Back safety presentation
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Back safety presentation
- 1. Back Safety in theBack Safety in the Workplace atWorkplace at MaineGeneral Medical CenterMaineGeneral Medical CenterWorkplace Health
- 2. Back Injury Statistics Back injuries account for one (1) of every five (5) workplace injuries or illness. Eight of ten Americans will experience back pain/injury in their lifetime (80%). After the first injury, an individual is 5 times more likely to experience a second or more severe injury. Fewer than 50% of lost time back injury sufferers return to work after 6 months. Less than 25% of those return after one year.
- 3. Common Causes of Back InjuriesCommon Causes of Back Injuries Heavy Lifting Sitting or Standing Awkward Postures Carrying & Lifting Twisting Reaching & Lifting Slips, Trips & Falls
- 4. The SpineThe Spine == 24 Moving Vertebrae + 23 Intervertebral Discs + 51 Facet Joints + Hundreds of Ligaments + Hundreds of Muscles = Many structures that can be hurt!
- 5. POSTUREPOSTURE Balance of Spine Curves is the Key
- 7. Stages of Disc HerniationStages of Disc Herniation
- 8. The Nerve Roots / The Spinal CordThe Nerve Roots / The Spinal Cord
- 9. Appearance on MRIAppearance on MRI
- 14. Injury: mindInjury: mind VSVS bodybody The Twinge……………….OUCH!!! VS The Stiffness…………..”just getting old” VS The Ache…………...”something doesn’t feel right” VS The Pain….. “I need to go to the doctor”
- 15. Self-help Ideas Rest This does not mean, become a couch-potato Ice vs. Heat Stretching and Walking Anti-inflammatory Medication Over the counter medicines, ointments, patches Adhere to the doctor’s recommendations Abide by the work restrictions Take the medication as prescribed Attend Physical Therapy consistently
- 16. What is wrong withWhat is wrong with these postures?these postures?
- 18. The mechanics of the spine and liftingThe mechanics of the spine and lifting The amount of force you place on yourThe amount of force you place on your back in lifting may surprise you!back in lifting may surprise you!
- 19. The Forces InvolvedThe Forces Involved If you shift the fulcrum to one side, it takesIf you shift the fulcrum to one side, it takes much more force to lift the same object.much more force to lift the same object.
- 20. The Forces InvolvedThe Forces Involved When you add in the average weight of 105 pounds for the upper torso, you see that lifting a ten pound object actually puts 1,150 pounds of pressure on the lower back.
- 21. The Forces InvolvedThe Forces Involved If you are 25 pounds overweight, it would add an additional 250 pounds of pressure on your back every time you bend over.
- 22. The lifting solutionThe lifting solution Wide base of support Object in center of stance Neutral spine Butt down Grasp object with both hands Hug the load Raise with head and shoulders first Slow and smoothly Keep spine in neutral Once standing, move your feet in the direction you are going to move in, do not twist Repeat to put load down
- 23. Ergonomic Risk FactorsErgonomic Risk Factors High repetition Static postures Excessive force Awkward joint positions and postures Poor physical condition Extreme temperatures Vibration
- 24. Common Causes of Back InjuriesCommon Causes of Back Injuries TwisTingTwisTing
- 25. Common Causes of Back InjuriesCommon Causes of Back Injuries Reaching and lifting . . .Reaching and lifting . . .
- 26. Common Causes of Back InjuriesCommon Causes of Back Injuries Lifting or carryingLifting or carrying awkward or odd shapes . . . .awkward or odd shapes . . . .
- 27. Common Causes of Back InjuriesCommon Causes of Back Injuries Awkward, uncomfortableAwkward, uncomfortable positions .positions . . .. .
- 28. Common Causes of Back InjuriesCommon Causes of Back Injuries Prolonged Sitting orProlonged Sitting or StandingStanding
- 29. Mechanism of InjuryMechanism of Injury Blood Flow to TissuesBlood Flow to Tissues At Rest Dynamic Work Static Work Blood Flow Demands Blood Flow Supplied
- 30. Common Causes of Back InjuriesCommon Causes of Back Injuries Tripping, slipping andTripping, slipping and Falling….Falling….
- 31. TreatmentTreatment Self Help Medications Diagnostics Manipulation Physical Therapy Massage Therapy Surgery
- 32. Prevention:Prevention: Avoid lifting and bending in combination Avoid using improper spinal mechanics. Assess proper storage and placement of objects. Alternate positions when able. Use carts and dollies. Use mechanical lifting devices whenever you can. Test the weight of an object before lifting. Get help if it’s too heavy. Continually assess your environment. Take Care of yourself, keep your body well and fit. Make Good decisions and choices REDUCE YOUR EXPOSURE and ERGONOMIC RISKS!!!!
