Wednesday, October 28, 2009

Low Back Pain, Workplace Prevention.

Often times, when we are preoccupied with the challenges of daily living, we do things that will place our backs at risk for herniations, end plate fractures ( loss of nuclear fluid), strains and other painful conditions. Although the individual workers play a role in their relative wellness, the employer must be a partner to provide successful outcomes.
Many feel that wearing a abdominal bracing belt will prevent injuries to the low back. This has been well studied and has been frequently noted to cause a loss of range of motion in the lower back. Additionally, during lifting exercises back belts have been linked to increases in blood pressure and heart rate. (Hunter and Colleages, 1989)It appears that during lifting activities with the belt on the blood pressure was elevated by up to 15mmHg, the heart rate was also significantly effected. This leaves individuals that have a compromised cardiovascular system at risk for vascular problems, and possible stroke. Additional studies have also shown that belts lower mean oxygen consumption. (Low Back Pain, Stuart McGill, 2007)
A better approach is to develop programs to help the employee learn better strategies to execute the work needed. Some individuals simply do not move in ways that are back sparing. In a study by McGill in 2003, they noted that workers who had a history of back troubles has a history of "adopting motion patterns that resulted in higher spinal loads!" They concluded that "Kinematic patterns need to be practiced and grooved into movement repertoires." It is evident certain individuals need to practice spine- saving movement patterns every day, especially prior to any heavy lifting to ensure that the movement pattern is successful. Even high performance athletes, it is noted, should practice grooved motion patterns on a daily basis.
Another strategy to prevent over-stressed tissue damage is the optimizing the workers rest break to ensure that the opposite muscle group is activated. It is suggested that a administrative secretary uses their rest break to perform a dynamic movement break. In a study in the 1960's, operators in a power plant responded to a buzzer at 10 minute intervals. The controllers needed to get up out of their chairs and going around the corner to the control panel to make adjustments. There were no incidents of back problems. There were changes made, due to the impression that getting up so frequently was "too strenuous." The job was redesigned so that workers remained seated through the 12 hour shift. There was an increase in back problems, and other related problems. In the final analysis, it appears it is crucial for back health to stand up and take "active" breaks regularly.
More successful programs incorporate the use of variable positioning, or multi-tasking. It has been noted that human beings were not meant to perform repetitive work that emphasizes only a few muscles, or tissues. It has also been noted that "too little activity can be just as problematic as too much. Krismer and colleagues' study (2001) strongly reinforced the idea that the object of good work design is not to make the job easier; in fact some jobs should be made more demanding for optimal health. Good occupational health from a musculoskeletal perspective is achieved when people perform a variety of tasks with well designed rest activities, along with traditional components such as proper nutrition, stress management, sleep, and avoidance of alcohol and cigarettes." (Stuart McGill PhD, Low Back Pain, 2007)
Another aspect in workplace prevention is the designing of ergonomic work areas. The seating and all equipment should be "user friendly." When companies look for effective ways of cutting cost in Workers Compensation cases related to low back injuries they nee d to consider working hand-in-hand- with the worker to eliminate undo stress do to unnatural postures, with creates stress upon tissue, creating pain and damage. In conjunction with a physical activity plan, a personalized plan for each persons work station should be implemented. This avoids many claims, costs and injuries in the long run. Often the worker will have the greatest insight into a solution for any intervention from their experience/s. Another added benefit to having the worker/s involved is that they are more likely to comply is they are part of the process.
These are a few key ideas that have been well studied, and documented, in regard to the very costly, and painful, topic of low back pain in relation to the workplace. It is estimated that 80 percent of all adults in North America will experience low back pain. It is the most common reason for visits to seek help from a physician. We have to think in terms of prevention, and seek spine saving alternatives to how we currently operate.

Tuesday, October 20, 2009

Low Back Pain.. Popular Misconceptions.

