Back injury: back to basics.
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Back Injuries↗
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Patient-handling skill, back injuries, and back pain. An intervention study in nursing.
The aim of this intervention was to evaluate the effect of training on patient-handling skills and prospectively to assess the effect of skill on subsequent back pain and back injuries in nursing. Of a total of 255 nurses, 199 were assessed for their skill in patient-handling. One-half (control group) received traditional training in patient-handling, and the other half (trained group) received a curriculum of instruction totaling 40 hours. The skills of both groups were assessed on graduation. The control group was rated as less competent in patient-handling. Nurses in both groups were questioned about the prevalence of back pain and incidence of back injuries in the first year after graduation. In multiple regression analysis, the major risk indicators for back injuries were poor patient-handling skill, low numbers of repetitions in the sit-up test, and high work-load scores. High score on the hysteria scale of Middlesex Hospital Questionnaire was a risk indicator for all kinds of back pain. Though back pain was independent of patient-handling skill, those rated as "bad" or "poor" had more back injuries (24%) than those who had been rated as "good" or "excellent" (2%) (P less than 0.001), but the difference between the trained and control groups was not statistically significant. It was concluded that back injuries may be prevented by the teaching of patient-handling skills.
Back Injuries↗
The role of exercise and posture in preventing low back injury.
Low back injury is a serious problem for U.S. industries, accounting for as much as one third of all workers' compensation payments. The number of low back injuries can be reduced effectively through the stressing of proper posture and the use of back care exercises. Body posture that maintains the spine's three natural curves decreases intradiscal stress. Back care exercises decrease the likelihood of low back injury by strengthening and adding flexibility to the spine's supportive structures.
Back Pain↗
The value of preemployment roentgenographs for predicting acute back injury claims and chronic back pain disability.
Preemployment roentgenographs have long been used in industry to screen job applicants. Roentgenographs have had little effect, however, in curbing the cost of back problems in industry. This study evaluates the capabilities of preemployment roentgenographs for predicting acute back injury claims within the longshoring industry and for predicting back problems that lead to back disability of more than six months. The data indicate that lumbosacral roentgenographs are not helpful in predicting who is more likely to make a back injury claim, or those few who make up the vast majority of the costs for industrial back pain by becoming disabled for more than six months. Lumbosacral roentgenographs have little link to back disorders and may be viewed as discriminatory. The radiation exposure is not justified by their predictive value as a preemployment screening tool.
Acute Disease↗
Back injury prevention program on a spinal cord injury unit.
A back injury prevention program was developed for the Spinal Cord Injury (SCI) nursing staff at the San Diego Veterans Affairs Medical Center (SDVAMC). This preventive program has the following components: 1. All nursing staff are sent to a one hour "back school" in order to learn and practice proper body mechanics. This program is held in the therapy clinic and conducted by a kinesiotherapist. In addition, each nurse must be certified in transfer techniques by our clinical nurse specialist, before performing transfers on patients. 2. All nursing staff participate in 5-10 minutes of stretching, warm-up exercises at the beginning of their shift. These exercises are helpful as injuries are less likely to occur when muscles have been warmed up prior to lifting and moving patients. 3. All nursing staff wear a lumbar sacral back support while on duty. This device will offer physical support to the lower back as well as provide a mental reminder to use proper body mechanics when transferring patients. This back injury prevention program has been in effect since the opening of the SCI unit in March 1989. The rate of low-back injuries on the SCI unit from October 1989 to September 1990 was compared to the rate of low-back injuries on the other hospital units. As a result of this program, there were only four low-back injuries with six lost work days on the SCI unit. This rate compares favorably with the incidence of low-back injuries in other patient care areas.
Back Pain↗
A study of three preventive approaches to low back injury.
The prevention of low back injuries in industry has traditionally been attempted by (1) careful selection of workers, (2) good training in safe lifting, and (3) designing the job to fit the worker (ergonomics). One hundred ninety-one low back injuries were analyzed to determine the effectiveness of each preventive approach. The results indicate that the common selection techniques, as they are being used today, are not an effective control for low back injuries. Similarly, training on safe lifting procedures, as it is being administered today, is not an effective control for low back injuries. It was determined that a worker is three times more susceptible to low back injury if exposed to excessive manual handling tasks. The ergonomic redesign of these tasks to reduce the manual handling exposure represents a partial control for low back injuries.
Back Injuries↗
Back injuries in college athletes.
Frequency and types of back injuries sustained by intercollegiate athletes were determined by examining medical records of 4,790 athletes that competed in 17 varsity sports over a 10-year period. These athletes sustained 333 back injuries, an injury rate of 7 per 100 participants. Injury rates were significantly higher in football and gymnastics, and 80% of the injuries occurred in practice, 6% in competition, and 14% during preseason conditioning. Muscle strains occurred with much greater frequency than other types of injuries, and acute back injuries were much more prevalent (59%) than overuse injuries (12%) or injuries associated with pre-existing conditions (29%).
Athletic Injuries↗
Back injuries to fast bowlers in cricket: a prospective study.
