7 - Back To Work - Skills

Goals Information Skills Drills Questions Review

 Skills to Master

You can take a role in managing your back condition at work or play. Develop healthy work practices by applying the skills listed below. The goal is to help you protect your back from future pain and problems. Not all choices are appropriate for everyone. Perform only the items recommended by your doctor or therapist.

Rearranging the Work Station

Ergonomics is the study of work and the work environment. The goal is to increase productivity by reducing fatigue and discomfort. Knowing how to rearrange a work station is important. We spend a large part of our lives at work. Efforts to improve our comfort at work and to make our work easier can pay off with reduced back strain.

Adjusting Your Work Bench

Rationale

When you spend long hours at a work bench, your back may feel tired and sore. If so, it's possible that the height of the bench isn't adjusted properly. Back posture can be improved when your work bench is at just the right height.

Description

The best height for a typical work bench is where the top surface hits at your hip bone, just below your waistline. You can also check for proper height by standing in front of the work bench and noting the position of your back. Do you have to hunch forward as you work? If so, the surface is probably too low. If you work with small tools and objects, consider raising the surface so you can rest your elbows on the top of the bench as you work. Or sit with good back posture on a stool to get your hands in good position.

Recommendations

You may need to work with your therapist or supervisor to find ways to properly adjust the height of your work bench.

Concerns

Standing with awkward posture for long hours can take a toll on your back. Correcting the height of your work bench will help you keep your back in the neutral position. A low surface forces you to have to hunch over, which takes more energy than standing upright with good back posture.

Adjusting Your Chair

Rationale

The position of your chair has a lot to do with the comfort of your back. An adjustable chair is ideal for getting your back aligned and supported in neutral.

Description

Ideally, you'll be able to choose an adjustable chair. Stand in front of the chair and adjust the chair up or down so the seat surface lines up with the bottom of your knee caps. Sit down, and check to see that there is at least one finger's space between the seat and the backs of your knees. Next, adjust the lumbar support and chair back to fit snugly against the small of your back. Adjust the chair up or down until your feet are flat on the floor or a foot rest. Your thighs should be parallel to the floor. Angle the chair seat forward or backward for optimal support. If you have arm rests, adjust them for best comfort.

Recommendations

Adjusting your chair may not be enough. Training in how to adjust other office equipment, including the mouse, keyboard, and computer monitor, is equally important. Get assistance from your supervisor or therapist to properly align all parts of your workstation.

Concerns

Avoid slouching in the chair by keeping your low back firmly against the lumbar support. If your chair doesn't offer true lumbar support, roll up a towel or pillow to place in the small of the back. You could also purchase a commercial lumbar support to help keep your low back in its neutral position. Plan frequent breaks to get out of your chair to do some stretching, walking, and breathing.

Work Postures

Does your back feel tired and uncomfortable as the day goes on? Pay attention to your posture as you work. You've learned in previous sessions the importance of the neutral spine position. This is the ideal posture for the low back. You should strive for it when doing your work tasks. Whether you sit, stand, or walk as part of your job, paying attention to your work postures is a good starting point. It is a first step toward making adjustments to help you stay comfortable throughout your work day. Get in the habit of moving often to combat fatigue, discomfort, and pain.

Standing

Rationale

When you must stand for long periods, check your posture often. If you don't engage your trunk and hip muscles, you'll begin to rely on ligaments for postural support. The hips relax and begin to sag forward. The inward curve of the low back arches. The abdomen protrudes. Gravity pushes downward, putting a continuous strain on the spinal discs and ligaments. If you first align your back in its neutral posture while engaging your trunk muscles, your posture will be more efficient, and you'll avoid the fatigue and discomfort that comes with unhealthy standing postures.

Description

Place equal weight on both feet. Stand tall by lengthening your spine, elevating your ribs slightly and breath normally. Check your posture often to make sure you are keeping your low back in the neutral position.

Recommendations

Your doctor or therapist may prescribe special insoles to reduce fatigue. People who stand in one place for long periods may benefit by standing on a commercial-type mat designed to reduce fatigue. Check your standing posture often. Correct your posture by "standing tall."

