Caring for Your Back
The bones, muscles, nerves, and other tissues of our backs are critical to nearly every move we make. Reliance on our backs for support and movement makes the back particularly vulnerable to wear-and-tear and to injury, which ultimately leads to back pain. Back injury is common in the workplace; according to the Bureau of Labor Statistics, it accounts for one of every five workplace injuries or illnesses. Back pain affects an estimated 80% of people at some point in their lives (National Institute of Arthritis and Musculoskeletal and Skin Diseases [NIAMS]). Many work days are lost due to back pain.
Environmental Health and Safety has a Back Safety webpage devoted to back injuries, lifting and carrying techniques and prevention of injuries. If you wish to request a workstation evaluation please complete the comment form. It will go to Environmental Health and Safety. Your supervisor should be notified of this request, but does not need to approve the request.
Anatomy of the Back
The back is the support system for the rest of the body. The spine consists of 24 bones (vertebrae) aligning the back in three natural curves.
The spine is properly aligned when none of the three curves (cervical, thoracic and lumbar) are exaggerated. Each vertebra is cushioned by a shock-absorbing disc that allows for flexible movement of the spine. Discs are round and flat and have a jelly-like interior with a tough outer layer. The muscles surrounding the spine allow for support, balance, and movement of the back. Thirty-one pairs of spinal nerves and roots run through the spine as part of the central nervous system.
What are the risk factors for back pain and injury?
- Improper lifting - using the wrong technique for lifting or lifting too heavy objects can cause back strain and lead to pain.
- Repetition - certain tasks done repetitiously can lead to muscle fatigue. Activities such as raking or painting are examples of repetitious activities that can cause back pain.
- Poor posture - improper posture while standing, sitting, or during activity can lead to back pain.
- Stress - muscle tension and tightness related to stress can lead to back pain.
- Age - According to the NIAMS, the first attack of low back pain typically occurs between the ages of 30 and 40. Back pain becomes more common with age.
- Poor physical fitness - back pain is more common among people who are not physically fit because weak back and abdominal muscles may not properly support the spine.
- Overweight and obesity - extra weight on the body's frame can lead to added stress and pain in the back.
- The presence of other diseases - many diseases can cause or contribute to back pain, including osteoarthritis, rheumatoid arthritis, and cancers located in or spread to the back and spine. Back pain is a common manifestation of stress.
- Cigarette smoking - while smoking itself does not directly cause back pain, it can increase the risk of developing or prolong low back pain and sciatica because it decreases circulation and slows healing.
What types of injuries and conditions can occur?
- Herniated disc - also called a slipped or ruptured disc, this occurs when activity, aging, or a mechanical problem in the spine causes one of the discs to bulge, which can place pressure on a nerve and cause pain. When the sciatic nerve is pinched by a herniated disc, it is called sciatica and causes shooting pain down the buttock and back of the leg.
- Disc degeneration - disc degeneration occurs as the body ages with general wear-and-tear and the discs lose their ability to be good shock absorbers. Pain occurs as the discs become pinched and put pressure on nearby nerves.
- Spinal stenosis - spinal stenosis occurs when the spine is narrowed at the space in the center of the spine, the canals where nerves branch out from the spine, or the space between vertebrae, all of which puts pressure on the nerves and spinal cord and can cause pain. Aging, osteoarthritis, rheumatoid arthritis, and some congenital conditions can cause spinal stenosis.
- Spondylolisthesis - spondylolisthesis occurs when one vertebra in the spinal column slips forward over another and is caused by osteoarthritis of the joints.
What types of self-care can be used to relieve back pain?
- Check your study area or workstation to ensure it is properly set up for optimal posture. Changing positions can relieve back pain.
- Stretching exercises can alleviate pain. Try the following: hold of a desk or bed and with your arms fully extended and bend your knees until you feel your back stretch. Hold it for a count of 10 and relax. Or stand against a wall and bend your knees until the small of your back is flat against the wall. Again hold it and relax.
- Over-the-counter pain relievers (i.e. acetaminophen) can be used to relieve pain and over-the-counter anti-inflammatory medications (ibuprofen or naproxen) can be used to reduce inflammation.
- Cold and/or hot compresses can be used to alleviate pain. Use a cold compress to reduce inflammation and a hot compress (or heating pad) to relieve tension. Use cold first, and then heat.
- Keep moving. Stop the aggravating activity, but keep moving to speed healing and recovery. Bed rest is not recommended for back pain.
