Workplace back injuries are a big deal. There are more than 1 million back injuries per year in the U.S. alone, and about one of every four of all workers’ compensation indemnity claims involve back pain. The loss is measured in the billions of dollars.
That doesn’t even count the personal cost in loss of well-being (a euphemism for misery). I have had two low back surgeries, so my expertise is, unfortunately, more than academic. If serious low back pain is not on your bucket list, let’s figure out how to avoid it.
The low back is a complicated system of bones, muscles, cartilage, ligaments and nerves. At its simplest, the low back is a stack of 2-inch cylindrical bones, with cushions between them, hinged on one side to allow a little movement. This stack is attached to the pelvis. The spine is oriented up and down and sits on the pelvis, which is transversely oriented (sideways) – picture an upside down T. Most back trouble comes from where the spine is attached to the pelvis, which is called the L5-S1 or bottom disc.
Most back injuries understandably come from lifting, and the rest result from pushing, pulling and lowering.
Here are a few tips to keep in mind to avoid back injuries:
Pick ‘em: One way to reduce back injuries is to make sure the person selected to do the lifting is strong enough to physically do it. When you are operating at the limit of your strength, all thoughts of technique are ignored; you are just trying to survive. Strength testing before putting someone on a heavy lifting job can ensure their strength is appropriate for the job.
Train ‘em: Some variation of “back school” should be a part of anyone’s orientation to a lifting job. The basics include keeping heavy lifts between knees and shoulders. Getting outside of those limits puts more pressure on the back and takes more strength to perform.
- Weight needs to be kept close to the body. Any distance between the weight and your trunk acts as a lever magnifying the force on your low back.
- Lift with your back straight, or lift with your knees bent (another way of saying it). The point is to use your thigh muscles, which are some of the strongest muscles in the body, and are difficult to injure.
- Keep your lifts simple and sure. Get a good grip – many injuries occur while fumbling to improve your hold. Lift, then turn with your whole body. Combining a heavy lift with rotation puts complex forces on the back and increases the injury rate.
Remember to warm up if expecting to do some heavy lifting. Stretching is important before stressing any complex system. You instinctively know you should not start a car in extremely cold weather and immediately “floor it.” Something will break. The same goes for your body.
Next, look at the job and the job site. This primarily applies to a formal job where the person does specific lifting tasks. “Sanity in design” should be the motto. Are the floors skid proof? Can the employee physically get close enough to the load to safely lift it? Are there obstructions that limit the ability to lift safely? Can the load be lifted more safely by ordering smaller packages, doing a two-man lift or machinery assist?
Some jobs make safe lifting a challenge, at best. Take, for example, commercial airlines. Loading commercial passenger airline baggage has the physical dimensions of the plane to contend with. The cargo hold is only 4 feet high.
Compounding that, many passengers routinely travel with deceptively heavy bags. In this rather extreme case, the employer uses selection, training and administrative tools to reduce injuries. Bags are weighed and red- tagged if heavy, reducing surprises, which can cause injury. Fees discourage heavy bags. Machinery moves the bag to the level where it can be loaded with the least risk to back. Employees are tested for strength, flexibility and extensively trained.
Considerable reductions in back injuries have been accomplished, even in this challenging circumstance.
Back injury prevention is possible with attention to the whole dynamic surrounding the injury. The individual, the training, the work and the circumstances all need to be examined.
Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic.