February, 2009 Facts on Backs Keith Sullivan, PT BodyWorks Physical Therapy Inc. Edina,MN

Goals Educate you regarding anatomy and pathology. Instruct you in proper body mechanics, posture, and prevention. Discuss what physical therapy has to offer. Answer any questions you may have (if there is any time).

Reasons for Interest / Statistics Prevalence of Lower Back Pain Recurrence of Lower Back Pain

Prevalence of Lower Back Pain  80% of adults experience lower back pain severe enough to seek medical attention at some point in their lives; 100 million Americans per year.  The cost in lost work time and medical/legal expenses is over $60 billion per year.  There are over 300,000 back surgeries performed in this country per year.  Lower back injuries are most common in the year old age group.

Recurrence of Lower Back Pain  60% of those with back injuries reinjure their backs within the first year.  75% within the first two years. Our goal during this presentation is to help decrease those numbers and to help you prevent either the original injury or any re-injury if you have already experienced back problems.

Misconceptions  “Most back injuries are caused by accidents”  “Slipped discs”  “Back injuries are a recent phenomenon”  “Most people with back injuries are exaggerating or faking”  “All back injuries are the same”

This is the Spine  33 vertebrae separated by discs.  Primary functions are movement, protection of spinal cord, and maintaining posture in erect position.  “Mast of the Ship”

Cervical Thoracic Lumbar

The L-S Junction  90% of back problems occur between L4-5-S1.

Spinal Disc  Gel in center  Fibrous material surrounding nucleus  Watery when young - lose water with age.

Spinal Nerve

Bulging Disc

Spinal Problems Spondylolisthesis Compression Fracture

Muscles/Ligaments

Posture

Concept of Neutral Spine Critical times to be in neutral spine position 1. Increased force (lifting) 2. When maintaining one position for long duration (driving) 3. During repetitive action (bending)

Plumb Line

Prolonged Standing  Bar owners installed bar rails above the floor because people would stand there long with one foot up (and drink more beer).

Improper Sitting Posture

Correct Sitting Posture

 Keep work in front of you.  Raise work to 15º below eye level.  Use headset if on phone often.  Keep notes in front if dictating. Correct Sitting Posture

Resting Positions

Overhead Work  Use a step stool or ladder to keep work at chest or waist level

Get Down to Work Level Use knee pads.

Function

Moving Filing Cabinet  Pushing better than pulling.  This person needs to use neutral spine.

Lifting It’s important to bend your knees.

Center of Gravity  Center of gravity determines force on disc.  A ten pound weight held 3 feet away from chest feels like 100 lbs.  When lifting with straight legs - now feels like 1000 lbs.

Do Not Lift and Twist  This is how most injuries occur.  The weight of the object does not have to be large.  The number of time you do it is important.

Taking Groceries Out of Car  Break big tasks in to small ones.  Pull bags close  Lift in stages  Find neutral spine  Turn feet to avoid twisting  You could place your knee of

How Back Injuries Occur

Cumulative Trauma  It is very rare for a single event to injure a healthy back.  You are born with a clean slate.  The little things add up over time and can result in further injury.

Factors Contributing to LBP

Risk Factors  Being overweight  Incorrect lifting and body mechanics  Poor posture  Smoking  Poor physical condition  Stress  Poor nutrition  Poor flexibility

Physically Intense or Demanding Jobs

Flexed Positions (Sitting)  Similar to doing a standing toe touch for 8 hours.

Prolonged or Poor Sitting  We sit too much  Eat meals  Drive to work  Sit at desk  Etc.

Couch Potato  Overweight  Poor nutrition  Smoking  Sedentary lifestyle

Stress  Increases perception of pain  Makes you focus on it more

Poor Body Mechanics Due to Lack of Flexibility  Need sufficient hamstring length to bend over correctly.  In addition to flexibility you will need good quadriceps strength to squat.

Work Simplification and Body Mechanics

Work Simplification Techniques  Organization of work and home environment  Utilization of power saving devices (dollies, wheel barrows).  Reduction of steps in performing daily routines.

Assess task to:  Minimize risk  Minimize exertion  Maximize effectiveness

Review Lifting:  Bend knees  Keep back in neutral spine  Pull object close

Is this Box too Big to Lift?

Use a Dolly or Wheelbarrow

Swallow Your Pride and Get Help  Organize yourselves  Lift on “3”  Designate a leader  etc.

Closing Comments