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  • #16
    Shoulder Instability: An Introduction
    https://thesportsphysio.wordpress.co...-introduction/

    Shoulder Impingement… some extra thoughts
    https://thesportsphysio.wordpress.co...ra-thoughts-2/

    Shoulder pain, GIRDs and Sleeper Stretches….
    https://thesportsphysio.wordpress.co...per-stretches/

    Rotator cuff tears: cables and crescents?
    Rotator cuff tears: cables and crescents?

    Why does my shoulder hurt? A guest article by Ben Dean
    https://thesportsphysio.wordpress.co...e-by-ben-dean/

    Shoulder Instability: An Introduction
    https://thesportsphysio.wordpress.co...-introduction/

    Shoulder Instability Part 2: Traumatic Causes
    https://thesportsphysio.wordpress.co...part-2-trauma/

    Shoulder Instability Part 3: Non Traumatic
    https://thesportsphysio.wordpress.co...non-traumatic/

    Shoulder Instability Part 4: Adverse Muscle Patterning
    https://thesportsphysio.wordpress.co...le-patterning/

    This should get you started.
    Jo Bowyer
    Chartered Physiotherapist Registered Osteopath.
    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

    Comment


    • #17
      https://www.reddit.com/r/AdvancedFit...in_on_posture/

      The top comment in reply to this post is a guy who carried a heavy backpack on his shoulder for long distance on one shoulder everyday throughout middle and high school. He now says he has intense pain that he has been to two physios for that couldn't rehab it. If you had to bet, is he a case of the brain mainly causing his pain or does he have still have lingering tissue damage and why would it be seemingly "unrehabbable".

      Thanks for the links they are great

      Comment


      • #18
        Neurotags can be difficult to unwire. I teach my patients as though they were students and encourage them to find solutions for themselves but to keep in touch with me via email

        Fear of pain, movement and loading can be difficult to overcome and is best addressed by graded exposure tailored to the individual, I get them in to the practice to see how they are progressing with this.

        I find the tag cloud and the search function on this site extremely useful, if there is something in what I read which I find difficult to get past, there is usually someone here who can clarify.

        Pathology requiring onward referral should always be at the back of every practitioner's mind, as should scope of practice.

        If you had to bet, is he a case of the brain mainly causing his pain or does he have still have lingering tissue damage
        I don't bet.

        I spent nine years in the NHS, and a further six running an outpatient and sports injuries clinic during which I was a travelling physio with world class sports teams. I have retired from travelling but continue to attend multidisciplinary meetings and masterclasses.

        I am still vulnerable to failure to notice something which would be better dealt with by another health care professional.
        Last edited by Jo Bowyer; 18-10-2016, 07:26 PM.
        Jo Bowyer
        Chartered Physiotherapist Registered Osteopath.
        "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

        Comment


        • #19
          What pain-related factors are associated with lost work days in nurses?

          http://www.bodyinmind.org/pain-lost-work-days-nurses/

          Low back pain (LBP) is a leading cause of disability [5] including lost work days (LWDs) and early retirement [3; 4]. Among the work-related disability domains, LWDs are particularly important because they increase the economic burden of pain for the individual, family and society. A number of factors such as overall work demands, working on a nightshift, perceived lack of support and/or encouragement from supervisors, and lack of rest time have been previously found to be associated with LWDs among nurses [4]. Although a variety of factors are known to be associated with LWDs, not a lot is known about the role that modifiable pain-related factors play in LWDs. Exploring the role that these factors might play is important because it could inform the development of treatments designed to reduce the impact of chronic pain on LWDs.



          Prognostic psychosocial factors for disabling low back pain in Japanese hospital workers

          http://journals.plos.org/plosone/art...l.pone.0177908

          Abstract

          Background

          Although the occupational health field has identified psychosocial factors as risk factors for low back pain that causes disability, the association between disabling low back pain and psychosocial factors has not been examined adequately in Japanese hospital workers. Therefore, this study examined the association between low back pain, which interfered with work, and psychosocial factors in Japanese hospital workers.

          Method

          This cross-sectional study was conducted at a hospital in Japan. In total, 280 hospital workers were recruited from various occupational settings. Of these, 203 completed a self-administered questionnaire that included items concerning individual characteristics, severity of low back pain, fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), somatic symptoms (Somatic Symptom Scale-8), psychological distress (K6), workaholism, and work-related psychosocial factors (response rate: 72.5%). Logistic regression was used to explore risk factors associated with disabling low back pain.

          Results

          Of the 203 participants who completed questionnaires, 36 (17.7%) reported low back pain that interfered with their work. Multivariate analyses with individual factors and occupations adjusted for showed statistically significant associations between disabling low back pain and fear-avoidance beliefs (adjusted odds ratio [OR]: 2.619, 95% confidence interval [CI]: 1.003–6.538], somatic symptoms (OR: 4.034, 95% CI: 1.819–9.337), and interpersonal stress at work (OR: 2.619, 95% CI: 1.067–6.224).

          Conclusions

          Psychosocial factors, such as fear-avoidance beliefs, somatic symptoms, and interpersonal relationships at work, were important risk factors in low back pain that interfered with work in Japanese hospital workers. With respect to occupational health, consideration of psychosocial factors is required to reduce disability related to low back pain.
          Update 26/05/2017



          Insufficiently studied factors related to burnout in nursing: Results from an e-Delphi study
          http://journals.plos.org/plosone/art...l.pone.0175352

          Abstract

          Objective

          This study aimed to identify potentially important factors in explaining burnout in nursing that have been insufficiently studied or ignored.

          Methods

          A three-round Delphi study via e-mail correspondence was conducted, with a group of 40 European experts. The e-Delphi questionnaire consisted of 52 factors identified from a literature review. Experts rated and scored the importance of factors in the occurrence of burnout and the degree of attention given by researchers to each of the variables listed, on a six-point Likert scale. We used the agreement percentage (>80%) to measure the level of consensus between experts. Furthermore, to confirm the level of consensus, we also calculated mean scores and modes. Regardless of the degree of consensus reached by the experts, we have calculated the mean of the stability of the answers for each expert (individual's qualitative stability) and the mean of the stability percentages of the experts (qualitative group stability).

