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LOW BACK PAIN

A. Siswanto
2011
Back Pain
• Back pain is a major health problems.
•An estimated 80% of the population will
experience low back pain at some time during
their lifetime.
•Impairment of the back and spine are the
third leading cause of disability of people in
their employment years.

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S
P
I
N
E
Ruptured Disc
Never lift heavy
loads alone

Examine the load (object)


and assure for a firm grip

Adopt a posture which


ensures
a good body balance

Wear the right clothing and footwear


Lifting – Lowering - Carrying
Reduce the horizontal distance
between the load and the body

Keep the back straight


and lock the spine
Lift with the legs

Never rotate the trunk


during lifting
• In the United Kingdom, the estimated
prevalence of herniated disc is from 1% to 3%
---- 3,1% of men and 1,3% of women.
• In men aged 55 to 64 years old, the prevalence
was 9,6 %; in women the maximum prevalence
of 5% occurred after the age of 64 years old.
• Similarly, in Sweden the lifetime prevalence of
sciatica was found to be 3,6% in those younger
than 25 years and 22,4% among those aged 45
to 54 years old.

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• Strain berlaku untuk kesatuan otot dan tendon
(muscle tendo unit), sedangkan sprain berlaku
untuk cidera yang mengenai ligamen.
• Keduanya jelas merupakan akibat dari rudapaksa
pada jaringan lunak sitem muskuloskeletal.
• Strain didefinisikan sebagai : kerusakan yang
terjadi pada satuan otot tendon karena
penggunaan yang berlebihan (overuse) atau
karena peregangan otot yang berlebihan
(overstretch).

21
• Istirahat di tempat tidur selama tiga minggu
akan menurunkan daya tahan kardiovaskuler
sebanyak 17-27%.
• Efek latihan aerobik selama 8 minggu setelah
istirahat tersebut akan meningkatkan daya
tahan kardiovaskuler sebesar 62% dari nilai
setelah istirahat selama 3 minggu tersebut
dan bila dibandingkan dengan keadaan
sebelum istirahat selama 3 minggu tersebut,
maka terjadi peningkatan nilai sebesar 18%.

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• Daya tahan otot berkaitan dengan kapasitas otot
melakukan kerja aerobik secara terus menerus.
Pada keadaan demikian, intensitas kontraksi otot
tidak tinggi sehingga tidak mengganggu
pemasukan oksigen dan pembuangan CO2.
• Daya tahan otot tergantung dari jumlah “slow
twitch fiber”, kadar myoglobin, sumber energi
yang tersedia dan aktifitas enzim citrate synthase.

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• Kekuatan otot menggambarkan kontraksi
maksimal yang dihasilkan oleh otot atau
sekelompok otot.
• Faktor fisiologik yang mempengaruhi
kekuatan kontraksi otot antara lain
adalah usia, jenis kelamin, dan suhu otot.

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• Mereka yang secara fisik aktif cenderung
memiliki fungsi otot and sendi yang lebih
baik, karena memiliki otot yang lebih
kuat dan lebih lentur.
• Hampir 80% dari semua kasus nyeri
pinggang yang ditemukan sering
disebabkan karena kurangnya latihan
fisik yang teratur.

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• Don’t lift by bending over. Lift an object by
bending your hips and knees and then
squatting to pick up the object. Keep your
back straight and hold the object close to
your body. Avoid twisting your body while
lifting.
• Push rather than pull when you must
move heavy objects.

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• If you must sit at your desk or at the
wheel of a car or truck for long hours,
break up the time with stops for stretch.
• Wear flat shoes or shoes with low heels (1
inch or lower).
• Exercise regularly. An inactive lifestyle
contributes to lower back pain.

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• Sit in chairs with straight back or with
low-back support.
• Keep your knees a little higher than your
hips.
• Adjust the seat or use a low stool to prop
your feet on.
• Turn by moving your whole body rather
than by twisting at your at your waist.

