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23 May 2006

Does work give you a pain in the back?

With simple and often common sense practices, many back complaints and injuries can be avoided or even cured.

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With simple and often common sense practices, many back complaints and injuries can be avoided or even cured.

Backache is the second most common reason for a visit to the doctor in America - behind the common cold and is the third most common reason for hospitalisation in America.

While only 15 percent of those suffering from spinal problems suffer from specific lower back pain resulting from tumours, inflammatory disease and infection, a massive 85 percent of all back pain is none specific - cause unknown - but just as debilitating, costing millions annually in terms of medical bills and lost productivity.

South Africans have not escaped this problem either and in fact, disorders of the lower back have reached epidemic proportions. Upper back pain combined with neck pain is the most common complaint followed by lower back pain and then, a combination of both. Adding to the discomfort, nearly all sufferers have referred pain in other regions. Those with upper back pain, often also experience pain in the shoulders and arms while those suffering from lower lumbar discomfort frequently experience pain in the hips and legs.

Mechanical disorders are believed to be the primary cause of back problems. Normal stresses on soft tissue do not cause pain but, where tissue has been damaged, normal stress will result in discomfort. Likewise, abnormal stress on normal or abnormal tissue will also result in pain. Any stress on the soft tissues of the spine can cause tiny injuries to the tissue. As the spine is forced to take that stress day in and day out, those tiny injuries eventually result in degeneration of the tissues; reduction in cushioning between the spinal vertebrae and quite probably, relatively serious back problems.

The type of work one does may put extra strain on the body, causing discomfort and tiredness as well as pain to the back, shoulders and neck. If the job you do involves any of the following, you are at risk and need to take extra care in ensuring that you know how to prevent spinal problems.

  • sitting or standing for long periods
  • repetitive production work
  • lifting and carrying heavy objects
  • bending and twisting actions
  • working in awkward positions
  • walking
  • Physiotherapy in the workplace

    Employers will find it in their own interests as well as that of their staff to consult a physiotherapist to ensure that the best possible constitutions exist to protect staff against spinal injury and chronic backache and, in so doing preventing their businesses from suffering profit loss as a result of reduced manpower and man-hours in a month.

    Physiotherapists will also be able to advise both the employer and the employee as to the best manner of doing jobs that contain some risk, so that the dangers can at least be minimised.

    If a worker is injured on the job the physiotherapist will be able to assess the cause of the injury and provide effective treatment to promote speedy and full recovery to the benefit of both the worker and employer. He or she will also draw up special programmes for injured workers returning to work and advise them and their employers as to what type of labour they may safely undertake during the healing process so that they may remain productive without the risk of re-injuring themselves or aggravating the injury.

    Walking

    Work that involves a lot of walking can also put stress on the back and cause problems if one does not walk with the spine in mind. When standing or walking one should stand up straight, walk tall, tighten the stomach and buttock muscles and make sure that the bodyweight is carried over the front part of the foot. Walking with a longer stride is less tiring and less stressful for the spine as it reduced jerkiness.

    Shoes are also important. Anyone in a job that requires standing or walking for long periods should invest in supportive, well-cushioned shoes, which reduce the impact on the back.

    Lumbago

    Also called lower back pain, this is the most common of all back complaints and also one of the easiest to avoid. Lumbago is generally caused by excessive stress placed on the spine during twisting and lifting activities. The action produces pain and muscle spasm which makes movement difficult and work, often impossible. Fortunately, Lumbago is easy to treat and 90 percent of sufferers return to full productivity within two weeks. The point is, however, that lumbago can, in most cases, be prevented completely by following some basic rules of lifting and carrying.

    Lifting and Carrying

    Most back injuries in the workplace as well as in the home are incurred as a result of incorrect lifting and carrying of heavy or bulky objects. Learning how to lift properly can prevent a lot of backache, injury and loss of production as a result of time off work.

    Ideally a worker should have access to cranes and trolleys to lift and carry heavy items but this is not always possible. There are, however, several things that every worker can do to reduce the risk of back injury.

    Back injuries and strain usually occur as a result of unexpected happenings for which the employee is not prepared when he or she tries to lift an object which results in a jerking and jarring of the spine. The main potentially painful surprises are lifting boxes thought to be light which turn out to be very heavy; mistiming two-man lifts; and the jarring that results from trying to lift something that is actually stuck to the floor or wedged in somewhere and just will not budge.

