructed to “hold” and contract the muscle against resistance from a partner for 10 seconds. The person is then instructed to relax and the partner slowly moves the muscle to a new static position. Many experts agree that static stretching, where the muscle is stretched and held, is simpler to perform and also is very effective as a choice for most workplace stretching programs.
Benefits of Stretching
It is clear that workplace stretching does improve flexibility. Morning warm-up exercises conducted with construction workers, for example, can be beneficial for increasing or maintaining joint muscle flexibility. These workers typically are exposed to manual materials handling and strenuous working positions.
There also may be a psychological benefit at work in a stretching program. Company managers and workers together in a space doing a common activity can create bonding and increase workplace moral. This semi-social grouping or bonding in the workplace creates the perception of caring and support felt by employees from management.
Advocates of workplace stretching programs claim that improving flexibility can prevent work-related musculoskeletal injuries. Even though many companies have implemented stretching programs, their effectiveness has not been demonstrated, according to some researchers, who propose effectiveness claims are based on in-house evaluations that rely on self-reported outcomes rather than objective measures.
The implementation of workplace stretching programs provides a feel-good aspect to injury prevention. However, the scientific data on the true effectiveness of workplace stretching programs is in doubt. A 2003 review of three well-known studies related to the efficacy of stretching at work to prevent injuries determined that stretching did not result in any meaningful or statistical reduction in MSDs.
That said, an effective ergonomic program that includes engineering controls, administrative controls and stretching can reduce the physical demands of manual material handling and reduce the occurrence of MSDs. Employers who have implemented OSHA's ergonomic guidelines have lower incidence of cumulative trauma injuries and associated workers' compensation costs.
Despite ergonomic programs having a demonstrated scientific benefit in the workplace, they only are required in California. The California ergonomic standard is triggered when a workplace has two or more cumulative trauma injuries as identified by a medical professional.
Companies seeking to implement stretching or ergonomic programs need to ensure that they have appropriate instructors for the programs, and the exercises or stretches must be tailored to the duties of workers. For a stretching program to be effective, workers have to participate at least 2 to 3 days per week with a time commitment for each session of 5 to 10 minutes.
As with any training in the workplace, there's a cost, and the cost has to be justified by a benefit or return on investment. If you cannot demonstrate that any expenditure is realizing a benefit to the company (i.e., reducing soft tissue or musculoskeletal injuries for a reduction in workers' compensation costs, or improved worker productivity and wellness) then the training will not be perceived as a benefit by the employer.
The costs of implementing a workplace stretching program are related to program development and implementation. These costs include not only the cost of educational materials and an instructor or trainer, but also the time that employees spend stretching rather than working, which could be as much as 15 minutes a day. No matter the size of your company, a workplace stretching program will represent a significant non-value added direct cost.
Some employees might refuse to participate or won't participate because of religious reasons. If a company does not make a stretching program mandatory and only selectively implements the program for selected departments, the true impact of the program on injury and illness rates cannot be determined. Requiring employees to participate can cause problems with unions, so make sure that union representatives are included in the discussion about stretching programs.
Implementing workplace stretching programs alone as a way to reduce soft tissue musculoskeletal injuries is controversial and studies have shown that stretching programs alone do not reduce injuries in any meaningful, statistical way. Companies are better off implementing a comprehensive ergonomics program to address engineering and administrative controls and implement a stretching program as an element of the overall ergonomics program.
Donald Graham, M.S., WSO-CSE, is the safety director at Jensen Precast in Sparks, Nev. He can be reached at [email protected].