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BACK PAIN
 Back pain is the second leading
cause of work absenteeism (after
upper respiratory tract complaints)
and results in more lost
productivity than any other
medical condition.
 Low back pain is ubiquitous
problems.
 Between 70% and 80% of world’s
population experience low back 29
BACK PAIN

 Back pain is one of the most common


ailments, affecting three out of four
people at least once in their live.
 The financial applications for the
workplace are enormous.
 The problem causes huge losses
associated with compensation claims,
work absence and reduced
productivity.
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THE MUSCLES OF THE BACK

 When the muscles of the back go into spasm,


the most common form of back pain occurs
(lumbago = painful muscle spasm).
 This often happens when you have been doing
something strenuous or that involves a lot of
bending like gardening, or when you have
been in an awkward position for a long time
and go to move.

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THE MUSCLES OF THE BACK

The are other more serious causes of back pain


such as disc prolapse and diseases of the spine,
but if your pain has subsided and there are no
unusual symptoms such as numbness, pins and
needles or pain down the leg, muscles spasm
would usually be the culprit (if your pain last
longer than 48 hours and is getting worse, you
should consult your GP immediately).
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THE LUMBAR REGION OF THE BACK

 The lowest region of the back --- the lumbar


region --- is the most vulnerable area, and
back pain often occurs here.
 This is because the lower part of the spine
bears the entire weight of the upper body, and
is flexed, twisted, and bent more than any
other part of the spine.
 It is therefore, inevitably, suffers more wear
and tear.
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THE CAUSES OF LOW BACK PAIN

 Most low back pain is caused by


musculoskeletal problems, for example,
acute lumbosacral strain, unstable
lumbosacral ligaments and weak muscles,
osteoarthritis of spine, spinal stenosis,
intervertebral disc problems, and inequality
of leg length.
 Other causes include kidney disorders,
pelvic problems, retroperitoneal tumors,
abdominal aneurysms, and psychosomatic34
problems.
THE CAUSES OF LOW BACK PAIN

 Most back pain due to musculoskeletal


disturbances is aggravated by activity, whereas
pain due to other considerations is not
influenced by activity.
 According to a survey published in 2000,
almost half of the adult population of the United
Kingdom (49%) reported low back pain lasting
for at least 24 hours at some time during the
year.
 In a similar survey carried out 10 years earlier
just over one third of the population complained
of such back pain.
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Back Pain
 In 1998 in over half of those people who
reported back pain, the episode lasted for
over 4 weeks ---- affecting 8 million people
and in the case of 2,5 million of these
back pain lasted throughout the year.
 Young people are more likely to have brief
acute episodes of back pain while chronic
pain is more characteristic of older people.
 There is little difference in the occurrence
in men and women.

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RISK FACTORS ASSOCIATED WITH
MANUAL MATERIAL HANDLING INJURIES

1. Personal factors
- Age  Medical history
- Gender  Years of
- Anthropometry employment
(body weight  Smoking
and height)
- Physical fitness  Psychosocial factors
and training  Anatomical
- Lumbar abnormality
mobility  Marital status
- Strength
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RISK FACTORS ASSOCIATED WITH
MANUAL MATERIAL HANDLING INJURIES

2. Environmental factors
- Humidity
- Lighting
- Noise
- Vibration
- Air temperature
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RISK FACTORS ASSOCIATED WITH
MANUAL MATERIAL HANDLING INJURIES

3. Job related factors


- Location of load related to the worker
- Distance object is moved
- Frequency and duration of handling
activity
- Weight of object or forced required to
move object
- Bending and twisting
- Stability of the load
- Postural requirements 39
AGE AND LOW BACK PAIN

 Low back pain typically begins in young


adulthood, affecting the most productive years
of life in an industrial workers.
 There is a rising prevalence with age until the
fourth and fifth decades., after which there is a
leveling off or decrease.
 Attacks of back pain seem to be more common
among those who have had previous back pain
episodes (Borenstein D.G. et al., 1995).
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RISK FACTORS

 Poor physical fitness may be a predisposing


factor for back pain.
 Cady and associates in a prospective study
of fire fighters found that the least fit group
of employees was 10 times more
susceptible to develop back pain than the
most fit group.
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AGE AND LOW BACK PAIN

