Central West Health & Rehabilitation
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Return to work following routine Knee Arthroscopy Jul 19th, 2014
Knee injuries are a common workplace problem and Knee arthoscopy is the most common procedure performed by orthopaedic surgeons (Salata et al, 2010). However there is scanty literature documenting expected recovery duration (often suggested as anywhere from nine days to four weeks for routine uncomplicated arthroscopy).


The above study of a military population noted that while patients were able to walk around without any support at two weeks post surgery, 88% still had restriction to activities of daily living (and therefore work) because of knee related problems. Function improved gradually over the following 12 weeks. At 6 weeks 91% resumed their preinjury status which reached 94% in eight weeks.

Predictors of poor  outcomes include total removal of the meniscus or removal of the peripheral meniscal rim, lateral meniscectomy, degenerative meniscal tears (more common in older age groups), presence of chondral damage (more common in older age groups), presence of hand osteoarthritis suggestive of genetic predisposition, and increased body mass index.

Psychosocial factors (anger, depression, social support [i.e. workplace support]) play a significant role in recovery and are predictive of surgical outcomes (Rosenberger et al, 2006). Patients undergoing surgery must cope with the psychological and physical stress that often accompanies injuries and surgical procedures. In addition, patients must cope with the demands of the recovery process, which likely include managing postoperative pain and limitations in physical functioning (Rosenberger et al, 2004).


Following routine knee arthrscope the majority of workers should have capacity for 'suitable' modified duties by 2 week. However remember some patient will still be having considerable difficulty with tasks of daily life such as dressing, climbing stairs and getting up from sitting.

The majority of workers should be able to complete normal duties by 6-8 weeks following surgical date. However, some 6-10% still may need some duty modification beyond this.

Those at risk of a longer recovery can be predicted pre-surgically or early post surgically by the following:

  1. Age

  2. Type of procedure (full meniscus removal, peripheral meniscus lession, cartlidge damage and or microfissuring)

  3. Poor Lifestyle factors (High BMI, current smoker)

  4. Psychosocial factors (anger, depression, poor social/workplace support)

Video - Mentally Healthy Small Business Jul 18th, 2014

Infographic - Costs of Unhappy Employees Jul 18th, 2014


9 tips to reduce the risks for an ageing workforce Jul 17th, 2014
Australia’s population will both grow strongly and become older in the medium term. This population growth and ageing will affect labour supply, economic output, infrastructure requirements and governments’ budgets, and has lead to the gradual increase in the retirement age from 65-70 for those people born after 1965.

As for safety on the job, workers who are older actually tend to experience fewer workplace injuries than their younger colleagues. This may be because of experience gathered from years in the workplace, or because of factors such as increased caution and awareness of relative physical limitations.

This caution is well-founded. When accidents involving older workers do occur, the workers often require more time to heal, underscoring the need for a well-planned return to work program.

Also evidence suggests incidents affecting older workers are more likely to be fatal. A recent Safe Work Australia document suggested people over 65 have a higher fatality rate (7.73 fatalities per 100,000 workers) than their young work collegues (0.98 fatalities per 100 000 workers). This underscores the need for employers to be mindful of how best to gradually adapt the conditions of work to protect workers as well as explore opportunities for preventative programs that can maintain or build the health of employees through their working life.

Here are 9 tips you can use to eliminate or reduce the risks posed to older workers in your workplace:

  1. Ensure that a person (regardless of age) is suited to the task and can carry it out safely; Pre-employment Physical Assessments are vital.

  2. Adapt tasks to suit older workers, e.g. an older worker with reduced physical strength may spend more time operating machinery than labouring;

  3. Rotate physically demanding or repetitive tasks;

  4. Provide ergonomically-designed work area and workstations for all workers;

  5. Regularly assess stress levels of workers and implement stress management training if required;

  6. Train all workers in injury prevention strategies (it is important to keep in mind that as you age, the pace and way that you learn changes, meaning that training requirements may be different for older workers and training may require repetition);

  7. Ensure workplace lighting is adequate for the job at hand;

  8. If possible, offer older workers flexible work arrangements, (e.g. reduced hours, fixed term contracts, working from home); and

  9. Consult workers about where they are having trouble and keep them informed about what you are doing to reduce the risks.

Cost savings from early ergonomics involvement in projects Jul 17th, 2014
graphicRegardless of the other benefits that may be realized from ergonomic improvements, managers usually are not able to justify providing funds for the intervention unless there is a clear economic benefit to be derived. Accordingly, in developing an ergonomics proposal for management, it is extremely important to clearly identify the costs and economic benefits that can be expected and outline how they will be measured.

