1. Cardinal Hill Healthcare System 2014 AgrAbility National Training Workshop Back Pain Lisa Harris, PT, MS, Cert MDT, HPCS, MSVSc

2. Cardinal Hill Healthcare System Session Learning Objectives 1. The participant will understand basic spine anatomy. 2. The participant will be able to determine common causes of back pain. 3. The participant will be able to list three ways to prevent back pain.

3. Cardinal Hill Healthcare System Basic Anatomy Vertebral body Spinous process Disc Facet joints Spinal canal Nerves

4. Cardinal Hill Healthcare System Spine and Disc Mechanics Flexion/forward bending –Increased space between vertebrae –Disc moves toward the back Extension/backward bending Decreased space between vertebrae Disc moves toward the front

5.  Body Mechanics: refers to the use of proper body movements and postures with daily and work activities in an effort to prevent injury  Understanding proper body mechanics and how they relate to your specific job tasks will decrease your chances of having injuries as well as decrease the risk of injuries to patients/clients Body Mechanics

6.  Back injuries are the most common work related injury and seldom caused by a single incident  They occur over time from repeated stress from faulty positions and/or movements  ”the straw that broke the camel’s back” Back Injuries

7. Almost all back disorders result from: –Poor Posture –Faulty Body Mechanics –Stressful Living and Working Habits –Loss of Flexibility –General Decline of Physical Fitness What Causes Back Injuries?

8. Cardinal Hill Healthcare System Back Conditions Osteoarthritis/Degenerative Joint Disease Degenerative Disc Disease Abnormalities of the spine (kyphosis/scoliosis) Stenosis (narrowing of the spinal canal) Sciatica

9. Tip Number 1: Maintain normal spinal curves Cervical – inward curve of neck Thoracic – outward curve Lumbar – inward curve of low back Prevention: TIP 1

10.  Be aware of your posture during the day!  When experiencing back or neck pain, check your posture to see if you are maintaining the normal curves in your spine.  Change positions frequently to avoid long duration stress or tension in the muscles, ligaments and discs in your back  Make an effort to change positions every 30 minutes if possible Maintain Normal Curves

11. TIP Number 2: Minimize bending and twisting Minimize bending and twisting  The disc stays healthy by moving the trunk. It is like a sponge moving fluid in and out as you move.  Movement is important, but some movements should be avoided. Prevention : TIP 2

12.  Twisting while lifting is the most common way to injure your back.  This person should turn his body towards the object he is lifting and pivot his feet when he turns. Body Mechanics

13.  Forward bending pushes the disc fluid to the back of the disc (the thinnest part).  Repeated forward bending causes disc “micro” trauma until “the straw that broke the camel’s back.” Improper Movements

14. Disc Injury These people are NOT maintaining normal spinal curves!

15. Prevention  Backward bending pushes fluid to the strongest part of the disc.  Since it is not a very common position, it is a good stretch for the lower back.

16. Tip Number 3: Plan for lifting and carrying Plan for lifting and carrying  test the weight of the object  determine what you plan to do with the object before lifting object before lifting  position your body facing the object and close to it to use “power muscles” in your close to it to use “power muscles” in your legs and buttocks legs and buttocks  carry objects from the bottom if possible and with elbows bent Prevention: TIP 3

17. Back vs Legs

18.  This is an example of very poor body mechanics.  How should he change what he is doing to what he is doing to perform a better lift? Body Mechanics

19.  This is the beginning of a lift using perfect body mechanics.  What has the person done to correct his posture for this lift? Body Mechanics

21. TIP Number 4: TIP Number 4: Use the “golfer’s pick up” for light objects Use the “golfer’s pick up” for light objects  Face the object  Body weight to one leg  Use hand on un-weighted side for support if needed  Slightly bend weighted knee  Keep back straight and bend at hips letting the un- weighted leg come off the floor Prevention: TIP 4

22. TIP Number 5: Avoid excessive reaching up, down or all around  Use a ladder or step stool to reach overhead  Position equipment / materials between shoulders and knees.  Heaviest objects should be at waist height  Lighter objects above and below  Stagger your feet with a wide base for more stability  Avoid looking up for prolonged time periods Ligaments (cont.) Prevention: TIP 5

23. There are many other tasks besides direct pt.care activities or lifting activities in which you should be careful to maintain normal spinal posture. This is a good example. Body Mechanics

24. This is a much better position for this task. Body Mechanics

25. TIP Number 6: Push don’t pull Push don’t pull  Pushing objects allows for use of “power” quads and gluts.  Allows use of muscles to be used in mid range with elbows bent rather than arms out straight.  Avoids excessive strain on back as well as arms and shoulders  Decreases sprain/strain on joints and ligaments of the arms Prevention: TIP 6

26.  Proper body mechanics also applies to desk jobs.  This work setup is horrible—he is twisted in his seat, he has to turn his head to see the computer, and his hand/ elbow position is bad. Work Station

27.  This is a much better setup.  Facing straight towards the monitor with his keyboard straight ahead also.  Knees, hips, and elbows are all at right angles with his wrists supported.  Added lumbar support. Work Station

28.  Decreased flexibility makes you less tolerant of some positions and more prone to injury.  Establish a consistent stretching program.  Exercise program of at least 20 – 30 min most days/week—walking, lifting weights, stretching, etc.  The more physically fit we are, the less likely we are to be injured. Prevention/ Wellness Opportunities

29.  Proper body mechanics is a must with patient care transfers.  This lift would put much unnecessary stress on the clinician’s back and be very uncomfortable be very uncomfortable to the patient. to the patient. Body Mechanics for Caregivers

30.  This is a much better beginning position for the clinician.  The use of a gait belt during the transfer will make it easier and more comfortable. Body Mechanics for Caregivers

31. The powerful leg muscles are used throughout this lift with less stress on the back. Body Mechanics for Caregivers

32. Mechanical Diagnosis and Treatment/McKenzie Reliable assessment process Developed by Robin McKenzie, 1950’s Well researched Mechanical source (position/movement is cause and cure) Exercise based Patient gains control of symptom management Three steps: Assessment, treatment, prevention Cardinal Hill Healthcare System

33. Thank you for your attention lsh@cardinalhill.org Cardinal Hill Healthcare System