Physical well-being was the focus of the AAEP Annual Convention’s Lifestyle & Wellness sessions. These sessions covered utilizing ergonomics to minimize physical injuries in practice and ways to decrease the harmful effects of inflammation through mindfulness, diet and exercise.
Guy Fragala, PhD, PE, CSP, CSPHP, a retired faculty member and director of environmental health and safety at the University of Massachusetts Medical Center, shared his expertise in ergonomics in two comprehensive presentations. Citing research on human health care workers, he described how little progress has been made in preventing back injuries in this cohort, despite years of effort.
Back pain, Fragala said, is experienced at a disabling level by nine of 10 adults at least once in their lives. While mathematical formulas can determine the safe amount of weight that can be lifted in various body positions, rarely has this information decreased injuries.
Ergonomics research has helped to identify risk factors for all types of musculoskeletal injuries in the workplace. Fragala stated that 27% of workers' compensation claims for veterinarians involved musculoskeletal injury.
Risk factors for musculoskeletal injuries include repetitive movements, awkward postures, lifting and vibration. When these factors occur in combination, he said, injuries sharply increase. Work-related injuries can include repetitive strain injuries, repetitive motion injuries, cumulative trauma disorders and occupational overuse syndrome. These injuries, according to Fragala, can involve tendons (e.g., tendonitis, tenosynovitis, bursitis), as well as nerves (e.g., carpal tunnel syndrome, Reynaud’s syndrome).
The speaker explained that cumulative trauma disorders are musculoskeletal conditions that develop gradually over a period of time and do not occur after a single acute event. Nonetheless, they can cause significant damage by repetitive wear and tear on tendons, muscles, related nerves and bones, he said.
The cumulative trauma cycle begins with micro-trauma to tissue that results in scar tissue and adhesions that coalesce. The resulting decrease in flexibility, strength and function results in ongoing inflammation in a never-ending cycle, especially when the inciting activity continues. Musculoskeletal disorders can cause decreased range of motion, decreased grip strength and loss of muscle function, he added. The patient might experience pain, numbness, tingling, burning, cramping or stiffness.
Utilizing an array of photographs of equine veterinarians performing various job functions, Fragala pointed out the risk factors for musculoskeletal injuries that were being demonstrated by the doctors pictured. These included awkward posture, static loading, sustained exertion, force, vibration, multiple repetitions of a particular motion, insufficient rest periods and psychosocial stress. Of these, he called out posture, force and repetition as the most important.
Posture can be static or dynamic, the speaker explained. In static posture, the body and its segments are aligned and maintained in certain postures. A dynamic posture, by contrast, refers to postures where the body or its segments are moving. Hand and wrist posture in equine veterinary work often contribute to chronic injury, he said. While static postures lead to lowered blood flow, overload and fatigue, dynamic postures allow for normal blood flow.
Bending postures increase the risk of injury substantially, he stated, especially if the time is lengthy. Other risky postures are twisting, reaching behind or in front of you with arms outstretched, and working with your arms, hands or elbows above your shoulders. Kneeling, squatting and bending the trunk are among the most traumatic of postures, he noted, especially when combined with stretching the arms forward.
Addressing physical fitness, rest and good nutrition are among the most important general preventions for musculoskeletal injuries, Fragala continued. However, in studies of how to prevent back injuries, many approaches have been tried, including teaching patients about the anatomy of the back and spine, teaching the importance of fitness and nutrition, counseling about stress reduction, and introducing ergonomics and redesigning jobs. Of these four methods, the only one that was modestly successful was ergonomics. It is difficult to modify behaviors when there is minimal follow-up, he said, and theoretical principles can be hard to implement in the workplace.
“Ergonomics” is defined as the science of arranging and adjusting the work environment to fit the employee’s body. Because equine veterinary medicine is one of the most dangerous civilian occupations, according to the 2014 BEVA study, applying ergonomics is important, he said. This study reported that over a 30-year career, an equine veterinarian could expect to incur seven to eight work-related injuries that limited the ability of the professional to work. Dental, obstetrical and lameness procedures were those most frequently cited by respondents, he said.