Fortunately, properly planned and implemented ergonomics projects usually do result in significant economic benefits, and the literature consistently has shown that the earlier there is professional ergonomics participation in workplace design, the less costly is the effort.

For example, a number of studies have suggested the ergonomics portion of the engineering budget increases from about 1% of the budget when ergonomists are brought in at the beginning of a development project, to more than 12% when brought in after the system is put into operation.

This increase is believed to happen when ergonomists are brought in late in the project because serious human–system interface problems have surfaced that require major retrofits in order to correct them. A second major cost saving of early, or pre-emptive, ergonomics involvement can be in reducing the total cost of the design budget.

Personnel-related benefits from pre-emptive ergonomic involvement include:

Increased output per worker- Increased output per worker can be done for improvements in workplace design, hardware product design, software design and work system (macroergonomic) design.

Reduced error rate- Because correcting errors takes time, reduced errors frequently translate into increased productivity. Reducing errors also translates into fewer, accidents, and resultant reductions in equipment damage, personnel injuries, and related costs.

Reduced accidents, injuries, and illness- One of the most frequently encountered benefits. For example in one reported case study an ergonomically designed pistol grip type of knife was introduced to replace a conventional straight handle knife for deboning chickens and turkeys in a poultry packaging plant. This enabled the employees to de-bone the foul without having to significantly deviate their wrists, as was the case with the conventional knife. The resulting reduction in cases of carpal tunnel syndrome, tendonitis, and tenosynovitis translated into a saving in workmen’s compensation of $100,000 per year.

Reduced absenteeism- Reductions in lost time from persons failing to show up to work for reasons other than accidents, injuries, or illness, already noted, also is a common outcome of effective ergonomic interventions. Reduced absenteeism also can result in a productivity increase.

Reduced turnover- When ergonomic interventions improve the quality of work life, it is not uncommon to see a reduction in turnover rate, which can represent a significant financial benefit.

Reduced training time- Reductions in training requirements may come about because work system changes result in easier to perform functions and processes that require less time to learn. Alternatively, training requirements may be reduced because of:

(a) less turnover,

(b) reductions in lost time from accidents and injuries,

(c) less absenteeism, or

(d) because fewer people are required to perform a given function

Reduced skill requirements- Improved job designs and related work system processes may also result in reducing the skill requirements required to perform some jobs

Reduced maintenance time- Ergonomic improvements to jobs, worksites, equipment, or work systems can result in reducing the system’s maintenance requirements, thus requiring fewer maintenance personnel.

Doctors With a Special Interest in Back Pain Have Poorer Knowledge About How to Treat Back Pain Jul 16th, 2014
Doctor surveys continue to demonstrate that general practitioners only partially manage low back pain (LBP) in an evidence-based way. This is despite increasing evidence that positive advice to stay active and continue or resume ordinary activities is more effective than rest and early investigation and specialist referral are unwarranted in the majority of cases. In part, this may reflect physician knowledge and beliefs, although physician behaviour may be influenced by many factors including patient expectation and other psychosocial factors.

Providers treating LBP may hold alternative beliefs regarding the association of pain and activity that may influence their practice behaviour. The preparedness of the clinicians to change may be another important barrier that has not been well studied to date.


The aim of the above study was to determine whether general practitioners’ beliefs about LBP differ according to whether they have a special interest in back pain, musculoskeletal medicine or occupational medicine; and whether these beliefs are modified by having had continuing medical education (CME) about back pain in the previous 2 years.

The results found that GP’s that suggested a ‘special interest’ in back pain were more likely to provide back pain management contrary to the best available evidence. GP’s with a special interest in occupational medicine and physicians with recent Continued CME about back pain had significantly better back pain management beliefs.


Many other factors besides the employee's medical conditions affect outcomes– e.g. organizational, work-environmental, and social. Providing employees a preferred medical provider and building a relationship with them by presenting them with appropriate and helpful information can improve not only return to work, but also patient management.

Video - Low Back Pain Jul 16th, 2014

Safe Work Australia - Worker fatalities Australia 2013 Jul 15th, 2014

Data has been released by Safe Work Australia. The aim of this report was to highlight the number of people who died in 2013 from injuries that arose through work-related activity.