Concerns

Relying on your ligaments requires no effort, but it puts added strain on your low back. It takes a conscious and continual effort to stand in good posture and to use your trunk and hip muscles. Avoid relaxing into unhealthy standing postures.

Driving

Rationale

Driving is taxing on the low back. Driving is a risk factor for work-related back pain when people must drive more than half their workday. The vibration from the vehicle is one culprit. The other problem is that driving requires static sitting postures. High-mileage drivers must sit for long periods, which can produce discomfort and back soreness. Proper sitting postures can help, as can driving a vehicle with good seating. When possible, plan hourly breaks to get out, walk around, and do some stretching and breathing.

Description

The seat in your vehicle may not provide ideal sitting posture. Most seats are designed for the person of average height and weight, which means they fit few people well. You may need to experiment with commercial back and seating cushions. And don't get stuck in one position. Routinely change positions by re-adjusting the seat or by applying or removing an optional back cushion. Use cruise control when it is safe. Stop at designated rest stops along your route. Get out. Go for a brisk walk, and do some stretching.

Recommendations

Your therapist may show you some stretches that can be done safely as you drive. You may be given a commercial back cushion or lumbar roll. Short drivers who end up driving with their legs straight forward may benefit by using pedal extensions. These extensions are typically available through the vehicle manufacturer. Follow the advice of your therapist and supervisor about taking rest breaks.

Concerns

High-mileage drivers are subject to back problems from vibration and from static sitting postures. The problem is compounded by poor seating. Drivers are advised to take breaks often, to get and stay in good shape, to avoid tobacco, and to monitor their body weight.

Taking Mini-Breaks

Rationale

The human body is made to move. Even staying too long in good posture can be harmful to the parts of the back. After about 15 minutes, supportive ligaments start to stretch out, and the discs and joints in the back become starved for the blood flow that normally comes with movement. Staying too long in one position also produces fatigue. Fatigue leads to discomfort and, eventually pain. The key is to upset this continuum by dealing with the hazards of fatigue - before they happen. Using mini-breaks gets the body moving and diminishes fatigue. This is also a way to stay alert and productive, while also improving work quality and safety.

Description

Plan to stop and move briefly every 15 to 20 minutes. Find other ways to approach the task so that your body gets a break. For example, if you've been standing at a work bench, alternate by sitting on a stool. If you've been bending over to work on a project, stop for a moment. Stand up, place your hands on the small of your back, and lean back for a slow and gentle stretch. Then resume your task. People who are sitting for long periods can stop and perform some movement right where they are. They can reach their arms up toward the ceiling, bend back, or stretch to the side. Plan a mini-break every 15 minutes so you can pause, breathe, and move for 20 seconds or so.

Recommendations

Plan a mini-break every 15 to 20 minutes. Take a few moments to relax, to breathe, and to do the stretches demonstrated by your therapist.

Concerns

Don't get stuck in one position for too long. Plan ahead so you can stop, move, and stretch. Feelings of fatigue and discomfort are signals that something is wrong. If you continue to work through them, you may be headed for pain. Breaks to reduce muscle tension and fatigue must be spaced throughout the day. Breathing and stretching exercises should be an important part of the breaks.

Work Fitness

Have you noticed that when you feel good about your mind and body, life and work are easy? That's where work fitness comes in. It plays a significant role in reducing injuries at work (and play). Promoting wellness and fitness are two important ways to keep life and work in proper perspective. The goal is to keep your body and back healthy.

Wellness

Rationale

You have some control over your spine health. One strategy for improved health and wellness is to know the risks for back problems and how to avoid them. Review the risks outlined earlier in this session. Which ones can you control? Attempt to deal with the risks within your control. Seek help when you need it. By taking action, you'll have an immediate impact on your quality of life and on the health of your back.

