Humans are designed for hard work, but our backs are prone to injury. Back injuries lead to more lost days of work than any other kind of injury or illness.
Of the 1.3 million reported lost-time injuries and illnesses in 2003, sprains and strains were by far the largest category, 43 percent, according the Bureau of Labor Statistics (BLS). Of these, most were back-related. Not surprisingly, construction has the highest lost-time incident rate for back injuries (51.2 lost-time injuries per 10,000 full-time workers in 2004).
It’s not only workers who suffer, but their employers as well. Not only must companies compensate injured workers during their absences, they also often must pay for their treatment. According to Liberty Mutual, the largest workers’ compensation insurance provider in the United States, overexertion injuries – lifting, pushing, pulling, holding, carrying or throwing an object – cost employers $13.4 billion every year.
Whose job is it to prevent back injuries – the worker’s or the employer’s? Both have a role to play.
Companies should set the tone by acknowledging the problem and making it company policy to limit these injuries. Companies that do so strengthen their bottom line.
The most significant action a company can take is to examine the administrative and engineering options available to limit or eliminate the threat of back injuries. Some things to do include:
- Plan to minimize manual handling of heavy materials – make sure crane time is available, forklists are used and materials are delivered and stored close to where they will be used
- Consider options for use of lighter weight materials when possible
- Store materials so they are accessible, easier to get to (not above shoulder height and not at ground level) and out of the way of on-going work
- Make sure walkways are clear and even so that dollies can be readily employed
- Train supervisors, foremen and workers to recognize and avoid back injury risks
- Identify and discuss the problem with employees and encourage them to report back injuries in order to pursue immediate treatment
- Supply better, ergonomically-designed tools which may be lighter, require less force to operate or fit the hand better for comfort in use
- Encourage use of carts, dollies and hoists to move materials as much as possible, rather than physical labor
- Provide handles for carrying loads and knee and shoulder pads to reduce contact stress
- Promote a work culture that encourages workers to ask others to help with objects that are too large or too heavy to handle alone
- Encourage and organize stretching activities before work begins
- Train supervisors so they respond quickly and in a non-judgmental manner to workers who report injuries
- Establish a strong case management program to find alternative work for back-injured workers that may avoid or shorten disability leave
Employers should avoid the skepticism in their response when workers say they have hurt their backs. No reliable data show that any significant portion of workers fake these injuries. And, on its face, construction work – among the most physically demanding of all jobs – certainly is bound to produce more than its fair share of back injuries. Nevertheless, back injuries are too often ignored or dismissed because some can be quirky. Even a minor movement can trigger a back injury, and sometimes it is only a small range of motion that actually is impaired and painful. Yet, the pain in that range can be excruciating and debilitating. Other, more serious back injuries can develop slowly and without pain for months, only to suddenly become unbearable. The best advice when an injury is reported is to acknowledge the event, stop work to avoid possible further damage and encourage immediate evaluation by a qualified professional.
The LHSFNA Occupational Safety and Health Division has a variety of ergonomic resources to help companies and workers develop effective worksite-based programs to avoid back injuries.
For workers, the first step is to get in good physical shape and maintain it. Being overweight, especially when most of the excessive weight is carried in the abdomen, creates tremendous stress, day in and day out, on the back. Getting in shape means developing good eating habits and exercising regularly. It also may include building strength through weight training or other exercise designed to strengthen the body core.
It is also important to maintain good posture and find effective ways to manage stress.
The next thing is to learn how to avoid back injuries on the job.
- Stretching before work starts is a good idea. The goal is to slightly elevate the heart rate and get blood flowing to the muscles as well as to the discs between the vertebrae in the spine.
- When facing a specific task, always assess the load and decide if it can be handled by one person. See how far it must be moved. See if there are obstacles in the path. Set the task up to be as easy as possible and bring in help whenever necessary. Many tasks (stacking forms, for instance) can be done faster and safer with two people. Note that back belts do not prevent back injuries and can provide a false sense of security.
- Keep in mind that some tasks can be better done with mechanical equipment. Talk to the foreman about using lifts or other equipment.
- When actually lifting, bend the knees and get as close to the load as possible. Keep the back straight and use the legs to do the heavy work. Avoid twisting when lifting, carrying or lowering the load. While carrying, keep it as close to the body as possible. When finished, take a few seconds to straighten and stretch the back.
Finally, pay attention to your back and address any problems that arise. Often, a back injury begins with a slight twinge. If it is ignored, the whole back can lock up. More significantly, minor, daily back pain can be ignored, but then its cause is not addressed. Eventually, a herniated (ruptured, pinched) disc can result.
Back injuries – whether steady, long-term pain rooted in the spine or painful pulls or knots in the muscle – require rest for recovery, although excessive bed rest can actually worsen the condition. A doctor should be consulted, especially if the pain is severe, and medication may be required to alleviate pain and help afford the necessary rest (i.e., to sleep at night).
The most severe pain is usually caused by one of the discs – soft tissue between the vertebrae that keep them from rubbing on each other – pinching the spinal cord, the long nerve that runs along the vertebra from the neck to the legs. Vertebrae are hard bones; typical back stress does not affect them. But back stress can cause the vertebrae to crush the discs, squeezing them so that they pinch the nerve.
For many people, rest will allow the discs to repair themselves, eliminating the pinch on the nerve and, thus, the pain. Appropriate exercise will strengthen the body core and help prevent a similar injury. In some cases, the pain is too great or the condition so deteriorated that back surgery is necessary.
However, comparisons of the rate of back surgery in different parts of the United States raise questions about whether surgery is too often prescribed. Though there is no reason to think that a given region has more or more serious back injuries than another, the highest rate regions have eight times more surgeries than the lowest rate regions.
Moreover, back surgery is expensive. Lower back pain is a condition that 80 percent of Americans will experience at one time or another in their lives. Treatment costs reach $25 billion annually, not counting another $25 billion for lost time and workers’ compensation. And the fastest growing share of treatment costs is for surgery.
Between 1997 and 2004, the number of fusion surgeries (in which two or more vertebrae are locked together to prevent crushing of the disc between them) rose 127 percent to more than 303,000. Yet, the data do not show that surgery leads to an improved result.
A study published last November in The Journal of the American Medical Association compared results for two groups of patients with sciatic pain arising from back injuries (the sciatic nerves run down the legs from the base of the spine; when the spinal cord is pinched, it can shoot pain down the sciatica). One group had immediate surgery; the other began simply with rest. Within three to six months, both groups reported marked improvement, and after two years, about 70 percent described “major improvement.” Moreover, no one who waited for surgery or avoided it entirely had a disastrous result, and no one who had surgery experienced serious consequences. The only apparent difference was that, for some, immediate surgery produced a more immediate reduction in pain.
One misconception, common among patients and doctors alike, that the study debunked is that permanent nerve damage can occur if surgery is postponed or avoided. That, simply, is not the case. Therefore, unless the pain is unbearable, patients, doctors and their health plans can save considerable expense by waiting to see if rest and exercise will solve the problem. If not, surgery remains an option.
The LHSFNA publishes a 15-page Back Injury Prevention Manual designed to help instructors train Laborers about how to avoid these injuries. Also available, in English and Spanish, is the Back Injuries health alert. Other LHSFNA publications address issues of fitness and nutrition, stress management and other kinds of sprain and strain injuries. All publications can be ordered online through the Publication Catalogue.