 If the ligament mesh surrounding the disc


has been torn, the pulpy core of the disc
may squeeze through it. This is called
“rupture disc”, and may cause pain by
pressing on the nerve that enter and leave
the spinal cord.
 Most people with back pain or backache do
not have any damage in their spines.
 Very few people with backache have a
slipped disc or a trapped nerve. Even than
a slipped disc usually gets better by itself.42
SMOKING AND LOW BACK PAIN

 At least two studies have found low


back pain to be more prevalent in
cigarette smokers than in nonsmokers.
 It is not clear whether this association is
a result of increased intradiscal
pressure from chronic coughing and
straining or whether nicotine itself has a
direct biochemical role in the
pathophysiology of back injury.
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THE FFECTS OF
POSTURES ON INTERVERTEBRAL DISC

Standing 100%
Lying down 24%
Sitting upright 140%
Sitting with back slightly 190%
stooping
(Grandjean E., 1988)
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LOW BACK PAIN

 Lifting, handling and dragging loads


involve a great deal of static effect,
enough to be classified as heavy work.
 The main problem of these forms of
work, however, is not the heavy loads
on the muscles, but much more the
wear and tear on the intervertebral
discs, with the increased risk of back
troubles.
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DISC TROUBLES

 The vertebral column, or disc, has the shape of


an elongated S; at chest level is has a slight
backwards curve, called kyphosis; and in the
lumber region it is slightly curved forwards, the
lumbar lordosis.
 This construction gives the spine elasticity to
absorb the shocks of running and jumping.
 The load on the vertebral column increases
from above downwards, and is at its greatest in
the lowest five lumbar vertebrae.

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DEGENERATION OF THE DISCS

 Degeneration of the discs first affects the


margin of the disc, which is normally
tough and fibrous.
 A tissues change is brought about by loss
of water, so that the fibrous ring becomes
brittle and fragile, and loses its strength.

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DEGENERATION OF THE DISCS

 At first the degenerative changes merely


make the disc flatter, with the risk of
damage to the mechanics of the spine, or
even of displacement of the vertebrae
 Under these conditions quite small actions,
such as lifting a weight, a slight stumble or
similar incidents, may precipitate severe
backache and lumbago.
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DEGENERATION OF THE DISC

When degeneration of the disc has


progressed further, any sudden force
upon it may squeeze the viscous internal
fluid out through the ruptured outer ring,
and so exert pressure either on the
spinal cord itself or on the nerves running
out from it. This is what happens in the
case of a “slipped disc” or disc
herniation.
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DEGENERATION OF THE DISC

Pressure on the nerves, narrowing of the


spaces between vertebrae, pulling and
squeezing at the adjoining tissues and
ligaments of the joint are the causes of the
variety of aches, muscular cramps and
paralyses including lumbago and sciatica
which commonly accompany disc herniation.
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LIFTING TECHNIQUE AND DISC PRESSURE

 If a person bends over until the upper part of


his body is horizontal, thee leverage effect
imposes very heavy pressure on the discs
between the lumbar vertebrae.
 An average of the upper part of the body
would be about 45 kg and the length of
leverage about 350 mm, with a resulting
moment of between 1000 and 2000 Nm.
 If a weight is lifted at the same time, the
force on the disc could rise to 3000-4000 Nm.

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LOADING OF THE
DISC BETWEEN THE L3 AND L4
Posture/activity N
Standing upright 860
Walking slowly 920
Bending trunk sideways 20 o
1140
Rotating trunk about 45o 1140
Bending trunk forward 30o 1470
Bending trunk forward 30o, supporting 2400
weight of 20 kg
Standing upright holding 20 kg (10 kg in 1220
each hand)
Lifting 20 kg with back straight and knees 2100
bent 52
INTRA-ABDOMINAL PRESSURE

