Edition No. 15

Zavitz on Ergo:

Surviving the Holidays: The Top 10 Preventative Strategies to Reduce Low Back Pain

by Ben Zavitz, CPE

About Zavitz on Ergo

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Recently, ergo consultants at EORM were asked to provide a two-hour Back Safety/Lifting Training class for a client. I thought some of the information from the class would be of interest, especially during the holidays when we all do activities we don’t normally perform on a regular basis.

‘Tis the season for performing facility and workstation changes at your workplace; lifting heavy baskets and boxes of food and toys for the needy; setting up a holiday tree; or even pulling out, dusting off, and unfolding those cots for the relatives to sleep on. These “back protection” strategies will hopefully get you through the holidays and are applicable to both work and home activities.

Facts about Backs

Low Back Pain (LBP) is a common problem that affects at least two thirds of the population at some point in their life. Take a survey at your next staff meeting and you’ll be surprised at how many people suffer from LBP. Here are some Facts about Backs that you may not know.

LBP is a common problem for all types of people in all occupations.
LBP costs the US over $50 billion a year (including the medical, legal and loss productivity costs).
85 percent of LBP is idiopathic – meaning it is of unknown cause.
40-80% of people with LBP will have a reoccurrence.
The longer a person is off work due to LBP, the less likely they are to return to work.
Intervertebral discs are the primary source of LBP.
LBP is generally not a serious problem. The body typically heals itself within 4 weeks with or without medical treatment (for uncomplicated LBP).

Top 10 Preventative Strategies to Reduce LBP

These ten strategies, which can be applied to both work and home activities, will reduce the load on the spine and minimize the risk of LBP.

1. Design Activities that Facilitate Variety
The single most important guideline should be not to do too much of any one thing. Scientific studies have shown that reducing peak and cumulative shear and compressive loads on the spine and surrounding tissues minimizes the risk of injury. Both too much and too little loading is detrimental (a.k.a. the Three Little Bears Syndrome). Ways to add variety include: varying your posture frequently (sitting, standing, shifting your weight, placing your foot on a footrest), or performing activities that use different muscles.

2. Preserve the Curves
When performing any activity that requires bending or lifting, always preserve the natural lumbar spine curvature and avoid end range of motion (flexion or extension). The natural lumbar spine curvature is called lordosis (the natural “C” shape of the spine when standing). Rounding the back, or kyphosis, increases the shear forces on the spine and magnifies the risk of disc herniation, ligament tears and sprains, and neural arch (posterior bony elements) damage. Ways to preserve the curves include: locking your spine in its neutral position (lordosis) and rotating your upper body about your hips.

3. Minimize Reaction Moment / Torque
When performing activities that require forceful exertions (lifting, carrying, pushing or pulling), choose a posture that minimizes reaction torque on the lower back and keeps the external load close to the body. Ways to minimize reaction moment or torque include: keeping objects to be lifted as close as possible to your belly button; keeping your upper body as straight as possible (remember your upper body weighs 50% of your total weight – if you lift a 20lb. box, and you weigh 200lbs., in reality you are lifting 120lbs., not the 20lbs. of the box!); and when exerting force with the hands or shoulders, directing the line of force through the lower back (pull towards your belly button, not off to the side). This strategy can also be applied when opening doors or vacuuming.

4. Divert the Force around the Lumbar Spine
Using your hand or forearm to build a bridge that supports your upper body when lifting will minimize the force on the spine. Ways to employ this technique include: placing your hand on a table or your knee when grabbing or lifting something; resting your forearm on your thigh when lifting a shovel full of snow, for instance, and using your thigh to assist with lifting.

5. Avoid Twisting and Simultaneous High Twisting Torques
Twisting motions with the generation of high twisting torques reduces the intrinsic strength of the disc, disabling some of its supporting fibers, and increases the stress on the remaining fibers under load. Always avoid twisting the back while exerting force.

6. Avoid Exertion Immediately After Prolonged Flexion
Studies have shown that prolonged flexion causes changes to the discs and ligaments that reduce their stability and increase the risk of injury. After performing prolonged stooping or sitting activities, spend time standing upright to allow the discs to equilibrate and the ligaments to regain their stiffness.

7. Avoid Prolonged Sitting
Studies have shown an association with prolonged sitting and disc herniation. This is due to the mechanical changes that occur to the discs with prolonged seated postures. Ways to avoid LBP from prolonged sitting include: using an ergonomic chair and using it properly (very few actually do – see #1 above); standing up every 50 minutes for at least 20 seconds; and integrating non-sitting activities with sitting activities.

8. Avoid Lifting and Bending Shortly After Rising from Bed
At night the spine absorbs more fluid than normal and as result in the morning the spine is stiffer and more vulnerable to injury. It is best to wait for 1-2 hours after rising to perform bending and lifting tasks.

9. Maintain a Reasonable Level of Fitness
Performing a regular exercise program designed to improve whole body muscular strength and endurance and improve core muscle strength and spine stability is recommended. Three exercises that are beneficial to relieve LBP include: 1) brisk walking while swinging the arms; 2) the cat/camel motion; and 3) extension exercises (i.e. leg extensions, birddog/superman stretch, and McKenzie exercises). NOTE: Consultant a physician prior to starting or performing any exercise routine.

10. Control the Pain and Remain Active
When faced with LBP, (especially this time of year) don’t stop all activities and remain in bed. Bed rest is one of the worst things you can do (again, see #1 above). Ways to control pain and promote recovery include: use over the counter medicines to control pain (aspirin, acetaminophen, ibuprofen, etc), remain as active as the pain permits and continue normal daily activities. This helps to promote a faster recovery, faster return to work, and less chronic disability.

And Finally…

If we know that two thirds of the population will experience LBP, shouldn’t be the goal of organizations to design workplaces and jobs that would allow employees with LBP to continue working at their regular jobs?

Please contact me if you would like to learn more about our customized ergonomic and back safety training classes.

Have a safe and prosperous New Year.

Ergonomically Yours,

Ben Zavitz, CPE
EORM, Inc.
zavitzb@eorm.com.
tel: 781.938.9152 ext 106