Better Health. No Hassles.

Injury Prevention:Back Safety

Ron Mullis, MPAS, PA-CJohns Hopkins University/PBG

Employee Health and Wellness Center

Atlanta/Stone Mountain, Georgia

Better Health. No Hassles.

Back Safety

• Background and Rationale– Low back pain (LBP) is common in the general population

• 70% lifetime prevalence in the general population

• The most frequent cause of lost work time and disability in adults younger than age 45

• 85% of LBP sufferers return to work within 1 month

• 4% of LBP sufferers have symptoms that persist greater than 6 months and represent 85 to 90% of the cost

• LBP accounts for 16% of workers compensation claims and 33% of workers compensation cost

– Back Injury can compromise quality of life• Reduced life-time earnings

• Loss of independence

• Emotional and Substance abuse issues

• Interpersonal conflicts

Better Health. No Hassles.

Back Safety

• Back Anatomy– Bones and Joints

• 24 stacked boney vertebrae separated by an intervertebral disc

– 7 cervical– 12 thoracic– 5 Lumbar– Sacrum– Coccyx

• Primary functions are to assist in maintaining an upright posture and protect the spinal cord

– Connective Tissue• Intervertebral disks serve

as shock absorbers between the vertebrae

• Ligaments and layers of Muscle to provide force of movement and stable posture

Better Health. No Hassles.

Back Safety

• Back Anatomy– Nerves

• The spinal cord passes through the spinal canal located within the vertebrae

• Spinal nerve roots branch off of the spinal cord and travel between each vertebrae

• The spinal cord and its branches (roots) serve to provide motor (movement) impulses and sensory (touch) impulses so that the body can respond to its environment

Better Health. No Hassles.

Back Safety

• Types of Back Injuries– Low back Sprain

• Injury to the deep (paravertebral) spinal muscles and ligamentous structures

• Most common cause of occupational back pain

• Usually preceded by repetitive or heavy lifting, twisting or operating vibrating equipment

• Risk factors

– Poor fitness (overweight, poor posture)– Poor work satisfaction (morale)– Smoking– Hypochondriasis (over concern/worry about health problems)

• Recurrence (re-injury) is usually separated by months or years

• More frequent episodes suggest more significant back problem or malingering behavior

Better Health. No Hassles.

Back Safety

• Types of Back Injuries– Lumbar Degenerative

Disk Disease/Chronic Low Back Pain

• Age related shrinkage and destruction of the disk located between the vertebrae

• Painful symptoms are often made worse by acute injury and repetitive trauma

• Other contributing factors include smoking and poor lifestyle/fitness level

• Recurrences are frequent and episodic and in some, unremittent: affecting the employees vocation and quality of life

Better Health. No Hassles.

Back Safety

• Types of Back Injuries– Lumbar Herniated Disc

• With degeneration or injury, the gel-like substance within the disc can leak into the spinal canal—causing compression of the spinal cord or it’s nerve root(s)

• Herniated disc sufferers will generally complain of back pain that is accompanied by pain or numbness in one or both legs as well as weakness on the involved side

• Affects roughly 2% of the population-with only 10-25% of those who actually have symptoms lasting longer than 6 weeks

Better Health. No Hassles.

Back Safety

• Treatment– Though there are several different types of back injuries, the

treatments required are virtually the same:• Rest: one should expect an employee to have some degree of

rest following a back injury

– Transitional Duty: Usually limited lifting, bending, stooping and twisting

– Bed Rest: Reserved for the more severe cases only» 1-3 days maximum; more than that can actually make things worse

• Medications: anti-inflammatory meds (Ibuprofen) are the mainstay of treatment; muscle relaxant meds (Flexeril) are also used for short term; Steroid medications

• Physical Therapy

– Moist Heat Compresses (relaxes muscles)– Home exercises and stretches– Professional physical therapy visits (usually if no better in 1-2

weeks)• Specialist (Orthopaedic) evaluation and treatment

– Surgery in rare cases

Better Health. No Hassles.

Back Safety

• Prevention: The best medicine– Lifestyle modifications

• Exercise and lose weight– Modest exercise will strengthen and stretch your back and leg

muscles—thus reducing the chance of injury– Excess body weight can only add to the strain of your spine and

will lead to degenerative disc disease and arthritis• Stop Smoking

– Smoking cigarettes causes tissue damage and delays healing once injured

• Reduce your stress level– Stress can reduce attentiveness and make accidents and injuries

more likely– Stress can accentuate pain symptoms– Stress can lead to poor job satisfaction and poor quality of life

Join a Healthy Changes Program. There are a number of programs offered through PBG tailored to address these lifestyle

modifications

Visit https://pbg.online.staywell.com or call 1-800-784-9256 for more information about healthy changes

Better Health. No Hassles.

