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1 sss Page Up to Reverse Employee Health sss Employee Health sss sss Page Down to Advance BACK INJURY PREVENTION A guide for healthcare workers Page Up to Reverse sss Employee Health sss Page Down to Advance Page Up to Reverse sss Employee Health sss Page Down to Advance Page Up to Reverse sss Employee Health sss Page Down to Advance Page Up to Reverse sss Employee Health sss Page Down to Advance BACK FACTS LIFE STYLE FACTORS MATERIALS HANDLING PATIENT TRANSFERS & MOVING Page Up to Reverse sss Employee Health sss Page Down to Advance BACK FACTS Back pain is a very common complaint 4 out of 5 people will have back pain during their lives Back pain occurs most commonly between 30-50 years of age The majority of back pain will resolve on its own within 8 weeks Recurrence of back pain is common Work related back injuries in the US cost billions of dollars per year and cause loss of work Of all the money spent on back pain, very little is spent on preventative care Page Up to Reverse sss Employee Health sss Page Down to Advance ANATOMY BACK FACTS The human spine has 24 vertebrae: individual bones The spine has different parts: CERVICAL – neck THORACIC – chest LUMBAR – low back SACRUM – “tailbone” section – attaches to the pelvis Page Up to Reverse sss Employee Health sss Page Down to Advance ANATOMY BACK FACTS LUMBAR – The low back or LUMBAR area has five vertebrae SACROILIAC JOINT is a joint between the sacrum and the pelvis Page Up to Reverse sss Employee Health sss Page Down to Advance ANATOMY BACK FACTS SACROILIAC JOINT is a joint between the sacrum and the pelvis Page Up to Reverse sss Employee Health sss Page Down to Advance ANATOMY BACK FACTS DISCS are structures in between the vertebrae that act as “shock absorbers” between the bodies of two adjacent vertebrae Page Up to Reverse sss Employee Health sss Page Down to Advance ANATOMY BACK FACTS DISC has two parts: ANNULUS – outside layer rubbery and tough NUCLEUS – “gel” like center Page Up to Reverse sss Employee Health sss Page Down to Advance ANATOMY BACK FACTS FACET JOINTS are joints in between two individual vertebrae Page Up to Reverse sss Employee Health sss Page Down to Advance ANATOMY BACK FACTS MUSCLES contract and allow us to move TENDONS connect the muscles to the bones LIGAMENTS are tough band like structures that hold bones together Page Up to Reverse sss Employee Health sss Page Down to Advance ANATOMY BACK FACTS SPINAL CORD is composed of nerve fibers coming from the brain The spinal cord runs through each vertebra in a big central hole The spinal cord stops growing earlier in development than the vertebra (bones) do - Therefore the vertebral (bone) column is longer than the spinal cord Page Up to Reverse sss Employee Health sss Page Down to Advance ANATOMY BACK FACTS The spinal cord stops growing earlier in development than the vertebra (bones) do - Therefore the vertebral (bone) column is longer than the spinal cord The spinal cord does NOT extend into the lower lumbar segments Instead, at these lowest levels of the vertebral column, there are nerve roots extending from the spinal cord which is higher above through to the neural foramen exit below Page Up to Reverse sss Employee Health sss Page Down to Advance ANATOMY BACK FACTS NERVES then branch out from the spinal cord both to the left and to the right at each vertebra The nerves exit through a NEURAL FORAMEN on the left and the right at each vertebra The NERVES carry signals from the brain to the muscles to make the muscles of the body move Page Up to Reverse sss Employee Health sss Page Down to Advance BACK DISORDERS BACK FACTS The complaint of BACK PAIN may be brought on by an injury -HOWEVER other pre-injury factors are often involved Page Up to Reverse sss Employee Health sss Page Down to Advance BACK DISORDERS BACK FACTS Back strains – injury to the back muscles – caused by sudden falls, heavy and/or improper lifting Herniated (ruptured) disc – The outer layer of the disc, annulus, can tear or give way causing the gel inner portion, nucleus, to protrude and can in some cases cause pressure on the nerve branching out from the spinal cord at that vertebral level. Symptoms include: leg pain, numbness, and leg muscle weakness Page Up to Reverse sss Employee Health sss Page Down to Advance BACK DISORDERS BACK FACTS Sciatica pain extending down the leg pressure to the sciatic nerve caused by: *tightening or spasms of muscles in lumbar area *tightening or spasms of muscles in buttocks area *herniated disc *degenerative changes of bone structures by nerve Fractures – broken back bones – falls, contusions, trauma Page Up to Reverse sss Employee Health sss Page Down to Advance BACK DISORDERS BACK FACTS Compression Fracture injury to the body of the vertebrae causing loss of height of the vertebral body usually trauma to an already weakened vertebra Osteoporosis – weakening of the bone – usually occurs in older people with women being at higher risk – falls in a person with this condition can lead to a increase incidence of fractures including vertebra compression fractures Page Up to Reverse sss Employee Health sss Page Down to Advance BACK DISORDERS BACK FACTS Osteoarthritis – degenerative process not related to a specific injury or incident – bone changes develop in the back over time – can involve the facet joints, the vertebral canal, the neural foramina. Spinal Stenosis – degenerative process causing narrowing of the vertebral canal where the spinal cord runs – symptoms can include lower leg weakness, pain, numbness Page Up to Reverse sss Employee Health sss Page Down to Advance BACK DISORDERS BACK FACTS Tumors – rare cause of low back pain – can be a primary bone cancer or a spread of cancer from another area of the body Page Up to Reverse sss Employee Health sss Page Down to Advance BACK DISORDERS BACK FACTS The complaint of BACK PAIN may be brought