In 2013, 191 workers were fatally injured at work. This is 16% lower than the 228 deaths recorded in 2012 and 39% lower than the highest number of worker deaths recorded in the series in 2007. Most of the decrease from 2012 to 2013 was due to a decrease in the number of workers killed in vehicle crashes on public roads (68 down to 43).

The 191 fatalities in 2013 equates to a fatality rate of 1.64 fatalities per 100 000 workers. This is the lowest fatality rate since the series began 11 years ago. The highest fatality rate was recorded in 2004 (2.94).

Notable characteristics of worker fatalities in 2013 include:

- 176 of the 190 fatalities (92%) involved male workers. The fatality rate for male workers was 10 times the rate for female workers.

- Self-employed workers have much higher fatality rates than employees. In 2013, self-employed workers had a fatality rate of 4.39 fatalities per 100 000 self-employed workers, which was over three times the rate for employees of 1.32. The fatality rate for employees has fallen consistently over the past six years but there has been no improvement in the rate for self-employed workers. Perhaps highlighting the difficulties reaching small enterprises. Small enterprises often have limited resources to prioritise these risks and to improve the working environment, and they often have difficulties in complying with legislation.

- Fatality rates increased with age from 0.98 fatalities per 100 000 workers aged less than 25 years to 7.73 for workers aged 65 years and over. However if self-employed workers are removed then the fatality rate for older workers is substantially lower (4.56).

- Truck drivers accounted for 20% of worker fatalities over the past 11 years with 51 truck drivers killed on average each year. In 2013, 39 truck drivers were killed.

- Farm workers accounted for 18% of worker fatalities in 2013. This includes 24 farm managers and 11 farm labourers killed while working.

These are just some of the findings in the new Safe Work Australia report: Work-related traumatic injury fatalities, Australia 2013.

Infographic - Worksite Health Promotion Jul 14th, 2014



Workplace Walking Group - Worth the Effort?? Jul 13th, 2014
The combination of stress alongside sedentary behaviour is widespread in many workplaces. Therefore, workplace interventions specifically targeting sedentary behaviour and stress may help alleviate some of the risks for heart disease. Individuals who do not engage in regular physical activity (PA) have a 20–30% greater risk for heart disease, thus sedentary behaviour has been identified as a key health issue.

The workplace is a suitable location for incorporating PA, such as walking, at a community level. Increasing activity during suitable periods of the day, such as lunchtime, provide opportunities for performing moderate activity and may, thus, break up long periods of sedentary time.

Current guidelines suggest that employers should encourage more active transport to and from work, more moving within the working day and promote walking during work breaks. Walking is eminently suited to population exercise prescription as it is easy to do, requires no special skills or facilities, and is achievable by virtually all age groups with little risk of injury.

The lunch break is often a time when employees continue to remain at their workstations due to work demands or peer-pressure from colleagues. Thus a detrimental cycle of increased stress and sedentary behaviour can prevail. The lunch period offers an opportunity to engage in moderate PA, interrupting long periods of sedentary time (i.e. prolonged sitting) and providing an opportunity to decrease stress levels and restore physical and mental fatigue.

The American College of Sports Medicine has adopted the recommendation that "every adult should accumulate 30 minutes of moderate intensity activity on most, preferably all, days of the week". However, compliance with these guidelines requires considerable commitment in terms of time spent exercising per week (≥ 150 minutes) and this may deter individuals from starting an exercise programme. There is some evidence that a training frequency of as low as two days per week may elicit improvements in cardio respiratory fitness in the lower fitness categories.

Murphy et al, 2006 evaluated the benefit of a progressive eight week workplace walking program. Participants walked twice per week for 45 minutes at a speed of their own choosing.

The results suggested self-paced walking 45 min, 2 days per week for eight weeks, reduces systolic BP and prevented an increase in body fat, in previously sedentary employees, and was associated with high adherence.

As there was little evidence this exercise intervention improved other markers of heart disease (Aerobic fitness, diastolic BP, body mass, cholesterol and other cardiac enzymes). This walking prescription may be useful as a stepping-stone to further increase levels of exercise in a previously sedentary workforce.


The Daily Routines of Famous Creative People Jul 11th, 2014



Media Release - Disadvantaged Australians Most at Risk of Obesity Jul 9th, 2014


Image - The Priority Competency Model for Employee Supervisors Jul 9th, 2014


Proof Exercise Changes Everything Jul 8th, 2014
The average adult needs at least two hours and 30 minutes of activity each week, if it's at a moderate intensity level, like brisk walking. Up the intensity to jogging or running, and you can aim for at least 75 minutes a week. Add in a couple of strengthening sessions a week, and you can expect to build muscle, protect your heart, avoid obesity and even live longer.