 Load lifting is always accompanied by a


considerable increase in intra-abdominal pressure
due to the contraction of the back extensor
muscles (m. erector spinae) and the abdominal
muscles.
 These forces stabilize the spine while lifting loads.
A number of study have shown a close correlation
between the magnitudes of compression forces
acting on the lower spine during load lifting and
the magnitudes of intra-abdominal pressure rises.
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THE EFFECT OF FOUR
POSTURES ON THE INTERVERTEBRAL DISC

 The pressure measured when


standing is taken as 100%.
 Lying down : 24%
 Sitting upright : 140%
 Sitting in a relaxed posture, slightly
bent forward : 190%
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RISK IDENTIFICATION

 The purpose of risk identification is


to identify and place in priority
order, the jobs or tasks which
required risk assessment. There are
three basic steps to risk
identification :
a. Analysis of injury and incident
records;
b. Consultation with employees
and/or
their representative; 55
RISK ASSESSMENT

Factors which need to be taken into


account during risk assessment
include :
 Workplace layout
 Actions and movements
 Postures and position
 Duration and frequency
 Locations and distances
 Weights and forces 56
RISK ASSESSMENT

• Work organization
• Working environment
• Skill and experience of
employees
• Personal characteristics of
employees
• Clothing of employees
• Special needs of employees,
either
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MECHANICAL DISORDERS
OF THE LUMBOSACRAL SPINE

 Mechanical disorders of the lumbosacral spine


are the most common cause of low back pain.
 Mechanical low back pain may be defined as
pain secondary to overuse of a normal anatomic
structure (muscle strain) or pain secondary to
injury or deformity of an anatomic structure
(herniated nucleus pulposus).

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MECHANICAL DISORDERS
OF THE LUMBOSACRAL SPINE

• Mechanical disorders are local disorders


of the spine. That is, the process that
cause pain are limited to the structure
of the lumbosacral spine.
• Mechanical disorders are truly
musculoskeletal disease (Borenstein
D.G. et al, 1995).
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BACK STRAIN

 Frequency of back pain --- very common


 Location of back pain --- low back,
buttocks, posterior thigh.
 Quality of back pain --- ache, spasm.
 Signs and symptoms --- pain increased
with activity, increased muscle tension.
 Laboratory and X-ray tests --- none
 Treatment --- controlled physical activity,
medication.
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PREVALENCE AND PATHOGENESIS

• Back strain can be defined as none radiating


low back pain associated with mechanical
stress to the lumbosacral spine.
• The exact number of patients with back strain
is difficult determine.
• Most people with back pain (90%) have it on a
mechanical basis.
• Of patient with mechanical low back pain, back
strain may account for 60% to 70% of
abnormalities.
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BACK STRAIN
The etiology of back stain is not always clear but
may be related to ligamentous or muscular strain
secondary to either a specific traumatic episode or
continuous mechanical stress. Muscle pain in low
back pain patients may be cause by :
1. Pain associated with muscle strain that is related
to muscle disruption from indirect trauma
excessive stretch or tension.
2. Muscle fatigue associated with overuse.
3. Muscle spasm is associated with persistent
contraction of muscle.
4. Paraspinous muscles become deconditioned
after injury. 62
ACUTE HNP

 Frequency of back pain --- very common.


 Location of back pain --- low back to lower
leg.
 Quality of back pain --- sharp, shooting,
burning, paresthesias in lower leg.
 Symptoms and signs --- positive straight leg
raising test, weakness, asymmetric reflexes.
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ACUTE HNP

 Laboratory and x-ray --- CT, MR,


myelogram --- disc herniation. MR is the
most sensitive test.
 Treatment --- controlled activity,
medications, surgical excision of disc for
conservative therapy failures.

