A commentary by Peter Budnick concluding that stretching exercise programs are not ergonomics continues to generate controversy (Commentary: Ergonomics Is Not About Stretching Programs – Reprint). Today we present differing views from two Chiropractors.
The debate about the efficacy of stretching is particularly interesting to me. As a chiropractor I have found stretching to be a useful tool for the prevention and rehabilitation of many musculoskeletal disorders, including work-related problems. While some of my basis for using stretching is derived from journal articles and textbooks, I admit that much of my professional experience is anecdotal in nature. This isn’t all bad; after all, observation is the first step in the process of scientific inquiry, and the lowly case study/series has set the stage for understanding many important health issues. I think other clinicians would probably agree that stretching seems to have benefit for many people and employing stretching in the workplace is a logical step.
Yet, I don’t think it is enough to say stretching works or doesn’t work and rest on our laurels. Those who have challenged the evidence for the effectiveness of stretching in MSD prevention in this forum are absolutely correct. The literature today is lacking and no one can say with scientific certainty that stretching does or does not reduce the risk of injury, either in sports or in the work environment. My current work at the University of Oregon Labor Education and Research Center has put me in contact with industry stretching programs. It is fascinating to observe how people either love or hate these programs. As with others who have commented here, Steven Hecker and I recently completed a thorough review of the literature on stretching. In attempting to publish our manuscript on the efficacy of workplace stretching programs we found ourselves caught in this vitriolic debate that goes no further than yes it does or no it does not work.
Those in this forum who claim research supports their conclusion as to the effectiveness of stretching need to produce the evidence. We have not found it, at least in the English language literature. Most studies, whether in the area of sports or industry, suffer from poor, non-rigorous methodologies making it difficult to have confidence in the results and conclusions. The basic criteria for study design, methodology, and reporting of results that we applied for our literature review eliminated the great majority of studies from consideration. There is a need for additional, well-designed studies to better understand the role of stretching. For instance who exactly benefits? Perhaps older workers derive greater benefit than younger ones, or those who have never been injured versus those with an acute or chronic injury. And what body regions are most likely to respond favorably to stretching? It is possible that stretching is useful for reducing the risk of back injury but not for diminishing carpal tunnel syndrome or neck strain? What about the content of stretching programs? Are they all equal? Five-minute generic programs may be useless but programs that target muscle groups at risk in workers doing a specific task might be helpful. Is stretching most useful for 10 minutes in the morning or in short increments prior to beginning an task involving high levels of exertion? And is it appropriate to compare the effects of stretching in athletes in their prime, with workers of many ages and fitness levels? These and many more questions need to be answered before the book on stretching is closed. Studies to address these questions are difficult to carry out. We have attempted to conduct evaluation studies of stretching interventions ourselves in the construction industry, and it has been a challenge to collect much more than self-reported perception data. But we do need to take the debate to a new level, roll up our sleeves and do some to work.
Two final comments: Peter Budnick is right to raise the issue of the distinction between stretching/exercise programs and ergonomics. Whatever stretching is, it is clearly not a substitute for ergonomic analysis and intervention. Our experience in the workplace suggests it risks becoming such a substitute. When workers say “I do my ergonomics every morning,” we need to pay attention to better education and more care in implementing stretching programs. And there is irony in this debate. At a time when those in the U.S. opposed to any regulation of ergonomics in the workplace repeatedly argue that there is no “science” to back the need for such regulation, we see stretching programs widely advocated and implemented on the basis of considerably less “science.”
Jennifer Hess, DC, MPH
Labor Education and Research Center
University of Oregon
I am a Chiropractor that does quite a bit of “ergonomic” consulting to small, medium and fortune 500 companies. My interest is in the BEST interest of the patient, and prevention is the reason for an ergonomic program. Would you run 10 miles, play tennis or golf without stretching? So why would you sit at a computer, stand on an assembly line or lift 200 30 lb. boxes without stretching. I think it would do Mr. Budnick some good to actually visit a plant, call center or IT room and experience what actual employees do day in and day out at their actual job!
Yours In Health,
Dr. Kyle Pepple
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