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Back Safety In The Workplace

WASBO Facilities Management Conference

Jessica Schroeder

Risk Management Consultant

Session OverviewBack injuries can be extremely painful and long-lasting.

According to the federal Bureau of Labor Statistics, the back injuries of more than 1 million workers account for nearly 20% of all injuries and illnesses in the workplace.

Only the common cold accounts for more lost days of work.

There is not a specific regulation for back safety, but training employees to lift safely is implied by the General Duty Clause of the federal workplace safety statute.

The law requires employers to provide employees with a workplace that is “free of recognized hazards.”

This session will focus on back safety and identify ways to reduce hazards that cause worker strains and sprains.

Anatomy of the Back• The spine is made of 33 bones stacked one on top of the other

• This spinal column provides the main support for your body, allowing you to stand upright, bend, and twist, while protecting the spinal cord from injury

• Strong muscles and bones, flexible tendons and ligaments, and sensitive nerves contribute to a healthy spine

• Yet, any of these structures affected by strain, injury, or disease can cause pain

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Spinal Curves• When viewed from the side, an adult spine has a

natural S-shaped curve

• The neck (cervical) and low back (lumbar) regions have a slight concave curve, and the thoracic and sacral regions have a gentle convex curve

• The curves work like a coiled spring to absorb shock, maintain balance, and allow range of motion throughout the spinal column

• Strong muscles keep our spine in alignment

Spinal Alignment• The muscles and correct posture maintain the natural spinal curves

• Good posture involves training your body to stand, walk, sit, and lie so that the least amount of strain is placed on the spine during movement or weight-bearing activities

• Excess body weight, weak muscles, and other forces can pull at the spine's alignment:

• An abnormal curve of the lumbar spine is lordosis, also called sway back

• An abnormal curve of the thoracic spine is kyphosis, also called hunchback

• An abnormal curve from side-to-side is called scoliosis

Muscles• The two main muscle groups that affect the spine are extensors and flexors

• The extensor muscles enable us to stand up and lift objects

• The extensors are attached to the back of the spine

• The flexor muscles are in the front and include the abdominal muscles

• These muscles enable us to flex, or bend forward, and are important in lifting and controlling the arch in the lower back

• The back muscles stabilize your spine

• Something as common as poor muscle tone or a large belly can pull your entire body out of alignment

• Misalignment puts incredible strain on the spine

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Vertebrae• Vertebrae are the 33 individual bones that interlock with each

other to form the spinal column

• The vertebrae are numbered and divided into regions:

• cervical, thoracic, lumbar, sacrum, and coccyx

• Only the top 24 bones are moveable; the vertebrae of the sacrum and coccyx are fused

• The vertebrae in each region have unique features that help them perform their main functions

Vertebrae Regions• Cervical (neck):

• the main function of the cervical spine is to support the weight of the head (about 10lbs.)

• the seven cervical vertebrae are numbered C1 to C7

• the neck has the greatest range of motion because of two specialized vertebrae that connect to the skull

• the first vertebra (C1) is the ring-shaped atlas that connects directly to the skull

• this joint allows for the nodding or “yes” motion of the head

• the second vertebra (C2) is the peg-shaped axis, which has a projection called the odontoid, that the atlas pivots around

• this joint allows for the side-to-side or “no” motion of the head

• Thoracic (mid back):• the main function of the thoracic spine is to hold the rib cage and protect the heart and lungs

• the twelve thoracic vertebrae are numbered T1 to T12

• the range of motion in the thoracic spine is limited

• Lumbar (low back):• the main function of the lumbar spine is to bear the weight of the body

• the five lumbar vertebrae are numbered L1 to L5

• these vertebrae are much larger in size to absorb the stress of lifting and carrying heavy objects

• Sacrum:• the main function of the sacrum is to connect the spine to the hip bones (iliac)

• there are five sacral vertebrae, which are fused together

• together with the iliac bones, they form a ring called the pelvic girdle

• Coccyx region:• the four fused bones of the coccyx or tailbone provide attachment for ligaments and muscles of the pelvic floor

Vertebrae• While vertebrae have unique regional features, every vertebra has three main parts:

body (purple), vertebral arch (green), and processes for muscle attachment (tan)

• a drum-shaped body designed to bear weight and withstand compression (purple)• an arch-shaped bone that protects the spinal cord (green)• star-shaped processes designed as outriggers for muscle attachment (tan)

