Tree Planting Research Project 2017

1. Tree Planting Research Project 2017

2. Efficacy of Prophylactic Taping in Managing Tendonitis of the Thumb in Tree Planters Darrell Skinner MScPT, CAFCI Okanagan College Mike McAlonan BPHTY, Dip MT, CredMDT Total Physiotherapy Applied Research StudyNational Science and EngineeringResearch Council of Canada Engage Grant

3. Background • Tree planters experience a high incidence of shovel-sided tendonitis, termed de Quervain’s tenosynovitis • Most prevalent in the first month of the planting season • Current treatment strategies including taping, mobilization, education and technique modification and have been effective in allowing planters to continue planting or return to planting quickly

4. Anatomy and Pathology

5. Research Question Could prophylactic taping be used to help prevent de Quervain’s tenosynovitis in this vulnerable population?

6. Design • Randomized Control Trial • 113 Planters were recruited from two Windfirm Resources and two Summit Reforestation camps • Following informed consent planters were randomly allocated to a Taping Group or a Control Group • Standardized testing performed on all planters for de Quervain’s tenosynovitis on the day prior to planting season. Four planters were excluded due to signs of pre-existing tendonitis • Approved by the Research Ethics Board of Okanagan College • --

7. Methodology • Primary dependent variables were Finklestein’s test for de Quervain’s and presence or absence of crepitus • Other variables recorded included: age, gender, grip strength, years of planting experience, and handle type used • Following three weeks of planting, all planters were retested using the standardized testing protocol

8. Methodology • Planters in the Taping Group were instructed on the application of the tape and asked to repeat taping each shift for the first 3 weeks of the season • First Aide attendants were present when planters were taped, and were trained and supported planters if required • Planters in the Control Group were advised to report any symptoms to First Aide attendants and received the usual care using established treatment protocols

9. Demographics • Due to exclusions and drop outs the final sample size was n = 101 planters • Age range from 17 to 37 years with a median age of 22 years (SD = 3.2), and a median of two years of planting experience • Equal gender distribution in both the Taping and Control Groups • Control Group and Planting Group were well matched with no statistical difference for age or years of planting experience

10. Results

11. Results • Incidence of de Quervain’s in the Control Group of approximately 20% confirming a high susceptibility of this condition in planters • Risk Estimate - Planter who was not taped was 5.02 times more likely to develop de Quervain’s tenosynovitis • Gender, however, had no effect on who developed tendonitis

12. Crepitus • Crepitus is a palpable and sometimes audible sound of the tendon rubbing on the inside of a swollen inflamed tendon sheath with movement • Only three planters with clinical signs of tendonitis (positive Finklestein’s test) had signs of crepitus which limited inferential statistical analysis • Crepitus is often seen in more advanced cases of tenosynovitis which do not receive early intervention and treatment

13. Experience First year Planters, and planters with one year of experience were the most prevalent group with tendonitis. Incidence dropped dramatically after two years of planting experience Only one planter over 24 years of age developed tendonitis. Findings suggest that planting experience and technique may be a factor

14. Grip Strength Grip strength at assessment was not associated or predict those planters who would develop tendonitis There was a general decrease noted in grip strength in both groups following 3 weeks of planting, likely due to fatigue p < 0.001 Unexpected finding and practical significance unknown

15. Ergonomic Handle New ergonomic handle was adopted by 67% of planters Due to the effectiveness of the taping it was difficult to determine if the new ergonomic handle design had an influence on the incidence of de Quervain’s and warrants future research study

16. Potential Mechanisms Taping restricts excessive ulnar deviation mechanically preventing friction force at the wrist Taping provides a period of relative rest allowing positive adaptive changes in the tendon to the increased activity level Frequent repetition of movement while taped promotes motor learning and a neuroproprioceptive training effect(Morrisey, 1999; Callaghan, 2012

17. Practice Recommendations This study strongly supports the use of prophylactic taping in reducing the incidence of de Quervain’s tenosynovitis in tree planters All planters of both genders should consider taping for the first three weeks of the planting season and monitor for symptoms following First and second year planters may be especially vulnerable

18. Reduced Injury and Disability This proactive, evidence-based intervention could help prevent acute tendonitis and further development of chronic tendonitis and work disability in planters Taping is practical and adaptable for planters to use in the field once educated on the technique and supported until competent Adjunctive strategy to education on technique and other preventative strategies

19. ..next steps.. Implement and evaluate practice recommendations next planting season Evaluate treatment and prevention strategies for other common tree planting injuries such as tree-sided upper thoracic pain Research and evaluate changes in tools such as the new ergonomic shovel handle

20. Thank you!Owners and Staff of Total Physiotherapy

21. Student Researchers at Okanagan College

22. Windfirm Resources and Summit Reforestation

23. .. and all the Planters who participated in this study

24. Thank you for your time!Darrell Skinner dskinner@okanagan.bc.caMike McAlonan mike@totalphysio.ca