Eighty-two high performance young male fast bowlers (mean age 16.8 years) were tested immediately prior to the season for selected kinanthropometric and physiological data. Subjects were also filmed both laterally (200 Hz) and from above (100 Hz) while bowling so that their front foot impacted a force platform during the delivery stride. The players then completed a log book over the ensuing season that detailed their training and playing programmes. All cricket related injuries over this season were assessed by a sports physician who used computerized tomography to assist in the diagnosis of spinal injuries. At the completion of this season the players were grouped according to their injury status (Group 1--bony injury to a vertebra; Group 2--soft tissue injury to the back that caused the player to miss at least one game, and Group 3--no injuries). A one-way analysis of variance was used to identify if any variables were significantly (P less than 0.05) different between the three groups, and a Scheffe post hoc comparison was used to determine which groups were significantly different. Eleven per cent of the players sustained a stress fracture to a vertebra(e) (L4 to S1), while 27 per cent sustained a soft tissue injury to the back. Bowlers with a low longitudinal foot arch were more likely to develop a stress fracture than those with a high arch. Shoulder depression and horizontal flexion strength for the preferred limb and quadriceps power in the non-preferred limb were also significantly related to back injuries. Results suggest that bowlers with the above physical characteristics, who bowl with these biomechanical techniques for extended periods, are predisposed to back injuries.
Adolescent↗
Low back injury in sport.
Low back injuries are shown to present a serious hazard to sportsmen and women, and may lead to long-term disability in relation to their sport. Training methods, particularly weight training, led to many of the injuries and it is recommended that personnel involved in training become more aware of these dangers. Spondylolysis was found in 18% of cases and it is suggested that the full investigation of low back pain in a sportsman is incomplete until this lesion has been excluded.
Adolescent↗
[Back injuries and the work site].
Payments through obligatory accident insurance for back injuries as a result of an accident in the legal sense are common. In contrast, the acceptance of back injuries as an occupational illness is associated with such strict legal prerequisites that, considering the early appearance and frequency of degenerative back diseases in the general population, the condition whereby a back injury must have been caused exclusively or predominantly, i.e. at least three quarters, by the occupational activity is satisfied only in rare cases. Epidemiological studies show that back conditions occur more frequently in certain types of exposed occupation. The high degree of causality required by the legislature is, however, not demonstrated so that back injuries could therefore be recognized as occupational illnesses only in rare cases. Because of this, prevention at the place of work is all the more important.
Accidents, Occupational↗
A case-control study of risk factors for industrial low back injury: implications for primary and secondary prevention programs.
Data were collected on 228 consecutive back injuries in Boston's General Mail Facility and 228 non-injured controls drawn randomly from each case's work unit, matching on craft (clerk, mailhandler, maintenance), shift, and general supervisor. Data were collected on age, gender, duration of employment, 3 year history of injury claims, overtime work in the past 2 weeks, job change in the past 60 days, and machine vs. manual job. Risk factors for back injury were examined simultaneously in a conditional logistic regression for matched pairs. Risk factors included history of back injury claim (OR = 16.5, p less than 0.0001), younger age (OR = 3.0, p = 0.0001), shorter duration of employment (OR = 2.6, p = 0.0007), recent job change (OR = 2.5, p = 0.06), and history of non-back injury claim (OR = 2.0, p = 0.08). Among heavy lifters (vs. clerks) overtime and being female increased the risk of injury. In this setting, higher risk workers who may benefit from preventive education programs can be identified.
Accidents, Occupational↗
Australian workers with back injury: a statistical overview.
This paper reviews international and Australian data concerning the occurrence of back injuries amongst the labour force. Analyses of Australian Bureau of Statistics data for the period 1977 to 1986 revealed substantial differences between Australian states in their rates of back injury claims for work injuries, with a decline in rates over the ten years surveyed. Analyses of WorkCare data from the State of Victoria in Australia revealed that claimants with back injury claims of greater than 12 months standing were very costly. A total of 8,633 claimants accounted for 68.7% of all payments for back injury ($362 million out of a total of $527 million) when these claimants represented only 10.7% of all back injury claimants for the period September 1985 to May 1989. Substantial variations were found in claim rates across occupations and age levels. An almost linear (r = 0.98) association was found between age and proportion of long term claimants at each age level. It is suggested that these data could be used to identify 'at risk' groupings with a view to the implementation of preventive measures.
Adolescent↗
The effects of compensation on recovery from low-back injury.
The influence of compensation on recovery from low-back pain was assessed in a retrospective controlled cohort study. One hundred fifty compensable and 150 noncompensable back injury patients were invited for review between 1 and 5 years from presentation. A 91.3% follow-up was achieved, and there was no difference in the median age, follow-up, and initial injury score between the two groups. The incidence of reported pain, disability, psychological disturbance, unemployment, and length of time off work was greater in the compensation group (P less than 0.001). Settlement of the claim did not result in any reduction in morbidity, even up to 5 years later. These results demonstrate that the payment of compensation delays recovery from low-back injury.
Adult↗
Low-back injuries in a heavy industry. I. Worker and workplace factors.
