Watch your back!

We've all had that back twinge—a reminder we've either lifted something incorrectly or too heavy. It can be a scary moment.

When you were younger, you probably never worried about your back. Even if it gave you a little trouble, you most likely never gave it much thought because it probably was a result of some crazy thing you lifted with your friends or you just overdid it. That is until you did that one thing that made you realize your back isn't as resilient as you once thought. From then on, you likely have gained a lot more respect for this key part of your anatomy.

We all could benefit from some reminders about how our backs work and remembering easy tips to keep our bodies moving freely.

Back injuries

As we age, our backs seem to give us more trouble. Conventional wisdom correlates it with normal slowing down, lack of physical activity, gaining weight because of lower metabolism or the result of muscle mass loss that can occur from any of these situations, which all contribute to back injury risk.

It may seem as though most of us are destined for some kind of back trouble in our lives. Statistically speaking, this is accurate. In fact, a 2011 Bureau of Labor Statistics report shows musculoskeletal disorders (MSDs), which include back injuries, account for almost 40 percent of all injuries sustained by workers—the highest percentage of all injury groups. And of this MSD category, almost 40 percent of those injuries were back-related, again the greatest amount of that group. However, the data also show older workers injured their backs at lower rates than younger workers, but when they did, they took the longest to recover.

MSDs are wear-and-tear disorders of the musculoskeletal system. There are three main factors that often lead to MSDs. First is repetition. Second is how someone positions a lift. For example, working in awkward positions puts undue stress on the back or other parts of the body. For roofing work, any posture that forces the spine to lose its natural curve puts the person at risk for back injury. The third factor is force. The greater the force required to do a job, the greater the risk of developing an injury.

Any single factor, in isolation, is unlikely to cause damage; it is a combination of factors that increases the chances of a problem occurring. So reducing any of these elements also reduces the likelihood of an injury. Of course, not all people exposed to these risk factors will be equally affected by them. Age, gender, weight, heredity and overall physical condition all play a part when determining injury probability.

Back injuries often are difficult to diagnose. A majority of back pain cases are classified as "nonspecific," meaning their causes are not identifiable. Recent data show the average time off work is seven days for a back injury; for workers older than 45 it is up to 12 days. The good news is most back injuries heal. However, in many cases the pain can become chronic.

Fortunately, there are some easy things to understand and do to keep healthy and minimize re-aggravating an injury.

The back

First, let's look at the anatomy of the back and spine to better understand how it works.

The human spine naturally curves in three places. It is the curves that give the spine its strength and flexibility. The upper curve is the cervical or neck region; the middle curve is the thoracic region to which the ribs are attached; and the lower curve is the lumbar or lower back region. Below the lumbar region is the sacral region, to which the pelvis and coccyx, or tail bone, are attached.

The spine consists of 24 vertebrae that support the back and protect the spinal cord. Between each pair of vertebrae are small rings of cartilage called discs. The center of the disc, the nucleus, is made up of a jelly-like substance surrounded by fibrous tissue that holds the nucleus in place. The discs act as cushions, preventing the vertebrae from rubbing against each other when you move. They also act as the spine's shock absorbers. The vertebrae are connected by joints, which allow the spine to bend and move. Ligaments and muscles hold the vertebrae and discs in place.

Types of injury

The part of the back injured most often is the lumbar region, which bears the brunt of the stress from lifting, bending and twisting. There are several types of back injury common to this region:

• Muscle strain (also called a pulled muscle) occurs when you perform a sudden or rapid movement or when a fatigued muscle is asked to perform more work than it can handle. The muscle fibers, which are normally elastic, do not have enough time to respond properly and become stretched or torn, resulting in swelling and bruising.
• Ligament sprain is caused by repetitive bending or lifting, which fatigues the back muscles. Unable to support the continued movement, the muscles strain ligaments, causing them to stretch or tear. Maintaining demanding postures for prolonged periods also can place excessive stress on ligaments.
• Joint problems usually result from standing for long periods of time or lifting from overhead. The joints become jammed against each other, causing pain, and eventually wear down.
• Disc-related injuries generally are the most debilitating and expensive problems. When you repeatedly perform an action that takes the spine out of its natural curve, the vertebrae press unevenly against the discs, squeezing a gel-like material from one end of the discs so it bulges on the other end. Over time, this can lead to a condition where the bulge presses on the ligament, causing low back pain.

For disc-related injuries, eventually, the pressure on the discs may cause them to tear, leading to herniated discs. Over time, enough gel has been forced out so the vertebrae rub together, irritating or damaging the spinal nerves. This often is incorrectly referred to as a "slipped disc." The result may be numbness, tingling and/or severe pain, not just in the back but all the way down the leg, sometimes accompanied by weakness in the leg or foot. Once the gel leaks out or dries up, the damage is likely irreparable. However, creative medical approaches have given new hope to those who suffer from this condition.

Degenerative disc disease is another condition exacerbated by repetitive bending, twisting or lifting. As discs become worn and gel dries up or leaks out, the joints begin to grind against each other. This is a natural process—it's what causes people to become shorter as they age. But years of stress—either from heavy use or long periods of driving—can accelerate the decline.

Other factors that can contribute to back injury are body weight and overall physical condition. If you're in good shape, your back gets support from other muscle groups when it lifts, bends and pulls.

Fortunately, before the back becomes seriously and irreparably injured, it sends out warning signs in the form of continual back aches, spasms, soreness and/or stiffness.

