Fighting Back

Aug. 31, 2006
Back injuries are a staunch enemy of a productive work force and a healthy bottom line. Defeating such a formidable foe requires a comprehensive strategy one that goes beyond a one-size-fits-all mantra.

Bend your knees. Keep your back straight. Lift with your legs. Now, repeat that mantra three times. Good. This concludes your back safety training.

Clearly, it's important to educate workers on proper lifting techniques. But if that's the extent of your back injury prevention program, experts agree you're just scratching the surface.

Unfortunately, Fred Drennan, president and CEO of Ojai, Calif.-based Team Safety Inc., believes it's all-too-common.

"That's why U.S. workplaces haven't done a very good job of eliminating back injuries," Drennan says.

The numbers seem to bear this out. Of the 1.3 million reported lost-time injuries and illnesses in private industry in 2003, sprains and strains most often involving the back were far and away the leading type of injury in every major industry sector, accounting for 43 percent of the total lost-time cases, according to the Bureau of Labor Statistics (BLS).

In addition to the pain and suffering back injuries inflict on workers they've been known to prematurely bring productive careers to a screeching halt they're also capable of putting the hurt on the company budget.

In the language of workers' compensation, back injuries tend to lead to large chunks of days away from work which equates to paying your workers to stay at home longer than many other injuries. And the worker with the ruptured disc whose career came to a screeching halt? Your company likely will be paying for his medical costs from surgery to physical therapy to chiropractic work for the rest of his life.

While it's not easy to put a nationwide price tag on back injuries, the 2005 Liberty Mutual Workplace Safety Index found injuries caused by overexertion defined as excessive lifting, pushing, pulling, holding, carrying or throwing an object, all of which are key ingredients of back injuries cost employers $13.4 billion.

If those types of numbers have you feeling a little self-conscious about your back safety program, perhaps it's time to step back and make sure your program is covering all the bases. Experts recommend a program that includes job-specific safe-lifting training; exercise and stretching; mechanical aids; ergonomic workstations and job processes; and rest breaks and job-task rotation.

"You have to attack back injury prevention with a multi-faceted approach," Drennan says. "There's no silver bullet."

Back to Basics

The spine extends from the base of the skull to the tailbone and is comprised of 33 bones known as vertebrae. The spine has four major regions: the cervical spine (neck region); thoracic spine (chest-level region); lumbar spine (low back); and sacrum (pelvis) and coccyx (tailbone).

The lumbar region in particular, the L4 and L5 regions is involved in the vast majority of back injuries. Steve Geiringer, M.D., a professor in the Department of Physical Medicine and Rehabilitation at Wayne State University in Detroit, attributes that to the low back's "mechanically disadvantageous" setup.

While the cervical spine carries a lighter load the head and the thoracic spine benefits from having the rib cage, the lumbar spine has a much more onerous task: to support the entire amount of body weight from the waist up, armed with nothing more than the spine itself, the abdominal contents and, often, "a protuberant belly."

That protuberant belly is one of the biggest risk factors for back injuries, Geiringer says.

"The bigger the belly, the more weight the lumbar spine is going to have to support and the farther out [the weight] is."

'The Grand Finale'

There's still some debate as to whether back injuries are the result of cumulative trauma or acute trauma. Perhaps one reason is most back injuries appear to be the result of a single incident for example, bending down to pick up a ream of paper for the copy machine.

But Drennan, who estimates 85 to 95 percent of work-related back injuries are the result of cumulative trauma, believes there's a lot going on behind the scenes in the months and even years leading up to such incidents.

"Let's say you take a wire and start bending it back and forth, back and forth, back and forth," Drennan explains. "Eventually the wire will break in half. That's a cumulative trauma disorder, and that's the way the back is."

Unfortunately, there are few warning signs leading up to a back injury. A herniated disc is a classic example. As the intervertebral discs which provide cushioning between the vertebrae of the lumbar spine erode over time, the worker feels virtually nothing.

"There are no nerves or blood in there," Drennan says.

