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Workplace Wellness: How About this ROI?

Précis

A report commissioned by Health Canada on work-life conflict found that more than half of the 31,000 people surveyed reported high levels of stress. One in three suffered high levels of burnout and nearly 20 per cent rated their physical health as just fair-to-poor.

It’s no surprise that employees who are anxious and overloaded aren’t nearly as productive as those in good mental health. Stress, depression, and burnout are linked to increased absenteeism, and greater use of prescription medications and employee assistance programs. And chances are, the higher the level of stress within an organization, the lower the level of creativity and innovation which…has a negative impact on its bottom line and ability to compete.[i]

In the era of downsizing, Canadian workers have increased their workloads to keep up with diminishing budgets and fierce competition in all industries.  There are physical, mental and social costs to these workers, with resultant financial and human resource costs on employers’ bottom line.

According to data from the 2003 Canadian Community Health Survey (CCHS), nearly one in three employed Canadians, about 5.1 million, reported that most days at work were “quite” or “extremely” stressful.  Work-related stress costs Canadian taxpayers an estimated $2.8 billion annually in physician visits, hospital stays, and emergency room visits.[ii]

A 1992 United Nations report called job-related stress “the 20th Century disease”.  Job-related stress syndromes cost $16 Billion/year in Canada…the equivalent of 14% all net profits, and a conservative estimate figures job-related stress is responsible for:[iii]

  • 19% absenteeism
  • 40% turnover (employee replacement costs 150-250% of their yearly salary)
  • 55% Employee Assistance Programs (EAP)
  • 30% short term and long term disability costs
  • 60% of the total costs related to workplace accidents
  • 10% drug plan costs are for psychotherapeutic prescriptions

“Stress generally has more of an impact on white-collar workers, on employees lower in the organizational ranks, in the services sector, and on women.  Everyday small stressors are generally the most damaging. Each one of these stressors catalyzes 1,400 chemical reactions in your body, some of which continue for hours after the stressor that caused it has passed.

Individuals affected by stress smoke more, eat more, have more alcohol and drug-related problems, are less motivated, have more trouble with co-workers, and have more illness.  Stress impairs the immune system and can result in more infectious diseases, chronic respiratory illnesses, high blood pressure, obesity, cardiovascular diseases, gastrointestinal disorders, depression and cancer. [iv]

In 2000/2001, over two million Canadians had a repetitive strain injury (RSI) serious enough to limit their normal activities, and 55% of these injuries were caused by work-related activities.[v]

In one study of Federal Government workers, there were between 11,000 and 17,000 RSI claims / year, with total work days lost between 45,000 – 73,000.  The estimated cost of RSI to the workplace…$24 – $40 million annually.

Contributing factors include excessive work rates (and inadequate rest breaks); badly designed equipment, tools, machinery, and furniture; poor workstation layout that requires bending, twisting or stretching to perform a single task; chairs, desks and benches that are not suitable to a person’s height; and lack of job variation.

Progressive employers are looking for ways to support their employees with safer workplaces, more comfortable/ergonomic equipment and workplace wellness programs.

Workplace Wellness: An Antidote to Rising Health Claims and Low Productivity

Workplace wellness programs are instituted by progressive employers to boost morale and productivity, stem absenteeism, “presenteeism” and turnover and yield the benefits of a loyal, healthy workforce.  Workplace wellness initiatives include: health screenings and biometrix, health fairs and information, occupational safety improvements, on-site paramedical interventions/therapies, exercise, walk-to-work and quit smoking/curb obesity programs.  These programs are paid for directly by the employer or indirectly via employees utilizing their employee health benefit plans.  Sixty-five percent of employees polled state a health benefits plan is a strong incentive to stay with their current employer.[vi]

According to Joan Burton, Senior Strategy Advisor, Healthy Workplaces, Industrial Accident Prevention Association (IAPA), the components of a healthy workplace include the organizational culture, physical work environment and the personal health resources an employee brings to the workplace.  She states the cost of “doing nothing” puts an organization’s employees at risk for doubling or tripling the incidence of injuries, mental health problems, conflicts, substance abuse and other undesired outcomes.[vii]

According to Burton’s report, companies that incorporate workplace wellness programs experience strong benefits-to-cost ratio.  Here are a few examples: BC Hydro: For every $1 spent on the organization’s wellness program, the company saved an estimated $3 (after running 10 years)

Canada Life Insurance: The company saved $3.43 for every $1 spent on its fitness program.