- 33. Back Injury PreventionBack Injury Prevention Sitting or standing too long in one position. Sitting can be very hard on the lower back especially in a bad position. For every one hour of sitting, stand up and take a stretch or walk. (standing Back Bends) Use Back supports For every one hour of standing, sit down or move around and stretch. (flexion type stretch) Use Foot stools and anti-fatigue mats
- 34. Back Injury Prevention:Back Injury Prevention: Maintain good postureMaintain good posture Lift objects holding them close toLift objects holding them close to your bodyyour body Never “twist” when carrying,Never “twist” when carrying, handling, or transferring a heavyhandling, or transferring a heavy objectobject Avoid “locking out” the kneesAvoid “locking out” the knees Use proper lifting techniquesUse proper lifting techniques
- 38. Activities at HomeActivities at Home
- 39. Things You Can DoThings You Can Do In addition to work smart practices You need to ….. Get the appropriate amount of sleep Eat nutritionally balanced meals Get regular exercise/activity Work on specific muscle groups
- 40. Back Belts: Do They Work?Back Belts: Do They Work?
- 41. ExercisesExercises Exercises that work your back, hips, thighs, and abdominal muscles can minimize back problems. Warm up slowly and exercise regularly.
- 42. STRETCHING PROGRAMS AT WORK
- 43. Wall Squats Stand with back leaning against wall Walk feet 12 inches in front of body. Keep abdominal muscles tight while slowly bending both knees 45 degrees. Hold 5 seconds. Slowly return to upright position. Repeat at least 5 to 10 times. Exercises To Help Strengthen Your Back and Legs
- 44. Exercises……..Exercises……..stretchingstretching Single knee to chest Lie on back, knees bent with feet flat on floor. Raise one knee toward your chest. Place hands under knee & pull knee to chest. Do not raise head. Do not straighten legs as you lower them. Start with 5 repetitions, 3 times a day.
- 45. Exercises………Exercises……… f l exi bi l i t yf l exi bi l i t y Partial Press Ups Place hands under shoulders with elbows bent Push on hands and raise chest off the floor. Keep hips and legs on floor, with buttocks relaxed. Hold position for one or two seconds. Repeat 3 times per day
- 46. Starting Position: Standing tall, feet shoulder width apart, chin tucked in Place your palms on the small of your back, fingers pointing down. Keep your head up as you lean back slowly as far as possible. Hold for at least 10 seconds. Return to starting position and relax. Exercises…Exercises…standing Backstanding Back BendsBends
- 47. The message is….The message is…. TAKE CARE OF YOUR BACKTAKE CARE OF YOUR BACK ……And it will take care of you Exercise daily Get the proper amount of sleep/rest Eat right Do not ignore your signs and symptoms Limit your exposures during “heavy” lifting Get Help with heavy or bulky objects If you must bend, do it properly Avoid twisting at the waist when moving objects Always be aware of your environment and watch where you are going Change Positions Frequently-movement is good!
- 48. Back SafetyBack Safety Any Questions????Any Questions???? Comments????Comments???? Thank you.Thank you. Take Care of yourTake Care of your back!back!
Editor's Notes
- Lifting: Lifting or carrying objects with awkward or odd shapes . . . In addition, Reaching and lifting . . . over your head, across a table, or out the back of a truck . . . Twisting: Twisting at the waist while lifting or holding a heavy load . . . This frequently happens when using a shovel. Carrying: Make sure you can see Take small, stable steps Do not twist your back
- Discussion: Each disc is a circular pad filled with a gelatin type substance, that is under constant pressure. The disc acts like a shock absorber between the vertebrae and allows for the smooth segmental movement that occurs when you move. You may have a relative or you may have been told that you have arthritis, degenerative joint disease or a narrowing of the joint spaces in your spine, this is due to the compression of the discs over time and the loss of volume or fluid that they contain. You can see that as you bend and extend your back part of the disc is compressed while the other part is stretched. This is why therapists are always emphasizing the maintenance of your curves and keeping your back straight while you lift. You can see if you constantly bend and twist without maintaining a neutral spine, then the wear and tear on your disc becomes more and more of an issue and the joint spaces begin to approximate or touch one another, causing wear and tear on the joint surfaces.