When the intervertebral discs "blow out" say while bending over to pick up that ream of paper the materials in the discs push against the sciatic nerve, causing "the most excruciating pain you could imagine." That, Drennan says, is the "grand finale."

"Slipped disc, bulging disc, herniated disc they're all pretty much the same phenomena," Drennan says. "When that happens, you've done major damage to your back. It's irreversible. That didn't happen picking up a ream of paper for the Xerox machine. It happened over time."

Maintaning the Curve

In the view of Lauren Hebert, PT, OCS, who specializes in work-injury treatment and prevention at a private physical therapy practice in Dixfield, Maine, the primary underlying risk factor for back injuries is the amount of time workers spend bending forward including when they're sitting.

"The human spine is made to be postured with an inward, swayback curve," Hebert explains. "In that position, the discs and joints and ligaments are in their correct, most stable, strongest position." But when a worker bends forward, "all of those mechanics just go bad."

While it might be easy to look at the spine as a fragile, flawed piece of human equipment, Dennis Downing, CEO, founder and president of Santa Barbara, Calif.-based Future Industrial Technologies Inc., believes the spine is "perfectly designed." In fact, Downing says his research has revealed we unlearn how to correctly use our bodies at an early age.

"Take a look at babies lifting a ball: They do it perfectly," Downing says. "As we get into 4, 5 years old, we tend to stop using our bodies correctly. If you observe mothers lifting babies, children lifting backpacks, people gardening ... there's one thing you'll see, and that's incorrect technique, and it's pandemic."

Brewing Back Safety

Still, proper lifting technique is just one piece of the puzzle. Perhaps no one knows that better than St. Louis-based Anheuser-Busch Companies Inc., which has reduced back injuries by 36 percent over the past decade, according to Dale Pendleton, senior director of environmental, health, safety and security.

Anheuser-Busch, an Occupational Hazards America's Safest Companies selection in 2004, has built its back safety program on the two fundamental principles of its overall EHS management system: empowering the company's 31,500 employees to take responsibility for their own safety and health, and holding senior to first-line managers at all of its divisions accountable for EHS performance.

Anheuser-Busch's back safety program has four components:

  • Training The company enlisted the aid of consultants to provide training on safe techniques for lifting, twisting, pushing and pulling. One of the reasons the training has been successful, Pendleton says, is Anheuser-Busch has intertwined it with home safety education. "We might say, 'Here's the proper feet position and line-of-power position if you want to lift a box at work, and also if you want to get your groceries out of the trunk,'" Pendleton explains. This approach resonates with workers because "[t]hey understand it's for them."
  • Engineering controls The company made a number of "ergonomic enhancements," such as providing lifting aids for beer delivery drivers, to reduce back and other soft-tissue soreness, limit fatigue and improve productivity.
  • Fitness Anheuser-Busch has fitness rooms at all of its 12 U.S. breweries and at two of its international breweries. At its U.S. facilities where there is no fitness room, the company has negotiated reduced rates for local gym memberships. Anheuser-Busch also encourages employee participation in cycling, walking, running and other fitness-oriented events. The objective, Pendleton explains, is to help reduce injuries by increasing participation in overall fitness programs.
  • Health Care Initiatives Employees are encouraged to visit their primary care physician (PCP) to aid in early detection of illnesses or health trends that can be addressed before they become serious. To encourage participation, Anheuser-Busch holds an annual drawing for those workers who have visited their PCP and have completed a health-risk appraisal. The winner of the drawing gets a choice of tickets to the Daytona 500, the Super Bowl or other major sporting event. However, Pendleton believes "the real winner is the employee who goes to see their doctor" and takes the initiative to act on their doctor's suggestion, "whether it's lose 20 pounds, manage your diabetes, cut fat out of your diet or use the fitness center."

The company has a number of communication tools at its disposal to reinforce the message of back safety (and other safety and health topics), including newsletters, "AB TV," the company's in-house television system, and the company's EHS Intranet site.

Other facets of Anheuser-Busch's back safety program stem from its guiding principles of employee involvement and line management ownership. For example, production workers assist in teaching a variety of safety and health training programs, including proper lifting techniques.