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Intervertebral discs• Each vertebra in your spine is separated and cushioned by an

intervertebral disc (purple), keeping the bones from rubbing together

• Discs are designed like a radial car tire

• The outer ring, called the annulus, has crisscrossing fibrous bands, much like a tire tread

• These bands attach between the bodies of each vertebra

• Inside the disc is a gel-filled center called the nucleus, much like a tire tube

• Discs function like coiled springs

• The annulus pulls the vertebral bodies together against the resistance of the gel-filled nucleus

Intervertebral discs• The nucleus acts like a ball-bearing when you move, allowing the vertebral

bodies to roll over the incompressible gel

• The gel-filled nucleus is composed mostly of fluid

• This fluid absorbed during the night as you lie down and is pushed out during the day as you move upright

• With age, our discs increasingly lose the ability to reabsorb fluid and become brittle and flatter; this is why we get shorter as we grow older

• Also diseases, such as osteoarthritis and osteoporosis, cause bone spurs to grow

• Injury and strain can cause discs to bulge or herniate

• A condition in which the nucleus is pushed out through the annulus to compress the nerve roots causing back pain

Vertebral Arch & Spinal Canal• On the back of each vertebra are bony projections that form the vertebral arch

• The arch is made of two supporting pedicles and two laminae

• The hollow spinal canal contains the spinal cord, fat, ligaments, and blood vessels

• Under each pedicle, a pair of spinal nerves exits the spinal cord and pass through the intervertebral foramen to branch out to your body

• The vertebral arch (green) forms the spinal canal through which the spinal cord runs

• Seven bony processes arise from the vertebral arch to form the facet joints and processes for muscle attachment: the spinous process, (2) transverse processes, (2) superior facets, and (2) inferior facets

• Surgeons often remove the lamina of the vertebral arch to access and decompress the spinal cord and nerves to treat spinal stenosis, tumors, or herniated discs

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Facet Joints• The facet joints of the spine allow

back motion

• Each vertebra has four facet joints

• One pair that connects to the vertebra above (superior facets) and one pair that connects to the vertebra below (inferior facets)

Ligaments• The ligaments are strong fibrous bands that hold the vertebrae together, stabilize

the spine, and protect the discs

• The three major ligaments of the spine are the ligamentum flavum, anterior longitudinal ligament (ALL), and posterior longitudinal ligament (PLL)

• The ALL and PLL are continuous bands that run from the top to the bottom of the spinal column along the vertebral bodies

• They prevent excessive movement of the vertebral bones

• The ligamentum flavum attaches between the lamina of each vertebra

• The three major ligaments allow the flexion and extension of the spine while keeping the vertebrae in alignment

Spinal Cord• The spinal cord is about 18 inches long and is the thickness of your thumb

• It runs within the protective spinal canal from the brainstem to the 1st lumbar vertebra

• At the end of the spinal cord, the cord fibers separate and continue through the spinal canal to your tailbone before branching off to your legs and feet

• The spinal cord serves as an information super-highway, relaying messages between the brain and the body

• The brain sends motor messages to the limbs and body through the spinal cord allowing for movement

• The limbs and body send sensory messages to the brain through the spinal cord about what we feel and touch

• Sometimes the spinal cord can react without sending information to the brain

• These special pathways, called spinal reflexes, are designed to immediately protect our body from harm

• The nerve cells that make up your spinal cord itself are called upper motor neurons

• The nerves that branch off your spinal cord down your back and neck are called lower motor neurons

• These nerves exit between each of your vertebrae and go to all parts of your body

• Any damage to the spinal cord can result in a loss of sensory and motor function below the level of injury

• For example, an injury to the thoracic or lumbar area may cause motor and sensory loss of the legs and trunk (called paraplegia)

• An injury to the cervical (neck) area may cause sensory and motor loss of the arms and legs (called tetraplegia, formerly known as quadriplegia)

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Spinal Nerves• Thirty-one pairs of spinal nerves branch off the spinal cord

• The spinal nerves act as “telephone lines,” carrying messages back and forth between your body and spinal cord to control sensation and movement

• Each spinal nerve has two roots

• The ventral (front) root carries motor impulses from the brain and the dorsal (back) root carries sensory impulses to the brain

• The ventral and dorsal roots fuse together to form a spinal nerve, which travels down the spinal canal, alongside the cord, until it reaches its exit hole - the intervertebral foramen

• Once the nerve passes through the intervertebral foramen, it branches; each branch has both motor and sensory fibers

• The smaller branch (called the posterior primary ramus) turns posteriorly to supply the skin and muscles of the back of the body

