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Banishing Back Pain Preventing work-related injuries can mean simple body mechanics
  - Anne Ahlman, MPT

Most Americans are prone to experience work-related back pain at some point. Whether a job requires sitting or standing for long periods of time or continuous heavy lifting, back pain often results. After sitting for long periods, back and neck strain increase, because the spine has been in a static position. Prolonged standing can compress the joints in the back. Lifting heavy items improperly can strain the back in the process.

People often ignore pain signals from the back and neck, continue lifting incorrectly, and rarely practice flexibility exercises. Over time the problem gets worse and a person may end up having a "back attack." The best back pain remedy available is to learn the proper steps for pain prevention. Physical therapists should make it their mission to educate all patients in proper body mechanics.

Avoid Statics
There is no one posture that is best for all types of work. The key to good posture is mobility. Any static, motionless posture will become uncomfortable if maintained too long, regardless of the position. Remaining in one position for a long time causes fatigue to the groups of muscles that support the back; they will become strained and tired over time.
Static positions also cause muscle tension, which can reduce the flow of blood to muscles. When sitting very still, blood tends to settle in the lower legs and feet, causing poor circulation throughout the body. Inactivity can also bring about tight joints, stiff muscles and spine compression, which cause back pain.
If advising someone who is sitting for long periods of time at a job, encourage them to stand, walk around, bend and arch the back every 30 minutes or once an hour. It is also wise to suggest an ergonomically designed chair that supports the lower back while a person is seated.
If patients are standing for long periods of time, propping one foot on a small stool or on a ledge can decrease lower back pressure. Bending over slowly (at the hips, not the waist) to touch the toes every half-hour provides added relief.
Stretching is critical for back pain relief and overall body wellness. For people suffering from back pain, this simple activity also becomes the hardest to do. Tight ligaments and muscles are everywhere and yet, the treatment is simple. Almost everyone knows to stretch before exercise, but stretching during the workday can also limber up muscles and help back pain sufferers handle each day more effectively.
When teaching patients to stretch, be sure to stress proper body mechanics, or injury could result. Stretching too quickly or too far can injure muscles or ligaments. Stretching slowly and carefully promotes tension, not pain. Stretching for 30 seconds per exercise and without bouncing provides an excellent, thorough stretch.
Remember, the key is to keep moving. Walking, stretching, and constantly finding new positions to ease the strain on the back create freedom from back strain.

Repetitious Movement
Repetitive motion can cause fatigue, pain, and overuse injuries. Improper lifting and repetitive straining can lead to severe back pain. Encourage patients to remember to test the weight of any object before lifting it. Simply "hefting" a heavy object can lead to severe pain and strain, because unexpected force is placed on the back muscles.
Educate patients on proper lifting techniques. When lifting, always keep the load close to the body. Keep the feet apart, with one foot slightly in front of the other, maintaining lordosis (the curve of the low back). Always bend at the hips and knees, and remember to move the feet instead of twisting at the waist.
The back is not a crane. Don't bend at the back and expect to lift an item up by straightening using the back muscles. All this motion serves to do is severely strain the lower back. Once again, reinforce proper lifting techniques.
When moving heavy objects that cannot be lifted, never pull them. This motion strains the lower back. Always use body weight to push rather than pull heavy loads. Use arms and legs to start the push. Better yet, get someone else to help.
When engaging in repetitive movements or continuous lifting, practicing simple stretches and movements is still the most effective way to reduce pain and strain. The movement of walking about and the gentle release from stretching will provide relief from back pain.

High-Tech Pain
Office stress can cause headaches, but improper positioning and poor posture at a desk often causes unexpected back pain. Hunching over a keyboard and staring at the computer monitor may be taking a toll on the back and neck.
Work requires many of us to spend countless hours at the computer, so it is important to practice proper posture and positioning to reduce back pain and neck strain. Poor posture, such as sitting slouched, can place a great deal of stress on muscles, ligaments and discs. Office tips include:
Do not lean or hunch over while working at a computer.
Rest your wrists on a pad while typing. Your lower arms should be close to horizontal when your hands are working on the keyboard.
Use ergonomically designed chairs with good lower back support, or roll up a towel to about the size of your forearm and place it in the small of your back to support the curve of your low back.
Place feet flat on the floor or on an inclined footrest when you are sitting.