          Results

          The response rate in the three rounds was 93.02% (n = 40). Eight new factors were suggested in the first round. After modified, the e-Delphi questionnaire in the second and third rounds had 60 factors. All the factors reached the third round with a consensus level above 80% in terms of the attention that researchers gave them in their studies. Moreover, the data show a total mean qualitative group stability of 96.21%. In the third round 9 factors were classified by experts as ‘studied very little’, 17 as ‘studied little’ and 34 as 'well studied'

          Conclusion

          Findings show that not all the factors that may influence nursing burnout have received the same attention from researchers. The panel of experts has identified factors that, although important in explaining burnout, have been poorly studied or even forgotten. Our results suggest that further study into factors such as a lack of recognition of part of the tasks that nurses perform, feminine stereotype or excessive bureaucracy is needed for a better understanding of this syndrome and improve the quality of life in nurses.
          Update 10/04/2017



          Cognitive Impairments in Occupational Burnout – Error Processing and Its Indices of Reactive and Proactive Control

          http://journal.frontiersin.org/artic...017.00676/full

          The presented study refers to cognitive aspects of burnout as the effects of long-term work-related stress. The purpose of the study was to investigate electrophysiological correlates of burnout to explain the mechanisms of the core burnout symptoms: exhaustion and depersonalization/cynicism. The analyzed error-related electrophysiological markers shed light on impaired cognitive mechanisms and the specific changes in information-processing in burnout. In the EEG study design (N = 80), two components of error-related potential (ERP), error-related negativity (ERN), and error positivity (Pe), were analyzed. In the non-clinical burnout group (N = 40), a significant increase in ERN amplitude and a decrease in Pe amplitude were observed compared to controls (N = 40). Enhanced error detection, indexed by increased ERN amplitude, and diminished response monitoring, indexed by decreased Pe amplitude, reveal emerging cognitive problems in the non-clinical burnout group. Cognitive impairments in burnout subjects relate to both reactive and unconscious (ERN) and proactive and conscious (Pe) aspects of error processing. The results indicate a stronger ‘reactive control mode’ that can deplete resources for proactive control and the ability to actively maintain goals. The analysis refers to error processing and specific task demands, thus should not be extended to cognitive processes in general. The characteristics of ERP patterns in burnout resemble psychophysiological indexes of anxiety (increased ERN) and depressive symptoms (decreased Pe), showing to some extent an overlapping effect of burnout and related symptoms and disorders. The results support the scarce existing data on the psychobiological nature of burnout, while extending and specifying its cognitive characteristics.
          Introduction
          Professional burnout is a syndrome that is currently receiving much interest from scientific research and organizational specialists. The concept of burnout is characterized by typical symptoms: psychophysical or emotional exhaustion, depersonalization and diminished professional efficacy (Maslach and Schaufeli, 1993; Maslach et al., 1996, 2001; Maslach and Leiter, 1997, 2004, 2008; Leiter and Maslach, 2004). The processual character of burnout refers to cumulative negative consequences of long-term work-related stress. The core burnout symptoms are exhaustion (associated with a lack of energy, fatigue, and discouragement) and depersonalization/cynicism (associated with withdrawal, lack of motivation and emotional distance with clients, patients or co-workers). These usually lead to a further decrease in personal accomplishment and professional efficacy. However, additional effort and other compensative mechanisms may prevent these consequences (Berggren and Derakshan, 2013; Moser et al., 2013). The sequential process of burnout (e.g., Leiter et al., 2010) implies that the initial state of fatigue and exhaustion may lead to further psychosocial and health consequences.
          Update 01/05/2017




          At-risk and intervention thresholds of occupational stress using a visual analogue scale

          http://journals.plos.org/plosone/art...l.pone.0178948

          Abstract

          Background

          The visual analogue scale (VAS) is widely used in clinical practice by occupational physicians to assess perceived stress in workers. However, a single cut-off (black-or-white decision) inadequately discriminates between workers with and without stress. We explored an innovative statistical approach to distinguish an at-risk population among stressed workers, and to establish a threshold over which an action is urgently required, via the use of two cut-offs.

          Methods

          Participants were recruited during annual work medical examinations by a random sample of workers from five occupational health centres. We previously proposed a single cut-off of VAS stress in comparison with the Perceived Stress Scale (PSS14). Similar methodology was used in the current study, along with a gray zone approach. The lower limit of the gray zone supports sensitivity (“at-risk” threshold; interpreted as requiring closer surveillance) and the upper limit supports specificity (i.e. “intervention” threshold–emergency action required).

          Results

          We included 500 workers (49.6% males), aged 40±11 years, with a PSS14 score of 3.8±1.4 and a VAS score of 4.0±2.4. Using a receiver operating characteristic curve and the PSS cut-off score of 7.2, the optimal VAS threshold was 6.8 (sensitivity = 0.89, specificity = 0.87). The lower and upper thresholds of the gray zone were 5 and 8.2, respectively.

          Conclusions

          We identified two clinically relevant cut-offs on the VAS of stress: a first cut-off of 5.0 for an at-risk population, and a second cut-off of 8.2 over which an action is urgently required. Future investigations into the relationships between this upper threshold and deleterious events are required.
          Update 07/06/2017


          The quitting economy

          https://aeon.co/essays/how-work-chan...ee3ac-69418129

          When employees are treated as short-term assets, they reinvent themselves as marketable goods, always ready to quit


          The change that saw business writers, career counsellors and others adopting the view that individual employees, or potential employees, should think of themselves as businesses occurred at the same time that the way the value of a company was assessed also changed. Not so long ago, business people thought that companies provided a wide variety of benefits to a large number of constituents – to upper management, to employees, to the local community, as well as to shareholders. Many of these benefits were long-term.