Healthy tips

The key to preventing back injuries is to keep the back in its natural S-curve as much as possible, especially when lifting, bending, reaching or twisting. Following are some guidelines to follow in different lifting situations and with different roofing applications:

• Stretch back muscles. Warm-up stretches prepare the musculoskeletal system for exertion. Compensatory stretches help it recover after exertion.
• Move an object as close to the body as possible before lifting.
• If lifting from the ground, plant one foot beside the object, and one foot behind it. If it's too big to straddle, get as close to it as possible.
• Lifting an object from arm's length places 10 times more stress on the back. When removing materials from the truck, push them to the edge of the truck bed before lifting them off the truck. When loading a truck, lift objects onto the edge of the bed before pushing them back on the bed.
• Avoid unnecessary bending and reaching. Try to lift from a moderate height. The safest lifting range for the back is from the knees to the shoulders. Stack materials on pallets to raise them off the ground. Instead of stacking materials above chest height, make additional piles.
• Grasp objects properly.
• Tuck in arms and elbows, and use the palms, not fingertips, to lift objects.
• Bend the knees, not the back.
• Use the legs to push the body upward rather than pulling up with the back. When lifting a roll of felt or polymer-modified bitumen, kneel next to rolls and tilt them against your chest. Grab rolls from underneath and use your legs to push up to a standing position.
• Look up when lifting. Looking upward helps keep the spine in its natural curve.
• Lift straight up without twisting or jerking.
• If lifting and turning is necessary such as when shoveling gravel, point one foot in the direction you want to go before lifting. Then, lift the object before turning your whole body—not just your back—in the direction desired.
• Push, don't pull. Pulling takes your body out of its natural S-curve.
• Use mechanical aids whenever possible. Back-saving devices such as handcarts, dollies, forklifts, hoists, rockers, gravel sweepers and scissor lifts can reduce wear-and-tear on the musculoskeletal system.
• Rotate jobs to prevent muscle overuse. When a job entails performing activities that can strain your back, such as removing shingles, switch tasks with someone to relieve the pressure on your spine. If that's not possible, try to spread the load onto different muscles while working.
• Get help when an object is too heavy to lift alone. Use the tilt test: Get a good grip on one edge of the object. Try to tilt it up slowly. If it's too difficult to move, it's too heavy for you to lift alone.
• When bending to lift even a light object, it's a good idea to place one hand on the knee for support. Even if the object doesn't weigh much, the spine still has to lift the weight of the upper body.
• Proper footwear also can make a difference in the back's overall well-being. A well-fitting shoe that provides cushioned support helps the spine absorb impact and maintain good posture. Nonslip soles can prevent many cases of back injury.

Michael Melnick, an expert in back injury prevention, says: "For years, we've attempted to teach employees there is one ‘correct' way to lift. But expecting all individuals to lift the same way isn't practical. What is practical is to remind employees that every lift can be performed ‘better' by applying the principles of safe lifting. The goal isn't to get everyone lifting perfectly but rather to identify the strategies that make the lift less demanding."

Save yourself

Back injuries are preventable and can be completely healed. The key to preventing back injuries is to anticipate the load to be moved, get help and be smart about the way objects are moved.

Thomas R. Shanahan, CAE, is NRCA's associate executive director of risk management.

Back belts

There are several ways to prevent back injury, but one of the most debated is the use of back belts.

During the 1990s, back belts were coming into vogue in the workplace as an answer to back injury prevention. But back belts do not in themselves help the back do its job better. Back belts remind workers to keep their backs in a natural curved orientation, but strapping a back belt on will not otherwise prevent injury and may give a worker a false sense of security.

In 1996, the National Institute for Occupational Safety and Health (NIOSH) published a formal report stating the following: "NIOSH believes that the decision to use back belts should be a voluntary decision by both employers and employees. Back belt use should not be a mandatory job requirement. If your work force continues to wear back belts, you should remember the following points:

• There is a lack of scientific evidence that back belts work.
• Workers wearing back belts may attempt to lift more weight than they would have without a belt. A false sense of security may subject workers to greater risk of injury.
• Workers and employers should redesign the work environment and work tasks to reduce lifting hazards, rather than rely solely on back belts to prevent injury.
• The research needed to adequately assess back belt effectiveness will take several years to complete. In the interim, workers should not assume that back belts are protective."

And in 2005, the Canadian Center for Occupational Safety and Health stated:

"In spite of anecdotal claims, no evidence has so far been found to support the claim that wearing back belts improves one's back safety. In response to the substantial increase in the number of workers who rely on back belts to prevent injury from lifting, the National Institute for Occupational Safety and Health (NIOSH) in the United States formed the Back Belt Working Group to review and evaluate the existing data related to back belts. Their final conclusions are:

• back belts should not be considered as personal protective equipment;
• back belts should not be recommended for use in occupational situations.

The NIOSH groups' concerns which led to such conclusions were:

• the use of back belts may produce some strain on the cardiovascular system;
• the use of back belts limits mobility and may reduce the suppleness and elasticity of muscles and tendons, potentially contributing to back injury;
• the use of back belts may create a false sense of security, increasing the risk of lifting excessive loads."

With these recommendations in mind, the Ontario Ministry of Labour issued guidelines that warn users and potential users of any kind of back belts about the potential health risks that could result from wearing these devices.

Almost a quarter of a century later, it seems the issue still is unresolved but nevertheless one that is important to consider before offering workers the option to wear a back belt.

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