    Avoiding injury

    When lifting a heavy object, static lifting should be avoided. Instead, one should use one's whole body - especially the leg muscles to assist in the lift and to avoid making the spine take all the stress. If an object cannot be lifted, it should be pulled rather than pushed to where it needs to be taken. Pushing slumps the muscles whereas pulling braces them, providing more power and again protecting the spine from unnecessary stress and strain.

    When carrying a heavy object one should hold it as close to the body as possible and as near to the body's centre of gravity as is practical - in line with the waist or hips. Carrying an object at arms length to avoid getting clothes dirty is looking for trouble. It puts 10 times more stress on the spine than holding an object next to the body. Where dirt is a problem, overalls should be worn so that there is no temptation to sacrifice spinal safety for the sake of not getting clothes grubby.

    Using the crook of the elbow to support a weight is also a good idea as this too reduces excessive stress on the back and keeps the weight close to the centre of gravity. If one has to lift an object with one hand, one should put the other hand on the leg or a table to stabilise the weight. This too will ease the stress on the back.

    Before attempting to lift an object staff should always check to see if they can lift it alone or, if it is really a job for two people. If two people are needed to lift the object it is essential that they make sure to lift simultaneously. Where one person is slow to take their share of the weight, wrenching back injuries can occur in the person who is suddenly left holding all the weight with just one side of the body as this exerts tremendous pressure on the vertebrae. Again, before any attempt is made to lift the item, the workers should ensure that it can actually be moved.

    Before lifting an object, staff should be advised to get as close to it as possible and place the feet around it, to either side of it or, just behind it rather than to just one side. The hips and shoulders should be facing the same direction so that the spine is kept in a straight line. All bending should be done from the hips and knees and not from the back.

    It is a good idea to follow the procedure adopted by professional weight lifters as they go in for a heavy lift. Go down on one knee and then lift the object off the ground. Bring the object up as high as possible as early as possible as this limits the time during which the spine is taking most of the stress.

    Avoiding injury continued

    A lot of lifting can be avoided by storing heavy or bulky items that are in frequent use on shelves at waist height so that one need not bend awkwardly to reach them and so that they need not be lifted so far before they are at a safe carrying height.

    Fitness & Warming Up

    Manual labour is a form of exercise and just as one warms up and stretches before doing any sort of sport, workers should also make it a habit to warm up before they begin work. Warm muscles are less prone to tearing and are better able to cope with strain than cold muscles.

    Physiotherapists working in the occupational field can be consulted to design specific stretching and warm up exercise programmes for companies that, by ensuring that their employees are warmed up before they begin strenuous activity, will protect them to a greater degree against muscle tears and similar injury than they would be if they started 'cold'.

    It is also important for workers involved in heavy manual labour to keep themselves fit. This means that they should not only concentrate on good posture and good warm up habits before they begin work, but that they should maintain good general fitness away from their work.

    Swimming is an excellent way to increase the strength in the back muscles. Breaststroke is preferable to crawl, because crawl has a tendency to cause a rolling, twisting movement of the spine as one turns to breathe.

    Bending and Leaning

    Employees who have to work in leaning positions or in any situation where the back is bent should take the time to straighten up and stretch their backs frequently. This applies especially to construction workers who are often required to work at awkward angles and need to bend or stretch to reach places in which they need to work.

    Invertebral disc pressure increases by 20 percent when one leans forward at an angle of 20 degrees compared to the pressure present when one is standing normally. Increasing the leaning angle to 40 degrees causes the pressure to rise to 100% - doubling the normal pressure. The more bending and leaning a job requires, the more the discs are compressed and the more strain they have to support. Continual stressing of the discs can eventually lead to degenerative joint and disc disorders.

    Forward bending is achieved by flexing the hips and lumbar spine. Most people tend to move the spine rather than the hips when leaning forward, resulting in continual micro-injury of the lower back.

    Sedentary workers

    While the stress and strain and the consequent risk of back problems may be obvious among those whose jobs require a lot of physical labour, most of the sedentary jobs are in fact the ones which cause the most spinal problems and which are the biggest causes of chronic back pain. In many instances the fact that this has been laughed off - precisely because the stress caused by incorrect sitting wasn't obvious - may have contributed to and aggravated the problem

    Surveys regularly show that virtually every desk-bound worker can point to some back problem that can be attributed directly to his or her profession. In a frightening number of cases this problem and the associated pain is quite severe. Asked to rate the pain on a level of 0 to 5 with five the most severe, the average rating among sedentary workers is a 3 while close on 13% rated the severity as a 5.

