Prevention and Prevention and Management of Management of

Neck and Back InjuriesNeck and Back InjuriesJames Grubinskas DC, CEASJames Grubinskas DC, CEAS

ChiropractorChiropractorAlliance Occupational MedicineAlliance Occupational Medicine

Understand proper posture to prevent neck & back injuries

Understand the types of neck & back injuries Understand risk factors associated with neck &

back injuries Understand the common causes of neck & back

injuries Identify ways to prevent neck & back injuries Identify what to do in the event your neck or

back is injured

ObjectivesObjectives

Financial impact of occupational injury and illness in the US is $250 Billion (2007) affecting 3.8 million injured workers

Back injuries account for 1 out of 5 workplace injuries or illnesses (Bureau of Labor Statistics)

186 million work days are lost each year to back pain alone.

StatisticsStatistics

37.5% of adults are currently obese

CA. WC Institute claims with obesity as a comorbity vs. those without had the following characteristics:- more claims lost time from work (83% vs. 29%)- increased lost work days (approx. 80% greater)- more frequent attorney involvement (approx. 68% vs.

15%)- greater use of opiods (approx. 69% vs. 19%)- higher medical cost claims ($51K vs. $7503) and

indemnity costs ($59K vs. $5400)

Impact of Obesity on Impact of Obesity on Musculoskeletal Disorders and Musculoskeletal Disorders and WC CostsWC Costs

- Age- Gender- Genetic Predisposition- Smoking- Weight- Prior Injuries- Hobbies- Medical Conditions (diabetes, RA,

thyroid disease, heart disease, liver, kidney disfunction)

Non Work Combined Non Work Combined Medical ConditionsMedical Conditions

Neck PainNeck Pain

Neck muscle pain can be caused by the following neck muscles

becoming tight.• Scalene muscles (three pairs of muscles that help rotate

the neck) • Suboccipital muscles (four pairs of muscles used to rotate

the head) • Pectoralis minor muscles (a pair of thin triangular muscles

at the upper part of the chest) • Subscapularis muscles (a pair of large triangular muscles

near each shoulder joint) • Levator scapulae muscles (a pair of muscles located at the

back and side of the neck).

If alignment of head and spine is not optimal, the neck can bepredisposed to injury and/or the degenerative effects of wear

and tear over time.

  

Top 3 Bad Postures That Top 3 Bad Postures That Can Cause Neck PainCan Cause Neck Pain

1) Hunchback

2) Rounded Shoulder

3)Forward Head

  

Bad Posture #1 - Bad Posture #1 - HunchbackHunchback

Cause: Sitting for long hours with bad posture. For instance, sitting hunched over a computer screen.

Pain: Neck, shoulder, and back.

Problem: The bad sitting posture causes the chest muscles to tighten leading to an excessively curved back in the upper back or thoracic region. The muscles of the upper back loosen and eventually weaken.

Recommendation: The following exercises are very effective:

  

Bad Posture #2 – Rounded Bad Posture #2 – Rounded ShoulderShoulder

Cause: Sitting with a bad posture while typing, or imbalanced exercise regime involving excessive chest pressing.

Pain: Neck, shoulder, back

Problem: Sitting in that position results in the chest muscles tightening, causing the shoulders to rotate forward internally. The muscles of the upper back weaken and loosen.

Recommendation: Stretching to relax the tight chest muscles

   Bad Posture #3 - Forward Head Bad Posture #3 - Forward Head

Cause: Sitting hunched over in an office chair for long hours, staring at a computer.

Pain: Neck 

Problem: Tightness of the muscles of the back of the neck, along with the muscles of the upper back (levator and upper trapezius).

Recommendation: Stretches to loosen tight muscles in the back of the neck:

Poor Posture

Poor PosturePoor Posture

Correct PostureCorrect Posture

   BackBack

AnatomyAnatomy

Vertebrae (Bones) Spinal Discs Muscles and

Tendons Ligaments Spinal Cord Nerve Roots

VertebraeVertebrae

StackedStacked

InterlockingInterlocking

Flexibility – flexion/ Flexibility – flexion/ extension/ rotation/ extension/ rotation/ lateral bendinglateral bending

Protect spinal cordProtect spinal cord

Center of gravity located Center of gravity located in front of the sacrumin front of the sacrum