          But as market value overtook other measures of a company’s value, maximising the short-term interests of shareholders began to override other concerns, other relationships. Quarterly earnings reports and stock prices became even more important, the sole measures of success. How companies treated employees changed, and has not changed back. A recent illustration of the ethos came when American Airlines, having decided that its current levels of compensation were not competitive, announced an increase to its staff salaries. The company was, in fact, funnelling money to workers instead of to its shareholders. Wall Street’s reaction was immediate: American Airlines’ stock price plummeted.

          In general, to keep stock prices high, companies not only have to pay their employees as little as possible, they must also have as temporary a workforce as their particular business can allow. The more expendable the workforce, the easier it is to expand and contract in response to short-term demands. These are market and shareholder metrics. Their dominance diminished commitment to employees, and all other commitments but to shareholders, as much as the particular industry requirements of production allow. With companies so organised, the idea of loyalty receded.

          Companies now needed to free themselves as much as possible of long-term obligations, such as pensions and other worker incentives. Employees who work long, and in many cases, intense hours to finish short-term projects, became more valuable.



          In a way new to the world, and begun by the re-orientation of companies to maximise shareholder value, quitting work is now central to what it means to have a job in the first place. People apply for jobs with the conscious plan to quit, with an eye toward what other jobs the job for which they are applying might help them get. Managers welcome new employees by promising to position them as advantageously as possible to quit in a few years. Co-workers, the ones who like you, are now hoping you will quit – since if you do, you might help them get a good job somewhere else. As is often the case, history brings unintended consequences, even to doctrinaire and theoretical ideas. Hayek’s philosophy has led to workers thinking of themselves as the CEO of Me, Inc; and to survive in the neoliberal world of work, the CEO of Me, Inc must be a quitter.
          Update 26/07/2017




          Assessment of potential risk factors for new onset disabling low back pain in Japanese workers: findings from the CUPID (cultural and psychosocial influences on disability) study


          https://bmcmusculoskeletdisord.biome...891-017-1686-y
          Abstract

          Background


          Most studies of risk factors for new low back pain (LBP) have been conducted in Western populations, but because of cultural and environmental differences, the impact of causal factors may not be the same in other countries. We used longitudinal data from the Cultural and Psychosocial Influences on Disability (CUPID) study to assess risk factors for new onset of disabling LBP among Japanese workers. Methods


          Data came from a 1-year prospective follow-up of nurses, office workers, sales/marketing personnel, and transportation workers, initially aged 20–59 years, who were employed in or near Tokyo. A baseline questionnaire included items on past history of LBP, personal characteristics, ergonomic work demands, and work-related psychosocial factors. Further information about LBP was collected at follow-up. Analysis was restricted to participants who had been free from LBP during the 12 months before baseline. Logistic regression was used to assess baseline risk factors for new onset of disabling LBP (i.e. LBP that had interfered with work) during the 12 months of follow-up. Results


          Among 955 participants free from LBP during the 12 months before baseline, 58 (6.1%) reported a new episode of disabling LBP during the 12-month follow-up period. After mutual adjustment in a multivariate logistic regression analysis, which included the four factors that showed associations individually (p < 0.1) in analyses adjusted only for gender and age, the highest odds ratio (OR) was for past history of LBP (2.8, 95% [confidence interval {CI}]: 1.6–4.9), followed by working ≥60 h per week (1.8, 95% CI: 1.0–3.5) and lifting weights ≥25 kg by hand (1.6, 95% CI: 0.9–3.0). When past history of LBP was excluded from the model, ORs for the remaining risk factors were virtually unchanged. Conclusions


          Our findings suggest that among Japanese workers, as elsewhere, past history of LBP is a major risk factor for the development of new episodes of disabling back pain. They give limited support to the association with occupational lifting that has been observed in earlier research, both in Japan and in Western countries. In addition, they suggest a possible role of long working hours, which merits further investigation.
          Keywords

          New onset Disabling low back pain Prospective study Risk factors Japanese workers Symptom-free

          Update 03/08/2017

          Last edited by Jo Bowyer; 03-08-2017, 03:41 PM.
          Jo Bowyer
          Chartered Physiotherapist Registered Osteopath.
          "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

          Comment


          • #20
            So lingering pain like this would most likely be due to a neurotag which is basically pain memory in your neurons(correct me if I'm wrong here).

            Comment


            • #21
              What is a Pain Neurotag?
              http://www.drjoetatta.com/what-is-a-neurotag/

              This is one take on the subject, probably plenty of references here on SS if you want to use the search facility.

              Most of the surgeons and physicians I work with recommend a trial of physiotherapy, before going to the expense of ordering imaging, corticosteroid injections and then going down the surgical route. It is possible to have a perfectly executed surgical repair and still have pain following that. So it makes sense to address neurotags and get the patient moving and loading first.
              Jo Bowyer
              Chartered Physiotherapist Registered Osteopath.
              "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

              Comment


              • #22
                Prolonged Intermittent Trunk Flexion Increases Trunk Muscles Reflex Gains and Trunk Stiffness

                http://journals.plos.org/plosone/art...l.pone.0162703

                Abstract

                The goal of the present study was to determine the effects of prolonged, intermittent flexion on trunk neuromuscular control. Furthermore, the potential beneficial effects of passive upper body support during flexion were investigated. Twenty one healthy young volunteers participated during two separate visits in which they performed 1 hour of intermittent 60 seconds flexion and 30 seconds rest cycles. Flexion was set at 80% lumbar flexion and was performed with or without upper body support. Before and after intermittent flexion exposure, lumbar range of motion was measured using inertial measurement units and trunk stability was assessed during perturbations applied in the forward direction with a force controlled actuator. Closed-loop system identification was used to determine the trunk translational admittance and reflexes as frequency response functions. The admittance describes the actuator displacement as a function of contact force and to assess reflexes muscle activation was related to actuator displacement. Trunk admittance gain decreased after unsupported flexion, while reflex gain and lumbar range of motion increased after both conditions. Significant interaction effects confirmed a larger increase in lumbar range of motion and reflex gains at most frequencies analysed following unsupported flexion in comparison to supported flexion, probably compensating for decreased passive tissue stiffness. In contrast with some previous studies we found that prolonged intermittent flexion decreased trunk admittance, which implies an increase of the lumped intrinsic and reflexive stiffness. This would compensate for decreased stiffness at the cost of an increase in cumulative low back load. Taking into account the differences between conditions it would be preferable to offer upper body support during activities that require prolonged trunk flexion.
                Jo Bowyer
                Chartered Physiotherapist Registered Osteopath.
                "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                Comment


