Back Injury Prevention

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Back Injury Prevention
2
Modules

• Risk Factors for Back Injuries
• Basic Functions of the Back
• Whats in the Back?
• Back Injuries
• Preventing Back Injuries
• Office Ergonomics
• Appendix

3

• Rating the 5 Leading Back Injury Risk Factors!
• Risk factors
• Behaviors and working conditions that lead to
  back injuries.
• Please rate the risk factors in order from 1
  through 5
• with 1 being the greatest risk factor and 5 being
  the lowest risk
• factor.
• Poor posture
  _
• Poor physical condition _
• Improper body mechanics _
• Incorrect lifting
  _
• Jobs that require high energy _

4

• The Back's Basic
• Functions Include
• Providing support
• Protecting the spinal cord
• Providing flexibility to allow bending
• and rotating
• When normally aligned, the back (spine) forms
  3 natural curves (cervical, thoracic, lumbar).
  Maintaining these natural curves keeps the spine
  in balance.

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Whats in the Back?

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The Spine is in the Back

• 3 natural curves
• The Lumbar Spine
• Spinal Segments
• Vertebrae
• Disk

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3 natural curves. . . (cervical, thoracic,
lumbar)
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Whats the Lumbar Spine?

• The lumbar spine is made up of the last 5
  vertebrae of the spine.

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Whats in the Lumbar Spine?

• The spinal segment is
• composed of
• Two vertebrae
• Intervertebral disk between the two vertebrae
• Two nerve roots that leave the spinal cord, one
  from each side

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Spinal Segment
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Whats a Vertebrae?

• The vertebrae are the bones of the spine.
  They support and protect the spinal cord.

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Whats Between the Vertebrae?

• An intervertebral disk sits between each
  vertebra.
• This large round ligament connects the vertebrae
  together.

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Whats in the Disk?

• The disk contains a material with the consistency
  of crabmeat.
• This material is responsible for the shock
  absorption properties of the spine.

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What Happens to the Disk?

• Back pain is often a result of injury or
  degeneration (wear and tear) of the
  intervertebral disk.

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What Does Degeneration Do?

• As the degeneration of the disk progresses, it
  becomes stiff and loses its ability to act as a
  shock absorber.
• This may continue until the disk collapses
  causing pain.

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Why Does Degeneration Happen?

• Repeated bending and twisting can cause the disk
  to tear.
• Scar tissue, which is not as strong as normal
  tissue, may form during the healing process of
  the tear.
• This repeated cycle may lead to disk
  degeneration.

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Back Injuries
18
Back Injuries

• The Facts
• Insult to Injury
• Management of Injuries

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Back Injuries The Facts

• Many back injuries cannot be attributed to a
• single causal factor.
• They can be the result of cumulative damage
• incurred over a long period of time
• (Repetitive Stress Injury (RSI).
• Certain actions, motions, and movements are
• more likely to contribute to back injuries
  than
• others.

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Back Injuries The Facts

• Back injuries account for one of every
• five injuries and illnesses in the
• workplace.
• Re-aggravation of a previous injury
• almost always results from a new
• incident which involves the employee
• (i.e. slip, twist, trip, extended reach).

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Back Injuries The Facts

• The cause of back pain in about 90 of cases is
  strain or sprain of back muscles, ligaments or
  soft tissue. These conditions generally heal
  completely, but often recur if prevention
  strategies are not used.
• Back pain in the remaining 10 of cases is due to
  more serious conditions such as degenerative disk
  disease or herniated disks in the spine.

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Back Injuries The Facts

• One-fourth of all compensation
• indemnity claims involve back injuries,
  costing employers billions of dollars.
• Hidden costs 11.6 B in 1996 60 B in 2004
• Eighty percent of these injuries occur to the
• lower back and are associated with manual
• materials handling tasks.

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• Back Injuries The Facts
• Lifting-related injuries include
• Sprains
• Strains
• Neural related
• Neuro-muscular related injuries
• And/or bone related injuries
• These injuries can affect any part of the body,
• but the majority occur to the lower back.

