Flight attendant Tina Costanzo of Kennedy Township, Pennsylvania, was working a routine flight from Pittsburgh to Indianapolis serving drinks and snacks to passengers when the plane ran into "clear turbulence"—swirling air masses that appear without visual cues such as clouds—and dropped suddenly and sharply. Gravity pulled Costanzo into the air.
She landed in a twisted position.
“I was trying to make sure the passengers were OK. I was cleaning up the mess,” she says of her first reaction. “It wasn’t until later in the evening, back in my hotel, that I realized that my back was injured.” At first, she treated the pain like any other ache from her job: She iced the sore area and took Ibuprofen. The next morning, however, she realized her injury was significant enough to prevent her from getting back on the plane.
She filed a workers’ compensation claim. After seeing a company-approved doctor who diagnosed a back sprain, she did the physical therapy prescribed. After that, she sought her own treatment, which was primarily massage therapy with local therapist Renee Swasey, owner of Allegheny Muscle Therapy & Massage, in Imperial, Pennsylvania. For the first time since she was injured, Costanzo found significant relief from her pain.
Who Gets Hurt and Why
According to 2013 data collected by the United States Department of Labor Bureau of Labor Statistics, the overall incidence rate of nonfatal occupational injury and illness requiring days away from work was approximately 109 cases per 10,000 full-time employees. Overexertion accounted for roughly 35 percent of all cases, with slips, falls and trips 25 percent, and musculoskeletal disorders 33 percent of all injury and illness cases. On average, workers with musculoskeletal disorders required a median of 11 days away from work, compared to eight days for other types of injuries. Construction, manufacturing and health care employees are among the top categories of workers who get injured on the job, as well as office workers.
“What has changed over the years is sitting at the computer,” says Tiffany Field, PhD, director of the Touch Research Institute (TRI) in Miami. In fact, a survey by TRI of University of Miami School of Medicine employees showed neck, back and carpal tunnel syndrome among the most common workplace injuries. Perhaps somewhat surprisingly, librarians, who were the most sedentary of the employees surveyed, reported the highest levels of pain.
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Also, Beth Burgan, assistant professor at Northwestern Health Sciences University, in Bloomington, Minnesota, often reminds people: “We don’t really listen to our bodies, no matter what we’re doing, whether that’s loading UPS trucks or sitting at desks. We don’t have environments that are conducive to maintaining health. We have poor body mechanics. We don’t have a lot of personal self care education.”
How Massage Can Help
Conventional medicine, such as surgery, medications and physical therapy, may not entirely address the complex physical, emotional and social aspects of workplace injuries, like loss of wages, feeling like you’re no longer competent or good at what you do and, in many instances, the fear of getting injured again. Additionally, many workers need to be educated about ergonomics and self-care.
Enter massage therapy.
The physical. According to Field, one reason that massage therapy plays such an important role in the treatment of workplace injuries is because more and more studies are showing massage can help with the commonly injured areas—like the aforementioned neck, back and carpal tunnel. Also, massage therapy is effective in relieving some of the common side effects of on-the-job injuries, including anxiety, depression and disrupted sleep, for example.
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Field points out that massage also decreases substance P, which is a pain transmitter, and can impact sleep quality. In addition, a 2012 study by Crane shows that massage can actually help on a cellular level as well, by reducing inflammation (through production of inflammatory cytokins) and promoting mitochondrial biogenesis—or forming new mitochondria—in exercisedamaged muscle, which may make it a better candidate for muscle injuries than anti-inflammatory medications. These benefits resonate with Costanzo, who said that in her experience, doctors often wanted to just give her medication for her pain. “This didn’t solve the problem,” she says.
Massage therapy might also have an advantage for injured workers in that therapists often spend more time with clients than other health practitioners, and often consider the body more holistically. “We have to treat the whole [system], and not just isolated symptoms,” says Sebastopol, California-based massage therapist Tim Holt. “If I work on a client with forearm or hand issues, I am working the entire spine.” In fact, he says, where the client feels pain is often not the problem area.
Burgan recently treated a man at her school’s clinic, a self-employed welder who was largely unfamiliar with massage therapy and was about to be operated on for carpal tunnel syndrome. “I asked him, ‘What do you do every day?’” she recalls. “He described his routine of opening and shutting clamps.” They did myofascial work on his wrist area to relieve the symptoms of overuse he was experiencing, and the clinic’s chiropractor adjusted his wrist and elbow. The chiropractor gave him tips on what he could do differently at work, and the clinic offered him weekly massage. In the end, he was able to postpone surgery.
The emotional. Massage therapy can also help with the emotional fallout of a workplace injury. A 2013 study by Lin suggests that anxiety can be one of the greatest hindrances to full recovery after job injuries. According to Mark Goulston, MD, author of PTSD for Dummies, getting injured on the job can be traumatic because you often disrupt what he calls the “Three Cs”: competency, confidence and control. “You hum along. Then something throws you for a loop,” he says. “This can be traumatic to our system.”
Remember, too, that along with workplace injury comes the potential for unemployment—at least for a little while. Clients themselves often underestimate the significance of unemployment, and the impact being gone from work will have on their well-being. According to Daniel Gouws, MD and a Vancouver-based occupational health physician, this may be one of the most overlooked factors. “When people are [seriously] injured on the job, they basically become unemployed,” he says. Unemployment, regardless of injury or vocational field, can lead to co-morbidity factors, including depression, anxiety and loss of self-esteem, he adds. Injured workers have—sometimes overnight—lost their structure, support and wages. For many people, work serves as a social forum, a surrogate family system, of sorts.
Re-educating the Client
Part of helping these clients deal with injury, both physically and emotionally, is helping them learn new ways to decrease the potential of reinjury. In other words, helping these clients better understand the importance of self-care. You might, for example, educate clients on better ways to move or sit, depending on the demands of their workplace. Holt encouraged one of his clients who’s an architect to consider using a standing desk, which proved helpful in relieving this client’s low back pain. For office workers who spend a great deal of time at a computer, consider discussing the benefits of ergonomic seating and keyboards. “At least you can point your clients to something that can help them, whether a different keyboard design, wrist support or chair,” says Holt. “Sometimes, it’s an easy fix.”
Additionally, you can suggest self-care exercises to supplement the benefits of getting regular massage. A study by Furlan suggests that massage best benefits lower back pain if accompanied by exercises and education. Holt, for example, gives his clients “homework” that includes stretches, or icing or heat instructions. For some clients, he follows up with an email to check on how they’re doing with self-care, and what’s working and what’s not. “You have to get on a protocol of self-care, or you won’t recover,” he says. In the TRI studies on neck and carpal tunnel pain, Field included simple self-massage techniques for participants to perform in between weekly massage sessions, which can be very effective when combined with regular massage.
Massage therapists should also be willing to be part of a larger referral network. “I send clients to osteopaths, chiropractors, yoga teachers and orthopedic surgeons,” says Holt. He refers only to people he knows, has spoken with or come highly recommended.
Ultimately, when your clients leave your office, you want them to feel confident returning to their jobs, with clear ideas for self-care at work and at home—all of which can be a paradigm shift for some people. “We have a whole group of people being validated by the type of touch that massage therapists provide,” says Burgan. “This [validation] allows them to be the author of their own bodies.”
As for Costanzo, she now receives regular massage, which she considers essential to helping her prevent injury. She’s seeing a shift elsewhere as well. Recently, she went to her doctor for a minor, non work related injury. The doctor said to her: “There’s nothing I can do for you but give you an anti inflammatory, but if you know of a good massage therapist, I recommend you go do that.”
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