                • #23
                  Physiological and Psychological Predictors of Short-Term Disability in Workers with a History of Low Back Pain: A Longitudinal Study

                  http://journals.plos.org/plosone/art...l.pone.0165478

                  Abstract

                  Despite an elusive pathophysiology, common characteristics are often observed in individuals with chronic low back pain (LBP). These include psychological symptoms, altered pain perception, altered pain modulation and altered muscle activation. These factors have been explored as possible determinants of disability, either separately or in cross-sectional studies, but were never assessed in a single longitudinal study. Therefore, the objective was to determine the relative contribution of psychological and neurophysiological factors to future disability in individuals with past LBP. The study included two experimental sessions (baseline and six months later) to assess cutaneous heat pain and pain tolerance thresholds, pain inhibition, as well as trunk muscle activation. Both sessions included the completion of validated questionnaires to determine clinical pain, disability, pain catastrophizing, fear-avoidance beliefs and pain vigilance. One hundred workers with a history of LBP and 19 healthy individuals took part in the first experimental session. The second experimental session was exclusively conducted on workers with a history of LBP (77/100). Correlation analyses between initial measures and disability at six months were conducted, and measures significantly associated with disability were used in multiple regression analyses. A first regression analysis showed that psychological symptoms contributed unique variance to future disability (R2 = 0.093, p = .009). To control for the fluctuating nature of LBP, a hierarchical regression was conducted while controlling for clinical pain at six months (R2 = 0.213, p < .001) where pain inhibition contributed unique variance in the second step of the regression (R2 change = 0.094, p = .005). These results indicate that pain inhibition processes may constitute potential targets for treatment to alleviate future disability in individuals with past or present LBP. Then again, the link between psychological symptoms and pain inhibition needs to be clarified as both of these factors are linked together and influence disability in their own way.
                  Introduction

                  Of all musculoskeletal pain conditions, low back pain (LBP) is the most common, with an estimated worldwide 1-month prevalence of 23.2% [1] and a lifetime prevalence of up to 84% [2]. Such a high prevalence, and the numerous therapeutic interventions used for nonspecific LBP greatly increase the economic costs and burden of this condition on society [3, 4]. Since they always live with doubts as to when the next episode will strike [5, 6], many individuals with LBP report that their activities are limited and that they consciously make efforts to avoid pain recurrences when they are pain-free, or pain exacerbations when their pain is ongoing [7]. Most of these individuals still work, but with a decreased productivity [8, 9]. Moreover, flare-ups are characterized by increased pain causing additional activity limitations [7]. These recurrences of acute pain have been shown to mask the contribution of key variables in the prediction of disability in individuals with LBP [10]. Therefore, identifying factors that contribute to disability regardless of these fluctuating pain levels is critical to increase performance and productivity in the workplace.

                  Despite its high prevalence, nonspecific LBP and its underlying pathophysiology remains elusive. Even so, previous studies have noted that individuals with LBP often exhibit psychological distress, including increased pain catastrophizing [11], pain-related fear [12], anxiety [13], hypervigilance to pain [14] and avoidance behaviors [15]. Encompassing most of these factors, the fear-avoidance model of musculoskeletal pain [16] is now considered one of the most comprehensive model to understand the transition from acute to chronic pain [17]. As such, many of the psychological factors included in the fear-avoidance model have been identified as partially responsible for the development of short and long term disability in individuals with LBP [18]. Recently however, some authors have proposed that the fear-avoidance model of musculoskeletal pain could be reframed in order to include pain-related physiological processes [19]. This is consistent with numerous studies showing that neurophysiological alterations are frequent in individuals with LBP. These alterations include changes in neuromuscular activation of trunk muscles [20, 21] as well as hyperalgesia, localized to the lower back [22, 23] or widespread, which also affects other body areas [22–24]. Finally, some authors suggest that individuals with LBP may present pathological pain mechanisms such as altered pain inhibition processes [25] that are also reported in individuals with other chronic pain conditions [26].

                  In individuals with LBP, reduced pain thresholds [25], psychological factors and neuromuscular adaptations [27] have all been linked to increased disability. However, these cross-sectional studies focused on punctual disability, and because low back pain is a fluctuating condition, in terms of both disability and painful episodes, the relative contribution of all aforementioned factors to future disability remains unknown.

                  Therefore, the main objective of this longitudinal study was to determine the contribution of psychological factors, neuromuscular adaptations, pain thresholds and tolerance, as well as pain inhibition processes to disability recorded six months later in working individuals with a history of LBP. The main hypothesis was that at least one of the aforementioned factors, or their combination with clinical pain levels observed at six months would contribute to future disability in workers with a history of LBP.
                  Jo Bowyer
                  Chartered Physiotherapist Registered Osteopath.
                  "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                  Comment


                  • #24
                    The scourge that can only lead to misery

                    http://www.racingpost.com/news/horse...=last7DaysNews


                    SOME call it bulimia. Others believe it is not. There is, however, widespread agreement from those in the know that ‘flipping’, the weight-control method of self-induced vomiting by jockeys, remains not only common but has also been adopted to a worrying extent by young Flat riders.

                    In last week’s Racing Post, jockey Mark Enright spoke frankly of his depression, smashing through the taboo that still prevents people opening up about mental health issues.

