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Back Care in the Workplace

by Ian Fletcher Price(more info)

listed in back pain, originally published in issue 49 - February 2000

The most common form of spinal injury and back pain can be attributed to sedentary lifestyles, and is manifested by the same back injury from which I had suffered. Hunched, with shoulders leaning forward, in a car, over a desk, at your computer, or in front of the TV – all of these postures increase the risk of injury and back pain over time.

Around ten years ago I decided to leave my city job and start a new career. Years of number-crunching over a desk as a marine re-insurance broker with Lloyds had given me a lower back problem. My back was bad enough that I had to make regular visits to my osteopath, Dr Simon Petrides, who said that my complaint was not unusual.

seated posture, good and poor

The cumulative trauma of poor posture, with shoulders stooped forward, resulted in a stiff thoracic spine – which contributed to a frequent dull ache in my back. Occasionally, muscles surrounding this area of my spine went into spasms, which is the body's way of trying to protect the spine and as a result causes chronic pain. It's like getting cramp in your back, where the muscles grip the joints together, and is excruciatingly painful.

My problem was very common – it was not caused by an old sporting injury or by lifting something in an awkward position which is what most people think when back pain occurs. During the years I had spent stooped at my desk, doing the best for my career, I was actually doing the worst for my spine. I was suffering from a chronic back problem. Each joint in my spine had locked into the one below with the facets (the two pegs on each vertebrae). These facets normally provide a range of movement to the back, so if they become locked together, the discs do not receive a blood supply or nutrition and arthritic change or premature ageing is likely to develop.

Upon learning this, I decided to do something about it so that other people would not have to suffer in ignorance in the same way that I had. For years, Dr Petrides had been looking for a sloping writing board to provide relief for patients with back pain caused by working at conventional flat desks. I was inspired and, a few weeks later, had produced a prototype of the Posturite Writing Board.

Dr Petrides was impressed. At his suggestion I demonstrated my Posturite Writing Board at the annual British Institute of Musculo-Skeletal Medicine exhibition and sold enough boards to pay for the stand. From this initial idea, a business was born and in January 1991 Posturite (UK) Ltd was formed to take the design to the occupational health market.

The Challenge

It soon became clear that Posturite had identified a real need in the UK business market. As reported by the National Organisation for Healthy Backs, back injury is the largest single recorded cause of long-term sick leave at work. Absence from work lost UK business £10.2 billion in 1998 according to recent research by the Confederation of British Industry (CBI). Some 30% of all adults suffer from chronic back pain, of which the common effects are loss of ability to walk or sit, incontinence, intractable pain and depression. Some 60% of adults suffer from back pain annually.

The common age of patients undergoing a herniated disc operation is 40 and signs of disc deterioration are appearing as early as the age of 20. The incidence of back problems among children is also on the increase.

Common back problems associated with office based jobs

The most common form of spinal injury and back pain can be attributed to sedentary lifestyles, and is manifested by the same back injury from which I had suffered. Hunched, with shoulders leaning forward, in a car, over a desk, at your computer, or in front of the TV – all of these postures increase the risk of injury and back pain over time.

The wrong type of seating can also cause back pain. For example, a flat seat or one with a negative incline (the seat of the chair leaning backwards) tilts the pelvis backwards and flattens the inward curve of the lumbar spine – the base of the spine. To achieve the correct sitting posture, office workers need a chair which allows the seat to be tilted forward by 5-15 degrees. This position ensures that the curve in the lumbar spine is maintained while you are seated, because the pelvis is rotated forwards.

Other postures can be a pain in the neck for office workers, when people are continuously looking down at work on their desk or reading on a flat surface. The head weighs approximately one stone or 14 pounds and places considerable pressure on the neck and back muscles when hung forward for long periods of time. The optimum angle for working surfaces for reading or writing is 25°. When working at a computer, the optimum height for the monitor is with the top of the monitor at eye level.

For computer users, however, the most common complaint is sore wrists or Repetitive Strain Injury. Contrary to the name of the condition, damage to the wrists is not caused by repetitive motions but by the lack of movement when the wrists are held in a static position. When typing on a keyboard or using a mouse it is recommended that users take a five second pause every five minutes and a rest break once every hour. A rest break is a break away from the desk, to get up and walk around and stretch any static muscles. A new software product, Workpace, which allows computer users to schedule regular breaks, is attracting widespread interest from employers.

Case Study: The Rover Group

Ian Felix, director of Posturite Healthcare and a trained physiotherapist, has been working with Posturite for a number of years, providing healthcare advice to industry.

As Head of Physiotherapy at Rover's Longbridge plant, Ian Felix has adopted a very pro-active, integrated approach to back pain, with self responsibility being a key element. Within the first year of working with The Rover Group, Ian Felix and his team reduced absenteeism from back pain amongst the 17,500 employees by some 6,000 days.

About half of the people seen in an industrial situation were suffering from backaches and pains. They were often given weeks off work and if the problem wasn't serious, they received no specific treatment. That's no good for the company. Now, we treat sufferers like athletes.