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Spinal Cord Injuries (SCI) The Facts

• Approximately 450,000 people live with SCI in the
  US.
• There are about 10,000 new SCI's every year the
  majority of them (82) involve males between the
  ages of 16-30.
• These injuries result from motor vehicle
  accidents (36), violence (28.9), or falls
  (21.2).
• Quadriplegia is slightly more common than
  paraplegia.      

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Other Causes of Back Injuries

• It is also possible to injure your back as a
  result of a slip or fall

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Insult To Injury

• People tend to compensate for back injuries.
• People with back pain guard the injured area by
  using more muscles than they need to.The more
  muscles they use, the greater the load there is
  on the spine.

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Insult To Injury

• Injured people may employ muscles in their
  abdomen or sides or other uninjured back muscles,
  even though these muscles are not necessary for
  lifting.
• People with back injuries unknowingly inflict
  twice as much twisting force on their spine and
  1.5 times as much compressive force as uninjured
  people, when lifting the same object.

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Insult To Injury

• Over time, greater loads on the spine lead to
  more serious back injuries, such as disc
  degeneration, which require surgery.
• In addition, lifting objects slowly, as injured
  people also tend to do, only intensifies the
  harm. Moving slowly just increases the length of
  time the spine has to endure those extra forces.

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MEDICAL MANAGEMENT OF INJURIES

• It is extremely important that workers receive
  proper medical treatment at an early stage.
• Proper medical management requires that
• prompt and conservative treatment is provided
  by a medical provider familiar with back
  injuries.

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ADMINISTRATIVE MANAGEMENT OF INJURIES

• Jobs are redesigned to eliminate exposure to risk
  factors, including changes in equipment and
  duties.
• Workers are provided with sufficient time away
  from work and/or are reassigned to light duty
  jobs with no loss of pay, benefits, or seniority.
  

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Listen to your body!

• Feeling discomfort or pain is an indication that
  something is wrong! Heed the signs!
• Take more frequent "mini-breaks" before you
  become fatigued.
• Become aware of mounting stresses, aches and
  pains.

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Preventing Back Injuries
33
Preventing Back Injuries

• Risk Factors
• Job Task Evaluations
• Safe Lifting Procedures

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Risk Factors

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S T O P !

• WHAT ARE THE 5 LEADING
• BACK INJURY RISK FACTORS?
• Group Discussion

36

• Rating the 5 Leading Back Injury Risk Factors!
• Risk factors
• Behaviors and working conditions that lead to
  back injuries.
• Please rate the risk factors in order 1 through 5
  with 1 being
• the greatest risk factor and 5 being the lowest
  risk factor.
• Poor posture
  _
• Poor physical condition _
• Improper body mechanics _
• Incorrect lifting
  _
• Jobs requiring high energy _

37
Risk FactorPoor Posture

• When your mother told you to sit and stand up
  straight, she was giving you good advice. It is
  best to try to maintain the back in its natural
  "S" shaped curve.
• You want to avoid leaning forward
  (unsupported) when you sit, or hunching over
  while you're standing.

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Posture

• Stretch often! Shift positions!
• Change (shift) your posture often.
• Stretch frequently throughout the day.

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Posture

• Practice good posture. Don't force your body to
  conform to its workspace. Habitually poor posture
  will cause increased aches and pains.
• Keep your body flexible (not rigid or fixed)
  static posture becomes uncomfortable and
  decreases productivity.

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Posture

• Take note of your posture!
• Our bodies are designed to move, bend and flex -
  and our posture changes to fit the task. Static
  posture leads to discomfort and lower
  productivity. Be aware of your posture while
  working.

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Risk Factor Poor Physical Condition

• Your stomach muscles provide a lot of the
  support needed by your back. If you have weak,
  flabby stomach muscles, your back may not get all
  the support it needs, especially when you're
  lifting or carrying heavy objects.
• Good physical condition in general is
  important for preventing strains, sprains, and
  other injuries.

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Exercise!