The practice of equine veterinary medicine includes awkward postures; high hand force; highly repetitive motions; repeated impact; heavy, frequent and awkward lifting; and moderate-to- high hand and arm vibration with use of motorized dental and surgery equipment. In addition, equine patients are large and unpredictable, the speaker said. All of these combine to create a high potential for work-related injury.
Some ideas offered by Fragala to mitigate the risks included using a stool for low positions to eliminate squatting, kneeling or bending; using an adjustable equine head support during dental procedures rather than relying on an assistant to hold up the head; assuring proper table height in surgery; and improving posture, force and repetition in rectal palpation, if possible.
The speaker reminded vets to pay attention to signs that they are developing repetitive strain injuries so they can attempt to minimize permanent injury. By having awareness of the risk factors and attempting to mitigate them, veterinarians might be able to reduce their musculoskeletal damage and chronic pain.
Floyd “Ski” Chilton, PhD, a professor in Nutritional Sciences and the director of the Precision Nutrition and Wellness Initiative at the University of Arizona, gave a presentation entitled “Escape from Inflammation Nation.” With personal stories of his own journey and anecdotes from people who have improved their lives through his initiatives, Chilton illustrated the importance of mindfulness and spiritual awakening in achieving health and wellness.
The speaker discussed dual process reasoning, comparing the unconscious brain (which he called System I) and the conscious brain (termed System II). He explained that System I operates in the primitive, “reptilian” areas of the brain and acts swiftly and unconsciously, recognizing and responding to danger and perceived threats with fear and action. This part of the brain, he said, triggers emotions, impulses, creativity and competition. It can often perceive things inaccurately.
By contrast, System II resides in the frontal cortex, is slow to arouse and act, and is the home of the conscious self. This conscious part of the brain deliberates, calculates and analyzes. It makes slow decisions utilizing executive functioning, he stated.
When unconscious systems are in overdrive through childhood trauma, previous terrifying events or other issues, it will cause relationships to suffer and happiness will be elusive. “If you constantly need to be in control,” he said, “you are operating in System I.”
Chilton explained that primarily operating in System II can be achieved through three steps: experiencing your pain, surrendering to a higher power, and trusting in the future. When you become aware of painful emotions, you can use this technique to concentrate on physically feeling your psychic pain and accepting it. Then, by letting it go, you no longer carry that burden, allowing yourself to feel calm and open to the future, he explained.
Chilton also spoke about the connection of inflammation to obesity. He noted that inflammatory diseases such as arthritis, asthma, cancer, diabetes, heart disease, stroke and Alzheimer’s Disease are associated with obesity. To break the cycle, the speaker recommended four steps: break the food addiction cycle, be intentional with food, be intentional with exercise and choose good nutritional strategies.
The speaker said that addictive foods include fat, sugar, salt and processed food. His recommendation for breaking free was to be very intentional about your eating, understanding the calories you are consuming and calories you are burning, and understanding that “you cannot exercise enough to zero out an unhealthy diet.”
For dietary health, the speaker recommended following a Mediterranean diet, avoiding processed foods, increasing protein, reducing simple carbohydrates, increasing complex carbs and fiber, increasing polyphenols (e.g., blueberries and red wine), and increasing omega-3 fatty acids.
Exercise has many positive effects, Chilton stated. They include increasing life span, muscle mass and bone density; decreasing depression, anxiety and inflammation; improving blood pressure and cognition; preventing chronic disease; and stabilizing blood sugar. Research shows that exercise dramatically slows aging, he added.
Mindfulness can bring about an emotional transformation that can change your life to a more joyful, peaceful existence, while careful attention to your weight, diet and exercise regime can add years to your life and improve your health substantially.