• The larger branch (called the anterior primary ramus) turns anteriorly to supply the skin and muscles of the front of the body and forms most of the major nerves

• The ventral (motor) and dorsal (sensory) roots join to form the spinal nerve

• The spinal cord is covered by three layers of meninges: pia, arachnoid and dura mater

Spinal Nerves

• The spinal nerves are numbered according to the vertebrae above which it exits the spinal canal

• The 8 cervical spinal nerves are C1 through C8

• The 12 thoracic spinal nerves are T1 through T12

• The 5 lumbar spinal nerves are L1 through L5

• The 5 sacral spinal nerves are S1 through S5

• There is 1 coccygeal nerve

Spinal Nerves• The spinal nerves innervate specific areas

and form a striped pattern across the body called dermatomes

• Doctors use this pattern to diagnose the location of a spinal problem based on the area of pain or muscle weakness

• For example leg pain (sciatica) usually indicates a problem near the L4-S3 nerves

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Coverings & Spaces• The spinal cord is covered with the same three membranes as the brain, called meninges

• The inner membrane is the pia mater, which is intimately attached to the cord

• The next membrane is the arachnoid mater

• The outer membrane is the tough dura mater

• Between these membranes are spaces used in diagnostic and treatment procedures

• The space between the pia and arachnoid mater is the wide subarachnoid space, which surrounds the spinal cord and contains cerebrospinal fluid (CSF)

• This space is accessed when performing a lumbar puncture to sample and test CSF or during a myelogram to inject contrast dye

• The space between the dura mater and the bone is the epidural space

• This space is most often accessed to deliver anesthetic numbing agents, commonly called an epidural, and to inject steroid medication

Back Injury Statistics• According to the Bureau of Labor Statistics (BLS), more than one million workers suffer

back injuries each year

• Back injuries account for one of every five workplace injuries or illnesses

• One-fourth of all compensation indemnity claims involve back injuries

• Costing industry billions of dollars on top of the pain and suffering borne by employees

• Lifting, placing, carrying, holding and lowering are involved in manual materials handling (the principal cause of compensable work injuries)

• BLS survey shows that four out of five of these injuries were to the lower back

• Three out of four occurred while the employee was lifting

Nature of Injury or Illness• In 2012, sprains, strains, and tears were the leading nature of injury and illness

• Accounted for 38% of the total cases requiring days away from work

• Of the 443,560 sprain, strain, and tear cases reported, 63% were the result of overexertion and bodily reaction

• Workers injured their back in 36 percent of the sprain, strain, and tear cases

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Occupation Information• For all occupations, the incidence rate for the public sector was over 71% higher than in the private sector

• The public sector rates were more than 2X greater than private sector rates for laborers, freight, and material movers, janitors and cleaners, and landscaping and grounds keeping workers

Common Injury Causes• Bending awkwardly

• Pushing something

• Pulling something

• Carrying something

• Lifting something

• Standing for long periods

• Bending down for long periods

• Twisting

• Coughing/sneezing

• Muscle tension

• Over-stretching

• Sitting in a hunched position for long periods

• Long driving sessions without a break

Risk Factors For Back Pain• Complacency

• Rushing

• Cutting corners

• A sedentary lifestyle

• Age

• Gender

• Obesity/overweight

• Strenuous physical exercise

• Strenuous physical work

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Causes of Back Pain• Strain

• Muscle spasm

• Ruptured disks

• Bulging disks

• Sciatica

• Arthritis

• Abnormal curvature of the spine

• Osteoporosis

• Infection of the spine

• Shingles

• Bad mattress

• Everyday activities

• Poor posture

Diagnosing Back Pain• Primary care physician physical examination

• X-rays

• CT (computerized tomography) scan

• MRI (magnetic resonance imaging)

• Bone scan

• Electromyography or EMG

• Blood test

• Urine test

• Chiropractic approach

• Physical therapist

Treatments for Back Pain• Pain resolves on its own

• OTC medication/prescription medication

• Exercises

• Physical therapy

• Injecting cells to regenerate spine discs

• Cortisone injections

• Surgery

• Cognitive Behavioral Therapy

• Chiropractor

• Acupuncture

• Transcutaneous electrical nerve stimulation

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Preventing Back Pain• Exercise