• Exercise regularly - every other day.
• Warm up slowly . . . A brisk walk is a good way
  to warm up.
• Inhale deeply before each repetition of an
  exercise and exhale when performing each
  repetition.

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Exercise Helps Here are the facts

• Most adults don't get enough physical activity.
• Lack of physical activity and poor diet
• combined are the second largest underlying
• causes of death in the United States
• (after smoking).

44
Exercise Helps Here are the facts

• Exercise can help people feel better and enjoy
  life more, even those who think they're too old
  or out of shape.

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Risk FactorImproper Body Mechanics

• To demonstrate this, think of your back as a
  lever. With the fulcrum in the center of the
  lever, how many pounds would it take to lift a
  ten pound object?
• A. 5 pounds
• B. 10 pounds
• C. 15 pounds

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Improper Body Mechanics

• When you add in the 105 pounds of the average
  human upper torso, you see that lifting a ten
  pound object actually puts 1,150 pounds of
  pressure on the lower back.

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Worker twisting in an awkward posture

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Twisting at the Waist

• Twisting at the waist while lifting or holding a
  heavy load.
• (For example, this frequently happens when using
  a shovel.)

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Awkward Positions

• Working in awkward, uncomfortable positions such
  as kneeling or working at tasks which require
  you to bend over for long periods of time

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Awkward Positions

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Stacking / Retrieving Objects
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Stacking / Retrieving Objects

• Reaching and lifting over your head, across a
  table, or out the back of a truck or car

53
Pulling vs. Pushing Pushing is generally
preferable to pulling. Pushing allows the worker
to use large muscle groups and apply more force
to the load. Pulling carries a greater risk of
strain and injury.
54
Repetitive Stress

• Repetitive Stress Injury (RSI)
• Most back injuries occur while lifting,
  pushing, and pulling over a long period of time.

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Repetition Static Positions

• Sitting or standing too long in one position.
• (Sitting can be very hard on the lower back).

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Risk FactorJobs That Require High Energy
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Inadequate Handholds Additional Force to Lift

• Inadequate handholds
• Makes lifting more difficult
• Moves the load away from the body
• Lowers the starting lift heights
• Increases the risk of contact stress and of
  dropping the load

58
Odd Shapes Make Objects Difficult to Grasp

• Lifting or carrying objects with odd shapes
  requires more force to grasp

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    FINDING RISK FACTORS

• Employer records which can be helpful in
  identifying problems include
• Injury logs
• Incident reports
• Workers comp claims
• Health insurance and sick leave usage
• Surveys of workers

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CONTROLLING RISK FACTORS

• Eliminate hazards where possible. Jobs should be
  reviewed to see if there are any tasks or
  movements that can be avoided.
• Use equipment to lift and move loads and objects
  (engineering controls).
• Change procedures and policies (administrative
  controls).

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CONTROLLING RISK FACTORS

• Administrative Controls
• Implement no-lift or no single-person lift
  policies.
• Alternate lifting tasks with tasks that do not
  require lifting.
• Give breaks, rotate jobs, or use other means to
  give workers time to rest their backs.

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CONTROLLING RISK FACTORS

• Administrative Controls
• Use "lifting teams" for lifting or moving loads.
  Lifting teams are made up of workers that perform
  load handling using lifting equipment.
• Increase staffing.
• Train workers on the use of mechanical devices
  and lifting techniques.

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ADMINISTRATIVE CONTROLS

• Train workers to recognize the symptoms of back
  injury.
• Train and encourage workers to report injuries
  as soon as they occur.

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Job Task Evaluations
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Evaluate VARIABLES

• Tasks
• Environment
• Object Handled
• Handler

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Evaluate Tasks

• Location/position of the object
• Frequency and duration of handling
• Precision, type of handling
• Time constraints, pacing, incentives
• Work/rest cycle, shift work, job rotation
• Availability of assistance

67
Evaluate Environmental Factors

• Size and layout of workplace (obstructions)
• Terrain
• Low visibility or poor lighting increases the
  chance of trips and falls
• Motion (vibration/transport)

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Evaluate Environmental Factors

• Cold temperatures can cause decreased muscle
  flexibility which can result in muscle pulls.
• Excessively hot temperatures can lead to
  dehydration, fatigue, and increased metabolic
  load.

