 People have always been accustomed to supporting or backing a cause, organization, sport, or politician. So it would seem that it would be just as important to back your back. Back pain is not new. The Egyptians were afflicted with back problems 5,000 years ago, and so were the people of the Middle Ages. Today, it is among the most common industrial injury and one of the leading health problems that interfere with our active working life. Back injuries account for a large proportion of lost time and money. Less than one-third of injuries in industry are back injuries, and over one-half of the industrial insurance dollars go to pay for them. Most people aren't sure what causes their back pain. It could be the way we live, or little things we do like twisting to throw away a piece of paper, or even the way we dance. It could be caused by simply pushing, pulling, or lifting an object. Cumulative trauma can also be a hidden cause of back pain. Competitive bending or twisting can weaken the back. Much like bending a wire back and forth several times can weaken the wire. And when force is applied, such as lifting something unexpectedly heavy, it can cause a back injury. Poor posture in conjunction with cumulative trauma can also cause back pain. Just sitting or lying down could cause pain. However, recovery from back pain is usually quick. Some back specialists feel that many back pains are psychosomatic. Most of them agree that back pain is more noticeable with tension, worry, fatigue, anxiety, boredom, family problems, lack of understanding, and unpleasant situations. Sometimes a less significant back problem can be aggravated by these symptoms. The back is a mechanical wonder and very flexible. It consists of a bony spinal column, muscles, and ligaments. The main purpose of the back is to support the upper body and protect the spinal cord. The spinal column has four natural curves that act like arches of a bridge. These arches allow us to load the spine 16 times more than if it were straight. The key to preventing back problems is to maintain these natural curves while standing, lifting, sitting, or just doing everyday tasks. The spine is made up of 24 moving vertebrae. There are seven in the neck called cervical. Problems in this area can cause pain in the neck, shoulders, and arms. The 12 in the back called thoracic run from the neck through the rib cage. Any problems in this area imitates heart trouble, pleurisy, or causes numbness. The five vertebrae at the bottom of the spine are called lumbar. The lumbar area supports most of the upper body weight. It is most vulnerable to injury and where most pain occurs. Problems in this area can cause pain in the lumbar area and in the legs. The vertebrae are stacked one on top of the other and attached by a cartuit-like cushion called a disc. These discs have the ability to bulge and act like coil springs or shock absorbers. They also prevent one vertebrae from sliding upon another. The vertebrae, in combination with the discs, allows the body to be stable and very flexible. The spinal cord is located in a protective passage of each vertebrae and behind the discs. It is a bundle of individual nerves that send out branches or nerves into other parts of the body to pick up sensations and control motion. The vertebrae are held together by ligaments, cartuits, and muscles. Other muscles of the entire trunk, legs, and upper arms also help control and reinforce the spine. Longitudinal ligaments run down the length of both the front and rear of the spine and are attached to each vertebrae. These ligaments give support to the spine and protects it from over flexing. Forward bending of the spine causes the ligaments in the back which are weaker to become tight. This is especially evident in the lower back where the most support is needed. Painful sprains are caused by stressful bending, lifting, or prolonged stretching. The hamstring muscle runs from below the knee up the back of the thigh and connects to the pelvis in conjunction with the buttock muscles. This powerful muscle propels us forward when we walk or run and is responsible for the posture of the lower back. Discs can be injured by vertebrae applying pressure to one side when the back is bowed out. Muscles and ligaments can also be injured by over stretching. One to two percent of back problems can be directly related to a disc hernia or rupture which is commonly called the slip disc. In truth, discs can't slip because they are attached to the vertebrae. Bending, twisting, or injury can cause accumulated or immediate stress on discs. Excessive bending and twisting can cause the strands of cartilage like wall to weaken and split. A jelly-like substance that is in the center of the disc will then flow between the strands causing a herniated disc. A ruptured disc develops when the jelly substance works its way out and presses on a nerve. Herniation commonly happens in the lumbar region and the back of the spine where the disc wall is thinner. The amount of pain experienced is determined by where the herniated material goes and how hard it presses on a nerve. During the normal aging process, changes with our discs occur. They become cracked and lose much of their center substance. Vertebrae come closer together and can create pain when excessive movement causes inflammation of the joints or irritation of the nerves. People approximately 40 or 50 years of age with this condition will have more pain than those in their 60s and 70s when the back is stiffer. Individuals with this condition will have to make changes in the way they live, work, and play to allow for their limited strength and flexibility. If they don't make changes, they may continue to produce their own pain or become psychologically disturbed because they can't do what they were able to when they