Back School 101Back to Health

Lunch and Learn

Lower Back Strains and Sprains

Background Information

70 – 80% of all people have back pain at some time in their life.

It is the most frequent cause of activity limitation in people younger than 45 years old.

10% of chronic back pain sufferers account for 80% of the cost for LBP patients.

What Causes LBP

Overuse, strenuous activity, or improper use such as twisting while carrying a load

Trauma/injury/fracture Degeneration of changes Obesity

Additional Causes that Effect the Spine

Poor muscle tone Muscle tension or spasm Sprains and strains Ligament or muscle tears Joint problems Smoking Herniated (slipped) disc Disease (i.e., osteoarthritis, spondylitis,

compression fractures)

Anatomy of the spine

Spinal Nerves-Motor and SensoryC1-C8: Neck,

Shoulders, Arms T1-T12: Chest, Upper,

AbdominalsL1-L5: Legs and FeetSacral: Leg and Feet

Disk Anatomy

Soft tissue structures of the spine

Ligaments-hold bones and joints together

Tendon and fascia connect muscle to bone

Soft spine structures

Ligaments, muscles, and nerves provide stability to the spine.

Poor spine posture causes small amounts of damage to the spine.

You may not feel it at first. With time, small amounts of damage add up.

Back muscles Multifidis

The multifidi muscles support and stabilize the spine

Back Muscles TA

The transverse abdominal muscle, wraps around the low back and abdomen. Helps us to walk.

Other back muscles of the low back

The latissimus dorsi muscle connects the back and upper arm

The gluteus maximus muscles connect to the pelvis and sides of the back.

Conditions of the Spine

Common Disorders

Lumbar Strain

A lumbar strain is an injury to the lower back, which results in damaged tendons and muscles that spasm and feel sore. 

Lumbar Strain

Risk Factors Excessive lower back curvature Forward-tilted pelvis (lordosis)Weak back and/or abdominal musclesTight hamstringsPoor Body Mechanics

Self Care Guidelines

●Use ice initially x 15 minutes every 2-3 hours. Then alternate or try heat

●Avoid bed rest for more than two days.

●Take OTC NSAIDS like Aleve, ibuprofen, or aspirin with food regularly for first three days according to manufacturers directions

● Move as much as possible-stay active and continue usual activities. Avoid sedentary activities. Walk.

● If you are working, continue to work.

● If off work, return sooner rather than later to avoid

Medical Treatment

Physical TherapyE-stim, Ultrasound, Heat, IceManual Therapy: soft tissue mobilization, Therapeutic Exercise, Pilates, Yoga

StretchesHome Exercise Program Rx NSAIDS-Naprosyn, Ibuprofen, etcMuscle relaxants

Disc Herniation

Disc Herniation Treatment

Conservative Treatment starts with Physical TherapyE-stim, Ultrasound, Heat, IceSoft Tissue massageExtension Exercises, Therapeutic ExercisePilates, Yoga

Steroid InjectionsSurgery

Osteoarthritis

Chronic disease involving the joints. characterized by: Destruction of cartilage Overgrowth of bone Spur formation Impaired function

Seen on weight bearing joints; knee, hip, and spine.

Treatment of OA –Self Care

Stay active and keep movingIce when acuteHeat when soreAnti-inflammatories (prescribed or OTC)Use time not pain as guide for gradually

resuming activities

Prevention of low back injuries

Proper lifting techniques and body mechanics Develop strong core muscles with exercise. Engage in aerobic exercise-Oxygenates &

maintains muscle. Stretch before and after exercise or strenuous

work activities. Care for sore muscles before they worsen Maintain good posture standing/walking and

sitting

Body mechanics of lifting

The spine acts like a lever. Weight in front creates a force on the spine.

Lack of counter force causes strain on muscles.