on by an injury – but it may be the combination of other problems that existed prior to the injury causing some of the symptoms Symptoms often are not caused by a disruption in one isolate structure: often back pain is a results of disruption of many of the structures in the back: ligaments muscles joints discs nerves Page Up to Reverse sss Employee Health sss Page Down to Advance TREATMENT BACK FACTS Since most back pain resolves in about 8 weeks, the outlook for the majority of persons with back pain is good. Most cases of back pain can be treated successfully by a primary care physician and do not require specialty referral. The occupational medicine physician, primary care physician, Orthopedic physician, Physical Medicine and Rehabilitation physician, the physical therapist, the occupational therapist, and the Pain Management team may be involved in the care of person with back pain. Page Up to Reverse sss Employee Health sss Page Down to Advance TREATMENT BACK FACTS However, the person with back pain plays the major role in their own future good back health. This future hopefully includes a lower risk of a recurrent back pain episode. Neither the physician nor the therapist is going to be with the patient after the acute injury is over to make sure that regular aerobic and back exercise programs are done consistently as instructed during treatment. The person with back pain does best when changes in lifestyle aimed at back injury prevention are adopted after recovery from the acute episode. Page Up to Reverse sss Employee Health sss Page Down to Advance TREATMENT BACK FACTS Persons with back pain that are irresponsible, blame the pain on everything else, have poor attitudes, and lack commitment to getting better, do not usually fair very well in the long run. These persons usually do not attend physician or therapist appointments faithfully and do not do the things that the therapist or physician has requested during treatment and are very unlikely to change lifestyle habits to include back injury prevention. Page Up to Reverse sss Employee Health sss Page Down to Advance TREATMENT BACK FACTS Medications are often a part of the treatment plan. Page Up to Reverse sss Employee Health sss Page Down to Advance TREATMENT BACK FACTS Physical therapy is often a part of treatment plan. Physical therapy may consist of: *Modalities to ease symptoms Heat packs, Cold packs, Ultrasound *Flexibility exercises *Strengthening exercises *Aerobic exercise ( treadmill, stationary bike, etc) *Education on proper lifting techniques *Education on prevention of a recurrent back pain Page Up to Reverse sss Employee Health sss Page Down to Advance DIAGNOSTIC TESTS BACK FACTS The physician’s first job when starting to treat each person with back pain is to take a history and do a good thorough physical exam. A good history and physical examination gives the physician clinical information needed to make a diagnosis and to prescribe appropriate therapy. Many patients do not need diagnostic tests. Page Up to Reverse sss Employee Health sss Page Down to Advance DIAGNOSTIC TESTS BACK FACTS X-RAYS – Plain x-rays show the bones only. These are often done if there is a fall, contusion, or other trauma. These are usually not helpful in a back strain Page Up to Reverse sss Employee Health sss Page Down to Advance DIAGNOSTIC TESTS BACK FACTS CT scan (Computerized Axial Tomography) – An xray test where thin horizontal section pictures of the back are obtained. In addition to the bones, other structures of the back can be seen on the xray pictures Page Up to Reverse sss Employee Health sss Page Down to Advance DIAGNOSTIC TESTS BACK FACTS MRI (Magnetic Resonance Imaging) uses signals from a magnet to obtain thin horizontal section pictures of the back. The pictures from the MRI show not only the bones but also other structures such as the discs Page Up to Reverse sss Employee Health sss Page Down to Advance DIAGNOSTIC TESTS BACK FACTS Bone Scan – Nuclear medicine test where radioactive tracers are injected into the body. A scan is then done later to help determine bony problems that may not be present on plain x-rays Page Up to Reverse sss Employee Health sss Page Down to Advance DIAGNOSTIC TESTS BACK FACTS Myelogram – Special x-ray procedure where radiological dye is injected into the spinal canal. This test may give information about what might be causing pressure on the nerves Page Up to Reverse sss Employee Health sss Page Down to Advance DIAGNOSTIC TESTS BACK FACTS EMG-NCV (Electromyogram – Nerve Conduction Test) – Neurophysiology test usually done under the guidance of a neurologist (or a similarly trained physician). This is not a picture test but instead information is obtained to tell if the nerve if functioning normally or slowly. In addition, it can tell if the nerve is sending signals to the muscles normally Page Up to Reverse sss Employee Health sss Page Down to Advance BACK FACTS WARNING SIGNS DO NOT HESITATE TO SEEK MEDICAL ATTENTION Medical attention should be sought especially if these symptoms are present: Back pain associated with leg pain Leg numbness Leg weakness Page Up to Reverse sss Employee Health sss Page Down to Advance BACK FACTS EMERGENCY WARNING SIGNS GO IMMEDIATELY TO YOUR DOCTOR OR EMERGENCY ROOM for loss of control of bowel or bladder. Incontinence of bowel or bladder is an emergent situation in a person with back pain and requires prompt medical evaluation. Page Up to Reverse sss Employee Health sss Page Down to Advance BACK FACTS As with many health conditions, persons can educate themselves and practice prevention to lessen the likelihood that a condition will occur. Learning about back pain prevention BEFORE an episode of back pain occurs can have a BIG payoff for your health Page Up to Reverse sss Employee Health sss Page Down to Advance sss Page Up to Reverse Employee Health sss Employee Health sss sss Page Down to Advance