"If co-workers are teaching someone about lockout/tagout or confined space entry or safe lifting, and they have done that job, they've turned the valves, they've lifted the case of beer the training is more effective," Pendleton explains. "Training has so much more credibility when it's coming from your fellow workers."

Back Safety at Delta Air Lines

Delta Air Lines Inc., an Occupational Hazards America's Safest Companies selection in 2005, also has approached back safety from several angles.

As part of its ergonomics program, Delta provides biomechanics training to its baggage handlers and flight attendants, instilling in them concepts such as "avoid twisting," "push, don't pull" and "keep loads close to the body," explains Ashley West, manager of ergonomics for the Atlanta-based airline.

"They're also encouraged to test the weight before picking it up to make sure they can handle it," West says. "If it's too heavy for them, we encourage them to ask for help from a co-worker."

West notes the airline has made ergonomic improvements to its baggage areas, based on a best-practices guide issued by the Air Transport Association, whenever it has upgraded those areas. Such improvements might include making sure baggage conveyer belts are at least 29 to 33 inches high to limit bending over for bags.

Delta even has implemented engineering controls up in the friendly skies, decreasing the weight of its full-size beverage carts from a maximum weight of 250 to 235 pounds. The number was based on the results of several sustained force studies as well as on the Liberty Mutual Manual Materials Handling Tables, both of which concluded the 235-pound maximum would be less taxing on flight attendants' backs and bodies.

The airline also switched from using metal drawers in its beverage carts to plastic drawers, which not only makes the carts lighter but also makes the drawers easier to pull out. The metal drawers, particularly when wet from melting ice, were prone to getting stuck, putting flight attendants at risk of back strains as they labored to open them, West points out.

Back injuries are the most frequent ergonomic injury at Delta, but they're becoming less and less common. Since Delta began its ergonomics program 7 years ago, West says, the airline has seen a 15 to 17 percent drop in ergonomic injuries.

'An Everyday Event'

Working against the safety professional are the demographics of the U.S. work force. Over half the work force is above the age of 40 the at-risk demographic for back problems and more and more workers in their 60s are deciding to postpone retirement, Drennan points out.

For safety professionals, that should provide even more incentive to have a comprehensive back safety program.

"Back safety is a 24-hour-a-day, 7-day-a-week job," Drennan says. "It's not an annual back safety fair or a back-injury video. It's an everyday event."

Sidebar: Getting Back to Work

When back injuries despite your best efforts sideline your workers, there are proactive ways the company can get involved to expedite their return.

Studies conducted by the Liberty Mutual Research Institute for Safety have shown providing training to supervisors on how to properly respond to workplace injuries can dramatically reduce the number of injury claims and shorten the duration of absences.

Such training should be rooted in communication, a genuine concern for the employee and an emphasis on being non-judgmental when an employee reports an injury or health concern, notes Barbara Webster, research scientist with the institute's Center for Disability Research Group.

Perhaps that begins with teaching supervisors how to react to reports of injuries and illnesses. Some supervisors are skeptical when employees say they've been injured particularly in the case of back injuries, which can be triggered by something as seemingly innocuous as picking up a pencil and that has a negative impact on the company's safety culture as well as on the number of future disability claims, Webster says.

Lauren Hebert, PT, OCS, who has created numerous injury-prevention training materials for Greenville, Maine-based Impacc USA, agrees, asserting less than 7 percent of employees who file workers' compensation claims are "faking it."

"If you want to save money, believe the injury until proven otherwise," Hebert says.

Obviously, supervisors and safety professionals should encourage the employee to seek appropriate medical care, if it's necessary. In addition, Webster recommends trying to find an alternate job task for the employee rather than have him or her miss work on disability leave.

In the event that an employee must miss work due to a back injury, a follow-up phone call or visit when the employee is recuperating is a simple but important way to speed up the employee's return to work, Webster notes.

"It should be about sending a message to the worker that, 'hey, we're concerned about you. We're not harassing you we're just concerned about you,'" Webster says. "'You're an important part of the team, and we want to get you back as quick as we can.'"

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