Back Safety

• Prevention: The best medicine– Pre-work stretches

• Standing Extensionsstand straight with both hands on hips, gently lean back at waist, keep head level and knees straight. Hold 10 seconds. Repeat 5 times.

• Standing Hamstring Stretch stand straight with one foot on a step stool/chair, keep legs straight, keep back straight, lean forward gently, do not bend at waist. Hold for ten seconds. Repeat 5 times on each side.

• Trunk Rotation Stretch stand straight with one hand on your hip and the other reaching across your chest, rotate your trunk to the side you are reaching toward, Hold for ten seconds. Repeat 5 times on each side.

Better Health. No Hassles.

Back Safety

• Prevention: The best medicine– Practice safe lifting techniques and encourage employees to

do the same

• Check the load before it is lifted

– Push the load lightly with hand or foot to see if it moves easily (just because it’s a small box doesn’t mean it’s a light load!)

– Make sure the weight is evenly balanced and packed in a stable fashion

– Make sure the load is easily gripped (lift from the bottom of the object if handles are not present)

• Make sure the load is easily reached

– Use a ladder to get to objects that are overhead– Avoid reaching out for an object—get as close to an object being

lifted as possible—sliding the object closer to you if you can– Avoid arching your back—this takes the work away from your

extremities and places it entirely on your back!• Haste makes Waste!

– Hurried, jerky movements will surely lead to back injury. Productivity and “numbers” can only happen with an adequately staffed, healthy team!

Better Health. No Hassles.

Back Safety

• Prevention: The best medicine– Safe Lifting Techniques

• Use of proper “body mechanics”

– Visualize proper posture– Minimize bending and twisting

movements» This maneuver accounts for the majority

of back injuries occurring among Bay Delivery Drivers and Warehouse employees

» Employees rationalize bending and twisting as a way of meeting their quotas.

– Plan the lift and carry maneuver» Know where your going, remove barriers

and obstructions and get help if needed– Push, don’t pull

» Pushing requires the use of both your legs and back—Pulling places the majority of the workload on your back

Better Health. No Hassles.

Back Safety

• Prevention: The best medicine– When lifting, the load should be kept close to the center

of gravity to reduce strenuous and injurious forces

10:1 1:10

10:1 Ratio = 4.5 lbs Force 1:10 Ratio = 450 lbs Force

Better Health. No Hassles.

Back Safety

• Prevention: The best medicine– Safe Lifting Techniques: Executing a proper lift

1. Plan-get close to the object and don’t reach!

2. Position feet shoulder width apart

3. Bend at the knees, keeping back straight

4. Tighten abdominal (stomach) muscles

5. Lift with your legs-They are stronger than your back

6. Hold object close to the body

7. Keep feet and shoulders pointed in the same direction and take short steps

8. When setting the object down, perform the same maneuvers in reverse

Better Health. No Hassles.

Back Safety

• Prevention: The best medicine– A word about back “support” belts

• NIOSH (The National Institute of Occupational Safety and Health) does not support the use of back belts in the workplace for the following reasons:

– There is no evidence to support their use as a preventative measure in reducing back injury

– Back belts may give the wearer a false sense of security--thus making the wearer believe they can lift more weight than they are truly capable of handling

– Though it is thought that back belts will remind wearers to lift properly, there is no evidence to support this claim

• NIOSH does acknowledge anecdotal case reports of decreasing incidence of back injuries in some workplaces where back belt programs were used but notes that simultaneous programs in safety awareness and ergonomics were also initiated.

Better Health. No Hassles.

Back Safety

Questions?

Better Health. No Hassles.

Back Safety

References

1. Essentials of Musculoskeletal Care (3rd Edition)

2. http://www.cdc.gov/NIOSH/backbelt.html

3. http://www.cdc.gov/NASD/docs/d001601-d001700/d001607/d001607.html

4. http://orthopedics.about.com/cs/backpain/ht/lift.htm

5. http://www.workingsafely.org/Topics/Ergonomics/PreventingBackPain.asp