Cardinal Hill Healthcare System 2014 AgrAbility National Training Workshop Back Pain Lisa Harris,...

Cardinal Hill Healthcare Cardinal Hill Healthcare SystemSystem

2014 AgrAbility National 2014 AgrAbility National Training WorkshopTraining Workshop

Back PainBack Pain

Lisa Harris, PT, MS, Cert MDT, HPCS, MSVScLisa Harris, PT, MS, Cert MDT, HPCS, MSVSc


Session Learning Objectives

1. The participant will understand basic spine anatomy.

2. The participant will be able to determine common causes of back pain.

3. The participant will be able to list three ways to prevent back pain.


Basic AnatomyBasic Anatomy

Vertebral bodyVertebral body

Spinous processSpinous process

DiscDisc

Facet jointsFacet joints

Spinal canalSpinal canal

NervesNerves


• Spine and Disc Mechanics• Flexion/forward bending

– Increased space between vertebrae– Disc moves toward the back

Extension/backward bending

Decreased space between vertebrae

Disc moves toward the front

Body MechanicsBody Mechanics: refers to the use of proper : refers to the use of proper body movements and postures with daily and body movements and postures with daily and work activities in an effort to prevent injurywork activities in an effort to prevent injury

Understanding proper body mechanics and Understanding proper body mechanics and how they relate to your specific job tasks will how they relate to your specific job tasks will decrease your chances of having injuries as decrease your chances of having injuries as well as decrease the risk of injuries to well as decrease the risk of injuries to patients/clientspatients/clients

Body MechanicsBody Mechanics

Back injuries are the most Back injuries are the most common work related common work related injury and seldom caused injury and seldom caused by a single incidentby a single incident

They occur over time They occur over time from repeated stress from from repeated stress from faulty positions and/or faulty positions and/or movementsmovements

””the straw that broke the the straw that broke the camel’s back”camel’s back”

Back InjuriesBack Injuries

Almost all back disorders result from:Almost all back disorders result from:– Poor PosturePoor Posture– Faulty Body MechanicsFaulty Body Mechanics– Stressful Living and Working HabitsStressful Living and Working Habits– Loss of FlexibilityLoss of Flexibility– General Decline of Physical Fitness General Decline of Physical Fitness

What Causes Back Injuries?What Causes Back Injuries?


Back ConditionsBack Conditions• Osteoarthritis/Degenerative Joint Disease

• Degenerative Disc Disease

• Abnormalities of the spine (kyphosis/scoliosis)

• Stenosis (narrowing of the spinal canal)

• Sciatica

Tip Number 1Tip Number 1::

Maintain normal spinal curvesMaintain normal spinal curves

Cervical – inward curve of neckCervical – inward curve of neck

Thoracic – outward curveThoracic – outward curve

Lumbar – inward curve of low backLumbar – inward curve of low back

Prevention: TIP 1Prevention: TIP 1

Be aware of your posture during the day!Be aware of your posture during the day! When experiencing back or neck pain, check your When experiencing back or neck pain, check your

posture to see if you are maintaining the normal posture to see if you are maintaining the normal curves in your spine.curves in your spine.

Change positions frequently to avoid long duration Change positions frequently to avoid long duration stress or tension in the muscles, ligaments and stress or tension in the muscles, ligaments and discs in your back discs in your back

Make an effort to change positions every 30 Make an effort to change positions every 30 minutes if possibleminutes if possible

Maintain Normal CurvesMaintain Normal Curves

TIP Number 2TIP Number 2::

Minimize bending and twistingMinimize bending and twistingThe disc stays healthy by moving the trunk. The disc stays healthy by moving the trunk.

It is like a sponge moving fluid in and out It is like a sponge moving fluid in and out as you move.as you move.

Movement is important, but some Movement is important, but some movements should be avoided.movements should be avoided.

Prevention : TIP 2 Prevention : TIP 2

Twisting while lifting is the Twisting while lifting is the

most common way to injuremost common way to injure

your back.your back. This person should turn hisThis person should turn his

body towards the object hebody towards the object he

is lifting and pivot his feetis lifting and pivot his feet

when he turns.when he turns.


Forward bending Forward bending pushes the disc fluid to pushes the disc fluid to the back of the disc (the the back of the disc (the thinnest part).thinnest part).

Repeated forward Repeated forward bending causes disc bending causes disc “micro” trauma until “the “micro” trauma until “the straw that broke the straw that broke the camel’s back.”camel’s back.”

Improper MovementsImproper Movements

Disc InjuryDisc Injury

These people are These people are NOTNOT maintaining normal maintaining normal spinal curves!spinal curves!

PreventionPrevention

Backward bending pushes Backward bending pushes fluid to the strongest part of fluid to the strongest part of the disc.the disc.

Since it is not a very Since it is not a very common position, it is a common position, it is a goodgood stretch for the lower stretch for the lower back.back.

Tip Number 3Tip Number 3:: Plan for lifting and carryingPlan for lifting and carrying

test the weight of the objecttest the weight of the object determine what you plan to do with the determine what you plan to do with the object before liftingobject before lifting position your body facing the object and position your body facing the object and

close to it to use “power muscles” in your close to it to use “power muscles” in your

legs and buttockslegs and buttocks carry objects from the bottom if possible and with carry objects from the bottom if possible and with

elbows bentelbows bent


Back vs LegsBack vs Legs

This is an example ofThis is an example of

very poor bodyvery poor body

mechanics. mechanics. How should he changeHow should he change

what he is doing to what he is doing to

perform a better lift?perform a better lift?


