xxx With the looming loss control issues of the public sector being health-related preventative safety mechanisms-particularly for the high risk/loss work arenas of public safety- it has become apparent that long-term preventative systems to reduce and control back-related employee losses and resulting retirements are a critical issue.

xxx There exist diverse strategic planning mechanisms to address the issue of back disability injury losses. They range from incentive-provoked safety awareness and constantly reinforced caution in statistically high-risk work functions to "wellness" programs including the modifying of existing work patterns together with re-engineering of the work environment where possible. In some cases-certain primary insurance carriers and corporations-redesigning the work environment is emphasized.

xxx In the physically demanding and environmentally changing work arena the limitations on engineering safe conditions are obvious. In the emergency services and other occupations with changing external environments, modifying the work arena is, of course, not possible. In these occupations the employee receives high degrees of technical training in work responsibilities. The approach to preventing occupational back and body response injury is pragmatically a synthesis of engineering safe apparatus with work behavior modification through classroom education.

xxx Statistically, neither of these has proved effective in controlling back and body response injury. It is, in effect, not easy in a classroom to modify the response patterns of an employee who deals in crisis-related body actions and other physically demanding and environmentally changing work exposures.

Why Not

xxx Symptomatic back safety education does not with any consistency produce back safe effort nor a resulting reduction in losses in the physically demanding occupation. Why? Because examples of symptomatic procedural training are: bend the knees, bring the weight close to you, tense the abdominal muscles and lift with the legs.

xxx However correct these examples of safe lifting and effort procedure are under ideal conditions, they may well produce injury as a first reaction in those work arenas where awkward position is part of the job.

xxx This is particularly true of those unforeseen contingencies at the environmentally changing work site; for example, a firefighter, a police officer, paramedic, or nurse reaching out for an unconscious victim or patient lying in a bed. Often the knees cannot be flexed because the edge of the bed is in the way and it is in the very act of attempting to safely bring the weight closer that the back injury will occur.

 

xx

 

Other dramatically obvious situations in which an employee might well sustain injury are:

A firefighter pulling wet hose or lifting a heavy patient litter over the balcony. Or, lifting a cardiac patient out of a couch or from between the sink and tub in the bathroom.

A police officer physically engaged with a resisting offender. Or, seated for a long period then quickly exiting a vehicle to pursue a suspect.

A public works or construction employee feeding duct in a a narrow ditch where he is unable to readily bend the legs. Or, offloading a truck and needing to reach over a tailgate.

A utility employee working on a pole, strapped in at the waist and angling a hot stick to hang a 14-pound insulator 10 feet away.

A mechanic working over an engine or a worker at work station with a waist level impedance to reach over.

xxx Indeed, for most of us the very ordinary act of reaching for a cumbersome object out of an automobile trunk means reaching for the weight at an uncomfortable distance and therefore precludes following the first rule of avoiding back injury - maintain the effort close to the body with legs underneath.

xxx Commonplace in the work arena is the awkward reaching for too much weight - a lesson in which the employee is educated and guided by back pain. This is unfortunate. Preferably, the worker should not be educated by pain to focus on correct procedure.

 

n the emergency services and other physical occupations, back related injury is of natural course a primary source of employee disability loss and retirement.

What is needed are employees who are aware when they are doing things correctly, and what the right experience feels like when it is applied all the time.

Cumulative results

xxx The smallest amount of back pain during effort may well produce damage. Even if this does not cause dysfunction at the time, it will invariably build into later disability. Most noteworthy is the fact that the discs which separate the vertebrae have neither nerve endings nor blood circulation within them. In effect, when overloaded and damaged the discs neither signal pain directly nor regenerate significantly.

xxx This is the cumulative nature of the career low back injury. It is invariably the same injury which repeats itself in each recurrence. Therefore, it gets worse progressively unless body reactions and efforts are modified enough to become correct on the first response and a habitual pattern. The spine must be held stable reflexively with the lumbar spine (lower back) brought into neutral, as a first and ongoing reaction to effort. This should happen automatically, while the mind is focused on the task at hand.

