Articles in Category: Ergonomics

Degenerative Low Back Pain

Written by Don Williams BSc, MChiro, ICSSD. on Wednesday, 23 September 2015. Posted in General Health, Ergonomics

Degenerative Low Back Pain

   By Don Williams

B.Sc., M.Chiro., ICSSD., PG Dip. NMS Rehabilitation,

Cert. DNS. Memb: CAA. FICS, CEA.

 

Low back pain is an extremely common problem impacting on a huge proportion of our population.

Statistics suggest that 80% of society will suffer back pain in their lives and in any given year, almost 60% of the working population will miss at least 1 day of work due to back pain.

 

But what causes back pain and how do we address it?

 

There are many different structures within our back, neck and body which can cause pain, including; the intervertebral disc, muscles, ligaments and facet (or zygopophyseal) joints. These are simply the basic musculoskeletal structures, however, sometimes back pain can be referred from internal organs, some common culprits are; uterine fibroids in females, bowel obstructions, kidney infections, aortic aneurysms, gall stones, stomach ulcers and malignancies or cancers.

 

Obviously, it is important when you have back pain to have it thoroughly assessed to identify whether it is a musculoskeletal complaint or whether it is a referred problem or something more sinister.

 

If the problem is musculoskeletal then there may be a range of treatment options available; Including Acupuncture, Chiropractic, Remedial Massage, Exercise or Physiotherapy. Some people will find heat or ice may help and some people will respond to pharmaceuticals. In fact, if you believe some of the advertisements on Television (with celebrity swimmers posing as experts) you could be forgiven for thinking that drugs will in fact cure that back pain, rather than the reality of which they will mask the pain until the body has recovered.

 

Certain presentations or complaints seem to respond well to different intervention strategies.

What works for one person will not always work for the next person. Good practitioners should have a range of available strategies to apply based on the response of the patient.

 

We sometimes have patients present to our clinic who have been told that they have “Arthritis”, or a “Degenerative Back” and they will have to live with it, however rarely is back pain this simple. We know that in clinical presentations, the amount or level of degeneration is not well correlated with the amount of back pain people experience. This simply means, sometimes people have awful degeneration and no pain and sometimes people have great xrays with no degeneration and lots of pain. If you have been given a diagnosis of, “it is arthritis and you will have to live with it”, then seek a second opinion. You may be able to have treatment which will significantly reduce or even eliminate your pain.

 

 Degenerative Spine         Healthy Spine

                            Degenerative Spine                                                            Healthy Spine

 

There are a number of different types of arthritis which can influence or affect the spine, broadly categorised into inflammatory arthritis (such as Rheumatoid Arthritis) and Degenerative arthritis.

Inflammatory arthritis can be quite problematic. Although the disease process is not directly treatable my musculoskeletal practitioners, the normal mechanical pain and dysfunction can still be treated.

Degenerative arthritis is the process in which wear and tear over a period of time causes the joints to degenerate. This can result in stiffness or a reduction in the range of motion.  This will often respond quite well to treatment. The biggest question generally surrounds the issue of whether the degeneration has actually been there for a period of time and the pain is as a result of an overload or injury which has triggered the reaction or whether the body has hit a tipping point in which the degeneration has built up to a degree that the body is not going to tolerate it anymore.

 

Everyone starts to degenerate when they reach adulthood. Essentially there is an age correlated expectation for the amount of degeneration that we have. Issue may arise when we degenerate more quickly than expected, or when this degenerative change starts to impact on the nerve and spinal cord. The interesting thing about degenerative compression of the nerves is that the signs and symptoms are somewhat different than those we see from an abrupt episode of compression or a disc injury. This is thought to be as a result of the body’s innate ability to adapt to change and degeneration.

 

Generally speaking, the more degeneration is present, the more conservative treatment is. Just because you have advanced degenerative change does not mean you cannot have conservative treatment. Skilled practitioners will always assess your presentation and will apply treatment that takes your history and presentation into account.  People with significant degeneration may be contraindicated for certain treatment methods, which will normally be discussed at the time of treatment.

The unfortunate circumstance is that people who don’t respond well or not at all often face quite aggressive intervention and surgery, which is of course a last resort when all else has failed.

 

If you have been told that you have “arthritis”, or “spinal degeneration”, then all is not necessarily lost, they may still be conservative strategies that work for you.

How To Correct Lower Back Pain

on Wednesday, 13 February 2013. Posted in Ergonomics, Chiropractic

Lower back pain is one of the leading financial burdens on the Australian public health purse. Costing the government and consumer billions of dollars per year.
This problem creates a massive negative impact on  peoples quality of life and their ability to participate in their normal daily routine.
According to one of the leading journals, 79.2% of Australians Suffer Lower Back Pain at some point in their life. (J manipulative Physiol Ther. 2004 May;27(4):238-44.)
We also know that

How to Lift Correctly

Written by Don Williams BSc, MChiro, ICSSD. on Wednesday, 23 September 2015. Posted in Ergonomics, Training and Performance

How to Lift Correctly

By Don Williams

B.Sc., M.Chiro., ICSSD., PG Dip. NMS Rehabilitation,

Cert. DNS.   Memb: CAA, FICS, CEA.

 

Effective lifting mechanics are an important aspect for our everyday lives. Patients often complain of low back pain and have not considered lifting or squatting technique as a factor in their complaint.