That's not to say that shorter bouts of exercise aren't worth it. Even just in 10-minute increments, exercise can make a marked difference in health and well-being. But those of us who make exercise part of their regular routine -- without overdoing it -- are certainly reaping the biggest benefits.

How much time do you spend sitting? Jul 7th, 2014

Preventing Shoulder and Neck pain in the Workplace Jul 5th, 2014
Neck and shoulder pain is a frequent health problem in employees. Globally, the annual prevalence has been estimated to range from 27.1 to 47.8 %. In general, acute neck pain resolves within days or weeks. However, neck pain may recur in 50–60 % of cases within 1 year, and for one in ten, neck pain may become a chronic condition. Thus, the identification of risk factors for neck/shoulder pain at the work place may be important in the prevention of recurrent and possibly chronic pain.

The prevalence of neck/shoulder pain varies considerably across occupations. In addition to mechanical exposure, several psychosocial factors have been acknowledged as potential risk factors. The best documented mechanical risk factors is repetitive movement of the shoulder and neck flexion repetitive associated with repetitive work or precision work. Other mechanical factors like working with the hands above the shoulders, awkward postures, heavy lifting and manual handling have been discussed as possible risk factors, but the evidence is limited or inconclusive.

Several systematic reviews have designated high job demands and low social/work support as the most consistent psychosocial risk factors, whereas different aspects of job control (e.g. influence on the work situation) have been identified as potentially important but less consistent predictors of neck/shoulder pain

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The aim of the above study was to determine work related psychosocial and mechanical factors that contribute to the risk of moderate to severe neck/shoulder pain. A significant relationship existed between both mechanical and psychosocial factors and the development of neck/shoulder pain in the general working population. Highly demanding jobs, neck flexion and awkward lifting appear as the most consistent and important predictors of neck/shoulder pain. Other significant work-related factors were low levels of supportive leadership, hand/arm repetition and working with the hands above shoulder.

Interventions aimed at reducing the development or return of neck/shoulder pain in the general working population may benefit from focusing on a range of both work-related mechanical and psychosocial factors.

Contact us for more.


Is Manual Handling Training Worth it? Jul 5th, 2014
graphicManual handling has been defined as any activity requiring the use of force exerted by a person to lift, lower, push, pull, carry, move, hold or restrain a person, animal or object. If these tasks are not carried out safely, there is a risk of injury and research shows a significant linkage between musculoskeletal injuries and manual handling, with the primary area of physiological and biomechanical concern being the lower back (Bernard et al, 1997).

Only some 2% of individuals with back injuries who have been off work for more than 2 years will ever return to gainful employment. The loss of the ability to work can have a devastating consequence on not only the injured individual but also his or her entire family.

Measures to reduce risk of injury start with the requirement to avoid hazardous manual handling wherever practicable. Where this is not possible, attention should be given to the provision of lifting aids and task/workplace design. If a job cannot be ergonomically modified to be less physically demanding Pre-employment Physical Assessment is vital. It is important not to place individuals in a job for which they do not have the physical capabilities to perform.

graphicEmployers are also required to provide their employees with health and safety information and training, and where relevant this should be supplemented with more specific training on manual handling injury risks and prevention (Work Safe Australia, 2011).

The type of training offered and its effectiveness often depends on a multitude of factors such as method of teaching, organization setting and type of training technique that is used. However, concerns have been raised over the efficacy of current manual handling training methods (Dawson et al, 2007).

Next – The most effective manual handling training 

The Most Effective Manual Handling Training Jul 5th, 2014
Employers are required to provide manual handling information and training, and where relevant this should be supplemented with more specific training on manual handling injury risks and prevention (Work Safe Australia, 2011). Manual handling training and its effectiveness often depends on a multitude of factors such as method of teaching, organization setting and type of training technique that is used. However, concerns have been raised over the efficacy of current manual handling training methods (Dawson et al, 2007).

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The above study systematically reviews the literature to determine the effectiveness of manual handling training interventions. Current manual handling training practices appear largely ineffective in reducing injury. Furthermore, there is considerable evidence supporting the idea that the principles learnt during training are not applied in the working environment.

The lack of effectiveness of technique- or educational based training is widely acknowledged; (i) people tend to revert to previous habits if training is not reinforced; (ii) emergency situations, the unusual case, a sudden quick movement, increased body weight or reduced physical well-being may overly strain the body and (iii) if job requirements are stressful, behaviour modification will not eliminate risk.

