On October 29-30, the Canadian Memorial Chiropractic College (CMCC) held
its 2011 Research Symposium, titled Cumulative Trauma Injury, and with a
focus on disability management, injury prevention and care for illness
attributed to the work environment.
On October 29-30, the Canadian Memorial Chiropractic College (CMCC) held its 2011 Research Symposium, titled Cumulative Trauma Injury, and with a focus on disability management, injury prevention and care for illness attributed to the work environment.
The weekend featured a formidable lineup of speakers that highlighted the progress of CMCC researchers in this field, but that also reached beyond CMCC walls – and indeed the profession – to harness the knowledge and work of an interdisciplinary group of North American health scientists and clinicians.
Overview and epidemiology of work-related cumulative trauma
Dr. Cam Mustard, a physician and president of the Institute of Work and Health, and Dr. Pierre Cote, a chiropractor and associate professor of epidemiology at the University of Toronto’s Dalla Lana School of Public Health, began the proceedings with an eye-opening overview of work-related non-traumatic injury. Along with citing the statistics characterizing these injuries and some of the more obvious factors responsible for them – ergonomic considerations, occupational requirements, etc. – both scientists made it clear that a variety of psychosocial factors also come into play in the formation and rehabilitation of cumulative traumas and in creating return-to-work strategies.
A biological approach
The event continued with presentations encompassing biomechanical, inflammatory and endocrine contributions to cumulative trauma injuries. Dr. Mary Barbe, a neuroscientist from Temple University in Philadelphia, outlined her studies aimed at characterizing the short-term effects of repetitive and/or forceful tasks on musculoskeletal and neural pathologies with a focus on how inflammation increases sensorimotor dysfunction.
CMCC’s own Dr. John Triano, professor and dean of graduate education, followed this with a discussion of the factors predisposing those with inflammation and/or impaired neuromuscular control resulting from cumulative trauma to a reduction in thoracolumbar myofascial shear. New information shows these soft tissues are highly innervated and capable of sensing pain. This sheds new light on the potential for soft-tissue techniques and the ability to help those with chronic low back pain.
Dr. Linda Woodhouse, associate professor at the faculty of rehabilitation medicine at University of Alberta, spoke of hormones and endocrine systems and their contributions to cumulative trauma. Dr. Woodhouse called attention to the fact that people with certain endocrine changes might be more susceptible to cumulative trauma and how endocrine “dysregulation” may underlie more chronic health disorders than previously thought.
These scientists drew parallels from their work at the bench to industries where workers are called upon to perform various physical tasks that may result in similar repetitive strains to those induced in their respective lab models. They emphasized the need for appropriate interventions at an early stage before tissue has the opportunity to degrade and/or before the brain solidifies any negative adaptive changes that will further compromise function and overall health.
Psychosocial factors and prevention
Following this biologically based discussion, Dr. Linda Carroll, professor of epidemiology at the University of Alberta’s School of Public Health and adjunct professor at CMCC, discussed the psychosocial factors involved in cumulative trauma injuries. Dr. Carroll drew on the neuromatrix theory of pain to demonstrate some of the fears and coping mechanisms involved in injury, recovery from injury and return-to-work efforts. She also discussed therapy concepts such as “hurt versus harm,” digging out the “disconnects,” identifying expectations for outcome, involving family/partners and the knowledge transfer and exchange that must occur among the triumvirate of caregiver, injured employee and employer.
Dr. Diane Grondin, a DC and research scientist and instructor in the graduate and research programs at CMCC, reviewed prevention strategies for work-related cumulative trauma injuries. Dr. Grondin gave an overview of ergonomic and work schedule considerations that could lead to cumulative trauma and how the alert clinician can effectively facilitate prevention and/or recovery once injury has occurred.
Work disability prevention: thinking differently
Dr. Patrick Loisel, orthopedic surgeon, disability scientist and CMCC’s newest cross-appointed faculty member, presented his groundbreaking achievements in work disability prevention theory. Dr. Loisel, who has developed a graduate-level program at CMCC, holds to the paradigm of “thinking differently” when approaching issues in work disability and prevention. He emphasizes that work rehabilitation is not a medication, but involves looking at the bigger context of the injury. He insists upon taking into consideration a number of determinants that go far beyond biological trauma, and emphasizes the need for co-operation among a team of stakeholders to effect successful injury recovery and return to work. Finally, Dr. Loisel reiterated his outlook regarding chiropractors’ potential to be leaders in this area due to their holistic approach to patients and their open efforts at interdisciplinary activities.
Strategies for managing cumulative trauma injuries
Dr. Tony Tibbles, associate dean of clinics at CMCC, went on to present chiropractic management of cumulative trauma. Dr. Tibbles’ emphasis was on the use of a broad scope of available modalities, and an interdisciplinary approach centred on evidence-informed decision making, when treating cumulative trauma within a chiropractic setting.
“Evidence is not scary,” noted Dr. Tibbles as he systematically reviewed a number of clinical case examples for which evidence showed itself to be a useful resource in effecting a positive outcome.
Ushering the event to a close, Drs. Mark Erwin (DC and Spine Program scientist, University Health Network), Linda Woodhouse, Tom Hyde (chiropractor and sports injuries specialist) and Mohsen Kazemi (associate professor, CMCC) presented a variety of evidence-based approaches for the treatment of cumulative trauma injury, including management of the disc patient, physical therapy, soft-tissue therapy and vibration therapy.
A different perspective
Dr. Aviad Haramati, professor of physiology at Georgetown University School of Medicine, surmounted the odds against drawing an audience’s attention at 8 a.m. on a Sunday and piqued the assembly’s interest with an unexpected take on the topic of cumulative trauma. His talk, titled “Mind-Body Factors,” was not, as many thought it might be, about treatment approaches for patients. Instead, it was about preventing burnout – a pervasive variety of cumulative trauma among health-care professionals – by addressing its precipitating factors while practitioners are still in training.
Dr. Haramati harnessed the science of telomeres – the biological cellular clocks degraded by chronic stress – behind mind-body medicine approaches to discuss burnout of physicians, chiropractors and other caregivers, both during training and in practice. He then presented a program credited with changing the culture of health-care education. The program has been in effect for nine years at the medical school in Georgetown, and is beginning to draw attention and participation from other programs at the university as well. It is currently a selective – students and faculty voluntarily sign up for it – that involves pulling trainees together into 11 weeks of sessions aimed at elements such as mindfulness, empathy, inclusion, lifestyle balance, stress-management and self-care. Dr. Haramati feels such a program should be considered for all schools that train health-care practitioners. He points out that these professionals will be at risk for burnout, but also that, in order to perform most effectively, their training programs must provide a vehicle for grasping the need to care for themselves, while treating patients in an empathetic, inclusive and holistic manner.
The alignment of Dr. Haramati’s program with chiropractic principles, and the potential utility of this program for chiropractic trainees, are obvious.
Concluding observations
The event was a conduit for interdisciplinary co-operation to facilitate education regarding cumulative trauma injury and its impact in a variety of work environments.
Furthermore, the speakers’ focus on translating their work into clinically relevant take-home points spoke of the profession’s determination to bridge the clinic-research divide.
CMCC’s Division of Continuing Education will be offering selections from the material as part of its distance education program within the coming weeks. For updates and more information on offerings, readers can visit www.cmcc.ca/ce or e-mail ce@cmcc.ca.
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