By FisioterapiaECO Physio, Sin categoría, Studies, Work Injury

Low back pain and sick leave: how physical therapy can prevent the collapse of the hotel sector

One sick leave avoided, one company saved

My neighbor is a truck driver for a hardware store, and he’s one of those guys who never complains. But that day, after unloading some bags of cement, something “cracked” in his back.

“It’s nothing,” he said.

Twenty days later, he couldn’t even tie his shoelaces. The back pain became unbearable. He was on his way to sick leave.

Until he came to the clinic. In the first session, we realigned his vertebrae, released the muscle spasm… and two days later he was back behind the wheel. Back to work. Back to living without pain.

The moral of the story: don’t wait for the pain to scream. Treat it when it’s just a whisper.

The reality of sick leave in Spain

In 2024, Spain recorded more than 5.24 million cases of sick leave due to common contingencies, 10.3% more than the previous year. These cases lasted an average of 41 days, accumulating more than 215 million lost working days between January and July alone.

Musculoskeletal disorders (low back pain, back pain, hernias, etc.) accounted for 1 in 3 cases. These were followed by mental disorders (anxiety, burnout, depression), which have doubled in incidence since 2017.

According to the Bank of Spain, the proportion of workers on temporary disability leave has risen from 2.7% (2019) to 4.4% (2024), widespread across all regions and sectors.

Hotel sector: the epicenter of absenteeism

In places such as the Canary Islands and the Balearic Islands, the problem is exacerbated. In the hotel sector in southern Tenerife (Arona and Adeje), absenteeism has reached 20% or more in the high season.

Main causes:

Physical overload: Housekeepers suffer from lower back pain and other chronic injuries from lifting beds, bending over, and pushing heavy carts.
Work-related stress: Long hours, changing shifts, and constant pressure affect mental health.
Staff shortages: This forces the employees who are present to work harder, creating a vicious circle.
Expensive housing and transportation: Many employees have to travel long distances, which increases exhaustion.

Economic cost of absenteeism

The impact is not only personal. It is also economic:

Spending on temporary disability benefits in 2024 exceeded €15 billion, 78.5% more than in 2019.
Companies assumed €4.613 billion in wage supplements and replacements.
In hotels, the additional labor cost due to sick leave reaches up to 25% extra compared to the initial budget.

Physical therapy: an effective and cost-effective solution

Let’s go back to my neighbor’s case. A timely session prevented him from taking 40 days off work. The same logic can be applied in companies:

Early intervention = fewer days off work.
Less medication. Fewer relapses.
Better quality of life for the worker.

In the case of the hotel sector, many hotels are already taking measures:

Real examples:

Hiring physical therapists for staff.
Agreements with clinics for preventive sessions.
Introduction of adjustable beds and ergonomic carts.
Stretching, yoga, and stress management classes.

Measures in place in Tenerife South

Internal reorganization:

Rotating shifts, support between departments, and cross-training to cover gaps.

Temporary hiring:

Although this increases costs, it allows services to be maintained. Some chains have created pools of substitutes.

Automation and technical aids:

The Canary Islands Government subsidizes the purchase of adjustable beds and ergonomic cleaning carts.

Well-being programs:

Such as “Lopesan Vita,” with health challenges, emotional support, and access to physical therapy.

Shared transportation:

Free buses connect Santa Cruz and other towns with hotels in the south, reducing the stress of commuting.

Housing for employees:

Spring Hotels has acquired properties to create affordable rental housing for its staff.

Changes in labor agreements

In 2025, the Tenerife hospitality agreement introduced a new clause: employees must now have 12 months’ seniority to receive 100% of their salary during sick leave. The aim is to discourage short-term sick leave among new staff.

A pilot project has also been set up with the Canary Islands Government to improve recovery and return-to-work processes.

Pain waits for no one

Lower back pain is not just simple pain. It is one of the main causes of sick leave in Spain. And most importantly, much of it is preventable.

The case of the truck driver is just one example. What physical therapy did for him can also be done for dozens of hotel workers, housekeepers, cooks, and receptionists.

Prevention is care. And care is savings.

In a sector such as tourism, where every person counts, caring for occupational health means protecting the quality of the destination.

Sources:

Ministry of Social Security
Bank of Spain
Hosteltur
CEHAT / Ashotel
Cadena SER / Canarias7
Trade union reports

Do you manage a hotel or tourism business?
Perhaps it’s time to integrate physical therapy into your workplace strategy. Preventing sick leave can be cheaper than covering it.

By FisioterapiaECO Physio, Studies, Therapy

Prospective multicenter study of 60-day percutaneous peripheral nerve stimulation for chronic low back pain

A prospective, multicenter study evaluated the long-term effects of 60 days of percutaneous peripheral nerve stimulation (PNS) in patients with chronic low back pain (CLBP). After an average follow-up of 4.7 years, the results indicate that this minimally invasive intervention may offer sustained pain relief and improvements in quality of life.