The costs and circumstances of low-back strains, low-back impact injuries, and non-low-back injuries among field employees of an offshore petroleum drilling company, 1979-1985, were compared. The objectives were to identify worker and workplace factors associated with low-back injuries, to identify factors differentially associated with lost-time injuries, and to formulate recommendations for the control of low-back injuries. Low-back-impact injuries resulted largely from falls. Efforts to prevent falls would have a potential to reduce other serious consequences as well as back injuries. Workers performing the heaviest physical labor were at highest risk of low-back strains. Based on activities precipitating the injury, modifications of work site, equipment, and procedures to help reduce low-back strains are recommended. Only job was a predictor of whether a low-back strain was likely to be associated with lost time. Even this association was lacking for low-back impact injuries. Cost control by preventing the small proportion of high cost injuries may not be feasible. Rather, subsets of low-back injuries defined, for example, by work site or activity can suggest options for intervention.
Accidental Falls↗
Results of a multicenter trial using an intensive active exercise program for the treatment of acute soft tissue and back injuries.
Dissatisfaction with current nonsurgical treatment of acute soft tissue and back injuries initiated a search for more effective treatment. A multicenter trial, involving 12 clinics, treated 1,072 patients. Treatment consisted of intensive, time-limited exercises emphasizing mobility, muscle strengthening, work conditioning, sequence training, and appropriate education sessions. Return to full-time work was proof that the patient had recovered fully. Time off work and compensation costs were parameters used to evaluate results. A detailed study of 703 patients treated at five clinics, operational for more than 12 months, showed superior results when compared with the comparison group of 2,172 matched control subjects. The treatment group returned to work earlier and realized substantial cost savings. This treatment program has proved to be superior to the miscellaneous variety of treatment modalities used for acute soft tissue and back injuries provided to the comparison group.
Back Injuries↗
MMPI scale 3 as a predictor of back injury report: what does it tell us?
Items and selected subscales of Scale 3 (Hysteria) of the MMPI were examined to pinpoint personality or emotional factors predictive of back injury reports in an industrial setting. Data were derived from a previous prospective-design study of back pain in volunteer hourly wage employees of an aircraft manufacturing company. After physical examination and completion of questionnaires pertaining to demographic, psychosocial (including the MMPI), and workplace factors, workers were followed for an average of 3 years. Those who subsequently reported back injury were compared with those who did not. In that study three variables predicted report of back injury, one of which was Scale 3 of the MMPI. Individual items, Ornduff et al. subscales of Psychological Denial and Body Concern, and the five Harris-Lingoes (1955) subscales of Scale 3 were analyzed. Three Harris-Lingoes subscales showed significant relationships to the criterion. Hy-3: Lassitude/Malaise; Hy-1: Denial of Social Anxiety; and, marginally, Hy-2: Need for Affection, significantly contributed to prediction effectiveness. Results and implications for the understanding of factors predicting back injury reports and for the medical evaluation of pain and the concept of pain are discussed.
Back Injuries↗
Occupational low-back injury in a hospital employee population: an epidemiologic analysis of multiple risk factors of a high-risk occupational group.
A case-control study was carried out using 84 cases of employee back injuries and 168 controls (matched triplets) at Children's Hospital and Health Center, San Diego. The objective was to examine the impact of multiple individual and work-related risk factors for low-back injury from hospital employee health records. Hospital workers include occupational groups historically regarded as being at high risk, particularly nurses and others involved in patient care. In terms of traditional risk factors, significant associations were found for history of low-back pain or "slipped disc" by self-report and for history of previous back injury. Working the day shift also was significant (odds ratio [OR] = 2.23, P less than 0.005). Marital status (single) approached significance (OR = 1.65, confidence interval [CI] = 0.091, 2.99), as did low body weight (OR = 1.47, Cl 0.70, 3.10). No significant association was found between cigarette smoking and low-back injury. Possible work site health promotion interventions to lower the risk of low-back injury in this population are suggested.
Adult↗
Tenderness at motor points. A diagnostic and prognostic aid for low-back injury.
In patients with low-back injury the motor points of some muscles may be tender. Of fifty patients with low-back "strain", twenty-six had tender motor points and twenty-four did not, while forty-nine of fifty patients with radicular signs and symptoms suggesting disc involvement had tender motor points, and the one without such tender points had a hamstring contusion which limited straight leg raising. Of fifty controls with no back disability, only seven had mild tender points after strenuous activity, while forty-six of another fifty controls with occasional back discomfort had mild motor-point tenderness. In all instances the tender motor points were located in the myotomes corresponding to the probable segmental levels of spinal injury and of root involvement, when present. Patients with low-back strain and no tender motor points were disabled for an average of 6.9 weeks, while those with the same diagnosis but tender motor points were disabled for an average of 19.7 weeks, or almost as long as the patients with signs of radicular involvement, who were disabled for an average of 25.7 weeks. Tender motor points may therefore be of diagnostic and prognostic value, serving as sensitive localizers of radicular involvement and differentiating a simple mechanical low-back strain from one with neural involvement.
Adult↗