Back Injury Prevention

10/6/2010 Sharon Sharpe, ScD, ATC

Targeted Programs to

Reduce Risks of Injury

#1. The Back


The Problem: Back Pain and Injury


Back Injuries – IncidenceSince January 10, 2010

• Back Pain non-recordable 7

• Back Pain recordable 3

Days Out Alt Duty

– Kitchen 1 4 ?

– Bakery 0

– Packing 1 2

– Sanitation 1 90+


Causal Factors of Back Pain

• Employee factors (organic)– Genetics (family History)– Personal History of previous injury – Posture– Muscle imbalances

• Employee factors (performance)– Ergonomic (technique) errors

• Job Factors– Prolonged positioning– Sudden “unprotected” movements


What goes wrong and Why?

• How is it built?

• How does it work?

• How does it get injured?


What does your spine do?• The base for all

arm/leg activity (“core”)

• Must be both STABLEand MOBILE

• Each of the 26 joints contributes to mobility and stability

• Muscle support is CRITICAL


How is your spine supposed to work?


Spine: Like a Tent Pole,

only better (and worse)

• This tent pole is not straight, and has many parts – inherently unstable

• Spinal curves allow for absorption of impact forces. (Walking, running)

• Not really built for prolonged positions


Structure - BonesVertebrae

From Anthony CP, Kolthoff NJ: Textbook of anatomy and physiology, ed 9, St. Louis, 1975, Mosby.

BackFront

Front

Back


Structure - Joints between bones

Steven M Lobel, M.D. EVMS Dept of PMR

��Small movement Small movement

between any 2 between any 2

vertebraevertebrae

��There are 26 There are 26

jointsjoints……....

��Combine for Combine for

Large movements.Large movements.


Structure – Side view of inner spine

Bone

Disk

Bone


Structure – Discs and Nerves


What makes the spine hold it’s shape?


Muscles – Tent Fabric


Outer Layers - Shoulder Movers


Mid Layer –Trunk Movers

Global Muscles

Inner Layer –Sensors

Local Muscles


Local Muscles

–When activated,

position/motion

sensors, not motion

generators.

• How much motion is occuring between any 2 vertabrae??

• How fast?


Summarize: a stable spine….

– Stability

• How much motion is occuring

between any 2 vertabraewhen the trunk moves?

– Sensors off

– Sensors on


Muscle Function Differences

SensorsSensorsTrunk MoversTrunk MoversActivated After

Trunk Movers -

Over activatedOver activated

Sensors – Under Under

activatedactivated

Proper activation Proper activation

patternpattern

Increased (less Increased (less

stable)stable)Small, safeSmall, safeMotion in local

joint

Trunk MoversTrunk MoversSensorsSensorsActivated First

Past InjuryPast InjuryNever injuredNever injuredPatient History


Muscle Strength vs Endurance

• Position sensors need to be ON– ALL THE TIME, so that

excess movement between bones can be prevented.

– ENDURANCE

• Trunk Movers need to be ON– For stability most of the

time– Higher level when body

movement is required– ENDURANCE and

STRENGTH


Working Example: Posture

• Cause or effect?

– Does the posture cause muscle imbalance or

does muscle imbalance cause poor posture?


Working Example - Posture

http://www.nlm.nih.gov/medlineplus/ency/images/enc

y/fullsize/9583.jpg

‘Normal’ Spine –Balanced Muscle

Groups.Anterior Muscles –

Shortened, Strong

Posterior Muscles –

Stretched, Weak

Lordosis


Lordosis –1.Pelvis tilts forward

2.Butt sticks out� Shortened hip flexor ms.

� Lengthened, weak Glutes

� Tight Hamstrings

3.Forward head

4.Tight Calves

Factors –

Overweight

Pregnancy

Other….


Posture

Forward Head


Problem Summary

Employee causal factors

• Prolonged position > muscle fatigue > poor

activation/endurance > poor standing posture >

increased RISK.

• Lack of understanding of the potential

BENEFITS of conditioning and ergo training.