    There are two primary factors that make sedentary office work notorious for contributing to spinal problems and both are easily avoidable. The first is purely and simply, bad posture. Most people do not sit properly - they slouch. This puts undue strain on the back muscles, which eventually weakens them.

    Secondly, few people have workstations that are ergonomically designed to suit their particular measurements in terms of both height and reach. Just as it is crucial for a cyclist to have a bicycle that is altered for his or her specific frame, so too is it important that office workers have a chair and desk that is suited to their body dimensions as well as the task they are performing.

    The fixed postures associated with many computer-operating jobs can also lead to spinal problems, particularly of the neck. These problems manifest themselves in the form of headaches and neck pain. The biggest culprit in causing this type of discomfort is the tilting forward of the head which causes an increase in the static loading on the back neck muscles.

    Factors, which contribute to these complaints, include:

    • Non-movable keyboards that cannot be adjusted to the user's requirements
    • absence of document holders for typing so that the user is forced to look down and to the side when copy typing;
    • lack of arm supports on chairs, causing the shoulders to take up additional weight and resulting in a forward slump;
    • chairs not designed for the user, that are either too high or too low in relation to the workstation and the floor;
    • poor sitting posture
    • incorrect sitting positions

    Sitting positions

    How one sits can also have a dramatic effect on one's susceptibility to spinal complaints. One's chair should allow one to sit as far back as possible with the spine supported and the feet placed flat on the floor. Any space between the spine and the back of the chair should be filled to provide sufficient support.

    Many people like to sit on one foot; sit with their legs crossed; or even rest one foot on the knee of the other leg. All these positions are detrimental to the spine. As they are asymmetrical sitting positions, they place added strain on one side of the body. In the first position, for instance, where the foot is tucked under the bottom, one shoulder is automatically lowered, causing a shortening of the trunk on one side. In addition, the pelvis on the other side is raised and the whole spine is curved in the opposite direction to maintain balance.

    Workers who slouch at their desks place great strain on the upper part of the thoracic spine. The thoracic spine is also the least flexible part of the back. This strain inevitably leads to a rounding of the upper body.

    A curved back leads to forward movement of the shoulders, shortening of the pectoral muscles and eventually fixing of the shoulders in a forward, hunched manner. The only way to overcome these problems is to ensure that all staff have workstations that allow them to work comfortably while maintaining normal and correct postures.

    Incorrect seat height is the most critical contributing factor to backache and neck tension. Ideally every staff member should be able to sit with their feet placed flat on the ground and their knees bent to ninety degrees. When one cannot sit with one's feet placed flat on the floor, the spine is not properly supported resulting in poor posture and subsequent muscle fatigue. When the seat is high in comparison to the desk, the back is strained as the person is forced to bend forward to work.

    Special considerations need to be taken when using a swivel chair. There should be a hard surface under the chair so that one does not have to push too hard to move about. If the office is carpeted, carpet protectors under the seat will assist movement. Five-wheel chairs are preferable to four-wheel varieties as they allow for easier movement and put less strain on the back.

    Ergonomic workstations

    True, it may be more expensive initially at least to provide each employee with a desk and chair that can be adjusted to suit his or her specific requirements but, it may well also prove to be an excellent investment when one considers the loss of productivity businesses experience as a result of back and associated problems. Ergonomically designed workplaces may well prove extremely viable and cost effective for those companies relying on a large administrative and secretarial staff.

    Employers should also consider slanted desktops wherever practical as this prevents sustained forward stretching of the neck. This type of desk is particularly beneficial to people such as architects, designers and engineers who spend long periods pouring over documents.

    Ergonomic workstations continued

    Placement of the computer workstation in relation to one's sitting position is crucial. The computer screen should be positioned so that it is at the correct height and also not at an angle. The head should not have to be turned to see the screen nor should the neck have to be stretched forward or tilted to one side.

    Ideally, screens should be situated directly in front of users and only the eyes should have to make any adjustment - and that should be slightly downwards.

    Taking frequent breaks from sitting at the desk, doing stretches and varying tasks during the day will make a significant difference to alleviating some of the discomfort felt. Workers should make sure that they stand up and stop working for five to 10 minutes to perform exercises designed to relieve muscle tension and improve the circulation.

    While the benefits to the employee are obvious, allowing staff these exercise breaks will also benefit employers by increasing work capacity and productivity as a result of reduced stress levels and reduced loss of man hours due to debilitating back and neck problems. Teaching workers how they can care for their spines and applying those practices in the work environment will also contribute greatly to a drop in back complaints.

    Information from the South African Association of Physiotherapy (SASP)

     
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