This is the beginning of This is the beginning of

a lift using perfect bodya lift using perfect body

mechanics.mechanics. What has the person What has the person

done to correct his done to correct his

posture for this lift?posture for this lift?



Use the “golfer’s pick up” for Use the “golfer’s pick up” for light objectslight objects

Face the objectFace the object Body weight to one legBody weight to one leg Use hand on un-weighted Use hand on un-weighted

side for support if neededside for support if needed Slightly bend weighted kneeSlightly bend weighted knee Keep back straight and Keep back straight and

bend at hips letting the un-bend at hips letting the un-weighted leg come off the weighted leg come off the floorfloor


TIP Number 5TIP Number 5: :

Avoid excessive reaching up, down or all aroundAvoid excessive reaching up, down or all around

Use a ladder or step stool to reach overheadUse a ladder or step stool to reach overhead Position equipment / materials between shoulders Position equipment / materials between shoulders

and knees. and knees. Heaviest objects should be at waist heightHeaviest objects should be at waist heightLighter objects above and belowLighter objects above and below

Stagger your feet with a wide base for more Stagger your feet with a wide base for more stabilitystability

Avoid looking up for prolonged time periodsAvoid looking up for prolonged time periods

Ligaments (cont.)Ligaments (cont.)Prevention: TIP 5Prevention: TIP 5

There are many other tasks There are many other tasks

besides direct pt.besides direct pt. care care

activities or lifting activities activities or lifting activities

in which you should be in which you should be

careful to maintain normal careful to maintain normal

spinal posture. This is a spinal posture. This is a

good example. good example.


This is a much betterThis is a much better

position for this task.position for this task.



Push don’t pullPush don’t pull Pushing objects allows for use of “power” quads and gluts.Pushing objects allows for use of “power” quads and gluts. Allows use of muscles to be used in mid range with elbows Allows use of muscles to be used in mid range with elbows

bent rather than arms out straight.bent rather than arms out straight. Avoids excessive strain on back as well as arms and Avoids excessive strain on back as well as arms and

shouldersshoulders Decreases sprain/strain on joints and ligaments of the arms Decreases sprain/strain on joints and ligaments of the arms


Proper body mechanicsProper body mechanicsalso applies to desk also applies to desk jobs.jobs.

This work setup is This work setup is horrible—he is twisted horrible—he is twisted in his seat, he has toin his seat, he has toturn his head to see theturn his head to see thecomputer, and his hand/computer, and his hand/elbow position is bad.elbow position is bad.

Work StationWork Station

This is a much betterThis is a much bettersetup.setup.

Facing straight towards Facing straight towards the monitor with his the monitor with his keyboard straight ahead keyboard straight ahead also.also.

Knees, hips, and elbows Knees, hips, and elbows are all at right angles with are all at right angles with his wrists supported. his wrists supported.

Added lumbar support. Added lumbar support.

Work StationWork Station

Decreased flexibility makes you less tolerant of Decreased flexibility makes you less tolerant of some positions and more prone to injury.some positions and more prone to injury. Establish a consistent stretching program.Establish a consistent stretching program.

Exercise program of at least 20 – 30 min most Exercise program of at least 20 – 30 min most days/week—walking, lifting weights, stretching, days/week—walking, lifting weights, stretching, etc.etc. The more physically fit we are, the less likely The more physically fit we are, the less likely

we are to be injured.we are to be injured.

Prevention/ Wellness Prevention/ Wellness OpportunitiesOpportunities

Proper body mechanics Proper body mechanics

is a must with patient is a must with patient

care transfers.care transfers. This lift would put much This lift would put much

unnecessary stress on unnecessary stress on

the clinician’s back and the clinician’s back and

be very uncomfortablebe very uncomfortable

to the patient.to the patient.

Body Mechanics for Body Mechanics for CaregiversCaregivers

This is a much betterThis is a much better

beginning position for thebeginning position for the

clinician.clinician. The use of a gait belt The use of a gait belt

during the transfer willduring the transfer will

make it easier and more make it easier and more

comfortable.comfortable.


The powerful leg muscles are used throughout this lift The powerful leg muscles are used throughout this lift with less stress on the back.with less stress on the back.


Mechanical Diagnosis and Treatment/McKenzieMechanical Diagnosis and Treatment/McKenzie

Reliable assessment processReliable assessment process

Developed by Robin McKenzie , 1950’sDeveloped by Robin McKenzie , 1950’s

Well researchedWell researched

Mechanical source (position/movement is cause and cure)Mechanical source (position/movement is cause and cure)

Exercise basedExercise based

Patient gains control of symptom managementPatient gains control of symptom management

Three steps: Assessment, treatment, preventionThree steps: Assessment, treatment, prevention


Thank you for your attentionThank you for your attention

[email protected]@cardinalhill.org


Cardinal Hill Healthcare System 2014 AgrAbility National Training Workshop Back Pain Lisa Harris,...

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