- Braces can be used, but talk to your healthcare provider first. Evidence does not clearly indicate that back braces or belts can help to alleviate back pain or prevent injury, and they may even cause weakened back muscles and dependency on the brace.
- Strengthen your abdominal muscles as they support the back. A protruberant abdomen (a "beer belly" or a pregnant belly) pulls on the back and can increase the risk of back pain or injury.
- Maintaining a normal weight is important.
When should you visit a healthcare provider?
If you do not have any improvement in your back pain with self-care after 72 hours, you need to visit a healthcare provider. If your pain is from a work injury, it needs to be reported within 24 hours.
The Mayo Clinic recommends that if you experience any of the following, you should see a healthcare provider immediately. If back pain:
- is constant or intense, especially when lying down or at night.
- spreads down one or both legs.
- causes weakness, numbness, or tingling in one or both legs.
- causes new bowel or bladder problems - go to the nearest ER.
- is associated with abdominal pain or throbbing.
- is associated with fever.
- follows a fall, blow to your back, or other injury.
- is accompanied by unexplained weight loss.
How can back injury and pain be avoided?
Back injury and pain can be avoided or reduced by using proper body mechanics. The use of lifting aids greatly reduces the incidence of back injuries. Use a lift team if you have one!
- Learn the proper technique for lifting.
Do not lift a load that is too far in front of you. Keep the object as close to your body as possible. Bend at the knees (NOT the waist), tighten your abdominal muscles, and with your back straight, stand up—your leg and buttocks muscles should be bearing the weight. This type of lifting is only appropriate for items that are sized so that you can "hug" them.
When lifting an item that is too far away or that you can't "hug," get as close to the object as possible. Hold your buttocks out and your head and back in a straight line. Tighten your abdominal muscles and bend your knees. Lift with your leg, buttocks, and abdominal muscles bearing the weight.
- Improve your posture.
When standing, abdominal muscles should pull up in front and buttocks muscles should pull down in back so that the three natural curves of the spine are maintained but not exaggerated. When the natural curves are properly aligned, the ears, shoulders, and hips are in a straight line.
When sitting, use a chair that provides the proper support for the natural cures of the spine. The backrest should fit snugly against the lower back; if not, a small pillow or towel can be rolled up and placed to support the lower back. Adjust your chair so that your feet rest flat on the floor; if you are unable to do so, use a footrest. Keep your knees at or below the level of your hips, and do not cross your legs.
When sleeping, lie on your side with the knees bent to keep the spine in balance. If you can only sleep on your back, sleep with a pillow under your knees to relieve pressure on the lower back. Sleep on a firm mattress.
- Take breaks.
If you are doing an activity that is repetitive, take a 30 second break every 15 minutes to stretch, move, or relax.
- Make your workstation back- and body-friendly.
Adjust your chair and sit properly as described above. Place your monitor at or just below eye level and position it so that it arm-length from your eyes and without glare from indoor or outdoor light. Place your keyboard at a height that allows you to keep your wrists straight while typing. For more information, IUPUI Environmental Health and Safety provides a detailed Proper Workstation Setup Guide. There is also information about Work Station Design.
- Minimize hazards.
Take appropriate precautions to prevent falls, which can cause serious back injuries. Also, avoid unnecessary bending, twisting, reaching, and lifting.
- Reduce stress.
Stress is the cause of many cases of back pain. Some people get headaches, others have stomack problems and many tense the muscles of the upper and/or lower back. Studies have shown that many cases of "back injuries" occur at times of increased family problems or financial issues.
- Improve your overall wellness.
To help you feel stronger, healthier, more flexible, and healthier. Eat a well-rounded nutritious diet, engage in regular exercise, and make sure you get plenty of sleep (which can also reduce mistakes that can lead to injury). If you are overweight, weight reduction can help to lessen the amount of stress on your back.
- Practice exercises that will stretch and strengthen your back.
The NIH Office of Research Services Division of Safety, and the McKinley Health Center at the University of Illinois at Urbana-Champaign all provide detailed guidance on back exercises.
Occupational injuries must be reported to IUPUI Health Services within 24 hours of their occurrence or on the next business day if they occur on a weekend or holiday. An IU Incident Form must be obtained from and signed by your supervisor and brought to the clinic. If a musculoskeletal injury occurs at home, see a health care provider if you experience no improvement after a few days or if your symptoms worsen.