Description

Wellness is not the absence of disease. It's doing the best with what you've got. And it means taking action and making decisions to deal with problems. For instance, smoking is a known risk factor for back trouble. Taking steps to stop a nicotine habit is a major step toward improved wellness. Many resources are now available to help people who want to quit their habit.

Other risks at work may need attention. You might need to work with your supervisor to control other parts of your job, such as the amount of overtime you are putting in. Outside resources are available to help with the ergonomics of your job, such as finding ways to improve your safety when dealing with heavy loads.

Recommendations

Seek out resources to help you improve your health and wellness. Start by discussing concerns with your doctor and therapist. They can work on your behalf to help you find a solution.

Concerns

Ignoring known risk factors is a roadblock to improved wellness. It's your back and your body. Improving wellness requires your involvement. It's your responsibility to make decisions and take actions to improve the health of your body and your back.

Physical Fitness

Rationale

People who are physically fit benefit from improved energy, alertness, and self-esteem. They are also generally better able to deal with stress, control body weight, and combat a variety of diseases.

Description

A well-rounded physical fitness program addresses flexibility, strength, aerobic conditioning, and relaxation.


Examples of Moderate Activity

  • Washing and waxing a car for 45-60 minutes
  • Washing windows or floors for 45-60 minutes
  • Playing volleyball for 45 minutes
  • Playing touch football for 30-45 minutes
  • Gardening for 30-45 minutes
  • Wheeling yourself in a wheelchair for 30-40 minutes
  • Playing wheelchair basketball for 20 minutes
  • Playing basketball for 15-20 minutes
  • Shooting baskets for 30 minutes
  • Bicycling five miles in 30 minutes
  • Dancing fast for 30 minutes
  • Pushing a stroller 1.5 miles in 30 minutes
  • Raking leaves for 30 minutes
  • Walking two miles in 30 minutes
  • Swimming laps for 20 minutes
  • Bicycling four miles in 15 minutes
  • Jumping rope for 15 minutes
  • Running 1.5 miles in 15 minutes (10 min/mile)
  • Shoveling snow for 15 minutes
  • Walking stairs for 15 minutes

(From the Surgeon General's Report on Physical Activity and Health)

Recommendations

The Surgeon General recommends 30 minutes of moderate activity on most days of the week. (Refer to the box above for examples of moderate activity.)

Concerns

Being physically fit may not prevent a back problem. But people who stay active and who work on flexibility, strength, and endurance seem better able to manage back pain once it strikes. People who are sedentary and unfit are subject to back trouble, along with a host of preventable diseases such as colon cancer, joint problems, and heart disease.

Symptom Awareness

You can take an active role in heading off long-term back problems. Know the signs and symptoms that need attention.

Report Problems Early

Rationale

By reporting problems early, you may be able to head off a major back problem. Too often, people rationalize their back pain by saying, "It'll go away in time." That's not always true. Sometimes, reporting the problem early will let your supervisor help you find solutions. Perhaps minor changes can be made in the way you do your job. Or maybe you need a checkup with your doctor or therapist. You'll get advice on what changes you can make to help you recover, and tips to keep the problem from happening again.

Description

Know these symptoms of back pain. They signal changes in your body that should act as a trigger for seeking help.

  • Back discomfort that seems to be getting worse.
  • Back pain that doesn't change when you rest or when you move around.
  • New or increasing pain, numbness, or tingling in one or both legs.
  • Changes in bowel or bladder function.

Recommendations

Talk to your supervisor, doctor, or therapist if you discover new back discomfort or pain.

Concerns

If you neglect the signals your body gives you, you may be headed for even bigger problems. If symptoms are left to linger, they may not go away. Worse yet, they may snowball. Get help early, rather than later. Solutions may be easier in the early days or weeks of a back problem, before they mount into a more challenging situation.

Special Situations

Shoveling

Rationale

It's hard to keep your back safely positioned while shoveling. You may have a tendency to twist and flex your back to get the job done. The key is to engage your core muscles and to generate power from your hip and leg muscles. Practicing good technique may seem awkward at first, but it helps by protecting your back during this work task.