- Discussion: If the disc becomes really irritated and inflamed, it can begin to bulge and swell, thus putting pressure on the nerve roots that come out between the vertebrae and possibly on the spinal cord. The term slipped disc, really is a misnomer, since the disc does not really slip out of place, it tends to swell and bulge and finally herniates and ruptures.
- Discussion: The twinge: micro tearing of the ligaments, deep structures. The stiffness: body’s attempt at repairing injury, induces inflammation and decreases mobility The ache: the inflammation settles in and causes tissue irritation, which in turns registers as discomfort The pain: point in time where your body tells you enough is enough, I am hurt.
- Discussion: What can you do to help yourself during the stages of injury? Rest does not mean to stop all activity, it means to take it easy. You can actually become more sore if you dramatically alter you activity and movement patterns. The Big debate to use ice or heat. Some feel that ice only helps in the first 24 hours, but if you are in pain, something is inflamed and irritated, and therefore there is an active process taking place….you need to ice. Using heat would be adding warmth to an already “overheated” system and can actually cause more inflammation. If you feel that you are really stiff and the muscles are sore, then you can apply heat to the area for 10 - 15 minutes; the best way to heat the area is through a hot shower or hot-tub since warm water tends to penetrate better. You should not sleep on an ice-pack or heat-pack, both can cause burns. Using an ice-pack for longer than 10 – 15 minutes is not indicated either, since your body accommodates for the cold and actually increases the blood flow to the area, which eliminates the effectiveness of the ice-pack. Another treatment mode is to alternate the hot and cold applications, this helps to stimulate the blood vessels to constrict and dilate, acting like a pump, to pump out the inflammation. During your injury phase you need to continue to move using normal movement patterns as much as possible. If you typically perform stretching exercises, then back off to about 25% of normal and progress yourself through the discomfort stage. If you typically do not perform any stretching or exercise, you need to keep walking during your typical day, encourage yourself to walk around the house, garden or neighborhood….ultimately you need to keep moving. You should consult your physician prior to taking any new or additional medication. But over the counter anti-inflammatory medicine, such as Ibuprophin, motirn, alieve can aide in the reduction of inflammation and thus in the reduction of pain. There are several topical analgesics that may help reduce pain, such as Ben-gay, biofreeze, benalog, and in addition there are “medicated” patches that can be placed over the area of pain. All of these may or may not be effective in reducing your pain symptoms. Just make sure you check you skin for break-down and allergic reaction, but over-all there is no harm in trying these topical treatments. Once you go to the doctor, you must adhere to your physician’s orders. You need to abide by the work restrictions, medications and therapies that are prescribed. If you have issues with your course of treatment, you need to consult with your physician.
- Discussion: think of your back as a lever, with the fulcrum in the center. If you keep the fulcrum in the center, the amount of pressure exerted onto the spine equals the amount of the weight that you are lifting. Your waist acts like the fulcrum in the lever system, it is a 10:1 ratio.
- Discussion: Demonstrate the improper position, with an empty box. So the result is, that a ten pound object places 100 pounds of pressure on your spine. The further away the object is from your waist, the greater amount of pressure placed on your spine.
- Discussion: The upper torso is the area from above the waist to the shoulders, unfortunately it where most of us carry additional weight.
- Discussion: As we demonstrated before, the wear and tear of the discs and surrounding tissues lead to injury over time. But with increased abdominal mass, the wear and tear is accentuated. Everyone talks about weight loss and I have certainly seen many patients that are thin with injured backs, so again what it really gets down to, is the use of correct body mechanics, working smart, knowing your lifting limits, changing your workstation to fit you and ultimately staying strong and flexible.
- Discussion: demonstration. Obviously, there are times that you are not able to perform the lift entirely correct, but think before you lift, “how can I minimize my exposure to injury during this lift”. Number one priority? Get as close to the object as you can, either by widening your base of support, bending your knees more, getting your butt down, using mechanical devices or by asking for assistance. Attempt to keep your spine in a neutral position and use your arms and legs to lift the object. I do not emphasize a straight back lift, since you can lift incorrectly using a straight back and perform a hinge type of movement from the waist (demonstrate); the emphasis is on raising with head and shoulders first, keeping the spine in neutral.
- Discussion: When you twist in the flexed position, you are essentially winding up your spine; (demonstrate with spine model or with a towel the compressive forces). In this position, compressive forces in the discs along with the stretching that occurs on the other structures is extremely dangerous. You need to look at your work station and assess how you can reduce or eliminate the need to twist during your day.
- Discussion: What can you do to your work environment to eliminate or reduce excessive reaching. Ask yourself, do you really need to stack the objects that high? Should you use a step stool? How do you have the objects situated? Heaviest at waist level, lightest on top and those items not routinely moved down low.