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PREVALENCE AND PATHOGENESIS

• A herniated disc can be defined as the


herniation of the nucleus pulposus through the
fibers of annulus fibrosus.
• Most disc ruptures occur the third and fourth
decade of life while the nucleus pulposus is still
gelatinous.
• The time of the day a herniation occurs relate
to diurnal alternations in spinal anatomy.
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PREVALENCE AND PATHOGENESIS

 Acadaveric study of lumbar spine


demonstrated change of disc heights,
water content, swelling pressure,
compressive stiffness, bulging,
loading of apophyseal joints, and
forward and backward bending
properties when loaded with
compressive forces.
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HERNIATED NUCLEUS PULPOSUS

 Approximately 80% of the population will


experience significant back pain in the course
of herniated disc.
 The groups at greatest risk of developing
herniations of intervertebral discs are younger
individuals, with a mean age of 35 years.
 Only 35% of patients with disc herniaion
actually develop true sciatica. Not
infrequently, sciatica develop 6 to 10 years
after the onset of low back pain (Borenstein
D.G. et al, 1995)
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RISK FACTORS
FOR LOW BACK PAIN

• In a retrospective study of 2000 workers, Rowe


found that 35% of sedentary workers and 45%
of heavy handlers had made visit to physicians
for low back pain within a 10 years period.
• Estrand reported a survey of Swedish workers
that suggested that the number of years
spent doing heavy labor have a cumulative
effect on predisposition to low back
problems (Borenstein D.G. et al, 1995).
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PREVALENCE OF LOW BACK PAIN

• Back pain is the second leading cause of


work absenteeism (after upper respiratory
tract complaints) and result in more in
productivity than any other medical conditions.
• Spine or back impairments result in an annual
average of 175,8 million restricted activity days.
• The lifetime prevalence of back pain exceeds
70% in most industrialized countries. National
statistics from the US indicate 1-year prevalence
rate of 15% to 20%.

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PREVALENCE OF LOW BACK PAIN

• Using the definition of low back pain of the


NHANES II (National Health and Nutrition
Examination Survey II) ---- an episode
lasting 2 weeks, the prevalence of back
pain among both men and women is 16%
for persons 25-74 years of age.

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PREVALENCE OF LOW BACK PAIN

• The highest prevalence was in the 45 to 64 aged


group. Rates were also higher for whites (16,5%)
than for either blacks (13,2%) or other racial
groups (11,3%).
• The primary site of pain was lower back (85,1%)
with middle back pain reported in 7,9% and upper
back pain in 7,0%.

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PREVALENCE OF BACKT PAIN AND SELECTED
DEMOGRAPHIC CHARACTERISTICS (RATE PER 100
PERSONS)

Age Back pain


Total 25-74 years 16.0
ages
Male 16.0
Female 16.0

Age 25-44 years 12.3

45-65 years 20.3


65-74 years 18.2
White 16,5
72
Black 13.2
GENERAL RISK FACTORS

 Back pain is a multifactorial disorder with many


possible etiologies; consequently, determining risk
factors for low back pain is difficult.
 In addition, many of the proposed risk factors have
a high prevalence in the general (asymptomatic)
population and require large data base studies to
make statistically valid statements about risk
factors.
 Thus, the literature is filled with a myriad of studies
with conflicting conclusions.

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GENERAL RISK FACTORS

• The maximal frequency of low back pain


symptoms appears to be in the age range of 35
to 55, while absences and duration of
symptoms increase with increasing age.
• While gender seems to be of little importance
with respect to low back symptoms,
symptoms surgery for
disc herniations is performed about 1,5 to 3
times more often in males.
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GENERAL RISK FACTORS

 Postural deformities such as


scoliosis, kyphosis, and leg length,
this discrepancy do not predispose to
low back pain in general.
 Studies of scoliosis have shown that
there is no increased association
with back pain unless the curve is
severe (> 80°). 75
GENERAL RISK FACTORS

 Anthropometric data are contradictory with no


strong relationship between height, weight,
body build, and low back pain.
 Physical fitness is not a predictor of acute low
back pain, but the physically fit have a lesser
risk of chronic low back pain and a more rapid
recovery after a pain episode.
 Several investigators have found an
association between smoking, herniated disc,
and low back pain.
76
OCCUPATIONAL RISK FACTORS

 The relationship between occupational


factors and low back pain is difficult to
study because exposure is usually
difficult or impossible to quantify.
 The problem is further complicated by
several factors :

