Workplace stretching programs are a hotly debated topic – so what are the arguments against these programs, and do they have any basis?

You want to do the right thing for your people.

You understand the value of a comprehensive MSD prevention plan that includes pre-shift stretching and warm-up.

You know that MSD prevention is a long game and the sooner you get started, the better.

You’re proactive and have a bias toward action so you’d like to get the ball rolling on this.

At your next health and safety committee meeting, you bring up the topic for discussion and next-action steps. Everyone is on board… except for one of your committee members who says he thinks he remembers an ergonomics guru say that pre shift stretching was a bad idea – that it may or may not be effective and that you’d be better off doing more ergonomics.

Now what?

The Debate on Pre-Shift Stretching

Pre-shift stretching programs are a hotly debated topic in the ergonomics community. There are two main arguments against pre shift stretching programs;

• there is inconclusive scientific evidence that pre shift stretching programs effectively reduce injury risk, and
• the cost of pre shift stretching is prohibitive and these resources should be re-allocated to ergonomics instead

I’ve read every study, article and report I can find about workplace stretching programs. The narrative of the authors who are against-pre-shift-stretching is nearly always the same.

They point out many of the same studies, demonstrate the cost of workplace stretching programs, and urge the reader to reallocate workplace stretching time and resources towards ergonomics initiatives.

Interestingly, in nearly every case, these authors come to the conclusion that, “while stretching alone may not reduce the risk of Musculoskeletal Disorders (MSDs), it does have a few benefits and should be implemented as part of a comprehensive injury prevention program that includes an ergonomics improvement process.”

I’m paraphrasing and not directly quoting a source, but I hope you get my point. Even those who don’t recommend workplace stretching often recognize the value of a comprehensive MSD prevention process that benefits from workplace stretching.

It should also be noted that we agree – ergonomics should be a core element of your MSD prevention process – as discussed in the previous post in this series. Improving the work environment to fit within the physical capabilities of workplace athletes is (of course) a focus of the work we do for clients. But should we stop there? Absolutely not.

Now let’s examine the anti-pre-shift-stretching narrative in more detail so you can make the case for your pre shift stretching program, and so you’ll have the right answers if someone on your health and safety committee or management team has doubts about the program.

Argument 1 Against Warming Up For Work: Inconclusive Evidence

Workplace stretching and warm-up exercises have not been studied exhaustively.

The studies we do have on workplace stretching are inappropriately extrapolated to fit every situation, every workplace and every industry. Many of the studies used to discount workplace stretching aren’t about the workplace at all, but rather athletic performance during intense physical exercise or competition, which is clearly much different in nature than the workplace setting.

Here are a few of the studies often cited:

Study: Static stretching prior to an athletic event will lower endurance and performance.

This study investigated the effects of static stretching on energy cost and endurance performance among trained male runners. (Injury prevention wasn’t even part of this study, yet it is one of the most often cited studies regarding workplace stretching and warm-up.)

Ten trained male distance runners with an average VO2-max of 63.8 6 2.8 ml/kg/min were recruited. Participants reported to the laboratory on 3 separate days. On day 1, anthropometrics and VO2-max were measured. On days 2 and 3, participants performed a 60-minute treadmill run randomly under stretching or nonstretching conditions separated by at least 1 week.

Stretching consisted of 16 minutes of static stretching using 5 exercises for the major lower body muscle groups, whereas nonstretching consisted of 16 minutes of quiet sitting. The run consisted of a 30-minute 65% VO2-max preload followed by a 30-minute performance run where participants ran as far as possible without viewing distance or speed. Total calories expended were determined for the 30-minute preload run, whereas performance was measured as distance covered in the performance run.

The study concluded that performance was greater in the nonstretching group vs. the stretching group. The authors of the study suggest that static stretching before an athletic endurance event may lower endurance, performance and increase the energy cost of running.

Study: Static stretching leads to reduced power in cycling athletes

The purpose of this study was to examine the time course of static stretching on cycling economy. The subjects consisted of 5 men and 5 women highly trained endurance cyclists. The first of 3 visits was baseline testing of their cycling VO2max. The second and third visits were either stretching or no stretching before a 30-minute stationary ride at 65% of their VO2max. The stretching condition consisted of four 30-second repetitions of 5 stretches with an average total stretching time of 16 minutes. VO2 demonstrated a significant condition by time interaction with the 5-minute time point being significantly less in the nonstretching condition (32.66 ± 5.35 ml·kg(-1)·min(-1)) than stretching (34.39 ± 5.39 ml·kg(-1)·min(-1)). No other time points were different.