Often when we experience an "injury." we assume that one particular event created the problem, or pain. How many times have you woken up with a stiff neck, or shoulder, and thought- "I must have slept on it wrong."Or bent over to pick something up and "thrown out your back?" Often these isolated circumstances are not the true culprits to the painful situation. They are part of a much larger picture, an ongoing "mechanical" problem in day to day living. Often it is continuous overload in various positions/ postures that compromise the tissue. These "positions" you may not even realize contribute to the break down of the tissues, creating a weakness, leading to pain and disfunction.
Our bodies are remarkable at adapting to situations, sometime a little too remarkable. If placed in the same "unnatural" (not anatomically correct) position for too long, the body will adapt to the position. It will assume this position, create a new habit of holding itself this way- the muscles will "adapt" to the environment that it is placed in. Often when an individual has a desk job, for example, the will assume certain "postural" tendencies from the seated position at their desk. The individual may develop shoulder problems, and low back problems in conjunction with the chronic" position that their body spends their time. We lose our optimal alignment. These alignment problems influence the entire body. The skeletal system, muscular system, and motor systems are all effected. This created imbalances- imbalances create pain.
If left unchecked, these imbalances create larger imbalances. They can even lead to "inhibition", or loss of function entirely.
Being that each individual is unique in their circumstances, there is no one exercise that fits all. Each persons history (health and injury), age, work environment, nutrition, hydration, hobbies and habits, emotional state and various other factor, effect the approach to be taken. However, there are certain precautions that can be taken to avoid trauma to the tissue(s).
Often we hear of an approach that worked for someone else, and we are compelled to follow suit. Unfortunately, many of these approaches are unscientific, with no real basis. Kind of a "feel good" philosophy. Such feel good approaches would be:
1) Stretching, lifting and twisting first thing in the morning to alleviate "stiffness. While it may "feel" like a great idea,it has no scientific basis. Your spine, during the course of the evening, obtains water through a process called osmosis. You are actually a little taller in the morning when you get up! Stretching with this additional water will not only stretch your muscles, but increase the incidence of damage to discs and also your ligaments. Adams, Dolan and Hutton (1987) noted that disc bending stresses were increased by 300%, and ligament stress by 80%. (Low Back Disorders, McGill PhD 2007). The is an actual loss of up to 19mm in height through the course of the day, 54% of this loss occurs in the first 30 minutes of raising. Full spinal flexion, or bending over, and twisting should be avoided first thing in the morning.
2)Muscles strengthening exercises are required for a "bad back." Although it does "feel good"
to work the large muscles in the area, and there is a school of thought that has created the misconception that the back is "weak" and need strengthening, this too is unscientific. Research has proven that muscular endurance is more protective than muscular strength (Luoto and Colleagues, 1995). There has been no correlation between muscular strength and back pain. There are exercises devoted to spinal endurance that have been scientifically proven to improve, and prevent, low back pain.
3)Bent knee sit up are "good for the back. This is a large misconception. While abdominal muscles are part of the "hoop" system that helps stabilize and protect the low back, bent knee sit ups are NOT the answer to obtaining them, or helping your back pain. One single double leg sit up, or "crunch" is potentially enough compression to damage your spine....ONE. "Each sit up produces low back compression levels close to the National Institute for Occupational Safety and Health (NIOSH) action limit of 3300 Neutons (N),and repeatedly compressing the spine to levels higher than the NIOSH limit has been shown to increase the risk of back disorders... Thus making this an ill-chosen exercise."(Axler and McGill, 1997) Other exercises to be avoided, based upon these standards (Compression in excess of 3300 N) would be:
a) Straight leg sit-ups. 3506 N.
b)Prone (facing down) extension (on machine.) 4000 N (or 890 lbs.)
c) Prone (facing down) extension with arm and legs lifted off of the ground. 6000 N (or 1300 lbs.)
d) Single arm push ups. 5848N.
e)Alternating push ups. 6224 N.
f)Hanging, bent knee. 3313 N.
As mentioned earlier, a single exercise, or exercise program is not the cure all for all cases of low back pain. Many personalized factors need to considered and evaluated. Obviously, previously considered "cure- alls" have been shown to have no real scientific basis, quite the contrary. A proper full assessment is a prerequisite for any program, no matter what the goal is.
I hope that this article has provided you with some insight into proper care, prevention and care for your spine. I found some of this research to be life changing in regards to the way I train my clients, and approach my own personal exercise programs.