                    Those jockeys who purge their bodies of food have been similarly reluctant to admit publicly to a practice that has been labelled by some as a form of mental illness. Now, however, a jockey who flips is prepared to speak.

                    “I’ve spoken to doctors and nutritionists and am certain in my own mind it isn’t healthy,” says the well-known rider, who wishes to remain nameless.

                    “It can’t be healthy,” he adds. “Personally, though, I don’t think it’s a major health risk to me. I’m not worried. I’ve seen different levels of flipping and I just see it as a help to me.”

                    It has long been regarded as a form of help. Rewind through the decades and some of the sport’s most famous jockeys, then also able to use dehydrating diuretics, habitually made themselves sick in order to make a weight. A number of leading Flat riders, who compete in and win some of the sport’s biggest races, still do so with varying degrees of regularity.

                    There is nothing in racing’s rules to say they should not, but there is nevertheless some embarrassment among those who flip or have flipped. That sense of shame is not felt by those who smoke or spend an eternity in a hot sauna or bath in order to lose the odd pound.
                    The mechanics of flipping and the many side effects
                    What follows may not make for easy reading. It is important to understand, nonetheless.

                    Jockeys flip because it works. It can have negative side effects, but for those who need to reduce their weight in order to fulfil a riding commitment, it is viewed as highly effective. Indeed, in the US it is so accepted that many weighing rooms contain a special heaving bowl, into which jockeys vomit. That is not the case here, but that does not mean changing room toilets are not used for the same purpose.

                    There are jockeys who flip only when needing to ride at a particularly light weight. For others, it is a daily requirement, with one insider suggesting certain individuals can repeat the process five or six times a day.

                    To make flipping easier, jockeys eat food that is not stodgy, like curry, rice or sweets, often accompanied by large quantities of fizzy drink. Some will gorge themselves, as a key attraction of flipping is that by rapidly feasting, the brain is made to believe the stomach has been satisfied, even if the consumed food is brought back up very quickly. Indeed, jockeys do need to act quickly and will seek to make themselves sick within around 30 minutes of eating.

                    As such, some when travelling will eat at one service station and ‘go for a flip’ at the next. Although fingers are generally used to make that process easier, those accustomed to the act can make them*selves heave simply by positioning themselves over a toilet bowl. When finished, they can even find themselves a pound lighter than before they ate.

                    Brushing the teeth straight after flipping helps to protect them from stomach acid that has been forced into contact with parts of the body not designed for exposure to a substance that can cause tissue damage.

                    Hill says: “There is no doubt flipping gives you an abnormal approach to food that may translate to a more formal eating disorder. About a third of jockeys who employ ‘traditional’ weight-control methods will have changes in their mental health, with a number at the depressive end of the spectrum. If they then follow an appropriate diet that often reverses.”

                    The list of other potential risks is long. It includes dental decay, gastro-oesophageal reflux, oesophageal ulcers that may increase the risk of cancer and reduced function of the sphincter (muscle valve) at the bottom of the oesophagus so unwanted vomiting becomes more likely. There is vulnerability to the opposite problem, with acid in the oesophagus causing scarring and then problems swallowing. There is a chance of oesophageal tears causing blood to be vomited. Through the mechanism of dehydration flipping can also, in the short term, drop a person’s blood pressure causing dizziness, fainting and renal impairment. Dehydration impacts speed of thinking, reaction time and muscular strength.

                    Most of those issues are reversible. Some are not.
                    Last edited by Jo Bowyer; 08-11-2016, 07:08 PM.
                    Jo Bowyer
                    Chartered Physiotherapist Registered Osteopath.
                    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                    Comment


                    • #25
                      Hi Jo,

                      Andreas Holtermann and his group from Denmark have published some interesting papers related to ocupational forward bending and LBP .

                      They've also published alot with regards to leisure time physical activity and it's potentially protective effect on (occupational) Health and heavy physical workloads.

                      Cory, and of course everyone else, might be interested in this as well
                      Morten

                      Comment


                      • #26
                        Thanks Morten,

                        There is also this one in SoS

                        Biomechanical constraints remain major risk factors for low back pain. Results from a prospective cohort study in French male employees

                        https://www.somasimple.com/forums/sh...ad.php?t=20143



                        Physical activity level at work and risk of chronic low back pain: A follow-up in the Nord-Trøndelag Health Study

                        http://journals.plos.org/plosone/art...l.pone.0175086

                        Abstract

                        Background

                        Physical activity in leisure time seems to reduce the risk of low back pain, but it is not known whether occupational activity, as recorded in a representative working population, produces a higher or lower risk.

                        Objective

                        To study associations between physical activity level at work and risk of chronic low back pain.

                        Methods

                        Associations were examined in a Norwegian prospective study using data from the HUNT2 and HUNT3 surveys carried out in the whole county of Nord-Trøndelag. Participants were 7580 women and 7335 men who supplied information about physical activity level at work. Levels considered were sedentary work, work involving walking but no heavy lifting, work involving walking and heavy lifting, and particularly strenuous physical work. Nobody in the cohort was affected by chronic low back pain at baseline. After 11 years, participants reported whether they suffered from chronic low back pain. Generalized linear modelling with adjustment for potential confounders was applied to assess associations with risk factors.

                        Results

                        In age-adjusted analyses both women and men showed statistically significant associations between physical activity at work and risk of chronic low back pain, suggesting positive relationships. For particularly strenuous physical work the relative risk of chronic low back pain was 1.30 (95% CI: 1.00–1.71) in women and 1.36 (95% CI 1.17–1.59) in men, compared to sedentary work. Women still showed a general association with activity level after adjustment for education, leisure time physical activity, BMI, smoking and occupational category. In men, the higher risk was only maintained for particularly strenuous work.