Key study results

Pain relief: 65% of participants (15 out of 23) reported a clinically significant reduction (≥30%) in low back pain compared to baseline levels.
Improvements in disability and quality of life: Patients who responded positively to treatment experienced an average 63% decrease in pain intensity, along with significant improvements in disability and quality of life.
Reduction in invasive interventions: 70% of respondents (16 out of 23) avoided more invasive and costly procedures, such as radiofrequency ablation, neurostimulation implants, or lumbar surgery.
Patient satisfaction: 61% of participants expressed a preference for stimulation therapy over the use of pain medication.

Clinical implications

These findings suggest that 60-day percutaneous PNS may be an effective and durable therapeutic option for patients with LDD, especially those seeking alternatives to more invasive treatments. In addition, the intervention could be integrated into multimodal treatment strategies, combining it with physical therapy and other conservative therapies.

Additional considerations

Although the results are promising, it is important to note that the study did not include a control group and had a limited sample size. Further research with larger samples and controlled designs is needed to confirm these findings and establish more robust clinical recommendations.

SEO meta description: Study reveals that 60 days of percutaneous peripheral nerve stimulation offers lasting relief from chronic low back pain for up to 4 years after treatment.

17/01/2025

By FisioterapiaECO Studies, Therapy, Uncategorized

Why does my ankle still hurt?

Ligament injuries (sprains)

I will not only discuss the location of these injuries, but I will also try to classify them by the type of tissue involved, starting with ligaments.

A ligament, which connects bone to bone, provides passive stability to joints, and an injury to this structure is known as a sprain. Let’s start by reviewing the most common ankle injuries.

Lateral ankle sprain

A lateral ankle sprain occurs when you twist or turn your ankle inward at high speed. The ligament usually affected is the anterior talofibular ligament (ATFL) and, sometimes, the calcaneofibular ligament (CFL). Both ligaments attach to the fibula, the bone on the outside of the ankle.

Regardless of the degree of injury, proper rehabilitation is crucial because up to 40% of people develop chronic ankle instability after a first sprain.

Lateral ankle sprains are generally classified on a scale of 1 to 3. Grade 1 is a mild injury with a relatively quick return to activity. Grade 2 is a moderate injury with a slightly longer recovery time. Grade 3 is a severe injury that takes longer to rehabilitate. Generally speaking, a grade 3 injury will also present with more swelling and bruising.

This is where we get to the heart of the problem.

Chronic ankle instability

Chronic ankle instability (CAI) is defined as a “chronic ankle instability condition characterized by repetitive episodes or perceptions of the ankle giving way: ongoing symptoms such as pain, weakness, or reduced range of motion (ROM) of the ankle: Decreased self-reported function; and recurrent ankle sprains that persist for more than 1 year after the initial injury.

An early and persistent approach is essential.

Working conscientiously on the mechanoreceptors and stimulating the ankle proprioceptively is an unavoidable step for successful treatment.

General recommendations:

Proper footwear: That provides support to the ankle.
Orthotics: If instability is severe, it may be helpful to wear a semi-rigid orthotic when engaging in physical activity.
Frequency: 2-3 sessions per week with a physical therapist, combined with daily home exercises.
Follow-up: Periodic reevaluation to adjust the plan according to progress.

If the problem persists despite adequate rehabilitation, it may be necessary to consult an orthopedic surgeon to evaluate surgical options, such as ligament repair or reconstruction in severe cases.

By FisioterapiaECO Physio, Sporting, Studies, Uncategorized

Adductor injuries

An adductor injury can develop into enthesitis due to a chronic inflammatory process. Initially, an injury to the adductor muscles, such as a tear or overuse, causes microtrauma to the muscle fibers and their insertion into the bone. If not managed properly, these injuries can trigger persistent inflammation at the muscle-tendon junction (enthesis).

Factors such as overuse, inadequate rehabilitation, or lack of rest can exacerbate inflammation, promoting degenerative changes in the tissue and contributing to the development of enthesitis. This clinical picture is characterized by pain, stiffness, and tenderness in the enthesis, often associated with physical activity or direct pressure.

Enthesitis may occur more frequently in people with a genetic predisposition or systemic inflammatory diseases, such as ankylosing spondylitis, which could intensify the damage to the affected area. However, there’s good news!

With well-designed physical therapy focused on individual needs and eliminating harmful stimuli, it is possible to achieve efficient and lasting recovery. Furthermore, when combined with harnessing the body’s natural regeneration processes, balanced nutrition, and a functional and integrative approach, well-being and quality of life are further enhanced.

