April 7, 2003
 
Guidelines To Reduce Low-Back Injuries in the Workplace
 
Dr. M. Donald Whorton, MD, MPH
FACOEM, FACE
Vice President, WorkCare
  
Work related back injuries continue to be one of the most common types of injuries involving lost workdays. Of the 1.5 million injuries and illnesses that resulted in lost workdays for private industry during 2001, more than 4 out of 10 cases were sprains or strains, most often involving the back [1]. In fact, the United States Bureau of Labor Statistics (BLS) states that the trunk, which includes the shoulder and back, was the body part most affected by work incidents, accounting for 36.5 percent of all 2001 cases. Given the prevalence of this type of injury in the workplace, a targeted approach to prevent back injuries can have a substantial, positive impact—reducing a company’s overall incident rate. This paper discusses effective administrative and engineering controls, as well as lifestyle modifications, that can reduce low back injuries on the job.
 
Low Back Pain
 
Low back pain (LBP) is common in the general population, second only to headaches as the most frequent pain location, according to the Mayo Clinic in Rochester, Minnesota. It is estimated that 70 percent of the population experiences low back pain every year. [2] Fortunately, 90 percent of back pain sufferers recover completely within 6 weeks. However, for the 10 percent of patients who do not recover within a few weeks, back pain can be a painful, prolonged, costly and frustrating experience. LBP can be defined as chronic or acute pain of the lumbosacral, buttock, or upper leg region.
 
Overexertion-The Leading Cause of Back Injuries
 
Sprains and strains are traumatic injuries to muscles, tendons and ligaments and joints. These types of injuries are classified as musculoskeletal disorders (MSDs). Overexertion is the most common cause of sprains and strains, usually the result of excessive lifting, pushing, pulling, holding, carrying or throwing an object. Although total MSDs cases (522,500) declined by 9.6 percent from 2000 to 2001, they continued to account for over one-third of all lost workday cases. [3]
 
Work-Related Musculoskeletal Disorders
 
MSDs can be worsened by factors in the work environment, causing work-related musculoskeletal disorders (WMSDs). WMSDs can cause severe and debilitating symptoms such as pain, numbness, and tingling; reduced worker productivity; lost time from work; temporary or permanent disability; inability to perform job tasks; and an increase in workers compensation costs. The National Institute of Occupational Safety and Health (NIOSH) states the following risk factors contribute to WMSDs: repetitive, forceful, or prolonged exertions of the hands; frequent or heavy lifting, pushing, pulling, or carrying of heavy objects; prolonged awkward postures; and vibration. The risk for musculoskeletal problems increases if risk factors are combined through working conditions or the job environment. The level of risk depends on how long a worker is exposed to these conditions, how often they are exposed, and the level of exposure.
 
Prevention Methodologies for Low Back Injuries
 
When used in conjunction, administrative and engineering controls can prevent low-back injuries. Administrative controls include carefully selecting and/or training workers so that they can safely perform physical work activities. Engineering controls include ergonomic programs that are aimed at redesigning or modifying a job function and/or work environment in order to minimize injury.
 
Administrative Controls
 
Strength Testing
 An effective preventive program depends on the coordination of a number of efforts, including proper selection and placement of employees, appropriate job design and maintenance of health through education and physical fitness. The preplacement physical provides an ideal starting point for an effective preventive program by identifying those employees who may be at higher risk of developing low back problems. During the preplacement evaluation, attention should be focused on previous job responsibilities and previous episodes of back pain. It has been shown by several studies that the best indicator for future back injuries is past history of back injuries. [4] Strength testing is an objective way to ensure that only people with sufficient strength to perform a job will indeed be assigned that job. [5]
 
Training
Individuals who engage in lifting and material handling, as a part of their work should be trained on the following:
 
Using proper lifting techniques (e.g. object close to the body, good grasp, back straight, lift with legs, etc.)
Techniques to use for difficult lifting jobs (e.g. oversized loads, lifts over the shoulders or below the knees, etc.)
Assessing load (e.g. too large or heavy for one person to lift, is the lift necessary, etc.)
Using the right personal protective measures such as warm-up and stretching before lifting.
 
Physical Conditioning
Employees should be aware of physical conditioning or stretching program/techniques that reduce the risk of muscle strain.
 
Management
Provide a surveillance program to identify potential work-related musculoskeletal problems and include a medical management program.
 
Engineering Controls
 
The American College of Occupational and Environment Medicine provides a 40-point prevention checklist, encompassing engineering controls for employees and employers. http://www.acoem.org/pdfs/1998LaborDayCheckList.pdf
 
In addition, NIOSH recommends the implementation of an ergonomics program that focuses on redesign of the work environment and work tasks to reduce back injuries. Engineering components of a program should include:
 
Adjusting the height at which the object or materials are retrieved or deposited
Implementing mechanical aids, such as hoists or adjusted lift tables to reduce the need to bend, reach and twist
Evaluation of production, storage and display workflows to remove excessive reaching, bending, pushing, pulling, lifting loading and unloading
 
Lifestyle Modifications
 
Exercise
Strong stomach and back muscles provide strength that is needed for work that involves your back muscles. Exercises designed to tone the back and stomach will strengthen the body’s natural back support and will reduce the stress placed upon it.
 
Lose excess weight
Excess weight around the stomach exerts extra force on back and stomach muscles. This condition will cause a person to sway backward in order support the weight in front, causing excess strain on the lower back muscles. Losing weight can reduce back strain and pain.
 
Smoking
Smoking reduces blood/fluid to the spine and is thus a risk factor for back injuries. Smoking cessation programs can help smokers quit.
 
Sleep
Proper sleep is important as insufficient sleep may impair job function and increase accidents.
 
These guidelines, in addition to the resources listed below, can help reduce the incidents of workplace back injuries.
 
Internet Resources
 
Check List
A quick checklist by the American College of Occupational and Environmental Medicine that provides about 40 preventative measures to avoid low back injuries in the workplace.
http://www.acoem.org/pdfs/1998LaborDayCheckList.pdf
 
OSHA Ergonomic Reference Page
http://www.osha.gov/SLTC/ergonomics/resources.html
 
NIOSH Fact Sheet on MSDs
http://www.cdc.gov/niosh/muskdsfs.html
 
How To Prevent Back Injuries on The Job
Source: Intelihealth
http://www.intelihealth.com/IH/ihtIH/WSIHW000/20813/30919/343750.html?d=dmtContent
 
Back Injury Prevention Tips By Agsafe, A Coalition for Health and Safety in Agriculture
http://www.cdc.gov/nasd/docs/d000101-d000200/d000108/d000108.html
 
References
 
[1] U.S. Bureau of Labor Statistics. Lost Worktime Injuries and Illnesses: Characteristics and Resulting Time Away From Work, 2001. Washington, D.C.: BLS, 2003. http://www.bls.gov/news.release/osh2.nr0.htm.
 
[2] National Institute for Occupational Safety and Health. Musculoskeletal Disorders (MSDs) and Workplace Factors. A Critical Review of Epidemiologic Evidence for Work-Related Musculoskeletal Disorders of the Neck, Upper Extremity, and Low Back (NIOSH Publication No. 97-141). Washington, DC.: July 1997.
 
[3] NIOSH, Musculoskeletal Disorders (MSDs) and Workplace Factors.
 
[4] Zenz, Carl. Occupational Medicine: Principles and Practical Applications. Second Edition. Chicago: Year Book Medical Publishers, Inc., 1975, 1988.
 
[5] Zenz, Carl. Occupational Medicine.