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Evaluate Object Handled

• Nature (animate/inanimate)
• Resistance to movement
• Size and shape
• Center of gravity
• Physical/chemical hazards
• Mechanical status
• Handling interference
• Information/instructions

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Evaluate The Handler

• Gender, age, strength, health status
• Physical status
• Motivation
• Skill/knowledge, perception
• Handedness
• (Right or Left Handed)
• Protective equipment

71
Case Study Risk Factors

• Force
• lifting, lowering
• Posture
• bending, reaching
• Repetition

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Case Study Ergonomic Solution

• Pallet Unitizer
• Automatically adjusts pallet height to optimum
  level for worker
• Rotates 360o to reduce walking and reaching
• May be powered or manual depending on frequency

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Safe Lifting Procedures

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Power Zone

• The power zone for lifting is close to the
  body, between mid-thigh and mid-chest height.
• Comparable to the strike zone in baseball,
  this zone is where arms and back can lift the
  most with the least amount of effort.

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Safe Lifting Procedures

• Stand close to the load with your feet spread
  apart about shoulder width. Stand with one foot
  slightly in front of the other for balance.

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Safe Lifting Procedures

• Squat down bending at the knees (not your waist).
  
• Tuck your chin in while keeping your back as
  vertical as possible.

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Safe Lifting Procedures

• Get a firm grasp of the object before beginning
  the lift.

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Safe Lifting Procedures

• Begin slowly lifting with your LEGS by
  straightening them.
• Avoid twisting your body during this step.

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Safe Lifting Procedures

• Once the lift is complete, keep the object as
  close to the body as possible.
• As the load's center of gravity moves away from
  the body, there is a dramatic increase in stress
  to the lumbar region of the back.

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Back Belts

• Do they prevent injuries?

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B R E A K!
82
B R E A K!
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OFFICE ERGONOMICS

• Avoiding a Painful Desk Job!

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Maintain A Neutral Posture

• Assume a neutral posture and your body will find
  its natural balance.
• Adjust your worksite to fit you before you begin
  the task.

85
Improving Workstation Ergonomics

• Work in a neutral position
• Adjust your workstation
• Use good posture
• Change positions often

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NEUTRAL POSTURES INCLUDE

• Standing posture
• Keep your spinal column aligned in its natural
  curves.
• Prop one foot up on a stool to reduce stress in
  your lower back.

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NEUTRAL POSTURES INCLUDE

• Sitting posture
• Keep your head balanced naturally over your
  shoulders (not protruding in front of your body).
  
• Keep your shoulders relaxed, not hunched.
• Keep your forearms and thighs parallel to the
  floor.

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NEUTRAL POSTURES INCLUDE

• Sitting posture (Continued)
• Sit back in your chair for support (not on the
  front edge).
• Adjust the back of your chair for support.
• Settle your feet on the floor or footrest.

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NEUTRAL POSTURES INCLUDE

• Wrist posture
• Keep wrists straight- not bent or twisted
• Beware of the keyboard monsters!

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Beginning ABack Injury Prevention Program

• Assess all work activities to ensure the task can
  be accomplished without exceeding the workers
  physical capabilities.
• Provide on-going, comprehensive training on
  lifting mechanics and techniques.
• Provide a surveillance program to identify
  potential work-related musculoskeletal problems.

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POSITION YOUR EQUIPMENT PROPERLY

• Chair first
• Keyboard and mouse second
• Monitor last

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CHAIR

• Feet firmly on the floor
• Maintain space between top of thighs and
  underside of workstation
• Angle between thighs and lower legs should be 90o
  or more
• Maintain relaxed yet upright position

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CHAIR

• Use the entire seat and backrest to support your
  body
• Support forearms at arm supports so shoulders can
  relax
• Provide back cushions for additional lumbar
  support

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KEYBOARD AND MOUSE

• Position directly in front and close to you.
• Place mouse at same height of keyboard and next
  to it.
• Adjust keyboard as low as possible so shoulders
  are relaxed.
• Keep elbows near your body and forearms parallel
  to the floor.

