1. Prevention and Management of Neck and Back Injuries James Grubinskas DC, CEAS Chiropractor Alliance Occupational Medicine

2.  Understand proper posture to prevent neck & back injuries  Understand the types of neck & back injuries  Understand risk factors associated with neck & back injuries  Understand the common causes of neck & back injuries  Identify ways to prevent neck & back injuries  Identify what to do in the event your neck or back is injured Objectives

3.  Financial impact of occupational injury and illness in the US is $250 Billion (2007) affecting 3.8 million injured workers  Back injuries account for 1 out of 5 workplace injuries or illnesses (Bureau of Labor Statistics)  186 million work days are lost each year to back pain alone. Statistics

4. 37.5% of adults are currently obese CA. WC Institute claims with obesity as a comorbity vs. those without had the following characteristics: - more claims lost time from work (83% vs. 29%) - increased lost work days (approx. 80% greater) - more frequent attorney involvement (approx. 68% vs. 15%) - greater use of opiods (approx. 69% vs. 19%) - higher medical cost claims ($51K vs. $7503) and indemnity costs ($59K vs. $5400) Impact of Obesity on Musculoskeletal Disorders and WC Costs

5. - Age - Gender - Genetic Predisposition - Smoking - Weight - Prior Injuries - Hobbies - Medical Conditions (diabetes, RA, thyroid disease, heart disease, liver, kidney disfunction) Non Work Combined Medical Conditions

6. Neck Pain Neck muscle pain can be caused by the following neck muscles becoming tight. Scalene muscles (three pairs of muscles that help rotate the neck) Suboccipital muscles (four pairs of muscles used to rotate the head) Pectoralis minor muscles (a pair of thin triangular muscles at the upper part of the chest) Subscapularis muscles (a pair of large triangular muscles near each shoulder joint) Levator scapulae muscles (a pair of muscles located at the back and side of the neck). If alignment of head and spine is not optimal, the neck can be predisposed to injury and/or the degenerative effects of wear and tear over time.

7. Top 3 Bad Postures That Can Cause Neck Pain 1) Hunchback 2) Rounded Shoulder 3)Forward Head

8. Bad Posture #1 - Hunchback Cause: Sitting for long hours with bad posture. For instance, sitting hunched over a computer screen. Pain: Neck, shoulder, and back. Problem: The bad sitting posture causes the chest muscles to tighten leading to an excessively curved back in the upper back or thoracic region. The muscles of the upper back loosen and eventually weaken. Recommendation: The following exercises are very effective:

9. Bad Posture #2 – Rounded Shoulder Cause: Sitting with a bad posture while typing, or imbalanced exercise regime involving excessive chest pressing. Pain: Neck, shoulder, back Problem: Sitting in that position results in the chest muscles tightening, causing the shoulders to rotate forward internally. The muscles of the upper back weaken and loosen. Recommendation: Stretching to relax the tight chest muscles

10. Bad Posture #3 - Forward Head Cause: Sitting hunched over in an office chair for long hours, staring at a computer. Pain: Neck Problem: Tightness of the muscles of the back of the neck, along with the muscles of the upper back (levator and upper trapezius). Recommendation: Stretches to loosen tight muscles in the back of the neck:

11. Poor Posture

13. Correct Posture

14. Back

15. Anatomy  Vertebrae (Bones)  Spinal Discs  Muscles and Tendons  Ligaments  Spinal Cord  Nerve Roots

16. Vertebrae  Stacked  Interlocking  Flexibility – flexion/ extension/ rotation/ lateral bending  Protect spinal cord  Center of gravity located in front of the sacrum

17. Spinal Discs  Cushioning – “Shock Absorber”  Like a jelly donut  Disc anatomy - Tough outer covering - Soft gelatinous center - No blood supply - Few nerve endings - Helps the spine be flexible  Mostly water that dehydrates with age  Can deteriorate, protrude, herniate

18. Types of Back Injuries  Strain and Fatigue  Nerve Injury  Fractured Vertebrae  Tears in Disks  Disc Fractures and Ruptures Ruptures

19. Risk Factors  Posture  Force  Repetition  Stress  Other Factors-Physical Fitness, Aging, Diet, Smoking.

20. Posture What posture are you exhibiting?

22. Causes of Back Injuries   Improper lifting techniques (95%)  Overexertion  Work Area Conditions - Path of travel - Arrangement of work area

23. Risky Moves Certain actions are more likely to cause back injuries than others. If you are doing these things think: DANGER! I’m at Risk! Heavy Lifting Heavy Lifting Repetitive Lifting Repetitive Lifting Twisting at the Waist Twisting at the Waist Reaching and Lifting Overhead Reaching and Lifting Overhead Lifting Objects with Unusual or Awkward Shapes Lifting Objects with Unusual or Awkward Shapes Working in Awkward Uncomfortable Positions Working in Awkward Uncomfortable Positions Standing or Sitting for Long Periods Standing or Sitting for Long Periods

24. Lifting Hazards

25. Safe Lifting Zone   Lifting items between the hips and shoulders is the safest  The further from the lift zone, the riskier the lift

26. Safe Lifting Zones

27.  Your waist acts like the fulcrum in a lever system  Your lifting ration is about 10:1. Lifting a 10lb object puts 100 lbs of stress on your lower back  Add in the 106lbs of the average human upper torso, lifting a 10lb object actually puts 1,150 lbs of pressure on your lower back!  It is easy to see how repetitive lifting and bending can lead to back problems  Even leaning forward while sitting at a desk can eventually lead to back injuries. Lifting Ratio

28. Correct Lifting  Keep your lumbar spine in ”neutral.” To find your lumbar neutral arch and bow your back to the maximum in each direction. Mid-range is your lumbar neutral  Engage your abdominal muscles  Use your legs/thigh muscles to lift  Hold the load as close as you can to your center of gravity. This decreases the stress on your back  Always remember DO NOT lift heavy loads higher than waist- height and lighter ones higher than chest height

29. Proper Lifting Technique Plan Lift, Then Lift Get Close Tighten Abdominals Lift with your legs Hold Close Turn by stepping

30.   Always be aware of your technique - Poor body mechanics e.g. stooping, repetitive bending - Prolonged activity e.g. sitting or standing - Fatigue (take a small break) - Heavy loads (use tools/machines when possible)  Adjust workplace to the worker  Do not adjust worker to the workplace Prevention

31. Any Questions? James Grubinskas, DC., CEAS Alliance Occupational Medicine 315 South Abbott Ave., Milpitas 2737 Walsh Ave., Santa Clara 1901 Monterey Rd. Ste., San Jose Thank You!