University of Michigan:  For every $1 USD spent on workplace health programs, savings were estimated at $1.50 to $2.50 USD

Dupont (USA): For every $1 USD spent on a company health promotion program, the company saved $2.05 USD on disability after 2 years.

Citibank:  For every $1 USD the company spent on its comprehensive health program, there was a savings of $4.56 USD.

Pillsbury Company: For every $1 spent on wellness, the company saved $3.63 in health-related costs.

8 Halifax organizations: For every $1 spent on wellness, these organizations saved $1.64 on average/person plus: $2.04 for participants with 3-5 risk factors and $3.35 for smokers

Coors Brewing Company: For every $1 spent on a fitness program, the company saved $6.15

Telus-BC: The company saved $3 for every $1 spent on corporate health initiatives

A large diversified multi-site industrial setting: For every dollar spent on workplace health promotion, $2.05 was saved after 2 years

One of the best investments an employer can make is in a healthy workforce.

Incorporate Massage Therapy into Your Workplace Wellness Program

Businesses and corporations provided employee benefit plans during North America’s economic boom to retain skilled workers.  In the current economic recession, benefit plans help businesses mitigate job-related stress and repetitive strain injuries to promote healthy, productive and loyal employees.  Many benefit plans include massage therapy services in their coverage.

Massage therapy is consistently recognized as an effective intervention to the effects of stress, strain and pain.  Registered Massage Therapists (RMTs) are trained professionals, bound to ethics and standards under the Regulated Health Professions Act, and an essential component of paramedical care in our health care system.

In a study by Shulman and Jones posted in the Journal of Applied Behavioral Science, workers  in a company experiencing downsizing participated in an on-site massage therapy program.  These workers showed significant reductions in anxiety levels, compared to a control group that received a work-break but not massage therapy.[viii]  Other studies confirm the positive effects of massage therapy on low back pain, carpal tunnel syndrome, headaches and depression.[ix]

Companies using massage therapy as part of their on-site corporate wellness program include American Express, Apple, At&T, Canadian Tire Acceptance, IBM, Merrill Lynch and State Farm Insurance.  In a study conducted by the American Massage Therapy Association, 77% of Fortune 500 companies offer massage therapy in their benefit plans.  Particularly, companies in the financial, insurance and technology sector recognize the impact to worker productivity, health and loyalty, and proactively provide workplace wellness programs.

[i] Ariganello, A. CPA http://www.cga-canada.org/en-ca/AboutCGACanada/CGAMagazine/2009/May-Jun/Pages/ca_2009_05-06_network_reflections.aspx

[ii] ibid

[iii] www.stresscosts.com

[iv] Tangri, R: Stress Costs Stress Cures, 2003.  P 24

[v] Tjepkema M. Repetitive strain injury. Health Reports 2003; 14 (4): 11–30. [Statistics Canada, Catalogue 82-003].

[vi] Safoni Canada Health Care Survey 2011. P 7.

[vii] Burton, J: The Business Case for a Healthy Workplace. IAPA 2008

[viii] Shulman, KR & Jones, GE: The Effectiveness of Massage Therapy Intervention on Reducing Anxiety in the Workplace.  Journal of Applied Behavioural Science, 32, 160-173

[ix] http://www6.miami.edu/touch-research/Massage.html

“Pain is inevitable; suffering is optional.” – Buddhist saying

Pain is a signal sent to our awareness when something is wrong.  Injurious events are picked up by our nerve endings and send to relay stations in the brain where they are interpreted for reaction.  Sometimes pain is referred from another muscle or organ some distance from the pain.  Expertise is required to resolve the cause of the pain…not just the symptoms.

Pain is a common and normal occurrence in everyday life, yet few of us understand it.  For some “no pain, no gain” is a euphemism for life’s challenges, while for others pain is something to avoid and mitigate at all costs.  Pain is the most common reason for Canadians seeking health care and is the primary complaint in 78% of people reporting to hospital emergency rooms.[i]

Pain has a human and a financial cost.  “Direct health care costs for pain in Canada are more than $6 billion each year….Lost productivity costs relating to sick days and job loss are estimated at $37 billion each year.”[ii]

Let’s Get to the Bottom of Your Pain

Pain has many dimensions.  From a strictly physiological (ie: body-functioning) or sensory perspective, practitioners are interested in the location, onset, intensity, quality and pattern of the pain.  We also want to know the affective impact on how pain affects your mood – does it cause anxiety or depression?  How does it affect your well-being?  Your perception of pain is influenced by your cognitive processes: what does pain mean to you?  What are your attitudes and beliefs about yourself and about pain…is pain a punishment, or simply a signal of something off-line?  What are your coping skills and strategies in dealing with pain?  What has been your experience in receiving treatment for your pain?