Teaching the workforce how to reach, lift, apply force, bend and avoid stretching, plus self-help and remedial exercises on-site, forms the backbone of Rover's Back Care Programme. It alleviates many problems and keeps employees on the job, happy, well motivated and free from pain. Back pain is both unnecessary and expensive while prevention is considerably more cost effective than cure.

Industry and commerce are quickly reaching the same conclusions as sportsmen and women. A growing number of companies like Rover are providing posture supporting products and back care programmes for their employees. The measurable results are higher productivity, improved morale and reduced absenteeism. They feel that their money is being well spent and it's not hard to see why.

Common back problems associated with manual handling jobs

There are certain manual handling jobs which are more likely to put you in an unnatural posture and increase the risk of injury. For instance, laying ground pipe work, painting ceilings or bending over a car bonnet to check an engine.

By carrying out a risk assessment, it is possible to identify which jobs repeatedly take you into a position where, for instance, you are bending forward. This position is known as sustained forward flexion. If you add weight or loading to that bended position the risks of back injury are increased. It is important to avoid putting weight in hands while in the forward flexion position and any equipment or tools used in this position should be as light as possible.

Methods of reducing the risk of injury when you have a job with sustained forward flexion include job rotation. This means that individuals will only be doing jobs which require them to lean forward for short periods, rather than all day. Rest Pause Gymnastics is also encouraged, which requires stretching the back into the opposite position from that which you have been bending.

Alternatively, there are ergonomically designed belts, which you can wear to support the muscles around the spine. The elasticated straps mimic human musculature and help to develop core strength. A properly fitted back support can lift weight from the spine by up to 25%. The Work S'port is unique in being anchored firmly and comfortably into position with a strap that threads easily through the belt loops to keep the support from riding up.

Jobs that require the head to be tilted backwards increase the risk of neck injury. This position is known as full extension. For example, painters and decorators who work on a ceiling or site workers, with the added weight of the safety helmet, who are required to look upwards for their jobs put their neck under strain. Job rotation is a solution to this problem, or if this cannot be done, regular breaks are recommended with head rotations to provide a full stretch to neck muscles.

Finally, the third most common manual handling work position which increases the risk of injury, is when you are working with your hands above your shoulders. Reaching up to tall machines or up to high shelves can be problematic. The result is a decrease in blood supply to the upper limb. The tendons in the shoulder are very delicate and persistent static work will put these tendons under strain. Most people also experience discomfort and a dull ache in the upper back muscles as a result of holding their arms up in the air for long periods of time.

Case Study: Graham Thorpe, batsman for the England cricket team

World-class sportsmen and women are regarded as the image of health and fitness. However, athletes also suffer setbacks to their career through injury. A back injury may have prematurely ended Graham Thorpe's winter tour in the West Indies in 1997-1998, but not before he gamely returned to the crease during the fifth test in Barbados, delighting cricket fans with his sixth century for England. How did he do it?

It takes courage, as well as superb technique to perform world-class cricket whilst suffering from a painful injury. Back injuries are an enduring threat to cricketers, particularly during an arduous test series, which gives the players little time to rest. The bending and twisting needed to perform at the highest level puts a lot of stress and strain on the lower back; 90% of all back injuries occur at the base of the spine.

Thorpe was at the crease for over 5 hours as he notched up a century. He is the first to admit that this feat of endurance was made possible by a back support garment, S'port Max. S'port Max is anchored firmly and comfortably into position with integral underpants, preventing riding up or other movement. It is designed to stabilise the back, supporting the spine, without restricting mobility.

Thorpe explains: "The abandoned first test meant that all the players were submitted to a punishing schedule in order to complete the series. In the fifth test, I was 5 not out before lunch, when the muscles in my lower back went into painful spasm. The pain was so acute that I couldn't resume after lunch so Jack Russell went in.

"However, after some intensive work by Wayne Morton, our team physiotherapist and with the added support of my S'port Max to stabilise my spine, I was able to come back to the crease at the fall of the next wicket – and build on my partnership with Mark Ramprakash, with us both going on to score centuries."

Conclusion

Work-related injuries are going to happen whether on the cricket field, in the factory or in the office. Both cricket, manual work and office work put a lot of stress on the back and preventative behaviour is critical in avoiding long-term back problems. Adopting the right posture and knowing how to perform physical tasks like keyboard work, lifting, or moving work pieces, are as important on the shop floor or in the office as they are at the wicket.

Through nearly ten years of work in this field, the biggest challenge for Posturite has been to convince people who are at most risk of back and neck problems to follow simple guidelines on how to maintain a healthy back. Unfortunately, far too many people will only take preventative measures to look after their backs once a problem occurs. It is the healthy people with no evidence of back problems that are at greatest risk. It's not a question of if; it's a question of when.

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About Ian Fletcher Price

Ian Fletcher Price is the founder of Posturite (UK) Ltd, a company devoted to cutting the cost of work absenteeism relating to musculoskeletal disorders and providing ergonomically designed workplace accessories. He can be reached on Tel: 01323 847 777 or through their website www.posturite.co.uk

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