Description

Approach the task head-on by facing the material you intend to shovel. Keep your back in the power position, and engage your core muscles. This will give you better leverage as you work the shovel. With each load, bend your hips and knees. As you move the material from one spot to another, avoid simply using your arms and twisting with your body. Instead, bend and move with your hips and knees so they do the work. You'll know you're shoveling safely if you keep your back in a straight line, with your hips directly behind you.

Recommendations

Practice engaging your core and using your arms and legs to shovel. People who do a lot of shoveling need extra strong hips and legs. Focus on the hips and legs in your strength and conditioning program.

Concerns

Avoid forcefully twisting sideways to heave the contents you are moving. If you don't engage your core muscles, you'll be forced to flex and twist your back. Remember to bend with your hips and knees rather than keeping your legs straight. Avoid hurling the contents with just your arms.

Care Giving

Taking care of other people is physically taxing. When the job requires lifting and moving people, the potential for back injuries goes way up. Reported back injuries among workers who have to move and lift other people, such as nurses, are staggering.

Rationale

Even with safe techniques and a strong back, lifting other people is a dangerous job. Some experts say that good technique and safe work practices are not enough. They recommend that moving and lifting people only be done with a mechanical lifting device. Even then, workers still must move and position the device safely. Other workers don't have a lifting device. They must be careful to use the body safely when lifting and moving people.

Description

If you don't have a lifting device, consider teaming up with a co-worker whenever possible to move and lift people. When you must work alone, be conscious about the position of your back at all times. Apply the rules you learned in Session Four for safe lifting. The rules are listed for a quick refresher (see side bar). Along with safe lifting methods, always use a safety belt. The safety belt wraps around the person you intend to move. Apply the belt so it fits snuggly around the waist. Arrange the area for a smooth and safe transfer from one surface to the next. For example, if you're moving the individual from the bed to a chair, place the chair next to the bed to shorten the distance you need to go. Get as much help as possible from the person you are moving. Have her lean forward and push off the bed with her hands. You can get extra leverage by holding the safety belt. Help her stand, turn, and then slowly sit in the chair.

Recommendations

Check the List

• Plan and prepare.
• Use a wide base of support.
• Keep the load close.
• Use the neutral spine position.
• Engage your core muscles.
• Lift with your legs.
• Avoid twisting.
• Get help if needed.

Whenever possible, use a lifting device to lift and move others. If there is no lifting device work as a team. Only if necessary should you do the lift by yourself. Apply the concepts you've learned in Back Care Boot Camp
to keep your back as safe as possible.

Concerns

Caring for others is a potential hazard for the back. More people report back pain in this industry than in jobs such as construction, logging, and factory work. When giving care to others, give some thought to caring for your back.

Self-Care

Taking care of your back involves taking care of yourself. With as many hours as you put in, consider yourself an industrial athlete. Think like an athlete. For instance, weight lifters do best when they give their bodies a rest after a heavy workout. By allowing their muscles time to recover, they get better results. They'll often work their chest and back muscles one day, and then do their legs or arms the next. Your body also needs a chance to renew after a hard day's work. Here are some ways to help you rest and recover.

  • Apply a heating pad or cold pack on sore areas.
  • Do some gentle stretches at lunch, during breaks, and after work.
  • Take a brisk walk.
  • Position your back comfortably and rest for 10 to 15 minutes.
  • Engage the relaxation response.

Exercises

People who handle heavy items at work may think that's all the exercise they need. Others in less demanding jobs may conclude that only people in heavy jobs need to be in great shape. The truth is probably somewhere in between. When it comes to taking care of back problems, exercise has value. In Session Three you learned the importance of gaining strength and coordination of the core muscles. The same can be said about toning the muscles of the shoulders, arms, hips, and legs. You may not need a well-rounded strength and conditioning program in order to do your job better, but your back can sure benefit. As you near the end of Back Care Boot Camp, your therapist will put the finishing touches on an exercise program that you can enjoy for a lifetime.

Goals Information Skills Drills Questions Review






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