For some people their pain is made worse by behaviours they themselves are generating.  Using words and language that communicate a lost sense of control or victimization, or the opposite of not expressing painful feelings can repress those feelings and lead to physical pain.  Being fearful or apprehensive due to the fear of pain, limiting physical activity causing a deconditioned body, not getting sufficient sleep/rest or using medications excessively can impair our ability to deal with pain.

Your pain perception is also influenced by your socio- and ethno-cultural background.  Do you have family members relying on you?  Does pain affect your ability to function in your work, your social situations or recreational pursuits?  Is the display of pain rewarded or inhibited in your culture or family of origin?

The Enormity of Pain in Society

Leon Chaitow, DO, ND describes the enormity of pain this way:

“Pain is probably the single most common symptom experienced by humans and, along with fatigue, is the most frequent reason for anyone consulting a doctor in industrialized societies – indeed the World Health Organization (1981) has suggested that pain is ‘the primary problem’ for developed countries.

Within that vast area of pain, musculo-skeletal dysfunction in general, and back pain in particular, feature large.  If symptoms of pain and restriction are viewed in isolation, with inadequate attention being paid to the degree of acuteness or chronicity, their relationship with the whole body and its systems (including the musculoskeletal and nervous systems) – as well as, for example, the emotional and nutritional status of the individual and of the multiple environmental, occupational, social and other factors which impinge upon them – then it is quite possible that they will be treated inappropriately.”[iii]

Massage Therapy in the Treatment of Pain

According to Wright and Sluka,[iv] “Massage is thought to induce a variety of positive physiological effects that may contribute to tissue repair, pain modulation, relaxation, and improved mood.”[v]

Daniel C. Cherkin, PhD, from the Group Health Research Institute, Seattle, Washington, and colleagues reported that massage therapy may effectively reduce or relieve chronic back pain for 6 months or more.   [vi]

The results of this parallel-group, randomized controlled trial were reported in the July 5, 2011 issue of the  Annals of Internal Medicine.  Dr. Cherkin notes, “We found that patients receiving massage were twice as likely as those receiving usual care to report significant improvements in both their pain and function,” Further, “After 10 weeks, about two-thirds of those receiving massage improved substantially, versus only about one-third in the usual care group.”

[i]  http://www.canadianpainsociety.ca/pdf/pain_fact_sheet_en.pdf

[ii]  http://www.canadianpaincoalition.ca/media/cpc_brief_pall_comp_care.pdf, pg 7

[iii] Chaitow, L: Muscle Energy Techniques, 2nd edition.  Churchill Livingstone 2001 p 22

[iv] Wright A, Sluka KA. Nonpharmacological treatments for musculoskeletal pain. Clin J Pain 2001;17:33–46

[v]  http://www.medscape.com/viewarticle/559775_4

[vi]  http://www.medscape.com/viewarticle/745953

Strain

“Yeeoohhh!”  Were you exerting yourself, tensing muscles beyond measure and then felt something tear, rip or pull?  Was it followed by terrible pain, severe spasm in the muscle affected and a need to stop all activity immediately?  You’ve likely strained muscle, and it’s going to take some time to heal.  Muscles and joints handle tremendous loads.  Everything from shoveling snow, lifting heavy boxes and carrying groceries.  They endure prolonged postural loads when sitting at the computer desk, and if the body is overwhelmed with excessive or prolonged load, muscles and connective tissues may strain, causing inflammation, guarded movement and pain.

woman painIn addition to redness, swelling, immobility, pain, and heat over the area, you will notice muscle spasm – it’s the muscle’s way of shutting down movement and splinting the injured area.  If you notice excessive bruising and/or swelling, heard a “pop” sound or cannot use the limb or bear weight in your spine at all – seek immediate medical attention.  The physician or nurse practitioner may suggest a supportive bandage or splint, crutches or other assistive device, offer a prescription for non-steriodal anti-inflammatory drugs (NSAIDs) and in severe cases (for a mostly or fully ruptured muscle) surgery may be required.