were younger. Maintaining the natural curves demands good posture and can only be accomplished with firm muscles. The muscles act like guy wires to support the spinal column and if they become fatigued, they can't properly position and support the spine. More stress is then put on the bones and joints. Weight lifters spend hours lifting tremendous weights and suffer few back problems. They maintain their body much like a mechanic would fine-tune a machine. By lifting weights, the lifters maintain the three natural curves of the spine and use the muscles of the abdomen, products, and thighs. This group of muscles is much stronger than those in the back so it's real important to keep them in good shape. Loss of muscle tone from overeating and lack of exercise can develop poor posture. When the abdomen thrusts out, the muscles in the back work to offset the weight in front. Women in the last month of pregnancy have the same problem. Slouching or rounded shoulders can cause muscles to be overworked and increase the work of the spine. Any change of the normal curve of the spine is poor posture and affects the amount of work the back must do. Lifting a load is one of the main causes of back pain. From the time you get up in the morning and until you go to bed at night, you invariably will have to pick up or lift an object and it will continue throughout the day. Even picking up a small object such as a pencil if not done correctly can irritate your back. You can protect your back by practicing proper work habits all the time. Think of your back as a lever system. The distance between the load and the fulcrum can be up to 10 times greater than the distance between the fulcrum and the point where the lifting force is applied. With this ratio, it would take a lifting force of 100 pounds to lift 10 pounds. When you lift a load, keep it close to the body. Lifting without doing this will require the lever to apply a force much greater than the weight of the object itself. Just bending over with only the weight of your head, arms and upper body can exert 1200 pounds of pressure on the back. Add 50 pounds and this will exert 1700 pounds of pressure to your back. This diagram indicates probable lifting capabilities in percentage of load which can be handled easily at fingertip length, the 100% area and positions to avoid when lifting loads. The lifting ability decreases rapidly when the height of the lift increases above the optimum lift height. The lifting ability falls off more slowly as the lift height decreases below the optimum. Near the floor, the ability is about 75% of the optimum. Before lifting an object, size up the load. Can you handle it by yourself? Does it have any sharp edges, nails or slivers? Is the object slippery, hard to handle or grip? Test lift the load first to see if you can lift it. Mentally lift the load first. Don't let the size of the contents of the load fool you. For example, which is heavier? 32 pounds of lead or 32 pounds of feathers? We know both are the same. However, the bulk of the feathers makes the load more awkward to lift. Keep close to the body and carry. Check the load you're going to lift and see if you should be wearing proper protective equipment such as hand protection, safety shoes, goggles or apron. Before attempting a lift, make sure there is good footing by checking the condition of the floor. Is it slippery or wet? Are there objects that could cause you to trip? Be careful working on docks, walkways and platforms. To start the lift, the first thing is to make sure you have the proper foot position. Step up close to the load. Place your feet in a comfortable position on each side of the object. This provides a wide, stable support and helps maintain your balance when squatting down. Some people prefer to place one foot ahead of the other, but any method is good as long as you're comfortable and balanced. Touch down and keep your back feeling natural by maintaining the natural curves. Bow in your lower back. This allows the vertebrae, discs, ligaments and muscles to be in their normal positions. Extend your fingers and hand around the load using the full palm. Don't try to lift with just your fingers. They have very little power and strain will be placed on the forearm. Bring the load close to your body and keep your arms and elbows tucked in. If your arms are held away from your body, throw a tire and put a load on your back. Hands should be on the opposite corners of the load. Now when lifting the load, first raise your head then push up with your legs. Don't crouch down any further than you have to. Maintain those natural curves and know your physical limitations. If the load is lifted the length of a forearm away from the body, 10 times more pressure is put on the lower back than if it were held close to the body. So hug your work. If the object is too heavy or awkward, don't feel embarrassed to ask for help. Don't try to be superhuman. It's very important to remember to avoid pivoting at the waist while holding a heavy load. Many back injuries are caused by this maneuver. Shift your feet to point in the direction of the carry. Remember, don't twist. When going up or downstairs, make sure you can see where you're going to step. Don't carry so much that you can't see around or over the top of the object. When passing an object to another person, be sure the person has a good grip before you let go. Before removing a load from a shelf, check it out. Some objects are top heavy and some could be heavier than they look. If the object should slip and fall, don't attempt to catch it, let it drop. Stacking or removing objects above your head could put stress on your back, shoulders and neck. Don't stack too high or pick a shelf too high. Use a stool high enough to reach the shelf and make sure there is a place for the