Back School 101 Back to Health

1. Lower Back Strains and Sprains Back School 101Back to Health Lunch and Learn

2. Background Information • 70 – 80% of all people have back pain at some time in their life. • It is the most frequent cause of activity limitation in people younger than 45 years old. • 10% of chronic back pain sufferers account for 80% of the cost for LBP patients.

3. What Causes LBP • Overuse, strenuous activity, or improper use such as twisting while carrying a load • Trauma/injury/fracture • Degeneration of changes • Obesity

4. Additional Causes that Effect the Spine • Poor muscle tone • Muscle tension or spasm • Sprains and strains • Ligament or muscle tears • Joint problems • Smoking • Herniated (slipped) disc • Disease (i.e., osteoarthritis, spondylitis, compression fractures)

5. Anatomy of the spine • Spinal Nerves-Motor and Sensory • C1-C8: Neck, Shoulders, Arms • T1-T12: Chest, Upper, Abdominals • L1-L5: Legs and Feet • Sacral: Leg and Feet

6. Disk Anatomy

7. Soft tissue structures of the spine • Ligaments-hold bones and joints together • Tendon and fascia connect muscle to bone

8. Soft spine structures • Ligaments, muscles, and nerves provide stability to the spine. • Poor spine posture causes small amounts of damage to the spine. • You may not feel it at first. With time, small amounts of damage add up.

9. Back muscles Multifidis • The multifidi muscles support and stabilize the spine

10. Back Muscles TA The transverse abdominal muscle, wraps around the low back and abdomen.Helps us to walk.

11. Other back muscles of the low back • The latissimus dorsi muscle connects the back and upper arm • The gluteus maximus muscles connect to the pelvis and sides of the back.

12. Conditions of the Spine

13. Common Disorders Lumbar Strain A lumbar strain is an injury to the lower back, which results in damaged tendons and muscles that spasm and feel sore. 

14. Lumbar Strain Risk Factors • Excessive lower back curvature • Forward-tilted pelvis (lordosis) • Weak back and/or abdominal muscles • Tight hamstrings • Poor Body Mechanics

15. Self Care Guidelines • Use ice initially x 15 minutes every 2-3 hours. Then alternate or try heat • Avoid bed rest for more than two days. • Take OTC NSAIDS like Aleve, ibuprofen, or aspirin with food regularly for first three days according to manufacturers directions • Move as much as possible-stay active and continue usual activities. Avoid sedentary activities. Walk. • If you are working, continue to work. • If off work, return sooner rather than later to avoid

16. Medical Treatment • Physical Therapy • E-stim, Ultrasound, Heat, Ice • Manual Therapy: soft tissue mobilization, • Therapeutic Exercise, Pilates, Yoga • Stretches • Home Exercise Program • Rx NSAIDS-Naprosyn, Ibuprofen, etc • Muscle relaxants

17. Disc Herniation

18. Disc Herniation Treatment • Conservative Treatment starts with Physical Therapy • E-stim, Ultrasound, Heat, Ice • Soft Tissue massage • Extension Exercises, Therapeutic Exercise • Pilates, Yoga • Steroid Injections • Surgery

19. Osteoarthritis • Chronic disease involving the joints. characterized by: • Destruction of cartilage • Overgrowth of bone • Spur formation • Impaired function • Seen on weight bearing joints; knee, hip, and spine.

20. Treatment of OA –Self Care • Stay active and keep moving • Ice when acute • Heat when sore • Anti-inflammatories (prescribed or OTC) • Use time not pain as guide for gradually resuming activities

21. Prevention of low back injuries • Proper lifting techniques and body mechanics • Develop strong core muscles with exercise. • Engage in aerobic exercise-Oxygenates & maintains muscle. • Stretch before and after exercise or strenuous work activities. • Care for sore muscles before they worsen • Maintain good posture standing/walking and sitting

22. Body mechanics of lifting • The spine acts like a lever. Weight in front creates a force on the spine. • Lack of counter force causes strain on muscles. 35 lbs 35 lbs

23. Standing Posture • Ears over Shoulders • Shoulders over Hips • Hips over Ankles

24. Sitting Posture • Same as Standing • Back flat against chair • Knees/Hips at 90 degrees

25. Job Specific Examples • Opening Bay doors • Reaching cases • Reaching for bottles and cans off floor • Getting into trucks and forklifts • Lifting and carrying cases

26. Lifting and reachingWhat’s wrong/right? • Use both arms to lift bay doors • Get close to the item. Support knees against product or side of truck. • Bring product closer to you. • Grasp the item firmly, and lift by extending your hips while keeping the slight inward curve in your low back.