Medical findings

xxx Medical studies suggest that one or more of the lower three discs of a 35-year-old male in a physically demanding occupation over 10 years will have degenerated to some degree. There will have been repeated trauma to the lumbar spine and consequently some tearing and weakening of the layered walls of one or more of the lumbar discs.

xxx The worker is in greater danger of disc prolapsed (bulging or herniation with the tearing of the last outer layers of disc surface causing the inner gelatinous nucleus to push out). Attendant to such disc bulging is nerve impingement and ongoing mechanical dysfunction - the inability to work because of pain.This translates to progressively more lost time with each recurrence and usually disability and early retirement.

xxx At the very least both the cause and results of most short-term back related disability injury do not disappear with first-time recovery. In fact there's a high probability of the injury recurring and developing into a "back" condition.

Where should education start?

xxx There is a basic law of human physiology, subjectively clear to the athlete and speaker,boxer or opera singer. The key element to body integrity (poise, stability, and the capacity to adapt while maintaining body control) lies in the physical awareness of where the effort must be initiated, experienced, and maintained to allow the correct reaction margins necessary for performance.

xxx What the above all have in common is that they enter into the respective demand of their work acutely aware of a common mechanism. Breathing is experienced in the voluntary (and involuntary) muscle action of the diaphragm. The diaphragm controls respiration and initiates body effort.

xxx In fact, everybody utilizes this muscle in order to breathe, whatever their physical or athletic capacities. The diaphragm also connects the front of the body to the back and , indirectly through other connective tissue, the top to the bottom. It initiates holding the skeletal frame together and is pivotal to the different parts working in concert.

xxx With physical control beginning with the diaphragm, the control of the body's expression of effort and the margins for successful physical activity alter significantly.

Enhancing performance

xxx Every time we push a car, we hold our diaphragm, not our breath. It makes the whole unit body work together with the largest muscle groups taking the most effort - i.e. the legs.

xxx Without a very strong diaphragmatic action, the boxer may have the punch to win, but be unable to maintain spinal stability or the balance needed to receive blows. The defensive linebacker in football works from the same physical premise to initiate an extremely low center of gravity.

xxx Indeed, the football player may well be able to leap high in the air to throw or catch a ball. But if -when tackled by 300 pounds from behind- he is unable to spontaneously stabilize his upper body , he will be seriously injured.

xxx The opera singer ad orator have the ability to project forcefully, softly, and to modulate other forms of expression by focusing this effort through the action of breathing. This integral first ingredient to preventing body and spinal instability-the primary cause of back overloading and disc injury-is common to all breathing humans. In other words, it isn't hard to learn since it is already a natural human function.

xxx What must be established in the physically demanding arena are employees with a basic physical awareness of:

What they are doing automatically that is correct and what the "right" experience feels like when applied all the time.

How can this correct effort focus be then spontaneously applied with leverage and stability to allow a margin for safety before back pain or instability is experienced.

How to identify occupational procedure and tools which adversely affect the experience of correct effort, leverage and stability.

How to continuously re-enforce what the human body already knows feels correct.

How to allow gravity and therefore the employee's own developmental experience to maintain correct response and work pattern. That is to say, how to establish a response mechanism with built-in preparedness that is already an existing human function and develop it as a conscious mechanism, as must the athlete or opera singer who require it to successfully perform.

xxx This spontaneous mechanism for body preparedness must be there before the action is, or there would be injury every instant. If work behavior can be modified to maintain the experience of what it feels like to successfully push a stalled car, and this adapted with leverage through all circumstances with awkwardness built-in, we have significantly expanded the margin for safe response.

Summary

xxx The capacity to recover from a back injury has much greater challenges involved in it than a professional level intervention as a career preventative measure.

xxx In order to control losses of career oriented personnel, human and financial resources, safety professionals and risk managers must address the work hardening , self protective training of the employee to potential back-related injury with the attention consistent and parallel with procedural occupational training.

xxx The average back injury costs U.S. industry or insurers $10,000 before surgery or rehabilitation to other work. One in three employees will suffer back-related injury in their career.

xxx Upwards of five hours of hands-on training in order to trigger the correct professional response in the emergency services and others will return a measurable savings of human and fiscal resources over the potential career of the participant.

 

 

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BY JACK S. KANNER

Jack S. Kanner CEO, is director of engineering work behavior modification and career loss control for the
PSR Corp. , a nationally recognized public-sector oriented training agency based in
Corte Madera, California