Spinal DiscsSpinal Discs

Cushioning – “Shock Absorber”Cushioning – “Shock Absorber” Like a jelly donutLike a jelly donut Disc anatomyDisc anatomy

- - Tough outer coveringTough outer covering- Soft gelatinous center- Soft gelatinous center

- No blood supply- No blood supply- Few nerve endings- Few nerve endings- Helps the spine be flexible- Helps the spine be flexible

Mostly water that dehydrates with Mostly water that dehydrates with ageage

Can deteriorate, protrude, Can deteriorate, protrude, herniateherniate

Types of Back InjuriesTypes of Back Injuries

Strain and FatigueStrain and Fatigue Nerve InjuryNerve Injury Fractured VertebraeFractured Vertebrae Tears in DisksTears in Disks Disc Fractures and Disc Fractures and RupturesRuptures

Risk Risk FactorsFactors

Posture Force Repetition Stress Other Factors-Physical Fitness,

Aging, Diet, Smoking.

Posture

What posture are you exhibiting?

Causes of Back Causes of Back InjuriesInjuries

Improper lifting techniques (95%)

Overexertion Work Area Conditions

- Path of travel- Arrangement of work area

Risky MovesRisky Moves

Certain actions are more likely to cause back injuries than others. Certain actions are more likely to cause back injuries than others. If youIf you

are doing these things think: are doing these things think: DANGER! I’m at Risk!DANGER! I’m at Risk! Heavy LiftingHeavy Lifting Repetitive LiftingRepetitive Lifting Twisting at the WaistTwisting at the Waist Reaching and Lifting OverheadReaching and Lifting Overhead Lifting Objects with Unusual or Awkward ShapesLifting Objects with Unusual or Awkward Shapes Working in Awkward Uncomfortable PositionsWorking in Awkward Uncomfortable Positions Standing or Sitting for Long PeriodsStanding or Sitting for Long Periods

Lifting HazardsLifting Hazards

Safe Lifting ZoneSafe Lifting Zone

Lifting items between the hips and shoulders is the safest

The further from the lift zone, the riskier the lift

Safe Lifting ZonesSafe Lifting Zones

Your waist acts like the fulcrum in a lever system Your lifting ration is about 10:1. Lifting a 10lb object

puts 100 lbs of stress on your lower back Add in the 106lbs of the average human upper torso,

lifting a 10lb object actually puts 1,150 lbs of pressure on your lower back!

It is easy to see how repetitive lifting and bending can lead to back problems

Even leaning forward while sitting at a desk can eventually lead to back injuries.

Lifting RatioLifting Ratio

Correct LiftingCorrect Lifting

Keep your lumbar spine in ”neutral.” To find your Keep your lumbar spine in ”neutral.” To find your lumbar lumbar neutral arch and bow your back to neutral arch and bow your back to the maximum in each the maximum in each direction. Mid-range is your direction. Mid-range is your lumbar neutrallumbar neutral

Engage your abdominal musclesEngage your abdominal muscles

Use your legs/thigh muscles to liftUse your legs/thigh muscles to lift

Hold the load as close as you can to your center of Hold the load as close as you can to your center of gravity. gravity. This decreases the stress on your This decreases the stress on your backback

Always remember DO NOT lift heavy loads higher Always remember DO NOT lift heavy loads higher than waist-than waist- height and lighter ones higher than chest height and lighter ones higher than chest heightheight

Proper Lifting Proper Lifting TechniqueTechnique

Plan Lift, Then Lift Get Close

Tighten Abdominals

Lift with your legs

Hold Close

Turn by stepping

Always be aware of your technique - Poor body mechanics e.g.

stooping, repetitive bending

- Prolonged activity e.g. sitting or

standing - Fatigue (take a small break) - Heavy loads (use

tools/machines when possible) Adjust workplace to the worker Do not adjust worker to the

workplace

PreventionPrevention

Any Questions?Any Questions?

James Grubinskas, DC., CEASJames Grubinskas, DC., CEAS

Alliance Occupational MedicineAlliance Occupational Medicine

315 South Abbott Ave., Milpitas315 South Abbott Ave., Milpitas

2737 Walsh Ave., Santa Clara2737 Walsh Ave., Santa Clara

1901 Monterey Rd. Ste., San 1901 Monterey Rd. Ste., San JoseJose

Thank You!Thank You!