What has shown promise is strength and flexibility training based on industry specific ergonomic principles and task analysis (i.e. a regular exercise program including activities that replicate worksite tasks) (Dawson et al, 2007; Clemes et al, 2010). Manual handling training is generally given over a very short time; as a result, the “training” is really more of an information session. When training is specific to the task and dispensed over a longer timeframe, a decrease in back loading and back injuries is possible (Schibye et al., 2003).

As there is strong evidence of an association of occupational injury occurrence and certain personal and non-occupational risk factors. In industry, effective injury reduction programs should go beyond traditional methods of job-related ergonomic risk factors and include personal factors such as smoking, weight control, and alcohol abuse (Craig et al, 2006). More general whole body physical fitness and strength also has greater benefits in terms of reducing manual handling when combined with specific training alone

At Central West Health and Rehabilitation our Small Business Injury Management Service includes gym membership and ‘task specific’ conditioning sessions to assist you and your employees to improve manual handling and reduce injury risk.

Contact us for more

Next - Workers who sit all day need to consider ergonomics also 

The mechanical risks of prolonged sitting in the workplace should not be overlooked Jul 5th, 2014
Low back pain (LBP) is an important public health problem in all industrialized countries. It remains the leading cause of disability in persons younger than 45 years and comprises approximately 40% of all compensation claims in the United States. More than one-quarter of the working population is affected by LBP each year, with a lifetime prevalence of 60–80%.

With the rapid development of modern technology, sitting has now become the most common posture in today’s workplace. Some three-quarters of all workers in industrialized countries have sedentary jobs that require sitting for long periods. Because of the reported link with LBP and the fact that in industrialized countries more of the population acquires a sedentary lifestyle, research examining sitting postures is becoming increasingly relevant (Dankaerts etal, 2006).

Among high risk occupational activities believed to increase low back pain, sitting is commonly cited as a risk factor along with heavy physical work, heavy or frequent lifting, non-neutral postures (i.e., trunk rotation, forward bending), pushing and pulling, and exposure to whole body vibration (WBV) (i.e., Truck driving, plant operation). It has been shown that intradiscal pressure is increased during sitting postures and prolonged static sitting postures are believed to have a negative effect on the nutrition of the intervertebral disc (Lis et al, 2006). Individuals who sit for extended periods can be at increased risk of injury if full flexion movements are attempted after sitting. This risk was evident after 1 hour of sitting, which could be of particular concern for those who design work–rest schedules and job-rotation schemes (Beach et al, 2005).

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The above systematic review found the prevalence rate of reported LBP in those occupations that require the worker to sit for the majority of a working day is significantly higher than the prevalence rate of the general population. While the rate of LBP among occupations requiring extended periods of sitting was not quite as high as the rate of LBP among more strenuous occupations, it has been noted that the sitting group had the highest hospitalization rate for LBP (Lee et al, 2001). This suggests when low back injuries occur in people with sedentary occupations, these injuries tend to be more severe.

The risk of prolonged sitting in the workplace should not be overlooked and this risk appears to increase when coupled with whole body vibration (e.g truck driving or operating plant) and sustained awkward seating postures (e.g. lordosed or kyphosed, overly arched, or slouched).


Bovenzi and Betta compared a group of agricultural tractor drivers with a group of office workers. Both groups were exposed to static load due to prolonged sitting. However, only the tractor drivers group was exposed to the combined factors of WBV and awkward posture. They found that tractor drivers were 2.39 times more likely to report LBP than office workers.

Those people with chronic LBP (CLBP) often demonstrate difficulty in adopting a neutral midrange position of the lumbar spine. Furthermore, studies have described that during sitting CLBP patients often adopt such awkward seating postures potentially leading to abnormal tissue strain, pain  and increased injury risk (Dankaerts etal, 2006).

At Central West Health and Rehabilitation our Small Business Injury Management Service includes gym memberships and conditioning sessions for workers who sit the majority of a working day.

Contact us for more

Pre-Employment Physical - Cost Effective and Useful Jul 3rd, 2014
Pre-employment testing such as radiographic evaluations, physician administered physical exams, and lumbar range of motion, have generally been shown to be ineffective for injury prevention or injury prediction (Jackson, 1994). Strength testing when correlated to job specific tasks has shown a correlation to work-related injuries. Individuals lacking the physical capabilities to work at the level that their job physically required had a significantly increased incidence of low back injuries.