27. Bending and placing –what’s wrong/right? • Face the product • Bend from your hips, not your low back. • Pivot your feet in the direction you are moving, rather than twisting with your back.

28. Balance • BALANCE IS KEY • Back stays straight • If too heavy: • Squat lift • Don’t Kick the person behind you!!!!

29. Body Mechanics!!!!!!Lifting a Box • Lift with legs • Hold object close to body • Carry with a straight back

30. Stretches and Exercises • Pelvic Tilt - Gently roll your pelvis back and forth. 10-20 times gently

31. Cat and Camel • Gently roll your pelvis back and forth.

32. Aerobic exercise • Begin aerobic conditioning soon after the onset of low back pain, usually within two weeks. • Recommended to help you avoid potential debilitating effects of back pain, such as spine inflexibility, muscle weakness, and weight gain

33. Core exercises • Multifidus Muscle Activation • Place one or more fingers up and down the sides of your lower spine, just next to the bony bumps in the center of your low back. Gently tap or press on the multifidus muscles as shown by your therapist. Attempt to lightly engage the muscle under your fingers.

34. Transverse abdominals Concentrate on bringing your belly button toward your spine. Breathe normally as you draw your lower abdomen in.

35. Hinged squat • Place one arm behind your low back. Put your other hand lightly on your abdomen. Draw your abdominals in, setting your core muscles. Hinge forward bending slightly at your hips and bending your knees. Feel your trunk with your hands as you move to make sure your back stays in neutral.

36. Stomach Lying • For some people stomach lying can help to ease their back pain, "unload" the discs, relax muscles and improve nutrition to the structures of the back.

37. Back lying • Lying on your back with your knees supported takes pressure off the sore joints in the spine, widens the bony canals where the spinal nerve roots pass between the vertebrae, which can help take pressure off spinal nerve roots. • Deep breathing

38. Sitting An inward curve of the low back balances the spine and protects it from unnecessary strain. This alignment relaxes the tissues of the spine. Slouching, or staying in one position for too long can make back pain worse. Sitting raises pressure markedly within the disc Take breaks often to get up, stretch out, and move around.

39. Log Rolling • "log roll" is a way to get in or out of bed without twisting your spine.

40. Employee Behavior… Employee Injury… Three Year Injury History In PBC Lifting Bending Twisting Overexertion Reaching Pushing / Pulling 51% of all = STRAINS Coaching tips for handling PBC product and equipment: • Bend knees and use legs when lifting and lowering product • Do not bend at the waist when lifting and lowering • Mental effort to eliminate / minimize overexertion situations • Mental effort to eliminate / minimize over-reaching situations • Understand the risk of twisting and awkward postures • Understand the added risk of overexerting and twisting and being • in an awkward position all at the same time. Reinforce during Training, Behavior Observations, and MBWA’s…

41. Employee Job Hurt Statements…STRAINS History Lesson Nothing New Under The Sun

42. Back Math & Numbers Lesson Upper torso weighs 100 lbs. for the average person Improper lifting technique adds a stress factor to the lower back of 10 times the actual weight

43. 1200 Pounds of 12 oz. Cans A case of 12 ounce cans weighs 20 lbs. 1200 lbs. of pressure can be placed on your lower back when lifting a case of 12 ounce cans

44. Stretching For Health & Safety Stretching before work minimizes chances of injury significantly…some studies say as much as 40%. The following Stretches will help you warm up at the beginning of the day, and keep you flexible all day long! • Stretching Guidelines • Do each stretch 3 times • Don’t bounce - it causes muscles to tighten • If you feel pain you may be stretching too far • Hold each stretch 12-15 seconds • Take it slow, breath normally • Stretch a few times during the day Shoulder StretchStanding Side StretchTriceps StretchLow Back StretchQuad Stretch

45. Good vs. Bad Technique Less Strain More Strain Weak Strong

46. Lever Ratio - Demonstrating the power of a lever, have volunteer try to pick up the handcart loaded differently. Right Wrong

47. Back Anatomy Lesson