object before you set it down. When you are going to place an object on the counter, use the momentum of your body and legs to raise the load. It may be necessary to first set the load on the counter, change your grip and then lift. If you can, bend your knees and use your leg muscles whenever possible. Increased stress on the back can be caused by bending over to place or remove something on a low shelf. Squat down using the strong leg muscles and hug the load as soon as possible. Aggravation can occur if you suddenly twist while in the bent position. Many times a box or carton may be awkward to handle because of its size or construction. Turn it on its side or end to pick it up or if possible, split the load into two smaller loads. A sack or a bag can be awkward to lift. First, bring it to your knee, then to your shoulder and finally push up with your leg muscles. When carrying flat material like plywood or sheet metal, always wear gloves. Let the bottom edge rest on one hand and support the top edge with the other. Your vision may be blocked on one side, so be sure you know where you're going and what's on your blind side. Don't pick up something that could be moved in easier way. Use a hand truck or roll barrels and drums. Keep your hands in a position where they won't be scraped or pinched. When carrying long objects on your shoulder, keep the front end high to avoid running into people. Be aware of electric wires when carrying pipes. If it takes more than one person to carry a large object, it's better to have both people close to the same height or have them positioned from the tallest to the shortest with the tallest in front. One person should be the director of the lift and carry. Overreaching while on a ladder or stool may not only cause muscle problems, even if no lifting is involved, but can cause a fall. Take time to position the ladder or stool to avoid overreaching. Pulling an object can be dangerous if done improperly. Position yourself with one leg behind the other. Feet apart with your knees slightly bent. With your elbows bent and arms close to your sides, push back with your legs. This uses the body weight for leverage. Maintain those natural curves while doing this. Whenever possible, push, don't pull. It's better for your body. In fact, you can push twice as much as you can pull. Push with your whole body using your legs and again maintaining those natural curves. Objects to be moved come in many shapes and sizes. Know the proper lifting techniques. Use mechanical lifting devices whenever you can. And remember, common sense can avoid back injuries. Some factors to consider with a lifting are, how much will you have to lift? How often will you have to lift and carry a load? How high or low will you have to place the object? And is there a place for it? How long a period of time is the weight to be carried or handled? If you're required to do some prolonged standing, raise and rest one foot on a support about 8 inches high. This raises the front of your pelvis and relieves some pressure on your back. This isn't new. Rails weren't built around counters and bars for nothing. Good posture and support for your spine is just as important when you're lying down and it is while you're standing or sitting. Use a firm mattress. Sleeping on your side with your knees bent can help support the back and ease any tension. It may also help to sleep on your back with a pillow under your knees. Lying on a soft, sagging mattress can cause back problems. Sitting places the most stress on the back and its discs, even more than standing or jogging. When sitting, adjust your chair to a comfortable height and make sure it supports your lower back. Your knees should be slightly above or level with your hips. If the back of your chair doesn't adjust to your comfort, you may want to use a pillow or a backrest. Avoid slouching or reaching. Try not to sit too long and shift your position throughout the day. When sitting while driving, adjust your seat forward enough to allow your knees to bend and be slightly higher than your hips. Use a pillow or rolled up towel to help support the back if necessary. The best prevention of back pain is staying fit. Lack of endurance, stamina and poor posture can be the back's worst enemies. Muscles fatigue easily with lack of exercise and can't sufficiently perform their role to support the spine. This causes the vertebrae and discs to bear more weight than they should. Involve yourself in a good exercise like walking or swimming. A brisk walk is one of the best and safest exercises. Ask your doctor about an exercise program that would be good for you. Finally, let's summarize. To lift safely, size up the load and make sure you can lift it. Plan the move. Ask yourself how far do you have to carry the load and is there a safe place to put it. Make sure you have firm footing and a path clear of tripping hazards. Bend your knees and get a good grip on the object. Keep your back natural by maintaining those natural curves. Lift with your legs. Keep the load close. Hug your work. Know your limitation and ask for help if it's needed. Pick up the object smoothly. No jerking. Remember to prevent back problems. Avoid fatigue. Get a good night's sleep and don't over lift. Maintain a good posture by keeping the natural curves. Establish an exercise program. Eat a balanced diet. And no good work habits. Graham was developed by the state of Washington, Department of Labor and Industries, Division of Industrial Safety and Health. It is one of the many programs that the division has to offer employers and employees to help them establish a safe and healthy workplace. For further information about this subject, call your local Washington State Department of Labor and Industries, Division of Industrial Safety and Health, Consultation Services.