Controlling the incidence of work-related injuries is economically important for industry, but is of far more importance for the individual employee. Injuries occurring on the job can result in life-altering consequences to workers who depend on their physical well being for their livelihood. Only 2% of individuals with back injuries who have been off work for more than 2 years will ever return to gainful employment. The loss of the ability to work can have a devastating consequence on not only the injured individual but also his or her entire family.

The most efficient methods of controlling workmen’s compensation expenses are geared toward lowering the rate of injury. Several authors have demonstrated that jobs requiring heavier lifting result in a higher incidence of low back pain. One method of controlling work injury rates is to ergonomically re-engineer jobs to be less physically demanding. This approach creates a safer, less physically stressful work environment that benefits the employee. If a job cannot be ergonomically modified to be less physically demanding, it becomes a safety issue to place individuals in a job for which they do not have the physical capabilities to perform.

Aiming to identify and monitor any functioning or health abnormality in prospective employees, pre-employment medical examinations traditionally rely on the classic assessment of specific medical conditions or substance abuse. However, this is not particularly relevant for fitness-for-work decisions. The assessment of fitness for work related to physical and mental job demands seem a better predictor than searching for a medical diagnosis.

There is strong evidence of an association of occupational injury occurrence and certain personal and non-occupational risk factors. In industry, effective injury reduction programs should go beyond traditional methods of job-related ergonomic risk factors and include personal factors such as smoking, weight control, and alcohol abuse (Craig et al, 2006).

As well as highlighting candidate suitability, pre-employment physical assessments (PEPA's) with a trusted service provider provide a number of other important benefits:

  • PEPA's provide a mechanism that can be tightened or loosened according to the employment environment.

  • PEPA's provide a great place for manual handling education and training for injury prevention advice.

  • PEPA's provide a great place to highlight and commence worksite health promotion for high risk employees.

  • PEPA's can be used to negotiate a reduction in your insurance premiums when discussing your yearly insurance premiums with insurers.

Central West Health and Rehabilitation has significant experience in designing and providing Cost Effective Pre-employment Physical Assessments. Contact us for more

Video - Central West Health and Rehabilitation Jul 3rd, 2014

Alcohol: Impact on Sports Performance and Recovery Jul 1st, 2014
Above the safe levels recommended by the WHO, alcohol consumption becomes hazardous (4–6 or 2–4 standard drinks per day for males and females, respectively). Even larger amounts are classified as harmful and may significantly increase the risk.

In addition to hazardous, chronic alcohol consumption, heavy acute episodic or binge drinking, classified as the consumption of 60g of alcohol in a single drinking episode, is associated with significant physical, psychological and social harm. Approximately 16.5 % of the world’s population are thought to participate in heavy episodic drinking on a weekly basis of negative mental and physical health issues, such as a range of cancers, hypertension, stroke and injuries related to violence.

While acute and chronic misuse of alcohol is common place in the general population, the athletic/sporting population is not exempt from such behaviour. Athletes often do not consider alcohol as harmful in the same way they consider other recreational drugs. Therefore it is important athletes have a full understanding of the implications alcohol consumption may have on sporting performance, recovery and, perhaps more importantly, general health.

The most relevant point is how the consumption of alcohol after exercise alters recovery and adaptation. Dehydration has been shown to impair performance and so adequate rehydration and restoration of electrolytes after exercise is important to ensure recovery before the next training session or event. It has been suggested that the best opportunity for optimising glycogen stores occurs when carbohydrate is consumed in the initial hours after exercise; after that time, glycogen storage rates decrease significantly.

However, in many sports this period after competition may be spent consuming alcohol instead of following correct nutritional strategies. Small volumes of alcohol, at a dose less than 0.49 g/kg Body Weight, after exercise without negatively impacting rehydration, however, if fluid replacement is not a priority, for example if optimal performance is not required the next day, then the consumption of alcohol post-exercise in larger volumes may be acceptable, at least from a hydration stand point.

Particularly important for males, in both athletic and general populations, is the reduced production of testosterone and subsequent effects on body composition, protein synthesis and muscular adaptation/regeneration; these effects are likely to inhibit recovery and adaptation to exercise. Low doses of alcohol, post-exercise are unlikely to be detrimental to repletion of glycogen, rehydration and muscle injury; however, the effects of alcohol are dependent on the timing of consumption, nutritional status and the priority given to optimal rates of recovery. Higher doses should be avoided if injury to skeletal muscle has occurred. While very high, hazardous doses of alcohol consumed after strenuous exercise may not directly impact performance in the days after exercise, such bingeing behaviour is associated with long-term physical, psychological and social harm and should therefore be avoided.