– Pre-shift stretching

– Micro breaks

– Proper work techniques

– Preventive conditioning program


Recent Evidence

• Bigos et al. Spine, 2009, High quality

controlled trials on preventing episodes of back problems: systematic literature review of working-age adults

– Reviewed studies on effects of exercise,

education, lumbar supports, shoe inserts and

programs to reduce lifted loads

– 17 high quality studies

– ONLY EXERCISE significantly reduced

episodes of back problems


LiveWell Job Specific conditioning

program

�Pre-shift stretches

• Wellness based

exercise programs


Ongoing Ergonomic Training

X

• Job rotation

• Micro breaks

• Correct lifting

• Proper job technique

• Aug. 2010 Training

•Still have back injuries


Potential for Risk Reduction

• Evidence shows: back pain incidence could

be prevented with exercise.

• Exercise which impacts…..Proper muscle activation timing

Hamstring and Hip Flexor flexibility

Abdominal and sensor muscle endurance


Fix it

1. Reduce Lordosis (restore muscle balance)

Stretch Tight Muscles (Hip Flexors, quads, Hams, calves)

Strengthen weakened muscles (Hip Extensors)

2. Learn muscle control

Activate local sensors FIRST

3. Work on muscle endurance of these systems

4. Report back pain EARLY


Wellness Based Programs

• Conditioning for all employees

• Preventive Stretching and Exercise, both initial

injury and RE injury.

• In addition to the Core 6 pre-shift exercises


Effective Conditioning

1. Loosen up

2. Stretch tight muscles

3. Exercise – activate and strengthen weak/strained muscles


Reduce Lordosis -

Stretching

• Hip Flexors

• Quads

• Hamstrings

• Calves


Activate Stabilizers of the Spine

Tighten the fabric

Stabilize the Pole

10/6/2010 Sharon Sharpe, ScD, ATC http://back-exercises.com/


Learning How to Activate

Draw in Exercise – Activates Inner Abs AND

Position Sensors

Focus on:

Pull belly button DOWN toward the spine

while abs are RELAXED.


Spine Control Strengthening

Progression - example

• Draw ins

• Pelvic Tilts

• Maintain Pelvic Tilt, raise 1 arm over head

– Both arms

• Maintain Pelvic Tilt, lift single leg bent

– Single leg straight

– “Cycle” legs

• Maintain Pelvic Tilt, Hands and Knees

progression


Resources Needed:• Space

• Mats

– 1 yoga mat for each team member OR 1

large floor mat

• Need to be cleaned after each use.

• Committed Leaders

– Trained in the exercises

– Give immediate, ONGOING feedback and

coaching on exercises

• Buy-in, ATTENDANCE/participation by

employees


Resources Needed

• Supervision/Training

– Initial Training for Leaders

– Ongoing training for Leaders

– Coaching/feedback with teams

– Outcomes measures collected/analyzed

• Ability to control pelvis

• Measures of comfort/discomfort (1 -10)

• Days missed

• Days limited/alternative duty

• Days full duty but with pain

• Others??


• Time

– Training of Leaders – 2 sessions x 45 min

– Initial Presentation to teams – 30 min

– Time for teams to exercise – 15 min

• Daily - optimal

• 3x/week - minimal

– Ongoing supervision/coaching -1-2 hrs/wk

• Sharon > Leaders

• Sharon > Teams

Resources Needed


Summary• Back Injuries are a problem

• Spine needs both stability and mobility

• Exercise programs reduce incidence of LBP– Stretch tight muscles, strengthen weak muscles

– Prevent excessive local joint motion • Activate small sensors (“draw in”) BEFORE activating LARGE

MOVERS.

– Control Pelvis (muscle balance)

• Program must have proper resources to be successful.


Reference Materials

Bigos, SJ et al. High-quality controlled trials on preventing episodes of back

problems: systematic literature review in working-age adults. Spine Journal.

2009 Feb;9(2):147-68.

Herzog,W., 2000. The Mechanical, Neuromuscular, and Physiologic Effects

Produced by Spinal Manipulation. In: Herzog,W. (Ed.), Clinical Biomechanics of

Spinal Manipulation, pp. 191-207. Churchill Livingstone, Philadelphia.

Margo, M. http://ebm.bmj.com/content/14/4/117

Mendoza, G. “Diagnosis and Treatment in the Lumbar Spine” Powerpoint

presentation, Boston University, Sargent College of Health and Rehabilitation

Science. Feb 2005.

Back Injury Prevention

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