According to the authors, “The results of this study demonstrate that static stretching yielded an acute increase in submaximal VO2; therefore, coaches and highly trained endurance cyclists should exclude static stretching immediately before moderate intensity cycling because it reduces acute cycling economy.”

What can we learn from these studies on athletic performance and stretching?

We need to be extremely careful about how we interpret these studies and apply them in the workplace. You must take into consideration the differences in intensity, repetition and duration of the physical activity.

While stretching is a natural and beneficial activity for all of us, running to exertion over a 30-minute period of time or engaging in an intense cycling endurance event is far different than working an 8 hour shift on an assembly line. We’re mostly concerned with injury prevention in the workplace – not physical performance at very high exertion levels for short periods of time.

These studies contain different types of athletes, different stretching protocols, and different conditions. To conclude from these studies that all stretching is bad for you would be a mistake. If stretching is bad for you, then why does every athlete include stretching and warm-up activities before an athletic event? Why do we naturally stretch our bodies when we wake up, get out of the car after a long ride or engage in physical activity?

If we can learn anything from these studies, it’s that it’s best to include a general warm-up activity instead of only using static stretching – something we already knew and has been included in countless workplace stretching programs for many years.

Study: Do stretching programs prevent work-related musculoskeletal disorders?

This study reviewed seven often cited workplace stretching studies. The subjects of these studies ranged from computer workers (data entry, computer operators), athletes, military servicemen, firefighters, manufacturing operators (pharmaceutical), and construction workers. It’s also important to note that the stretching protocols were different in each study.

Here is the author’s conclusion after reviewing the available studies, emphasis added:

“While research does support that stretching improves flexibility/ROM and self worth, stretching alone might not prevent work-related musculoskeletal disorders and injuries. Some studies (e.g., Thacker, 2004) also suggested that strength training, conditioning and warm-up could play an important role in preventing WMSDs.

As pointed by OSHA (1993), implementing a comprehensive ergonomic program that includes both engineering and administrative controls to reduce the ergonomic risk factors should be the first choice in reducing work-related MSDs. The main focus of a comprehensive ergonomic program is to make tasks, jobs, products, environments and systems compatible with the needs, abilities and limitations of people, as opposed to making the people compatible with the work characteristics and demands (in Costa and Vieira, 2008).

Overall, this review study illustrates some favorable outcomes of stretching & exercise programs in different occupations, but there is still controversial evidence to accomplish a definite response about the exploit of stretching in preventing work-related musculoskeletal disorders and injuries.”

What can we learn from this study?

As mentioned earlier, this review study consisted of different study subjects under different stretching protocols over different periods of time. This lack of consistency presents several challenges if we are to find any meaning or draw any conclusions from this study.

• Different study subjects – From computer entry workers to firefighters to military servicemen, the study subjects are night and day.
• Different stretching protocols – Frankly, the stretching protocols studied are poorly designed and far from typical workplace stretching protocols.
• Different periods of time – In fact, the longest period of time studied was only six months and several of the studies lasted only 4 weeks – hardly long enough to study or observe a reduction of musculoskeletal disorders, which can form over long periods of time.

If this is one of the most widely cited studies on workplace stretching, we desperately need more studies.

We need more studies in the manufacturing and distribution environment.

We need more studies done with better stretching protocols.

We need more studies done of comprehensive MSD prevention programs that include workplace stretching, ergonomics, team member education, and early intervention.

We need these studies badly and I believe that someday we will have them.

But until then, you’ll have to consider the research and draw your own conclusions.

Also consider this – the (incomplete) research on workplace stretching is inconclusive, at best. Yet there are bright spots contained within the research. There are successful workplace stretching programs.

The hardcore evidence-based crowd tends to be skeptical about most new ideas, and we occasionally encounter those who object to implementing a Work Readiness System because it’s not backed by “enough” research. It seems important (to me at least) to consider that research-backed certainty is rare. Evidence-based practice is important, but we shouldn’t combine it with rigid pessimism. While we wait on the researchers to do their thing, let’s not make the mistake of completely discounting the plentiful anecdotal evidence that exists in support of warm-up stretching in the workplace. There’s nothing wrong with a healthy level of skepticism, but if we wait around for the peer-reviewed literature to “approve” warm-up stretching programs – we’ll miss out on the many benefits and great value that it offers.

You want to be successful, right?

Then let’s make your pre shift stretching programs one of the successful ones.

Argument 2 Against Warming Up For Work: Cost and Resource Allocation

Another common argument against workplace stretching is cost and resource allocation. The cost of workplace stretching programs should be reallocated to the company ergonomics program, argue these authors, because engineering and administrative controls are the best methods to reduce injury risk.

We agree that ergonomics should get the resources it deserves. But it doesn’t have to be an either/or situation. Applying resources to a comprehensive MSD prevention process is an investment that returns value many times more than the cost.

In a paper titled, “The Myth Behind Stretching Programs”, one author attempts to outline the cost of workplace stretching programs. The author estimates that a stretching program costs $286.22 per employee per year (see paper and calculations here). So for a facility with 100 employees, the annual cost of the program would be $28,622. This cost is reflecting the time it takes to conduct the stretching routine every day. The calculations assume $10,000 in cost savings and end up with with an ROI of $.35 per dollar invested.

In my opinion, there are several things wrong with this calculation:

• Indirect costs are not included: According to OSHA, indirect costs can be up to 4.5 times the direct cost of injuries. This part of the cost reduction is not included.
• The success rate of the stretching program was made up: The calculation assumes a 10% success rate, but you could easily redo the calculation using any number you wanted.

After reading this paper, I went over to OSHA’s Safety Pays estimator and plugged in a few common injuries to find out what they cost. Here is the screenshot:

According to Safety Pays, the total cost of a single sprain is $60,618, a strain is $70,408 and carpal tunnel syndrome is $63,000. At a 3% profit margin (the standard measure on Safety Pays) it takes millions of dollars in additional sales to make up for the cost of these injuries.

The $28K for the stretching program doesn’t feel as expensive after that. Prevent just one of these injuries every two years and you’re breaking even. (Institute a comprehensive MSD prevention process and the cost savings really start to add up.)

Surprisingly, I agree with most of the conclusion from the paper titled The Myth Behind Stretching Programs (emphasis added):

“While stretching alone does not appear to be the most effective mechanism for managing WRMSDs, it does take a step in the right direction to increase awareness concerning the benefits of movement, circulation, and posture. Even the most advanced use of equipment and design possible in new facilities requires human interface and vigilance. Adding a warm-up and exercise as part of an overall safety and leadership program can stimulate blood flow and movement when the job calls for static postures, it can activate overstretched and tired muscles to reduce fatigue and improve postural awareness, and it can go a long way to support company loyalty. And loyalty can be priceless!”

The bottom line: you’ll need to decide for yourself whether or not the value of instituting a workplace stretching program exceeds the costs. Please do not blindly accept someone’s analysis (including mine) and make your decision based solely on their assumptions. Instead, do your own research, apply it to your facility/ industry/environment and make your decision based on that.

The importance of engaging your people

While we believe in the power of ergonomics to reduce injury risk, our approach is different. We involve the people doing the job and part of that involvement is through our pre-shift Work Readiness programs.

Why do we involve workers in the process? Well, the reason is simply because there are numerous MSD risk factors that are related to the individual worker themselves. These are well documented in research and include:

• Chronic health conditions (such as obesity)
• Body mechanics and work technique
• Fitness, nutrition, recovery and general health of the worker

(see NIOSH Total Worker Health)

Remember that behind the data and the numbers at the end of your injury column are individual people who give a portion of their life to meet your company’s objectives. It’s important to involve them in the process and let them know they’re being cared for. After all, it’s their body and health at stake.

A Work Readiness Program is a great example of involving them in the process and helping them take responsibility for their part in the MSD prevention process. Ergonomic controls are important, but so are the individual workers themselves. Involving people in the process not only reduces risk, but helps create a positive culture of safety, health and teamwork.

Remember that beyond simply doing the right thing, the value proposition of creating a culture of health, safety and teamwork is that it is a competitive advantage for your business and a more fulfilling experience for your employees. And you can’t put a price tag on that.