Back Injury Prevention

Sponsored by the American Red Crossand Los Angeles Valley College Staff DevelopmentPatty Melody, M.A.Health and Physical Education InstructorOctober 19, 2005 11-12pm in PMRC

Disclaimer

This wellness seminar is not intended to substitute a consultation by your doctor. If you have been experiencing any neck or back problems you should seek advice from a physician immediately. Also, if you are starting an exercise program consult with a health care provider before beginning your program.

Agenda

Introduction to Back Injuries in the U.S. What is a Back Injury? Back Anatomy and Physiology Are you at risk? Risk Factors for Back Pain Prevention – Good Posture, Exercise, Eat

Healthy, Ergonomics

Introduction to Back Injuries in the United States 4 out of 5 adults in America (80%) Leading result of accidents (<45 years old) Workplace injuries and illnesses 20% due to

back injuries Annual costs $20-$50 billion dollars in workers

compensation, lost days of work, reduction in worker productivity, higher insurance rates, and long-term disability claims

What is a Back Injury?

Defined as damage to the spine or to its supporting structures that house and protect the spinal cord. This can result in mild fatigue or a dull ache or could be more serious. A physician should always be consulted for a diagnosis or referral.

Back Anatomy and Physiology

The Spine: 33 oddly shaped bones called vertebrae (divided into 4 naturally curved sections)

1) Cervical (7) 2) Thoracic (12) 3) Lumbar (5) 4) Sacrum and Coccyx (9)

Your Back Anatomy is responsible for various

functions: Cervical (7) – supports the neck, tilts,

bends and turns the head Thoracic (12) – supports the mid-back,

ribs and is limited in flexibility Lumbar (5) – supports the lower back

and carries most of the body weight. Under constant stress when you sit, stand and to some extent when you lay down on your back.

Sacrum and Coccyx (9) – 5 fused vertebrae in the sacral region and 4 fused vertebrae in the coccyx region. Responsible for positioning of pelvis and therefore the rest of the spine. Can be altered by excess weight, pregnancy, lordosis or poor body mechanics.

The Bones and Discs of the Spine

The vertebrae are the bones of the spine that collectively support the entire body’s framework.

Each vertebral bone is separated from its neighbor by a disc. The discs are in the anterior (front part) of the spine.

The discs allow movement and cushion shocks.

Each Vertebral Bone The vertebral body

provides the surface against which the discs rest.

The spinal canal provides the foramen (hole) where the spinal cord is housed and protected.

Each Vertebral Disc

The vertebral bones are separated from one another by intervertebral discs.

The discs provide flexibility and absorb impacts and shock.

The discs consist of two parts. The inner area is the nucleus and the outer area is called the annulus. It is described like a jelly donut.

The nucleus, or inner core of the disc, consists of a gelatinous material. The outer ring, or annulus, is the strongest portion, like a tire. When there is a rupture or herniated disc the annulus may be torn.

The Motion Segment Every two vertebral bones are

separated from one another by a disc.

The two vertebral bones and the disc together make one motion segment.

The strong fibers of the annulus and the posterior facet joints prevent excessive movement.

The spine can bend and extend because there are many motion segments which act together.

Spinal Cord and Nerves

The spinal cord begins at the base of the brain and runs down the spine to the low back.

Between every two vertebral bones, two nerves exit the spinal canal (one on the left and one on the right).

When there is damage to a disc, or the facet joint or the vertebral bone there can be too much movement resulting in pain, inflammation and possibly more damage.

Fusion surgeries are sometimes recommended for excessive movement.

Are you at risk? Pg.6

Do you carry heavy items? Are you more than 20% overweight? Do you stand or sit in one position for 30 minutes

or more? Do you cradle the phone between your ear and

shoulder? Do you sleep on a mattress that is too hard or too

soft? Do you wear improper footwear? Do you perform tasks requiring frequent bending? Do you reach for items above your shoulders? Do you carry children? Do you lift heavy objects off the floor?

Causes of Back Pain

Poor Body Mechanics

Causes of Back Pain

Weak and Fatigued Muscles

Causes of Back Pain

Overweight and Obesity

Causes of Back Pain

Improper Footwear Lack of Exercise

Causes of Back Pain

Causes of Back Pain Trauma

Clinical Causes of Back Pain

Osteoporosis Cervical stenosis Cervical disc herniation Cervical spondylosis Rheumatoid arthritis Meningitis Spinal cord tumors and abnormal growths Facet joint syndrome Pregnancy Chiari malformation

Treatment Options Hippocratic treatment of spinal injuries –

“the rack” or using gravity to straighten the spine

Maybe not…

Neurological Assessment Would Include the Following: Medical History Dermatomes, Myotomes and Reflexes

(sensation, strength and reactions) Decide on further testing and outcome Possibly prescribe physical therapy or

other modalities (heat, ice, anti-inflammatories or pain-killers, RICE)

Dermatomes

Dermatomes is the area of skin served by a particular nerve

List of Dermatomes of Commonly Injured Nerve Roots

C5 – The area over the shoulder. C6 – The thumb and part of the

forearm. C7 – The middle finger. C8 – The smallest fingers and part of

the forearm. L4 – The thigh. L5 – The medial part of the calf and

foot, the big toe. S1 – The lateral part of the calf and

foot, the smaller toes.

Myotomes

Myotomes are muscles that are innervated by a particular nerve.

List of Myotomes of Commonly Injured Nerve Roots

C5 – The deltoid muscle (abduction of the arm at the shoulder).

C6 – The biceps (flexion of the arm at the elbow).

C7 – The triceps (extension of the arm at the elbow).

C8 – The small muscles of the hand.   L4 – The quadriceps (extension of the leg at

the knee). L5 – The tibialis anterior (upward flexion of

the foot at the ankle). S1 – The gastrocnemius muscle (downward

flexion of the foot at the ankle).

Reflexes Some, but not all, of the nerve roots have a

reflex.  C5, C6 and C7 have reflexes.  L4 and S1 have reflexes.

For example, when the C6 nerve is pinched, there is loss of the pronator reflex in the forearm.  When the L5 nerve is pinched, there is no reflex loss.  Not all nerves have a reflex which can be tested.

List of Reflexes of Commonly Injured Nerve Roots

C5 – Flexion at the elbow, biceps. C6 – Flexion at the elbow, brachioradialis. C7 – Extension at the elbow, triceps. C8 – Finger flexion.   L4 – The knee reflex, quadriceps. L5 – No reflex. S1 – The ankle reflex, gastrocnemius.

Holistic Modalities

PreventionPrimary prevention –

Prehabilitation, Exercise, eat healthy, don’t smoke, get plenty of rest, maintain proper posture and mechanics at work or play, see your doctor for regular check ups, wear flat shoes, maintain healthy body weight, don’t lift more than you can handle, don’t reach overhead

Secondary prevention –

Consists of primary prevention guidelines plus the following: Consult a physician immediately, Begin early rehabilitation, take pain medications if needed and prescribed by your doctor, modify movements that are painful

Tertiary prevention –

Consists of primary and secondary guidelines plus the following: Continue consulting with your physician, continue with physical or occupational therapy, surgery may be given as an option

Resources

The American Red Cross. Workplace Training Module, Back Injury Prevention. Staywell, 2000.

www.lieberson.com/en/neuro_medical_info/spinal_anatomy.htm

www.sorm.state.tx.us/training2/backsafety/backsafety.htm

http://en.wikipedia.org/wiki/vertebrae http://www.gpc.edu/~jaliff/axskel.htm http://siri.uvm.edu/ppt/yourbacklifting/sld002.htm