95
KEYBOARD AND MOUSE

• Adjust slope of keyboard so wrists are straight
  while typing.
• Type with hands and wrists floating above the
  keyboard.
• Avoid twisting wrists to press hard-to-reach keys.

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KEYBOARD AND MOUSE

• Press keys gently and RELAX.
• Use padded wrist pads for additional comfort and
  support.

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MONITOR

• Position monitor directly in front of you.
• Adjust height so top of screen is at or slightly
  below eye level.
• Position monitor 90o to windows and other bright
  light sources to minimize glare and reflections.
• Position the monitor to approximately an arms
  length away.

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MONITOR

• Use a document holder placed next to the monitor.
• Mount lamps for additional lighting.
• Use anti-glare screens to filter bright light.
• Rest your eyes periodically.
• Clean the monitor regularly.

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FOOTRESTS

• Use a footrest if the chair is still too high
  after adjustments.
• Provide additional support to the lower back.

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101
VARY YOUR WORKDAY

• Build in short tasks that force you to stand up
  and walk away from the computer.
• Take frequent short breaks rather than fewer,
  longer breaks.
• Stretch muscles and joints that were stationary
  for extended periods.
• Relax muscles and joints that were active.

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You Spend At Least One-third of Your Day at Work

• Make It a Comfortable Day!

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References/Contact

• texasmutual.com
• BLS.com
• OSHA.gov
• www.pp.okstate.edu/ehs/
• Best Regards,
• Bill Cook, CSP
• Loss Prevention Consultant
• 214-886-5429
• bcook_at_texasmutual.com

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Questions
106
Thank You
107
Appendix Back Exercises Before
beginning any exercise program, you should
consult your doctor.
108
Exercises To Help Your Back

• Leg raises to strengthen back and hip muscles
• Lie on your stomach.
• Tighten muscles in one leg and raise leg from
  floor.
• Hold for count of 10, and return leg to floor.
• Do the same with your other leg.
• Repeat five times with each leg.

109
Exercises To Help Your Back

• Leg raises to strengthen back and hip muscles
• Lie on back, arms at your sides.
• Lift one leg off floor and hold for count of ten.
  
• Do the same with the other leg.
• Repeat 5 times with each leg.
• If this is too difficult
• keep one knee bent and the foot flat on the
• floor while raising the other leg.

110
Exercises To Help Your Back

• Leg raises while seated
• Sit upright, legs straight and extended at an
  angle to floor
• Lift one leg waist high
• Slowly return to floor
• Do the same with the other leg
• Repeat 5 times with each leg

111
Exercises To Help Your Back

• Partial sit-up to strengthen stomach muscles
• Lie on back, knees bent and feet flat on floor
• Slowly raise head and shoulders off floor and
  reach both hands toward your knees
• Count to 10
• Repeat 5 times.

112
Exercises To Help Your Back

• Back leg swing to strengthen hip and back muscles
• Stand behind chair, hands on chair
• Lift one leg back and up, keeping the
• knee straight
• Return slowly
• Raise other leg and return
• Repeat 5 time with each leg.

113
Exercises To Decrease the Strain on Your Back

• Lie on back, knees bent, feet flat on floor
• Raise knees toward chest
• Place hands under knees pull knees to chest
• Do not raise head
• Do not straighten legs as you lower them
• Start with 5 repetitions, several time a day

114
Exercises To Decrease the Strain on Your Back

• Lie on stomach, hands under shoulders, elbows
  bent and push up
• Raise top half of body as high as possible
• Keep hips and legs on floor
• Hold for one or two seconds
• Repeat 10 times, several
• times a day.

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Exercises To Decrease the Strain on Your Back

• Stand with feet apart
• Place hands in small of back
• Keep knees straight
• Bend backwards at waist as far as possible and
  hold for one or two seconds.
• Repeat as needed.

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