It should be remembered that alcohol is a poison and as such should be treated as one!

While less likely to occur than drinking large volumes of alcohol after sports, the consumption of even low doses of alcohol prior to athletic endeavour should be discouraged due to negative effects of alcohol on endurance performance.

Who will binge-drink at age 16? Teen imaging study pinpoints predictors

Health Related interventions for Shift Workers Jul 1st, 2014
Shift work is prevalent in healthcare, emergency services, manufacturing, retail, and hospitality. Some jobs require regular work on the same night shift (ie, permanent night shift), while others are employed on rotating shift schedules involving days and nights.

Shift work, particularly work at night, has been found to disrupt endogenous circadian rhythms involved in melatonin expression, sleep patterns, food digestion, and other physiological processes. Work at night is associated with a range of known and potential adverse health effects.

Aside from potential cancer risks, shift workers also experience increased incidence of chronic illnesses including cardiovascular disease, diabetes, and metabolic syndrome (a combination of obesity, dyslipidemia, high cholesterol, and insulin resistance), as well as gastrointestinal disorders, workplace injuries, and disruption of family and social life.

The short- and long-term effects of shift work on sleep have also been studied. Night work has been shown to reduce sleep quantity and quality on workdays and days off. While shift workers tend to fall asleep rapidly in the morning immediately following a night shift, sleep tends to be shorter due to the natural awakening effects of circadian rhythms during the daytime, as well as social cues and daytime commitments. Sleep questionnaires completed by shift workers show reduced sleep length and higher frequencies of sleep difficulties, intermittent sleep, and early waking. Poor sleep quality and quantity have been shown to be related to various chronic diseases including diabetes, cardiovascular disease, and obesity. Thus, sleep quantity and quality are important outcomes of interventions aimed at improving long-term health among shift workers.


There is a need for interventions that can be implemented in workplaces – or by workers outside of work hours – to mitigate the harmful effects of shift work. The main objective of this review was to synthesize intervention studies designed to mitigate the adverse health effects of shift work.

Controlled light exposure

The aim of interventions that control light exposure is to shift circadian rhythms and subsequently promote adaptation to work at night, thereby minimizing health effects. A combination of timed bright light and light-blocking goggles appeared to promote adaptation to shift work as primarily measured by changes in sleep and melatonin. Timed exposure to high intensity light during night shifts and wearing goggles during the commute home can increase circadian adaptation. Multi-pronged interventions to control light exposure may be more effective than using bright light or light-blocking goggles alone. Adverse events for bright light exposure were headaches or feelings of heat/cold in response.

Shift schedule change

Fast-forward rotating shifts tended to report more favourable results for sleep. However, findings were inconsistent for changes in shift length or start time. Shift workers may be less likely to engage in regular physical activity, smoking cessation, and healthy diet, which may contribute to increased risks of adverse health outcomes. Objective outcomes that may be the result of improved lifestyle habits, such as low-density lipoprotein cholesterol; triglycerides, fasting glucose, and blood pressure; cardiorespiratory fitness; and blood pressure, did show improvement in association with a change in shift schedule.

Interventions directed at physical activity and weight loss improved cardiorespiratory fitness and strength, body composition, blood pressure, and physical activity. This suggests that lifestyle habits may not improve spontaneously among shift workers as a result of shift schedule changes, and interventions specifically targeted at improving lifestyle behaviours may be necessary. Adverse effects were difficulty scheduling social or family activities as a result of a shift schedule change.

Behavioural interventions

Physical activity improved sleep length with variable results on subjective sleep quality, and education about sleep hygiene strategies resulted in significantly improved REM sleep time. A 1-hour rest period during the night resulted in no significant change in sleep duration following the night shift. Other outcomes were also evaluated. Exercise significantly increased maximal aerobic capacity and strength, although circadian phase did not differ between groups, as measured by body temperature. A group based lifestyle intervention for weight loss was associated with significantly decreased body mass index and blood pressure and significantly improved physical activity and fruit intake. 

Pharmacological interventions

Studies of melatonin, hypnotics, and stimulants showed mixed results, potentially due to different doses administered to workers, compliance, shift schedule variation, and other factors. Administration of Modafinil did not significantly change endogenous melatonin levels or sleep quantity before or after night shifts. Armodafinil resulted in a small but statistically significant improvement in nighttime sleep latency but had no effect on daytime sleep. Some adverse effects were reported, including insomnia and headache from Modafinil, and nausea, anxiety, low-back pain, and other effects from Armodafinil.


