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Back Injury Prevention

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Rationale for conditioning program to reduce the risk of back injury.

Rationale for conditioning program to reduce the risk of back injury.

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  • 1. Targeted Programs to Reduce Risks of Injury #1. The Back 10/6/2010 Sharon Sharpe, ScD, ATC
  • 2. The Problem: Back Pain and Injury 10/6/2010 Sharon Sharpe, ScD, ATC
  • 3. Back Injuries – Incidence Since January 10, 2010 • Back Pain non-recordable 7 • Back Pain recordable 3 Days Out Alt Duty – Kitchen 1 4 ? – Bakery 0 – Packing 1 2 – Sanitation 1 90+ 10/6/2010 Sharon Sharpe, ScD, ATC
  • 4. Causal Factors of Back Pain • Employee factors (organic) – Genetics (family History) – Personal History of previous injury – Posture – Muscle imbalances • Employee factors (performance) – Ergonomic (technique) errors • Job Factors – Prolonged positioning – Sudden “unprotected” movements 10/6/2010 Sharon Sharpe, ScD, ATC
  • 5. What goes wrong and Why? • How is it built? • How does it work? • How does it get injured? 10/6/2010 Sharon Sharpe, ScD, ATC
  • 6. What does your spine do? • The base for all arm/leg activity (“core”) • Must be both STABLE and MOBILE • Each of the 26 joints contributes to mobility and stability • Muscle support is CRITICAL 10/6/2010 Sharon Sharpe, ScD, ATC
  • 7. How is your spine supposed to work? 10/6/2010 Sharon Sharpe, ScD, ATC
  • 8. Spine: Like a Tent Pole, only better (and worse) • This tent pole is not straight, and has many parts – inherently unstable • Spinal curves allow for absorption of impact forces. (Walking, running) • Not really built for prolonged positions 10/6/2010 Sharon Sharpe, ScD, ATC
  • 9. Structure - Bones Vertebrae Back Front Front Back From Anthony CP, Kolthoff NJ: Textbook of anatomy and physiology, ed 9, St. Louis, 1975, Mosby. 10/6/2010 Sharon Sharpe, ScD, ATC
  • 10. Structure - Joints between bones Small movement between any 2 vertebrae There are 26 joints….. Combine for Steven M Lobel, M.D. EVMS Dept of PMR Large movements. 10/6/2010 Sharon Sharpe, ScD, ATC
  • 11. Structure – Side view of inner spine Bone Disk Bone 10/6/2010 Sharon Sharpe, ScD, ATC
  • 12. Structure – Discs and Nerves 10/6/2010 Sharon Sharpe, ScD, ATC
  • 13. What makes the spine hold it’s shape? 10/6/2010 Sharon Sharpe, ScD, ATC
  • 14. Muscles – Tent Fabric 10/6/2010 Sharon Sharpe, ScD, ATC
  • 15. Outer Layers - Shoulder Movers 10/6/2010 Sharon Sharpe, ScD, ATC
  • 16. Mid Layer – Inner Layer – Trunk Movers Sensors Global Muscles Local Muscles 10/6/2010 Sharon Sharpe, ScD, ATC
  • 17. Local Muscles –When activated, position/motion sensors, not motion generators. • How much motion is occuring between any 2 vertabrae?? • How fast? 10/6/2010 Sharon Sharpe, ScD, ATC
  • 18. Summarize: a stable spine…. – Stability • How much motion is occuring between any 2 vertabrae when the trunk moves? – Sensors off – Sensors on 10/6/2010 Sharon Sharpe, ScD, ATC
  • 19. Muscle Function Differences Patient History Never injured Past Injury Activated First Sensors Trunk Movers Activated After Trunk Movers Sensors Motion in local Small, safe Increased (less joint stable) Proper activation Trunk Movers - pattern Over activated Sensors – Under activated 10/6/2010 Sharon Sharpe, ScD, ATC
  • 20. Muscle Strength vs Endurance • Position sensors need to be ON – ALL THE TIME, so that excess movement between bones can be prevented. – ENDURANCE • Trunk Movers need to be ON – For stability most of the time – Higher level when body movement is required – ENDURANCE and STRENGTH 10/6/2010 Sharon Sharpe, ScD, ATC
  • 21. Working Example: Posture • Cause or effect? – Does the posture cause muscle imbalance or does muscle imbalance cause poor posture? 10/6/2010 Sharon Sharpe, ScD, ATC
  • 22. Working Example - Posture ‘Normal’ Spine – Lordosis Balanced Muscle Groups. Anterior Muscles – Shortened, Strong Posterior Muscles – Stretched, Weak http://www.nlm.nih.gov/medlineplus/ency/images/enc y/fullsize/9583.jpg 10/6/2010 Sharon Sharpe, ScD, ATC
  • 23. Lordosis – 1. Pelvis tilts forward 2. Butt sticks out Shortened hip flexor ms. Lengthened, weak Glutes Tight Hamstrings 3. Forward head 4. Tight Calves Factors – Overweight Pregnancy Other…. 10/6/2010 Sharon Sharpe, ScD, ATC
  • 24. Posture Forward Head 10/6/2010 Sharon Sharpe, ScD, ATC
  • 25. Problem Summary Employee causal factors • Prolonged position > muscle fatigue > poor activation/endurance > poor standing posture > increased RISK. • Lack of understanding of the potential BENEFITS of conditioning and ergo training. – Pre-shift stretching – Micro breaks – Proper work techniques – Preventive conditioning program 10/6/2010 Sharon Sharpe, ScD, ATC