35 lbs35 lbs

Standing Posture

Ears over Shoulders

Shoulders over Hips

Hips over Ankles

Sitting Posture

Same as Standing

Back flat against chair

Knees/Hips at 90 degrees

Job Specific Examples

Opening Bay doorsReaching casesReaching for bottles and cans off floorGetting into trucks and forkliftsLifting and carrying cases

Lifting and reachingWhat’s wrong/right?

Use both arms to lift bay doors

Get close to the item. Support knees against product or side of truck.

Bring product closer to you.

Grasp the item firmly, and lift by extending your hips while keeping the slight inward curve in your low back.

Bending and placing –what’s wrong/right?

Face the product Bend from your hips,

not your low back. Pivot your feet in the

direction you are moving, rather than twisting with your back.

Balance

BALANCE IS KEY Back stays straight If too heavy:

Squat lift Don’t Kick the

person behind you!!!!

Body Mechanics!!!!!!Lifting a Box

Lift with legs

Hold object close to body

Carry with a straight back

Stretches and Exercises

Pelvic Tilt - Gently roll your pelvis back and forth.

10-20 times gently

Cat and Camel

Gently roll your pelvis back and forth.

Aerobic exercise

Begin aerobic conditioning soon after the onset of low back pain, usually within two weeks.

Recommended to help you avoid potential debilitating effects of back pain, such as spine inflexibility, muscle weakness, and weight gain

Core exercises

Multifidus Muscle Activation Place one or more

fingers up and down the sides of your lower spine, just next to the bony bumps in the center of your low back. Gently tap or press on the multifidus muscles as shown by your therapist. Attempt to lightly engage the muscle under your fingers.

Transverse abdominals

Concentrate on bringing your belly button toward your spine. Breathe normally as you draw your lower abdomen in.

Hinged squat

Place one arm behind your low back. Put your other hand lightly on your abdomen. Draw your abdominals in, setting your core muscles. Hinge forward bending slightly at your hips and bending your knees. Feel your trunk with your hands as you move to make sure your back stays in neutral.

Stomach Lying

For some people stomach lying can help to ease their back pain, "unload" the discs, relax muscles and improve nutrition to the structures of the back.

Back lying

Lying on your back with your knees supported takes pressure off the sore joints in the spine, widens the bony canals where the spinal nerve roots pass between the vertebrae, which can help take pressure off spinal nerve

roots. Deep breathing

Sitting

An inward curve of the low back balances the spine and protects it from unnecessary strain. This alignment relaxes the tissues of the spine.

Slouching, or staying in one position for too long can make back pain worse.

Sitting raises pressure markedly within the disc

Take breaks often to get up, stretch out, and move around.

Log Rolling

"log roll" is a way to get in or out of bed without twisting your spine.

Three Year Injury History In PBC

LiftingBendingTwistingOverexertionReachingPushing / Pulling

Coaching tips for handling PBC product and equipment:

1. Bend knees and use legs when lifting and lowering product2. Do not bend at the waist when lifting and lowering 3. Mental effort to eliminate / minimize overexertion situations4. Mental effort to eliminate / minimize over-reaching situations5. Understand the risk of twisting and awkward postures6. Understand the added risk of overexerting and twisting and being in an awkward position all at the same time.