                        Conclusion

                        In this cohort, women had a higher risk of chronic low back pain with work involving walking and heavy lifting or particularly strenuous work, compared to sedentary work. Men participating in particularly strenuous work also experienced a higher risk of chronic low back pain.
                        Update 12/04/2012
                        Last edited by Jo Bowyer; 12-04-2017, 07:56 PM.
                        Jo Bowyer
                        Chartered Physiotherapist Registered Osteopath.
                        "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                        Comment


                        • #27
                          Drugs, games, and devices for enhancing cognition: implications for work and society

                          http://onlinelibrary.wiley.com/doi/1...yas.13040/full

                          Introduction

                          When the financial crisis in Greece reached its climax in July 2015, several European politicians, Angela Merkel, David Cameron, and the Greek finance minister Yanis Varoufakis, were in close contact; even U.S. President Barack Obama was involved because of the potential global economic consequences of the crisis. They were meeting in small groups, holding phone conferences, and debating and negotiating over days into the early morning hours.[1] This might have been a rather exceptional situation, but similarly critical and hectic constellations occur repeatedly in the life of politicians. These are highly demanding situations, because the individual politician has to stay sharp, focused, controlled, and be able to make decisions with potentially far-reaching consequences and often has to maintain this high-functioning state over days and, potentially, weeks. One historical case in which a politician admitted to using pharmacological “helpers,” barbiturates and amphetamines, to be able to fall asleep so as to be fit the next day was the former British Prime Minister Anthony Eden,[2] whose use of pharmacological substances has been suggested to have affected his decision making.[2]

                          Although life for most people is not as tightly clocked as it is for these politicians and does not involve decisions about the fate of states or war, the 9-to-5 Monday-to-Friday work rhythm assumed to be the norm is changing. In the last 150 years, the employment structure, and thus the work environment, for the majority of workers has changed dramatically: until about 1911, roughly equal proportions of workers in the United Kingdom were employed in manufacturing and services (40% each), whereas in 2011, more than 80% of workers were employed in the service industry, with less than 10% in manufacturing and agriculture/fishing.[3] This shift means that the majority of workers now use their minds instead of their muscles, and maintaining and improving brain function is now the focus of education and other governmental departments4—a trend that is accelerated by digital technology development, which is visibly eroding employment in manufacturing and retail, as well as affecting highly skilled services in multiple areas.[5]

                          A recent report by the International Labour Organization on the changing nature of jobs[5] describes the changes in work environments over the last 10 years. It identified increasing rates of part-time employment, accompanied by a decrease in full-time employment, and a considerable proportion of workers without permanent contracts (about 25% in high-income countries, with an increasing tendency). Within the category consisting of advanced economies and the European Union, the workers with nonpermanent contracts were the most affected by poverty (between 16% and 40%). Furthermore, the proportion of unemployed workers receiving unemployment benefits in high-income economies has decreased from 44% in 2009 to 35% in 2014. This reduction in benefits and insurance, in the case of unemployment, in turn, increases the pressure on those who are employed to perform and satisfy work demands. In addition, the increasing trend toward jobs involved in the global supply chain (2014: >30% in the European Union and about 10% in the United States[5]), e-commerce, and extended availability of online and offline services around the clock will increase the demand for “white collar” workers around the clock.[6] About 22% of workers globally are reported to work more than 48 h/week (United States: 18.1%[7]). With regard to shift work, the most recent U.S. data are from 2004, reporting over 15 million full-time wage and salary workers (14.8%) who are given shift schedules (fallen slightly since 1991 (18%), but clear difference from 1985 (16%)[8]). In Germany, the percentage increased during the late 1990s and is now at a plateau of about 17% (2013),[9] identical to the percentage in the United Kingdom in 2014.[10] Shift work has particularly been associated with negative acute and long-term health effects, such as subjective fatigue, reduced quality and quantity of sleep, reduced quality of life,[11] increased anxiety and depression, adverse cardiovascular effects,[12] increased risk for gastrointestinal disorders,[13] metabolic syndrome,[14] possibly increased cancer risk,[15, 16] as well as higher incidence of accidents and errors during work,[17] and a higher incidence of commuting accidents (for a review, see Ref. [6]).

                          The number of sick-leave days taken because of mental disorders (notwithstanding the phenomenon of presenteeism) has increased markedly over the last few decades: it increased, for instance, by 209% from 1997 to 2014 in the population covered by one of the main German health insurance companies, while the number of sick-leave days taken because of disorders in general increased only by 21% in the same time.[18] Mental disorders are now the second most frequent reason for the use of sick days (after musculoskeletal problems).[18] The causality between these two phenomena—the change in workplace conditions and the change in the prevalence and severity of mental disorders—is not clear. However, independent of causality, the direct economic effects of mental disorders are becoming an increasing issue for companies as well as national economies.

                          These changes in work environments and the ever-increasing demands on cognition associated with the changes contribute to the tendency to use strategies to improve work performance. There are several methods to enhance cognitive functions, which can be differentiated into pharmacological (“smart drugs,” “neuroenhancers”) and nonpharmacological strategies, including physical exercise, diet, sleep, meditation, as well as technical devices (transcranial stimulation) and computer games and applications aimed at boosting brain function.[19-21] In the following section, we will focus on pharmacological enhancers (using neuroscience-based nomenclature[22]) but not on generally consumed, widely available substances, such as caffeine, and will discuss the current state of other methods in the last section.