If the strain is less severe, apply PRICE – protection, rest, ice, compression and elevation – immediately and frequently (every hour for 20 minutes duration) over the next 24-72 hours.  This will help diminish the symptoms.  When symptoms abate, move the joints on either side of the strain within pain-free range while gently, gently tensing and relaxing the affected muscle (isometric contraction) for a count of 5 followed by 3 seconds relaxation, for 3 – 5 repetitions twice/day.

Eventually work up to weight-bearing and non-straining activities (example: a short walk, gentle stretching regimen) and eventually increase activity back to normal levels.  It’s very important to modify activity and increase gradually…injuring a muscle already strained will dramatically impact your recovery and the prognosis for a full recovery.

You can lessen your chances of strain through regular physical conditioning and a daily stretching regimen.  When exercising, stretch gently before exercise and a bit more vigorously after (when the muscles are warm and responsive).  Maintain sufficient rest and nutrition, and be careful when bending or twisting while handling heavy objects.

Massage Therapy for Strain

Massage therapy is indicated after 24- 72 hours of PRICE.  Your practitioner can relieve some of the painful spasm, reduce excessive swelling and treat compromised and compensating body regions directly or indirectly affected by the injury.  Don’t worry…your practitioner will not provide deep tissue penetration into the injured muscle while acute!   Over time, your practitioner will help mold and make pliable the scar tissue your body produces to repair the injury, eventually restoring it to maximum efficiency.

A recent research study provides some insight why massage is helpful in the treatment of strain and inflammation.

Mark Tarnopolsky, MD, PhD, and colleagues from the Department of Pediatrics and Medicine at McMaster University in Hamilton, Ontario, Canada reported the results of their research in the February 1 issue of Science Translational Medicine.

“Ten minutes of massage therapy can help repair exercise-induced muscle damage by subduing inflammation and renewing mitochondria (the cell’s “power plant”). This mechanism is similar to the way non-steroidal anti-inflammatory drugs (NSAIDs) work.”

“In summary, our findings suggest that the perceived positive effects of massage are a result of an attenuated production of inflammatory cytokines (signalling molecules in intercellular communication), which may reduce pain by the same mechanism as conventional anti-inflammatory drugs such as NSAIDs. The results elucidate the biological effects of massage in skeletal muscle and provide evidence that manipulative therapies may be justifiable in medical practice,” the researchers conclude.  [i]

“There is general agreement that massage feels good, now we have a scientific basis for the experience,” said coauthor Simon Melov, PhD, from the Buck Institute for Research on Aging, Novato, California, in a press statement.[ii]

[i] Study Shows Why Massage Aids Exercise Recovery  http://www.medscape.com/viewarticle/757978

[ii] ibid

“It’s Just Stress”

“It’s Just Stress”.  People worry about troubling symptoms such as headaches, neck tension, upset stomach and trouble sleeping.  A well-meaning friend, family member or even primary health care provider may assure them, “It’s just stress”.  More often than not, we receive little direction what to do about stress and its impact on our body.  We would do well to understand the stress response, its life-saving function in our body, and how too much of it can cause us real trouble.

Stress is costly.  Job-related stress costs the Canadian economy $16 billion annually.  Job-related stress claims are responsible for 19% of absenteeism, 40% of employee turnover and consume 55% of employee benefits. Thirty percent of short-term and long-term disability costs correlate with job-related stress, and at least 10% of drug plan costs are for psychotherapeutic prescriptions.*

It’s actually not stress that causes us harm…it’s our response to it.  In Dr. Robert Sapolsky’s book Zebras Don’t Get Ulcers, he describes most mammals are designed for “3 minutes of screaming terror” as they are pursued by a predator, or chasing prey as the desperately hungry predator themselves.

The stress response liberates available energy and delivers it along with blood and oxygen to the brain and muscles, shuts down long-term projects (growth, digestion, reproduction), boosts clotting factor and blunts pain sensation (anticipating injury) and focuses the mind for learning and recall.  Our survival depends on the stress response.  “After the 3 minutes of screaming terror,” Sapolsky summarizes “it’s over…or it’s over for you”.

Short-term stress as described above we can handle…it’s the chronic stress that kills us. Humans anticipate threat — real or perceived — in the deadline, the obligation or upcoming event we’re regretting, fear of failure or success, worried we will be disappointed or rejected. We can generate chronic stress through our own imaginings which, as Sapolsky puts it, lead to “anxiety, neurosis, hostility and paranoia”. Of illness, Sapolsky says “Stress is not a causative factor, stress is an exacerbative factor.  It makes pre-existing disease worse”.