Reinforce during Training, Behavior Observations, and MBWA’s…

Most Frequent Injuries

Strain51%

Burn4%

Cut4%

Slip Fall19%

Caught In5%

Struck By17%

51% of all = STRAINS

Employee Behavior… Employee Injury…

Nothing New Under The SunEmployee Job Hurt Statements…STRAINS History Lesson

Caller stated he was lifting up the overhead trailer door when he strained his right forearm and right elbow.Caller stated while bending down to put cans on a cartand he injured his lower back. Caller stated he was lifting a case overhead causing his wrist to arch backward when reaching to the top. Caller stated that while delivering coolers at a job site, a large concrete block was blocking the way and he strained his back when trying to move it.Caller stated that he was at a call attempting to open the door of his truck when the door became stuck. As he continued to try to open the door he hurt his back.Caller stated he opened a vending machine and the door became stuck. Employee twisted his back as he strained to open the door.Caller stated he was in the yard attempting to the raise landing gear on his trailer when the landing gear malfunctioned causing him to twist his low back.Caller stated he was condensing at a customer location and twisted wrong and he began experiencing pain to the lower back. Caller stated while he twisted around with a case of product in hand and felt a pain in his back just below the right shoulder blade.Caller stated he was on the sales floor on an aisle bending and turning to place stock on the shelves when he felt pain in his back. Caller stated that he feels that during the two hours and forty-five minutes of twisting to load product, he strained his back.Caller stated while he was pushing product to fall into place because of a tipped over pallet, he injured the lower-mid back. Caller stated he was putting tanks on the wheeler and pulled the wheeler over a curb when he felt pain in the middle back. Caller stated he was unloading a case of 2 liter bottles off a pallet, when the case became stuck on a nail. The EE injured his right shoulder.Caller stated that he was in the parking lot, pulling a skid of cases that was caught on a truck plate, and he experienced pain to his lower back.Caller stated that while he was opening and pushing a bay door upwards, he strained his upper back in the process.Caller stated while pulling down the rear door of the truck in the parking lot he sustained a strain to his left shoulder.Caller stated employee stepped out of truck and stumbled as he stepped on a curb jolting the back. Caller stated while putting cases on the bottom rack of a shelf she twisted her lower back when reaching in. Caller stated while pulling a skid of pallets, EE strained a muscle in the upper back area.Caller stated, he was opening a frozen bay door, when it jammed, and he sustained a strain in his lt shoulder area.Caller stated he was at a job site pushing against the door of the bay attempting to get the door open when he felt pain in the middle of his back.Caller stated while she was reaching over to pick up a bag in the cash room and dislocated her left shoulder.Caller stated EE was trying to catch a 24 case of canned sodas when he sprained his left wrist.Caller stated that he was leaning over reaching to change a part when he felt pain in his lower back. Caller stated that he was pushing 6 cases of bottled drinks on a hand truck when the wheel of the hand truck stopped abruptly. Employee strained shoulder.Caller stated he was stepping off of a forklift in the warehouse when he stepped onto the edge of a palette he lost his balance and strained his back.Caller stated he was in the parking lot attempting to shut the overhead door to the trailer when he heard a pop in his rt shoulder. Caller stated she was between two shelves on sales floor when she tried to push a row of cans over and experienced pain to her neck. Caller stated while re-piling a variety of product in garden center, he twisted awkwardly, resulting in a dull pain to left lower back. Caller stated he was bending down to pick up an object when he turned and felt a twinge in his right lower back area. Caller stated while carrying product up/down stairs, his lower back twisted in the process of preventing himself from slipping, resulting in back pain.Caller stated that while pulling a full hand cart up 4 steps into a customer location, he twisted his right knee while reaching for the door.

Back Math & Numbers Lesson

Upper torso weighs 100 lbs. for the average person

Improper lifting technique adds a stress factor to the lower back of 10 times the actual weight

1200 Pounds of 12 oz. Cans

A case of 12 ounce cans weighs 20 lbs.

1200 lbs. of pressure can be placed on your lower back when lifting a case of 12 ounce cans

Stretching For Health & Safety

Stretching Guidelines• Do each stretch 3 times• Don’t bounce - it causes muscles to tighten• If you feel pain you may be stretching too far • Hold each stretch 12-15 seconds • Take it slow, breath normally • Stretch a few times during the day

Stretching before work minimizes chances of injury significantly…some studies say as much as 40%. The following Stretches will help you warm up at the beginning of the day, and keep you flexible all day long!

Shoulder Stretch Standing Side Stretch Triceps Stretch Low Back Stretch Quad Stretch

Good vs. Bad Technique

Strong

Weak

More StrainLess Strain

Lever Ratio - Demonstrating the power of a lever, have volunteer try to pick up the handcart loaded differently.

Right Wrong

Back Anatomy Lesson