                          The option of using pharmacological helpers or cognitive enhancers to face the ever-increasing stress and demands of the work environment appeals not only to politicians, bankers, or academics,[23, 24] but also to a wide range of people: the authors of a 2015 report,[25] issued by a large German health insurance company, contacted 10,213 insured people (age range: 20–50 years old), of which 5017 responded (49.1%). Of the respondents, 6.7% reported the lifetime use of pharmacological neuroenhancement (increase from 4.7% in the previous report issued in 2009), with 3.3% having the aim to improve work-related performance and 4.7% with the aim to improve mood and anxiety. However, the authors reported that the rate of 6.7% might underestimate the true value, because of response bias. The estimated 1-year prevalence was 5.8%, with 63% of users reporting regular, more than once/month intake. This study focused on the intention of using prescription drugs rather than the specific pharmacological agents. The participants reported use of medications such as antidepressants, stimulants, and β blockers, and medications aimed at reducing anxiety/nervousness and improving memory (antidementia). Work environments with a high prevalence of drug use were characterized by high pressure (serious consequences resulting from small mistakes), low employment security, a requirement not to show emotions, and working at the limit of capabilities. In summary, this report showed an increasing frequency of the use of pharmacological substances aimed at improving work-related performance, amounting to up to five million users in Germany (population: 82.6 million). Despite frequent, alarming headlines in newspapers,[26-33] data on the use of cognitive enhancers in work environments from other countries are rare.[19] In student populations, several studies found prevalences between 2% and 25% in various countries, with most studies ranging from around 10% to 15%.[19, 34, 35] Furthermore, most research on the enhancing effects of pharmacological and other enhancing mechanisms, such as transcranial direct-current stimulation (tDCS) or transcranial magnetic stimulation (TMS), has until now only investigated the effects of acute or subchronic intake, rather than chronic use, on well-defined cognitive tests.[36]

                          From ethical and policy perspectives, however, the use of neuroenhancing interventions should be carefully considered. On the one hand, impaired cognition due to stress, shift work, or other effects can reduce the overall gross domestic product of a nation, be it directly by diminishing productivity or indirectly by accidents or long-term effects of stress and work-related disorders, such as musculoskeletal and mental disorders (e.g., see Ref. [37]). In addition, chronic stress can negatively affect cognitive function, particularly forms of memory,[38] as well as brain volume.[39, 40]

                          The above-mentioned German survey[25] suggests that people who are worried about their jobs, working at the limit of their capabilities, or in fields where small mistakes can have serious consequences seem to be particularly prone to using cognitive enhancers,[25] and the users reported the following motives for use: enhancement in specific situations (e.g., examinations, giving a presentation, important negotiations; reported by 41%), work becomes easier (reported by 35%), attainment of goals more easily (32%), more energy and better mood for other interests (27%), competitive edge at work (12%), inability to do the work otherwise (25%), and requirements for sleep become less (9%). This is in parallel to studies investigating the motivation of students who consume cognitive enhancers, mainly reporting motivations to increase performance and “keep up” (concentration, vigilance, memory, cognitive potential), to stay awake for longer periods, to cope with a pressure to succeed, and to maintain an active social life.[41-43] In addition, factors such as overcoming jet lag and improving focus and increasing motivation for performance of tasks over longer time periods are known reasons for taking drugs such as modafinil.[21, 23, 44, 45]

                          One important point with respect to cognitive enhancers is the differentiation between its use as treatment, which is usually understood as aimed at improving a measurable deficit related to a neuropsychiatric disorder, and its use as cognitive enhancers with the aim of improving normal cognition in a healthy person above their typical function, to maintain cognition for longer times, or despite sleep deprivation or jet lag.

                          In patients suffering from neuropsychiatric disorders, deficits can be easily measured, and no one would dispute the use of drugs or other interventions to improve clinical deficits that might enable patients to lead independent lives, return to work, and have better quality of life and well-being. However, when looking at cognitive enhancement in people without a clear diagnosis of a mental disorder, it is difficult to define the terms “normal cognitive function” and “deficit” (e.g., see Ref. [21]). It might seem rather easy to determine if someone has clear cognitive deficits, for instance, after a stroke or as is the case in chronic schizophrenia. However, it is more difficult in people without a clear medical disorder but with subjective deficits or in people who wish to improve their cognitive performance above their “normal” level or want to maintain their level despite being sleep deprived or jet lagged, or who may be noticing an aging-related decline. Therefore, in these situations, it is difficult to determine whether to describe the use of a cognitive-enhancing drug as restoration or as enhancement.[21]

                          In addition to these definitional questions, there are also questions as to which cognitive-enhancing methods are genuinely effective, in which populations (healthy or patients), and for which cognitive domains. It is also important to know if effects measured in an experimental laboratory setting can be translated into everyday performance and functioning. Besides the use of smart drugs, a number of other methods aim at improving cognitive function, such as cognitive training, possibly using novel technical methods (e.g., games and smartphone applications) or electrical or electromagnetic methods (e.g., TMS or tDCS), which directly modulate brain areas or networks in order to improve cognitive performance.

                          The aim of this review is to summarize the state of current knowledge on enhancing and restoring cognition in healthy participants and in patients suffering from neuropsychiatric disorders, with an emphasis on novel findings published in 2014 and 2015.
                          I'm old enough to remember "Big Bang" in the City of London. I reckon it took three or four years to clear that one up. I dealt with several who were prostrated by it and needed a great deal of rest before I could get them up and moving again.



                          Cells in the Retina Light the Way to Treating Jet Lag

                          http://neurosciencenews.com/jet-lag-retina-6439/

                          Researchers have found a new group of cells in the retina that directly affect the biological clock by sending signals to a region of the brain which regulates our daily (circadian) rhythms. This new understanding of how circadian rhythms are regulated through the eye could open up new therapeutic possibilities for restoring biological clocks in people who have jet lag through travelling or working night shifts.
                          Update 19/04/2017
                          Last edited by Jo Bowyer; 19-04-2017, 10:30 AM.
                          Jo Bowyer
                          Chartered Physiotherapist Registered Osteopath.
                          "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                          Comment


                          • #28
                            Associations of sitting behaviours with all-cause mortality over a 16-year follow-up: the Whitehall II study.