- Discussion: Awkward or odd shaped objects are difficult to lift and carry typically because it is so hard to get close to them. Again, you must assess your situation, use assistive devices, like a cart or dolly or ask for help.
- Discussion: When I look at job during my onsite analysis, I ask myself, “would I do that job that way?”, and “how can I make that job more comfortable” These are the questions that you must ask yourself. Everyone has a comfort zone in which they should work, if you feel like you are moving outside of what is comfortable for you, you must stop and assess the situation, typically you can come up with a solution to improve the work postures. Go over the pictures with the audience, get their feedback; discuss the significance of the postures in terms of cervical compression and lumbar extension; weight bearing through the knee caps, etc.
- Discussion: What position is harder on the spine? (discuss the difference in sitting and standing and the compressive spinal forces that occur in the spine). You need to try and alternate between the two positions if at all possible (this should be reviewed in terms of the work behaviors observed). If you have a job that requires you to sit most of the day, then you must make sure that the chair is fitting you correctly and that it is adjusted properly. In addition, you must make it a habit to get up out of your chair every 45 – 60 minutes and perform some type of stretching activity. Even if it is to just bend backwards a few times, do some laps of the cubicle and some shoulder rolls (demonstrate), this will improve the blood flow to the spine and lower extremities and ultimately change and improve the spinal compression. Typically, if you have a job that requires you to stand most of the day, you can change your position readily, by raising one foot onto a ledge/platform or leaning against a surface intermittently, all of which helps to maintain the vascular supply and reduce the compressive forces occurring in the spine. It is also important for those that stand for prolonged periods to stretch those muscles being used most often, like the calves and hamstrings.
- Discussion: You’ve seen the saying, “Safety is No Accident”. You have to make yourself aware of your environment and the areas that may potentially impact your day. If you work in an environment that has wet, slippery floors, make sure that you have good rubber soled shoes that will grip to the floor. If you work in an environment that is cold, such as a freezer, make sure you take the time to put on the correct clothing and protective gear….do not be in such a hurry, take your time to assess the situation, use good work decisions and get the task done correctly and ultimately safely.
- Note: The human spine as not designed to maintain a sitting position for long periods of time. Driving, working at your desk, spending time on a plane, sitting at the computer, and watching sports are all activities that can lead to back pain. The best way to avoid back strain is to get up every fifteen minutes or so and walk around. (If you are driving, pull over whenever convenient to stretch your legs.)If you sit for long periods at work, invest in a well-designed chair that supports your back and allows you to change positions easily. A cushion tucked behind your back while driving will help provide support and comfort.
- Discussion: Yes we have heard it all before. Open discussion with audience, why they need to… The studies show that most Americans are not getting adequate amounts of sleep. As we all know, sleep is the time when our minds and bodies are rejuvenated and the natural healing process from the days events can occur. As the saying goes, “you are what you eat”. Just as you work smart, you need to eat smart. You need to eat foods from the various food groups. If you are trying to lose weight, then eat smaller portions and less fatty foods. Do not try and cut out everything, you will be miserable and will not stick with the diet. The studies show that 30 minutes of moderate aerobic exercise, such as brisk walking, can improve your lung capacity, improve your metabolic rate and burn calories. For those of you just starting an exercise program, please check with your healthcare professional. Depending on the type of job (this should be based on the jobs observed), you can perform specific exercises that are specific to the muscle groups that you use during your work-day. You need to perform the exercises consistently and in a controlled fashion to gain the most from your efforts. The following are just a few exercises that can help to strengthen your leg and back musculature.
- Discussion: When you are performing your exercises, you need to be able to breath with minimal effort throughout the routine. Do not hold your breath, you muscles need the oxygen that your lungs and heart are supplying. Each exercise should be demonstrated with group participation. Again, these exercises should be based on the jobs observed and should be changed in the presentation to match the appropriate muscle groups.
- Discussion: Demonstrate proper technique. Discuss what muscle groups are being stretched and why these are important for a healthy back. Discuss the difference between stretching and the previous strengthening exercises. Place emphasis on breathing through the stretch, not holding the breath and performing within a pain free range of motion. The stretching may cause discomfort since the muscles are tight, but should cause pain.
- Discussion: Demonstrate proper technique and discuss what areas of the body will be affected. Emphasize that the stretch should not cause pain in the spine, but that it might not be all that comfortable. Demonstrate the stretch in standing, with emphasis on pelvic stabilization.
- Discussion: Wrap up concepts/ideas. Open answer/question session.