  • 26. Recent Evidence • Bigos et al. Spine, 2009, High quality controlled trials on preventing episodes of back problems: systematic literature review of working-age adults – Reviewed studies on effects of exercise, education, lumbar supports, shoe inserts and programs to reduce lifted loads – 17 high quality studies – ONLY EXERCISE significantly reduced episodes of back problems 10/6/2010 Sharon Sharpe, ScD, ATC
  • 27. LiveWell Job Specific conditioning program Pre-shift stretches • Wellness based exercise programs 10/6/2010 Sharon Sharpe, ScD, ATC
  • 28. Ongoing Ergonomic Training • Job rotation • Micro breaks X • Correct lifting • Proper job technique • Aug. 2010 Training •Still have back injuries 10/6/2010 Sharon Sharpe, ScD, ATC
  • 29. Potential for Risk Reduction • Evidence shows: back pain incidence could be prevented with exercise. • Exercise which impacts….. Proper muscle activation timing Hamstring and Hip Flexor flexibility Abdominal and sensor muscle endurance 10/6/2010 Sharon Sharpe, ScD, ATC
  • 30. Fix it 1. Reduce Lordosis (restore muscle balance) Stretch Tight Muscles (Hip Flexors, quads, Hams, calves) Strengthen weakened muscles (Hip Extensors) 2. Learn muscle control Activate local sensors FIRST 3. Work on muscle endurance of these systems 4. Report back pain EARLY 10/6/2010 Sharon Sharpe, ScD, ATC
  • 31. Wellness Based Programs • Conditioning for all employees • Preventive Stretching and Exercise, both initial injury and RE injury. • In addition to the Core 6 pre-shift exercises 10/6/2010 Sharon Sharpe, ScD, ATC
  • 32. Effective Conditioning 1. Loosen up 2. Stretch tight muscles 3. Exercise – activate and strengthen weak/strained muscles 10/6/2010 Sharon Sharpe, ScD, ATC
  • 33. Reduce Lordosis - Stretching • Hip Flexors • Quads • Hamstrings • Calves 10/6/2010 Sharon Sharpe, ScD, ATC
  • 34. Activate Stabilizers of the Spine Stabilize the Pole Tighten the fabric 10/6/2010 Sharon Sharpe, ScD, ATC
  • 35. 10/6/2010 Sharon Sharpe, ScD, ATC http://back-exercises.com/
  • 36. Learning How to Activate Draw in Exercise – Activates Inner Abs AND Position Sensors Focus on: Pull belly button DOWN toward the spine while abs are RELAXED. 10/6/2010 Sharon Sharpe, ScD, ATC
  • 37. Spine Control Strengthening Progression - example • Draw ins • Pelvic Tilts • Maintain Pelvic Tilt, raise 1 arm over head – Both arms • Maintain Pelvic Tilt, lift single leg bent – Single leg straight – “Cycle” legs • Maintain Pelvic Tilt, Hands and Knees progression 10/6/2010 Sharon Sharpe, ScD, ATC
  • 38. Resources Needed: • Space • Mats – 1 yoga mat for each team member OR 1 large floor mat • Need to be cleaned after each use. • Committed Leaders – Trained in the exercises – Give immediate, ONGOING feedback and coaching on exercises • Buy-in, ATTENDANCE/participation by employees 10/6/2010 Sharon Sharpe, ScD, ATC
  • 39. Resources Needed • Supervision/Training – Initial Training for Leaders – Ongoing training for Leaders – Coaching/feedback with teams – Outcomes measures collected/analyzed • Ability to control pelvis • Measures of comfort/discomfort (1 -10) • Days missed • Days limited/alternative duty • Days full duty but with pain • Others?? 10/6/2010 Sharon Sharpe, ScD, ATC
  • 40. Resources Needed • Time – Training of Leaders – 2 sessions x 45 min – Initial Presentation to teams – 30 min – Time for teams to exercise – 15 min • Daily - optimal • 3x/week - minimal – Ongoing supervision/coaching -1-2 hrs/wk • Sharon > Leaders • Sharon > Teams 10/6/2010 Sharon Sharpe, ScD, ATC
  • 41. Summary • Back Injuries are a problem • Spine needs both stability and mobility • Exercise programs reduce incidence of LBP – Stretch tight muscles, strengthen weak muscles – Prevent excessive local joint motion • Activate small sensors (“draw in”) BEFORE activating LARGE MOVERS. – Control Pelvis (muscle balance) • Program must have proper resources to be successful. 10/6/2010 Sharon Sharpe, ScD, ATC
  • 42. 10/6/2010 Sharon Sharpe, ScD, ATC
  • 43. Reference Materials Bigos, SJ et al. High-quality controlled trials on preventing episodes of back problems: systematic literature review in working-age adults. Spine Journal. 2009 Feb;9(2):147-68. Herzog,W., 2000. The Mechanical, Neuromuscular, and Physiologic Effects Produced by Spinal Manipulation. In: Herzog,W. (Ed.), Clinical Biomechanics of Spinal Manipulation, pp. 191-207. Churchill Livingstone, Philadelphia. Margo, M. http://ebm.bmj.com/content/14/4/117 Mendoza, G. “Diagnosis and Treatment in the Lumbar Spine” Powerpoint presentation, Boston University, Sargent College of Health and Rehabilitation Science. Feb 2005. 10/6/2010 Sharon Sharpe, ScD, ATC