• Managing body weight

• Posture when standing

• Posture when sitting

• Proper lifting

• Do not lift and twist at the same time

• Properly moving items

• Shoes

• Driving

• Your bed

Safe Lifting1. Assess the task, the area and the load

2. Keep your feet flat on the floor and maintain a broad stable base

3. Bend your knees

4. Keep your back straight

5. Get a good grip

6. Keep your arms in line with your trunk

7. Hold the weight close to your center of gravity

8. Turn your feet in the direction of movement

Engineering Controls• Redesigning the weight being lifted to help

make it easier to lift the item with the presence of handles, use of baskets and the stability of the package being handled

• Adjusting the height of the object being moved

• Installing mechanical aids such as pneumatic lifts, conveyors and/or automated material handling equipment

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Administrative Controls• Strength testing of existing workers: Studies have shown

strength testing can prevent up to one-third of all work-related injuries. Through the strength-testing process, employers can discourage employees from performing tasks that exceed their strength capacities.

• Physical conditioning or stretching programs: These programs are implemented to reduce the risk of muscle strain.

• Training: Employees should be trained to utilize proper lifting techniques that place minimum stress on the lower back.

Basic Exercises• A few basic exercises can stretch and

strengthen your back and supporting muscles

• Repeat each exercise a few times, then increase the number of repetitions as the exercise gets easier

• If you've ever hurt your back or have other health conditions, such as osteoporosis, consult your doctor before beginning these exercises

Knee-to-Chest Stretch • Lie on your back with your knees bent and your

feet flat on the floor (A)

• Using both hands, pull up one knee and press it to your chest (B)

• Tighten your abdominals and press your spine to the floor

• Hold for 5 seconds

• Return to the starting position (A) and repeat with the opposite leg (C)

• Return to the starting position and then repeat with both legs at the same time (D)

• Repeat each stretch two to three times —preferably once in the morning and once at night

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Lower Back Rotational Stretch• Lie on your back with your knees bent

and your feet flat on the floor (A)

• Keeping your shoulders firmly on the floor, roll your bent knees to one side (B)

• Hold for five to 10 seconds

• Return to the starting position (C)

• Repeat on the opposite side (D)

• Repeat each stretch two to three times — preferably once in the morning and once at night

Lower Back Flexibility Exercise• Lie on your back with your knees bent and your

feet flat on the floor (A)

• Tighten your abdominal muscles so your stomach pulls away from your waistband (B)

• Hold for five seconds and then relax

• Flatten your back, pulling your bellybutton toward the floor (C)

• Hold for five seconds and then relax

• Repeat

• Start with five repetitions each day and gradually work up to 30

Bridge Exercise• Lie on your back with your knees bent and your

feet flat on the floor (A)

• Keeping your shoulders and head relaxed on the floor, tighten your abdominal and gluteal muscles

• Then raise your hips to form a straight line from your knees to your shoulders (B)

• Try to hold the position long enough to complete three deep breaths

• Return to the starting position (C)

• Repeat

• Start with five repetitions each day and gradually work up to 30

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Cat Stretch• Position yourself on your hands and

knees (A)

• Slowly arch your back, as if you're pulling your abdomen up toward the ceiling (B)

• Then slowly let your back and abdomen sag toward the floor (C)

• Return to the starting position (A)

• Repeat three to five times twice a day

Seated Lower Back Rotational Stretch• Sit on an armless chair or a stool

• Cross your right leg over your left leg

• Bracing your left elbow against the outside of your right knee, twist and stretch to the side (A)

• Hold for 10 seconds

• Repeat on the opposite side (B)

• Repeat this stretch three to five times on each side twice a day

Shoulder Blade Squeeze• Sit on an armless chair or a stool (A)

• While maintaining good posture, pull your shoulder blades together (B)

• Hold for five seconds and then relax

• Repeat three to five times twice a day

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Hazard Reduction

District Hazard Reduction Ideas

Summary• Back injuries are the leading cause of disability

• Account for more than 20% of all workers comp claims

• Every time you bend over, lift a heavy object, or sit leaning forward, you put stress on your spine

• Two common types of back injuries are soft tissue and injuries to the intervertebral spinal discs

• Over time, the discs between your vertebrae can start to wear out and become damaged

• Factors contributing to back injuries include poor physical condition, poor posture, excessive weight and stress

• The lift safety check includes checking the object before you lift, determining if it is packed correctly and insuring a proper grip

• Proper lifting technique includes planning the move, using a wide, balanced stance, getting as close to the load as possible and pivoting your feet versus twisting

• Ergonomic hazard control strategies include engineering controls, management controls and personal protective equipment