Comprehensive, evidence-based approaches that include best practices in shift scheduling, a range of options to control exposure to light and dark, support for physical activity and healthy eating, as well as pharmacological agents, may be the best ways to improve health. There is also a need to develop and test novel approaches, like social support, possibly using new technologies such as smart phones to help with sleep or other adverse effects. There is no “one size fits all” solution, and individual shift workers may have different responses to interventions as the result of chronobiology, personal preferences that affect compliance, or other factors that remain to be assessed.

Fruit juice: just another sugary drink Jun 30th, 2014
The evidence for a role of sugar-sweetened beverages (SSBs) in the development of obesity and associated comorbidities, is becoming increasingly convincing.

Liquids have a smaller satiating effect than do solid foods, and consequently excess calories consumed in liquid form are not fully compensated for by reduction of intake of other foods. Evidence exists that non-alcoholic beverages contribute a substantial proportion of daily sugar intake (about a quarter of sugar intake in the UK), are consumed separately from other dietary components, are of little nutritional benefit, and that alternatives in the form of low-sugar drinks and water are readily available.

By contrast with the growing consensus to limit SSB intake, consumption of fruit is regarded as virtuous, with WHO guidelines recommending consumption of fruit and vegetables—eg, in the UK, the guidelines recommend five servings per day, and one of these portions can be in the form of fruit juice.


However, fruit juice has a similar energy density and sugar content to SSBs: 250 ml of apple juice typically contains 110 kcal and 26 g of sugar; 250ml of cola typically contains 105 kcal and 26·5 g of sugar. Additionally, by contrast with the evidence for solid fruit intake, for which high consumption is generally associated with reduced or neutral risk of diabetes, high fruit juice intake is associated with increased risk of diabetes.

In the modern context, where society is faced with an energy surfeit, health-care providers and policy makers must take every opportunity to help individuals to cut unnecessary calories from their diet. Some go as far as suggesting that fruit juices are sugary drinks and should be taxed and/or recommend elimination of all fruit juice consumption from children’s diets.

While extreme, this does highlight that the debate about the SSB reduction should include fruit juice.


Lifting Strategies of Expert and Novice Workers Jun 28th, 2014
Manual material handling (MMH) involves considerable physical work demands and is considered a high-risk task for low back pain (LBP). The risk increases with the magnitude of the physical exposure in terms of the load moment, trunk motion dynamics and trunk posture. There exists a large variability in low back loading and lifting posture that could be explained by individual differences (between subjects) and by trial-to-trial variations. Thus, for the same task, spine loading and posture can change markedly between trials and individuals.


liftgraphicThe above study showed that 'expert' workers differed from novices mostly in the posture-related variables (lumbar flexion angle, trunk inclination, knee flexion) and much less in the back loading ones (peak resultant moment or asymmetrical moment at L5/S1). Experts posture was quite different from the novices at the instant of the peak resultant moment as they bent their trunk and lumbar region less (even when age was accounted for with the lumbar flexibility index). Moreover, their knees were more flexed when the box was lifted from the floor of the pallet. Experts were also closer to the box during both the lifting and the deposit phases (See Image).

These posture-related variables could have a major impact on the distribution of internal forces on the spine, but expertise had a very small effect on the external back loading variables (peak resultant moment and peak asymmetrical moment at L5/S1), which are important indicators of risk in terms of work-related back injuries.

Various intervention strategies, such as training employees in safe lifting techniques, are used with the aim of protecting workers from back injuries. Recent reviews have seriously questioned the effectiveness of training programs as a mean of reducing back injuries. However, these reviews are based on a small number of studies, and the quality of the training intervention is generally not questioned. Important aspects such as the content of the training course, its duration and its specificity to the work context are worth consideration. 

A simple question that still needs to be answered is  “What should be taught?”.

Manual handling training is generally given over a very short time; as a result, the “training” is really more of an information session. When training is specific to the task and dispensed over a longer timeframe, a decrease in back loading and back injuries is possible (Schibye et al., 2003). The following study suggests ergonomic intervention with the aim of reducing external back loading should primarily focus on major factors such as the load height and horizontal distance between the lumbar spine and the load lifted in order to reduce the external back moment, and not just on workers’ technique.

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