                            https://www.ncbi.nlm.nih.gov/pubmed/26454871

                            Abstract:
                            BACKGROUND:
                            Sitting behaviours have been linked with increased risk of all-cause mortality independent of moderate to vigorous physical activity (MVPA). Previous studies have tended to examine single indicators of sitting or all sitting behaviours combined. This study aims to enhance the evidence base by examining the type-specific prospective associations of four different sitting behaviours as well as total sitting with the risk of all-cause mortality.
                            METHODS:
                            Participants (3720 men and 1412 women) from the Whitehall II cohort study who were free from cardiovascular disease provided information on weekly sitting time (at work, during leisure time, while watching TV, during leisure time excluding TV, and at work and during leisure time combined) and covariates in 1997-99. Cox proportional hazards models were used to investigate prospective associations between sitting time (h/week) and mortality risk. Follow-up was from date of measurement until (the earliest of) death, date of censor or July 31 2014.
                            RESULTS:
                            Over 81 373 person-years of follow-up (mean follow-up time 15.7 ± 2.2 years) a total of 450 deaths were recorded. No associations were observed between any of the five sitting indicators and mortality risk, either in unadjusted models or models adjusted for covariates including MVPA.
                            CONCLUSIONS:
                            Sitting time was not associated with all-cause mortality risk. The results of this study suggest that policy makers and clinicians should be cautious about placing emphasis on sitting behaviour as a risk factor for mortality that is distinct from the effect of physical activity.
                            I dislike how this study has mortality as its measurement. What about the amount of time sitting had on pain?

                            Comment


                            • #29
                              https://www.ncbi.nlm.nih.gov/pubmed/26454871

                              The results suggest that mortality risk is not associated with sitting time in this cohort. The findings may be due in part to a protective effect of a higher than average energy expenditure due to the habitual active transport associated with London-based employees. Further research is needed to address the uncertainties regarding the true nature of the exposure and the biological mechanisms that underpin previously observed associations between sitting time and health outcomes.
                              My own observations of this cohort seen for back and neck pain comply with the above. I would add that all those I see have moderate to high work related stress. I see a great change in them when they leave or retire.
                              Last edited by Jo Bowyer; 23-11-2016, 12:01 PM.
                              Jo Bowyer
                              Chartered Physiotherapist Registered Osteopath.
                              "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                              Comment


                              • #30
                                Drug-caused deaths among health care professionals: New insights revealed

                                https://www.sciencedaily.com/release...1122123611.htm

                                An Australian-first study conducted by Monash University has found that from 2003-2013 nearly five deaths per 1000 employed Australian health care professionals were caused by drugs, with a significant association between specific professions and drug type.

                                These deaths were more likely to involve females in their mid-40s, with a mental health condition, professional and/or personal stress and the intent to self-harm.

                                With the aim of identifying best approaches to health care professionals' drug use and their mental health care needs, the major study investigated drug-caused deaths of health care professionals including physicians, nurses, dentists, psychologists and psychiatrists, physiotherapists, pharmacists, paramedics and veterinarians.

                                A total of 404 drug-caused HCP deaths were reported to Australian coroners during this investigated timeframe, averaging 37 deaths per year.

                                Head of the Drug Harm Prevention Unit at Monash's Department of Forensic Medicine, Dr Jennifer Pilgrim said the study found a significant association between specific professions and drugs of choice.

                                "The mortality rate was highest in veterinarians, of which most involved death by suicide using potent barbiturates usually used in animal euthanasia.

                                "Our research also observed some different trends to existing literature on occupation-specific drug choice. For example, nurses, dentists and pharmacists reportedly gravitate towards misuse of opioids however in this study, these health care professionals misused opioids along with other substances, namely benzodiazepines," Dr Pilgrim said.

                                A mental health diagnosis and/or previous self-harm was reported in almost half the cohort and 50 per cent of the deaths were intentional self-harm deaths. The use of psychoactive drugs, both licit and illicit, is reportedly higher among medical practitioners than in the general population -- a trend that was observed in this study.

                                Numerous factors put health care professionals at a higher risk of substance abuse and premature death including high-stress jobs, access to controlled substances, long hours of practice and constant contact with the critically ill.


                                Kathryn
                                http://www.nejm.org/doi/full/10.1056/NEJMp1615141

                                On Wednesday, August 17, 2016, at about 5:15 in the morning, Kathryn, one of our fourth-year medical students, ended her life by jumping out of her apartment window. She was found minutes later by a small group of surgical interns who were headed to the hospital to attend rounds for their patients. One of her classmates, on his surgery subinternship, was with them. They began an effort to resuscitate her that continued, and ultimately ended, in our emergency department (ED). The classmate who had participated in the initial resuscitation efforts called Kathryn’s father as soon as she arrived in the ED to let him know that something terrible had happened. By the time her father called back, the resuscitation efforts were over and his daughter was dead.

                                In the hours that followed, our school was rocked by waves of anguish, anger, and frustration, guilt, fear, and profound sadness. Our new first-year class woke up that morning expecting to attend day 3 of medical school. As dean for medical education, I, along with my team, had spent most of orientation talking to them about well-being and self-care, the human side of medicine, and the importance of balancing social good with scientific progress and clinical excellence. We reinforced their expectations of a school that would care for them as people and teach them to do the same for their patients. Given all the anticipation, nervous energy, self-doubt of those first few days and the bravado required to survive them, I can’t imagine what it must have felt like to be introduced to medical school with a suicide.

                                The next 48 hours were a whirlwind. We put 24/7 emergency mental health services in place, had two town-hall–type meetings for all students and one with the first-year class, we worried about copycats, communicated with parents and alumni, and tried to process the feelings of guilt at not having done enough to prevent something like this from happening.

                                At the meetings there were students who publicly expressed their rage at not feeling adequately supported, at being ignored when they had been working so hard to provide us with feedback and suggestions, at knowing that they and their friends were also struggling with depression, anxiety, and suicidal ideation. There were also many students who privately expressed their gratitude for a school that they believed made extraordinary efforts to support their well-being, delivered on its promises, and was constantly striving to improve. Kathryn’s closest friends gathered at a vigil that first evening to share memories and experiences of her brief but very full life.
                                flagged up by Trisha Greenhalgh

                                Update 17/04/2017
                                Last edited by Jo Bowyer; 17-04-2017, 09:21 PM.
                                Jo Bowyer
                                Chartered Physiotherapist Registered Osteopath.
                                "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                                Comment

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