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OCCUPATIONAL RISK FACTORS

1. Workers maybe exposed to multiple


risk factor in the same jobs.
2. Workers in the same industries or
occupation may have substantially
different exposure, and
3. Workers with back pain may shift to
less strenuous jobs leaving a
preponderance of healthy workers on
the heavy tasks and shifting the
apparent prevalence of back pain.
78
OCCUPATIONAL RISK FACTORS

 Physical factors found to be associated


with increased risk of low back pain include
heavy work, lifting, static work postures
(prolonged sitting or standing), bending
and twisting and vibration.

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OCCUPATIONAL RISK FACTORS

 Psychologic and psychosocial work


factors including monotony at work, jobs
dissatisfaction, and poor relationship with
coworkers have been found to increase
complaints above low back pain.
 Prospective study have concluded that these
psychological risk factors were more predictive
than any of the physical risk factors.

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LOW BACK PAIN

 Most episodes of low back pain or sciatica


resolve spontaneously within the first to
weeks,
weeks and relative minority take 6 to 12
weeks.
 Only 1% to 2% of cases should require
evaluations for operative management.
 Knowledge of the physical and
psychosocial risk factors can help prevent
and minimize the severity of recurrences.
81
THE TENSE PERSON

 The person who is nervous, tense,


uptight (tegang, gelisah), fatigue, or
depressed very frequently can make
movements and actions that catch the
body unprepared.
 If repeated episodes of this occur, the back
can be weakened and can become more
susceptible to subsequent minor injury.
82
ENDURANCE

 There are two kinds of endurance; aerobic


endurance refers to the process of taking
in, transporting and using oxygen, whilst
muscular endurance represents the
capacity of the muscle for continuous
performance of localized activity. They are
of course, inter-related.
83
ENDURANCE

 Aerobic endurance, which refers to


prolonged activity of low intensity,
indicating the capacity to continue
physical work and withstand the onset of
fatigue.
 Muscular endurance which refers to the
capacity of a muscle or group of muscles
to do work continuously.
84
BODY COMPOSITION

 Body composition refers to the proportion of


lean body mass and body fat.
 It is more important than total weight as a
component of physical fitness, since it is
possible for a very muscular person to be
overweight according to popular height-weight
tables, and still have a relatively small
percentage of total weight deposited as fat.
85
PREVALENCE OF DISC HERNIATION

 In the United Kingdom, the estimated prevalence


of herniated disc is from 1% to 3% ---- 3,1% of
men and 1,3% of women.
 In men aged 55 to 64 years old, the prevalence
was 9,6 %; in women the maximum prevalence
of 5% occurred after the age of 64 years old.
 Similarly, in Sweden the lifetime prevalence of
sciatica was found to be 3,6% in those younger
than 25 years and 22,4% among those aged 45
to 54 years old.
86
STRAIN DAN SPRAIN

 Strain berlaku untuk kesatuan otot dan tendon


(muscle tendo unit), sedangkan sprain berlaku
untuk cidera yang mengenai ligamen.
 Keduanya jelas merupakan akibat dari rudapaksa
pada jaringan lunak sitem muskuloskeletal.
 Strain didefinisikan sebagai : kerusakan yang
terjadi pada satuan otot tendon karena
penggunaan yang berlebihan (overuse) atau
karena peregangan otot yang berlebihan
(overstretch).
87
AKTIVITAS FISIK

 Istirahat di tempat tidur selama tiga minggu


akan menurunkan daya tahan kardiovaskuler
sebanyak 17-27%.
 Efek latihan aerobik selama 8 minggu setelah
istirahat tersebut akan meningkatkan daya
tahan kardiovaskuler sebesar 62% dari nilai
setelah istirahat selama 3 minggu tersebut
dan bila dibandingkan dengan keadaan
sebelum istirahat selama 3 minggu tersebut,
maka terjadi peningkatan nilai sebesar 18%.
88
DAYA TAHAN OTOT

 Daya tahan otot berkaitan dengan kapasitas otot


melakukan kerja aerobik secara terus menerus.
Pada keadaan demikian, intensitas kontraksi otot
tidak tinggi sehingga tidak mengganggu
pemasukan oksigen dan pembuangan CO2.
 Daya tahan otot tergantung dari jumlah “slow
twitch fiber”, kadar myoglobin, sumber energi
yang tersedia dan aktifitas enzim citrate synthase.