Mini-Breaks on the Job
Feeling a little tense after sitting behind a desk all day long? Been standing too long in one position? Or maybe you've been lifting load after heavy load. Computer strain, static posture and heavy lifting can cause general fatigue and poor posture, causing back and neck strain and other aches and pains. Eye-fatigue, neck pain and back strain are all common symptoms of spending a long, stressful day at the office.
One of the best ways to keep your back healthy while sitting, standing or lifting is to take frequent breaks and walk around and stretch. Taking breaks can be hard if you're in the middle of a task and aren't always aware you've been working hard a few hours. This is true of physical therapists and patients alike.
To remind patients to take breaks, suggest setting a timer to go off every 30 minutes to remind you to get up and walk around. On a break, try some light back stretching exercises and walk around the workplace to get a change of scenery for a few minutes. Try these mini-breaks at the office to refresh and rejuvenate.
Cover your eyes. Lean your elbows on your desk or on a table. Cup your hands and place them lightly over your closed eyes. Hold for a minute while breathing deeply in and out. Slowly uncover your eyes.
Squeeze your shoulders. Push your hands up with forearms raised. Push your arms back, squeezing your shoulder blades. Hold for a few seconds. Relax and repeat three times.
Stretch your back. Sit up straight and imagine that you have a cable attached to the tip of your head. Feel the cable slowly pull you higher and higher. Hold for a few seconds. Relax and repeat three times.
Shake your arms. Drop your arms and hands to your sides. Shake them out gently for a few seconds. Relax and repeat three times.

The Cause? Muscle Tension
Tense? Surprise! it's your muscles. They seem to affect everything we do, and too often, we only notice them when they are cramping or tightening.
There is a reason for that. Muscles can only do two things. They can contract and constrict, or they can relax; but they can't relax without help, so they have a tendency to tighten. Muscle spasm is the most common reason for back pain. If it has ever happened to you, you know how uncomfortable and painful it can be. The muscles around the spine add protection and support, but if overexertion of those muscles takes place, the messages to the brain say "contract, contract, contract!"
Because muscles are designed to protect, they set off an alarm when they are mistreated, and a back injury without muscle involvement is rare. However, muscles that are warmed up, flexible and strong do not react as violently when a strange or unusual situation occurs.
Professional athletes know that to decrease their chances of injury, stretching and strengthening their muscles before an event is very important. A professional weightlifter would be foolish if he did not work up to his maximum lift gradually. Yet some patients think they can lean over and lift groceries or suitcases out of the trunk of the car just after they have been sitting for 30 minutes, stuck in traffic.
Is it any wonder many of us end up with back pain and severe muscle spasm? Of course not! It is the probable response muscles will have to our lack of consideration. Our alarm system triggers pain, the indicator that we are not taking good care of our backs. Listen to the message from those muscles.

Soft Tissue Strain
A soft tissue strain is an injury to the muscles, tendons and ligaments of the spine. About half of the patients who have this can recall a specific episode of increasing their activity, "sleeping wrong," or a specific minor injury. For the rest, the pain seems to come out of the blue.
The classic symptom is an excruciating spasm that makes patients drop to their knees. Sometimes, the muscles spasm with such force that they become a hard, tender lump. The specific source of pain is sometimes hard to pin down. This is because often the muscle spasm is not the primary injury, but rather a reaction to a nearby injury.
For example, if one of the small joints connecting the ribs to the spine becomes "stuck" or "out of alignment," the surrounding muscles may contract to take some of the load off of and protect the joint. These contractions can build into spasms much more painful than the original injury. Sometimes surrounding muscles can get into the act, going into spasm in a misguided effort to protect a spasming muscle. The good news is that these essentially never need surgery.
The natural thing to do when a painful spasm begins is to hold the injured area still until healing can take place. Ironically, this is counterproductive. Mobilizing the muscle with gentle stretched and massage is the fastest way to heal the injury.
For severe spasms, trigger-point injections, anti-inflammatories and a short course of muscle relaxants can be added, but the mainstay of treatment is soft tissue mobilization. Just as people brush their teeth to prevent cavities, encourage patients to stretch and strengthen the back and abdominal muscles to prevent "back attacks."

Prevention, the Best Medicine
The natural history of most back pain causes injuries to resolve themselves without any specific treatment. However, the re-injury risk is higher. Therefore, as a physical therapist it is important to stress to patients the incredible value of physical fitness, ideal body weight and good body mechanics to reduce long-term risk. Prevention is key!

Source: Crawford, Ben, MS, PT. (2002, June 24). Banishing back pain: preventing work-related injuries can mean simple body mechanics. Advance for Physical Therapists and PT Assistants p.29-31.



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