Bibliographic References

Benjamin, M., & McGonagle, D. (2009). The enthesis organ concept and its relevance to the spondyloarthropathies. Advances in Experimental Medicine and Biology, 649, 57–70.
Cook, J. L., & Purdam, C. R. (2009). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British Journal of Sports Medicine, 43(6), 409–416.
Rees, J. D., Stride, M., & Scott, A. (2014). Tendons–time to revisit inflammation. British Journal of Sports Medicine, 48(21), 1553–1557.
Paavola, M., Kannus, P., Järvinen, T. A., Khan, K., Józsa, L., & Järvinen, M. (2002). Achilles tendinopathy. The Journal of Bone and Joint Surgery, 84(11), 2062–2076.
D’Agostino, M. A., Olivieri, I., & Ferri, F. (2003). Entheseal involvement in spondylarthropathies. Clinical and Experimental Rheumatology, 21(3), 345–350.
Khan, K. M., & Cook, J. L. (2000). Overuse tendon injuries: where does the pain come from? Sports Medicine, 29(3), 207–211.
Biedert, R. M., & Warnke, K. (2001). Correlation between the tightness of the iliotibial band and patellofemoral pain syndrome. International Journal of Sports Medicine, 22(5), 331–336.
Loppini, M., & Grassi, A. (2019). Current concepts in the management of tendon disorders. Journal of Orthopaedic Surgery and Research, 14(1), 58.
Scott, A., Backman, L. J., & Speed, C. (2015). Tendinopathy: Update on Pathophysiology. Journal of Orthopaedic & Sports Physical Therapy, 45(11), 833–841.
van der Heijden, R. A., Zwerver, J., & Bierma-Zeinstra, S. M. A. (2017). Tendinopathy and sports. Journal of Orthopaedic & Sports Physical Therapy, 47(5), 359–369.

14/01/2025

By FisioterapiaECO Physio, Sporting, Studies

Anterolateral ligament of the knee. Review of current concepts

In recent years, there has been great interest in a structure located in the anterior and lateral regions of the knee due to its potential contribution to rotational stability. This structure has been termed the anterolateral ligament. To date, anatomical, histological, imaging, and biomechanical studies have been conducted on the subject. The purpose of this review is to summarize the publications on this ligament published between 2007 and 2015. Databases were searched for articles in English and Spanish that mentioned the anterolateral ligament of the knee. A total of 27 articles in English were found, of which 24 were original articles, 2 editorial letters, and 1 poster presentation. The anterolateral ligament of the knee is a real structure, independent of the joint capsule and the popliteus tendon, which is present in most patients. It appears to complement the stabilizing functions of the anterior cruciate ligament, as its tension increases when the knee is flexed and internally rotated.

Assessing the function of a healthy knee that only shows a very mild pathological tendency is a task that requires experience and a trained clinical eye. Understanding the function of the ALL helps us focus on that area and the knee’s overall behavior. A comprehensive approach that addresses all the factors of the pathology and the individual patient’s needs is essential for successful and, above all, long-term treatment.

We summarize the conclusions of the study:

Biomechanics

Parsons et al. performed a study on 11 cadaveric knees, to which they applied an anterior drawer force of 134 N at flexion angles between 0 and 90°, and an internal rotation of 5 N m at the same flexion angles. They determined the in situ forces of the ALL, ACL, and LCL using the superposition principle. They showed that the contribution of the ALL during internal rotation increased considerably with increasing knee flexion, while that of the ACL also decreased. During the anterior drawer, the ALL forces were considerably lower compared to the ACL forces at the different flexion angles. Based on this information, they concluded that the ALL is an important stabilizer of internal rotation at flexion angles greater than 35° and that, therefore, damage to this ligament can generate knee instability at high flexion angles, which is why a positive pivot sign can be observed in some patients with an intact ACL but an affected ALL. Conclusions

According to various studies published between 2007 and the present, the anterolateral ligament of the knee can be considered a real structure, independent of the joint capsule and the popliteus tendon, which is present in most patients. However, it exhibits anatomical variations, especially at its femoral origin. Histological analyses confirm the presence of ligamentous tissue, albeit with microscopic variations along its course.

It can be visualized in both ultrasound and magnetic resonance imaging, although no specific imaging protocol has been reported for its clinical evaluation. According to studies published since 2007, the mean length is 41.1 mm; the width is 6.9 mm; and the thickness is 1.9 mm.

The ligament appears to complement the stabilizing functions of the anterior cruciate ligament, as its tension increases when the knee is flexed and internally rotated.

– The anterolateral ligament of the knee is a critical structure for joint stability. It is important to continue researching it to expand anatomical knowledge and therapeutic options for patients with knee ligament injuries who do not improve after appropriate treatment.

https://www.elsevier.es/es-revista-revista-colombiana-ortopedia-traumatologia-380-articulo-ligamento-anterolateral-rodilla-revision-conceptos-S0120884517300500

10/11/2024

By FisioterapiaECO Physio, Studies, Work Injury Clinic

Degenerative disc disease: grades and treatment

One of the most common conditions treated in physical therapy, especially in the back, is degenerative disc pain syndrome. For effective treatment, an accurate differential diagnosis is essential to distinguish this condition from other potential sources of pain.

Category: Studies

Low back pain and sick leave: how physical therapy can prevent the collapse of the hotel sector

One sick leave avoided, one company saved