89
KEKUATAN OTOT
(MUSCLE STRENGTH)

 Kekuatan otot menggambarkan


kontraksi maksimal yang dihasilkan
oleh otot atau sekelompok otot.
 Faktor fisiologik yang mempengaruhi
kekuatan kontraksi otot antara lain
adalah usia, jenis kelamin, dan suhu
otot.
90
AKTIVITAS FISIK
DAN NYERI PINGGANG

 Mereka yang secara fisik aktif


cenderung memiliki fungsi otot and
sendi yang lebih baik, karena
memiliki otot yang lebih kuat dan
lebih lentur.
 Hampir 80% dari semua kasus nyeri
pinggang yang ditemukan sering
disebabkan karena kurangnya
latihan fisik yang teratur. 91
TIPS FOR
PREVENTING BACK STRAIN

 Don’t lift by bending over. Lift an


object by bending your hips and
knees and then squatting to pick up
the object. Keep your back straight
and hold the object close to your
body. Avoid twisting your body while
lifting.
 Push rather than pull when you must
move heavy objects.
92
TIPS FOR
PREVENTING BACK STRAIN

 If you must sit at your desk or at


the wheel of a car or truck for
long hours, break up the time
with stops for stretch.
 Wear flat shoes or shoes with low
heels (1 inch or lower).
 Exercise regularly. An inactive
lifestyle contributes to lower back
pain. 93
WHAT IS THE BEST WAY TO SIT?

 Sit in chairs with straight back or


with low-back support.
 Keep your knees a little higher than
your hips.
 Adjust the seat or use a low stool to
prop your feet on.
 Turn by moving your whole body
rather than by twisting at your at
your waist. 94
WHAT IS
THE BEST POSITION FOR STANDING?

 If you must stand for long periods,


rest one foot on a low stool to
relieve pressure on your lower back.
 Every 5 to 15 minutes, switch the
foot your are resting on the stool.
 Maintain good posture Keep your
ears, shoulders and hips in a
straight line, with your head up and
your stomach pulled in. 95
EMPLOYER’S RESPONSIBILITY

Employers should include the following elements in


any Low Back Pain Program :
• Injury and illness recordkeeping.
• Early recognition and reporting of LBP symptoms.
• Systematic evaluation and referral to a qualified
health care providers.
• Conservative treatment, such as restricted duty
jobs, when necessary.
• Conservative return to work.
96
EMPLOYER’S RESPONSIBILITY

 Systematic monitoring, including


periodic workplace walkthrough.
 Adequate staffing and facilities
where employers provide on-side
evaluation.
 Employee training and education.
 Access to health care providers for
each work shift
 No barriers to early reporting.
97
EFFECTIVE ERGONOMIC PROGRAMS

Effective ergonomic programs should


include the following elements :
 Management commitment and employee
participation.
 Job hazard analysis.
 Controlling ergonomic risk.
 Low Back Pain management.
 Training and education.
98
BACK PAIN
PREVENTION PROGRAMS

The basic principles underlying successful


back pain prevention programs in
workplaces are :
 Management commitment and support
 Employee consultation and participation
 Consideration of human factors
(ergonomics)
99
MANAGEMENT
COMMITMENT AND SUPPORT

Effective prevention programs require senior


management commitment and active support
shown by :
 The adoption of a policy relevant to the
prevention of back pain (usually integrated
with other organizational policies) stating the
responsibilities of parties in the workplace.
 Allocation of necessary resources.
 Personal involvement and the inclusion of
the issue in senior management forums
(e.g., board meetings) and in operational 100
decision making.
Terima Kasih
Atas Perhatian Anda

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