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Preventing Back Injuries

Todd A. Hoover, MD, DHt The Occupational Safety and Health Administration names back injuries as the number one safety problem in U.S. workplaces.1 Over 3 million Americans are seen in the emergency room each year for back problems. Adults aged 18 – 44 were most likely to be seen. And the overall costs for hospitalization of patients with back pain exceeded $9.5 billion in 2008.2 Since the majority of back injuries occur outside of the workplace, all of us are at risk for back pain during our lifetimes. Risk Factors for Back Injuries Back injuries appear to occur suddenly, but in reality usually result from the ongoing weakening of the back and stomach muscles over many years. Often the amount of lifting related to the injury seems quite minor. Risk factors for an injury include:  Sedentary lifestyle  Lack of exercise  Poor flexibility and stretching  Previous injury  Any prolonged period of bed rest  Frequent bending and twisting  Lifting heavy loads

How the Back Works The muscles of the back and spine are too small to handle a heavy lift. Let’s take a look at how the back actually works.
Diaphragm

As you lift a heavy object, the abdominal muscles, diaphragm, back muscles, and pelvic floor all work together to compress the liquid inside of the abdomen. The back muscles work in combination with both the side muscles and the stomach muscles to form a type of “piston” or hydraulic machine to do the lifting required.

Spine Abdominal Muscles Back Muscles

Pelvic Floor

Prevention You have to take care of your back before you lift objects to prevent injuries. Back care is a lifelong process. Exercises for the back include both Stretching and Strengthening.

Stretching exercises gradually lengthen muscles and remove knots. Remember that the back moves in 6 distinct directions: forward, backward, right bend, left bend, right rotation and left rotation. You must move the back through all six directions to fully stretch. Perform stretches every day to help maintain your full range of motion. By performing stretches in a seated or lying position, you will allow the body to relax from its normal workload of standing or bending. Use your breathing to help relax. As you breathe in, imagine that all of the muscles under tension are relaxing; and as you breathe out, allow your body to move further into the stretch. In and out, focus on relaxing the muscles as you stretch. Yoga classes offer a great way to stretch your muscles safely. Remember to work muscles slowly. Just stretch to your limit, and encourage your body to go just a bit more. Avoid bouncing or forcing your body as that will cause tearing of muscle fibers.

Strengthening exercises gradually make the stomach, side, and back muscles stronger. Although we all like to think we are just as strong as when we were 20, the fact is that the back and stomach muscles become progressively weaker as we age. This is especially true if we work at a desk, or do not devote some time each week to exercising. Many exercises can strengthen the back. The key is to do them gradually and progressively. If you have not exercised for a while, start with 10 minutes or less, every other day. Use your body as a guide. If you begin to develop soreness of the back or abdomen, you may be going too quickly. It is okay to back off a bit and then increase again. Swimming, walking, rowing, calisthenics, palates, yoga, aerobics, and martial arts are all great ways to increase your core back and abdominal muscle strength. Take a class if you can. This will allow you to learn the proper ways to move your body to avoid injuring yourself. Remember, “slow and steady” win the race to making your body stronger and more resilient. Ergonomics Proper lifting is a key to preventing back injuries. No matter how strong and flexible your back, there is always an amount of weight that will cause you an injury if you try to lift it. As a rule of thumb, lifting more than 1/4 of your body weight or 35 lbs total may cause an injury. If you have had a back injury, the amount you can lift safely may be even less. For lifting heavier objects, get help or use a mechanical lifting device. Back belts or braces have not been found to help prevent injuries.3 For lighter objects, use the correct body mechanics. Think about teeter totters from your childhood.

The heavier black weight can be lifted with much less force than the blue because it is closer to the lifting point. In the same way, objects held closely to your body during lifting will require less force to lift, then if they are held further away. Bending forward at the waist to lift objects has the same effect. This causes your body to move the weight further away from your core muscles. Also, because you are bent over, you lose some of the advantage of your “hydraulic piston”. Bending at the knees is much better as you can keep the weight close and take advantage of all the groups of muscles around your trunk. Objects that are large or bulky are best lifted by more than one person even though the weight may not be high. Back injury prevention is an ongoing process. Keeping your core muscles strong and flexible will reward you many times throughout your life.

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U.S. Department of Labor. Occupational Safety and Health Administration. Program Highlights Fact Sheet No. OSHA 89-09. 2 Owens P.L. (AHRQ), Woeltje M. (Student), Mutter R. (AHRQ). Emergency Department Visits and Inpatient Stays Related to Back Problems, 2008. HCUP Statistical Brief #105. February 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcupus.ahrq.gov/reports/statbriefs/sb105.pdf. 3 Wassell-JT; Gardner-LI; Landsittel-DP; Johnston-JJ; Johnston-JM. A prospective study of back belts for prevention of back pain and injury. JAMA J Am Med Assoc 2000 Dec; 284(21):2727-2732. http://jama.ama-assn.org/cgi/content/abstract/284/21/2727.