Revisiting Workplace Stretching Programs For Reducing Injuries

In an article I wrote last year, “To Stretch or Not To Stretch”, I concluded that stretching programs for the purpose of reducing injuries were not shown to be or not be effective.  As such, businesses should closely evaluate the costs of devoting time and resources to stretching programs compared to the supposed benefits.  I’d like to follow up that article with research done by Hess and Hecker on Workplace Stretching Programs:  The Rest of the Story.  In their research they reviewed three studies that looked at the effectiveness of stretching programs in regards to reducing worker injuries.  Two the three studies were strictly stretching programs and the third combined stretching and strengthening.  The conclusion reached by Hess and Hecker of these three studies was the following:

“the three studies that evaluated workplace-stretching programs demonstrated that stretching improves flexibility. However, two of these studies did not connect improvements in flexibility with meaningful outcome measures such as injury incidence or severity… The enhanced strength demonstrated by manual handling workers who stretch(ed and strengthened) is a notable finding in the real world of workers who bend, lift, carry, pull and push, over many hours a day. The current narrow focus on flexibility might be overlooking this valuable aspect of stretching that could contribute to injury reductions due to worker fatigue.”

One study that did not show a reduction in injuries did show a reduction in the total costs related to injury severity and lost time.  Whether this is a typical outcome has not be proven.

There are other aspects of stretching programs to consider when evaluating their effectiveness.  One is the application of studies that examined the effects of stretching on sports athletes which involved mostly college age athletes.  The results of these studies have been translated to the “industrial athlete”.  There are two issues with this that trouble me.  One is that the studies of college age athletes and stretching have not resulted in a single consistent conclusion.  In fact, the conclusions vary from stretching helps lower the number of strains and sprains, to no effect, to that it may actually increase the risk of injury.  The second point is that the thought that workers are “industrial athletes” and their bodies would respond in similar ways to sports athletes has not been proven.

A second point to consider is just what truly constitutes a “good” stretching program.  Are the stretching programs that businesses implement actually producing the wanted result?  It should be noted that not all methods of stretching are the same.   The American College of Sports Medicine has set forth the following stretching guidelines (In parenthesis I have added notes that pertain to work):

• Warm up for 5 minutes, minimum, prior to stretching
• Exercises should be tailored to sport performed (specific job duties performed)
• Stretch regularly: 2-3 days/week, minimum
• Perform stretches correctly: (need a trained, qualified instructor and overseer)
  • Use static or PNF stretches
  • hold stretch 10-30 seconds
  • 3-4 repetitions per muscle group
  • stretch bilaterally, emphasize tight muscles
  • Intensity should be to a position of mild discomfort only
• Effects on performance should be monitored (ditto, compliance should also be monitored)
• Stretch at the appropriate time before, during and after activity  (determine appropriate time based on work activity)

Are companies’ stretching programs following these guidelines?  Are they devoting enough time to stretch effectively?  Let’s just do the math on a stretching program that includes 6 stretches (1 lower back, 1 neck, 2 arm and 2 leg) and see how much time that may be:   5 minutes for a warm-up,  Lower back 30”x3= 1.5 min, neck 30”x3=1.5min, 2 arm 30”x6=3min, 2 leg 30”x6=3min, Total time= 14 minutes (minimum).  This calculation does not include any “wasted” time between stretches and the time it tasks employees to get to/from their work area.  A more realistic amount of time is 20min.   In talking with various companies, I’d say the most common amount of time devoted to employees stretching 5-10 minutes.  That being said, are they really stretching or just doing some body motion and calling it stretching?

The controversy of using stretching as a means of lowering/preventing injuries will continue as it has not been proven in studies.  This author is not convinced that stretching programs are the best method to reduce/prevent injuries.  Stretching is a form of control that relies on behavior.  As many personal experiences can attest, trying to use behavioral change to improve/modify a person to fit the situation has very limited success compared to changing the environment and systems around the person.  Stretching is not an effective means to reduce or eliminate exposure to risk factors.  Only by identifying and quantifying the root causes and then by using engineering controls, practices and methods is it possible to affect (lower/eliminate) the exposure.

The discussion of stretching programs will continue but next time the focus will be on asking if stretching programs are effective as a means of improving the overall health and wellness of employees.  Can they be used to increase employee awareness of personal health and fitness; thereby reducing healthcare consumption and improving the health and safety of the employee outside of work.

References:

Hess, J. and Hecker, S. Workplace Stretching Programs:  The Rest of the Story.  Labor Education and Research Center, University of Oregon.

Principles of Exercise Prescription. In:  American College of Sports Medicine Guidelines for Exercise Testing and Prescription, 6th ed., 2000. B. Franklin, Ed. Lippincott Williams and Wilkins, Philadelphia, PA. pp. 137-164.