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Preventing and managing back injuries.

Preventing and Managing Back Injuries

It is estimated that approximately 31 million Americans suffer from the costly hazard of work-related low back pain, and 13 million of these sufferers' functioning is impaired due to the ailment. Back pain can be blamed for a quarter of all work days missed, as well as annual medical treatment costs from $15 million to $20 billion.

But some industries, according to the Journal of Occupational Medicine, have a higher incidence of back pain and present a greater risk. Among them are construction, mining, transportation and manufacturing. In addition, such occupations as garbage collector, warehouse worker, auto mechanic and nurse's aide and such activities as manual handling tasks, lifting, twisting, bending and falling are prone to back strain.

However, the relatively sedentary desk worker is by no means exempt from back pain. Sitting for hours with poor posture while staring at a video display terminal can cause ligaments and surrounding soft tissues in the neck and back to be overstretched. And it is such prolonged overstretching that's the real culprit underlying so many aches and pains.

Not only is back pain common and costly to workers and industry, treatment procedures frequently provide only short-term relief. In a recent study conducted by Seattle Veterans Affairs Medical Center, 145 patients were treated with the popular transcutaneous electrical nerve simulation device. Results showed the device to be no more effective than no treatment at all.

Viewed within a broader context, experts are generally aware that musculoskeletal injury and spinal dysfunction tend to be self-limiting with individuals usually getting better on their own, with or without treatment. While short-term relief modalities cannot seem to resolve the problem, they appear harmless, except that they may depress those patients who despair of finding any lasting relief for their pain.

Such modalities also frustrate bill-paying employers and workers' compensation carriers which receive endless invoices for treatments that do not bring their injured employees back to work. Contributing factors include widespread ignorance of back biomechanics and a corresponding degree of passivity among employees and employers to comply with expensive, ineffective treatment modalities.

What is needed is a basic understanding of what the back does and how it works. The back's muscular tissues are threaded by the "backbone," or spine which is a series of 33 vertebrae, mostly separated by intervertebral discs. The spinal cord runs through the center of these discs and ultimately feeds out to every area of the body in a tree-like "foliation" of spinal nerves. Back injury is so painful because its damage often puts pressure on the body's nerve supply.

The main function of the back, aside from protecting the spinal cord, is to simultaneously provide stability and mobility for the trunk of the body. To do this, the vertebrae are stacked on top of each other in a series of normal curves. These curves, including the lordosis in the cervical and lumbar regions of the spine, allow for the least wear and tear on the vertebrae. They also provide the best upper body balance and the greatest freedom of movement.

The lumbar and cervical lordosis play an important role in preventing and treating neck and back pain. The relate to a therapeutic theory and treatment methodology developed by the New Zealand physical therapist Robin McKenzie during the 1950s. The McKenzie Method has been successful in reducing and eliminating the neck and back pain of 70 percent of those suffering from these ailments.

Mr. McKenzie discerned that the majority of bodily aches and pains have the same basic causes. They are the result of something as simple as chronic poor posture combined with faulty body mechanics such as bending at the waist, instead of at the knees, to pick up a pencil.

How can poor posture have such a devastating effect on so many people? The back functions optimaly only when the lumbar lordosis, or slight curve in the small of the back, is maintained. The lordosis keeps the intervertebral discs and surrounding ligaments in a neutral position producing minimal back strain. But this is easily lost when poor posture distorts spinal alignment, forcing the ligaments to compensate by overstretching. Years of overstretching can result in permanent ligament and soft tissue damage and lead to recurring low back pain.

The Exercises

As the mystery surrounding back pain dissolves, the concept of individual responsibility for a pain-free back must be asserted. The idea that sufferers are responsible for their own treatment, albeit with professional help, was emphasized by Mr. McKenzie. Indeed, it is inseparable from his therapeutic treatment, which requires active participation. Patients must make a commitment to complete in many cases repeated daily exercises that are central to the McKenzie Method.

For lower back pain, the McKenzie Method offers a series of exercises that are simple but highly effective in reducing or eliminating pain. They are not the calisthenics practiced in an exercise class, but instead more closely resemble yoga postures. Patients are asked to do a series of test movements to determine which McKenzie exercise would work best.

One that might be used for pain in the lower back begins with the patient lying face down on the floor, hands at either side. Placing the hands beside the shoulders, the patient thrusts gently against the floor, raising the upper body and holding this pose briefly. The number of times the exercise should be repeated will be determined by the practitioner.

But there is an alternative to the traditional and expensive route of a physician's and/or therapist's care. A back school approach to preventing occupational back injury returns control and responsibility to the employer and employee. Back school is an on-site, hands-on educational program that can drastically alter the way workers do their jobs and the degree to which they subsequently become injury-free. Each program is designed to fit a company's demands, but there is a basic "core curriculum" they all should share.

An introductory lecture provides information on anatomy and physiology, risk factors contributing to spinal dysfunction, background material regarding proper posture and body mechanics and exercises to maintain a healthy back. The lecture is followed by a demonstration of proper and improper posture. Lab sessions can also be included to provide exercises to resolve specific work problems. Mock work stations can be used to improve material handling techniques, under practitioner supervision. In addition, the facility will usually be toured by the practitioner to evaluate the need for ergonomic modifications. By combining improved worker technique with improved work site design, the risk of injury is greatly reduced.

Program costs can be quickly recovered. One need only think about the savings generated by preventing just one worker injury. Also, workers may become more aware of safety concerns, take shorter leaves of absence and improve their performance.

Eli Glick is a physical therapist with Phy-Care of Flourtown and Bala Cynwyd, PA.
COPYRIGHT 1991 Risk Management Society Publishing, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1991 Gale, Cengage Learning. All rights reserved.

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Author:Glick, Eli
Publication:Risk Management
Date:Oct 1, 1991
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