This is an important distinction – the chronic stress response becomes more damaging than the stressor itself!   Zebras don’t get ulcers because they don’t worry themselves over whether a threat will come along. They handle it as it arises. Humans however worry constantly, and their chronic stress response does them more harm than the stressor itself.

The Physiology of Stress

When the organism perceives a threat – real, exaggerated or imagined – the hypothalamus in the brainstem releases corticotrophin-releasing hormone (CRH). This hormone travels a short distance to the pituitary gland to stimulate the release of adrenocorticotropic hormone (ACTH). Adrenocorticotropic hormone travels via the blood to the adrenal glands, affecting the adrenal cortex. This functional nexus of the hypothalamus, pituitary gland and adrenal cortex is called the HPA axis, and is the “hub of the body’s stress mechanism.”

Once stimulated by ACTH, the adrenal cortex acts like an endocrine gland and releases corticoid hormones, including the oft-referenced cortisol. Cortisol acts on almost every tissue in the body and is key in the body’s response to stress, dampening the body’s stress reaction and, consequently, the immune system. Cortisol has an ulcerating effect on the intestines and a thinning effect on bone tissue. The alarm response, in addition to the taxation on the hormone, immune and intestinal systems, affects the heart, lungs, skeletal muscle and emotional centres.

The hypothalamus maintains two-way communication with the brain centres that process emotion; therefore, it is via the HPA axis that emotions exert their influence on the immune system.

How Stress Transmutes into Disease

In his book bodyNoWhen the Body Says No, author and Vancouver physician Gabor Maté states, “Stress is a complicated cascade of physical and biochemical responses to powerful emotional stimuli.” He elaborates: “Disease is disharmony. More accurately, it is an expression of an internal disharmony.” The new science of psycho-neuro-immunology (PNI) draws the relationship of distant and sometimes unconscious repressed feelings to physiological manifestations of disease.

Medical texts maintain a biological cause of illness, despite extensive research implicating emotions in the causation of many diseases.  Maté draws a correlation between the ravages of prolonged stress response due to the inability to effectively express emotions, and serious illnesses such as scleroderma, SLE (systemic lupus erythematosus), multiple sclerosis, ALS (Lou Gehrig’s disease), cancer, breast cancer, Alzheimer’s disease, and  irritable bowel syndrome.

Borrowing from Hans Selye’s research, Maté outlines the stress response. Stress contains three elements: the stressor, interpretation of the stressor by the organism and the response. In lab studies with rats exposed to stress, Selye found enlarged adrenals, shrunken lymph organs and ulcerated intestines. The literature identifies stress facilitated by feelings of: i) uncertainty; ii) lack of information; and iii) loss of control.

Maté describes common beliefs shared in people with chronic illness, such as “It’s not right for me to be angry,” “If I’m angry, I will not be loved,” “I’m responsible for the whole world,” and “I must justify my existence/I must do something.” He describes the development of “emotional competence,” which outlines the capacity to identify feelings, the ability and opportunity to express them, the facility to distinguish (current from past) and the awareness of the genuine need to address emotions to one’s satisfaction.

Autoimmune disorders are a type of civil war, ravaging the body’s own tissues. In one case, Maté shares, “Perhaps her body was doing what her mind could not: throwing off the relentless expectation that had been first imposed on the child and now was self-imposed in the adult ­– placing others above herself.”  Further, “When we have been prevented from learning how to say no, our bodies may end up saying it for us.”

Massage in the Intervention of Stress-Related Health Symptoms

You can interrupt the cascade of harmful chronic stress reactions with self-awareness techniques such as controlled breathing and meditation or prayer, taking a physical break and using various cognitive techniques to monitor your thoughts and feelings.  When stress is insidious and overwhelming, stronger interventions like psychotherapy, prescription drugs and body awareness therapies may be prescribed.

Massage therapy can be very helpful in ameliorating the physical effects of chronic stress response, and is even helpful psychologically.  Moore et (2002) found people treated with massage therapy showed a decrease in trait anxiety and subclinical depression while Diego et al (2001) hypothesized massage therapy promotes parasympathetic activity in the body – reducing stress hormone levels and promoting feelings of calmness and well-being.  Field et al (1996) studied the effects massage therapy had on office workers and noted an alleviation of anxiety and improvement in mental alertness.

Registered massage therapists are trained and well-educated to understand the impact of chronic stress, and provide remedy for stress’s ravaging effects.

*stresscosts.com