It really doesn’t matter whether you are lifting 100kg of weights on a bar or a tissue off the floor, correct form and technique is important.

 

One of the major problems which does catch people out is the magnification of force with loads in front of the body.

 

Low back mechanics are very complex, as demonstrated by the picture to the right (technical biomechanics are available in this link).   http://cnx.org/content/m42175/latest/?collection=col11406/latest

 

Figure 1

 

For lifting mechanics, we have a range of different lever classes and a stack of joints involved (ankles, knee, hips, spinal segments, shoulders elbows and wrists). But to put it in relatively simple terms, if you think of the low back as a pivot point, the lumbar extensor muscles are only 2-5 cm from the pivot point, when we lift, it is quite easy to have the load out in front 50cm. This can easily give us a magnification of force by 10 to 20 times the load. Essentially, this means that even though it is only 5kg you are lifting, the required compressive load in the lumbar extensors may be 100kgs. Wow!

 

Figure 2

 

 

Lifting with a straight back is not correct

There is a common misconception in the general population that we should lift with a straight back. (See diagram on right)

 

Many people interpret this as that the back is perpendicular to the ground. Lifting in this manner pushes the knees in front of the toes and necessitates lifting the heels off the ground to lift items at floor level. This increases load on the hips and knees, causes a lack of balance and a decreased lift capacity.

 

Figure 3

 

Don’t use you back

We certainly shouldn’t lift bending forward from the hips either.

As in the earlier explanation of lifting mechanics and lever arms, bending forward from the hips and lifting using the low back (like a crane) dramatically increases the likelihood of needing to see the team at Institute of Sports and Spines more often. We often hear complaints from people suggesting that using the hips and knees causes the knees to ache, commonly, when we assess the lifting mechanics with these people they are pushing too far forward with the knees causing increased load and pain, when we improve the mechanics, the knees feel much better in the squat position.

 

Figure 4 

 

Neutral Spine Position

When standing up straight and tall in good posture we have a lumbar lordosis and thoracic kyphosis. This “neutral” position of the spine is what we should strive to maintain when lifting and squatting. Effective use of this position should see the knees stay in line with or behind the toes, good balance capacity and effective use of the gluteal muscles as the main drive for the movement.

 

Figure 5

 

Additionally, good squatting technique should see alignment of the knees in the midline of the foot. In Prague school terms, this would be referred to as good “centration” of the joints. Poor alignment of the feet, knees and hips often contributes to pain on the inside of the knee or the outside of the hip (Trochanteric  bursitis)

 

Figure 6          Figure 7

    Poor Centration                                           Good Centration

 

Correct Squat (lifting) technique

At the bottom of the squat the lumbar lordosis should be maintained. Putting this into simple terms, this means that as you squat down, there will be a point at which the low back starts to “flatten out” and reverse the curve, this is the bottom of the safe lifting range and will be different from person to person. The knees should be in the midline of the foot and the knees should always be behind the toes. The feet should be straight or at maximum 15 degrees externally rotated (pointing out)

 

Figure 8

 

Squatting Drills

A great drill to assess your squat mechanics and to improve your function is to stand with your toes touching a box (or bedside table at home will work). It may be a good idea to put a chair behind you as some people will overbalance and fall backwards when they start this exercise. Slowly squat down, as if you were planning on sitting on the chair, and try to feel the point at which your back starts to move or flatten out. Try to ensure that your knees do not touch the box and that the knees stay in the midline of the feet. If you tend to collapse into the chair when you start this exercise, don’t lose heart, keep at it, reach out in front with the arm, the glut strength will build and this should become easier over a number of weeks. Try this 2-3 times per day, 10 reps each time for 6 -12 weeks until this pattern is easy and natural feeling.

 

Figure 9

 

Other Factors to consider

 

The last thing to mention in wrapping up is that when lifting load at work and around the home, weight is not the only factor which causes issues. The NIOSH guidelines are essentially internationally guidelines and equations which help to identify safe lifting practice and application in the workplace, the following links are very useful for those interested in learning more.

http://www.ergonomics.com.au/niosh.htm

http://www.cdc.gov/niosh/docs/2007-131/pdfs/2007-131.pdf

 

The following is a summary of the modifying factors for your consideration.

Increased weight. This is a no brainer, the heavier the load the harder it is to lift and to a degree, the more the risk. A good start point for safe working loads for 1 person are generally 15kg for females and 25kg for males.

Safe Lifting Zone. We tolerate and accommodate lifting loads between the knees and the shoulders fairly well, when the loads are above or below these points, the weight must be reduced.

Distance lifting (vertical or horizontal). Lifting an object from the knees to the shoulders repetitively is more difficult than just lifting from a bench at hip height to a bench 10cm higher.

Distance from the body. The further away from the body (out in front) the load is, the higher the relative load is on the back.

Repetitions or number of lifts. The more often you have to lift the load, the more the force summates on the back (and the body in general) and once again the greater the risk.

Object Size or Shape. Lifting a really big box (hopefully an exciting present) feels much heavier than a dumbbell of equal weight.

Constant vs Dynamic Load. If the load keep changing weight (a squirming child) it is a more difficult lift than a static load (a sleeping child).

 

If you have any further question or would like to work through lifting mechanics, please contact the team at Institute of Sports and Spines for more information.