Exercises for Back

Exercises for a Healthy back

Important is exercise in preventing low back injury:

The key to preventing lower back injury and pain (LBP), whether work-related or not, is physical conditioning. “Getting into shape” involves the overall conditioning of the body and the cardiovascular system. Aerobic exercise plus the exercising of the core muscles (those of the spine and the abdomen that are responsible for stabilizing the spine), are both critical for developing healthy and pain-free backs.

Most effective for preventing low back injury:

Traditional beliefs among exercise practitioners and even rehabilitation professionals that strong back and abdominal muscles alone protect the back and reduce LBP episodes have never been validated by research or experience. It’s time to debunk that myth.

Mobility and flexibility of the lumbar region seems to be another fallacy. However, that doesn’t mean that strong and supple back muscles, if you have them, are a bad thing. Nevertheless, developing them by using exercises that are conventionally prescribed for a strong and flexible back sometimes inflicts injury. So, if neither strength nor lumbar flexibility guarantees a healthy back, then what does?

Fairly recent studies on the biomechanics of the back suggest that muscle endurance is more protective than mere strength.

Stuart McGill, a world-renowned lecturer and expert in spine function and injury prevention and rehabilitation at the University of Waterloo, Ontario, suggests instead, in his book Low Back Disorder, Evidence-Based Prevention and Rehabilitation (Human Kinetics, 2002), that stabilizing the spine seems to be the answer.

The way to achieve and maintain spinal stability is to:

  • Exercise the spine’s major stabilizing muscles:
    • back extensor
    • abdominal muscles (the so-called “six pack”)
    • abdominal muscles (the lateral obliques)
  • Exercise all these muscles in a special way – by sparing the back

“Sparing” means exercising with the spine in a line with no additional load.

The focus of this document is on selecting the most appropriate types of exercises and the best way to conduct them to make you fitter without injuring yourself. Ideally you should have a set of exercises tailored to your individual objectives and ability. Because we are unable to satisfy every individual’s needs, we can suggest only a rather generic set of exercises that we hope will suit the majority of working people.

The other objective is to present exercises that everyone can do and eventually benefit from doing regularly, regardless of how deconditioned one might be at the outset.

Always consult with a doctor or medical professional before beginning any type of exercise program.

Start an exercise session:

Commencing Exercising:

Every session should begin with the “Cat-Camel” exercises (Figures 1A, 1B, and 1C)

Figure 1A - Start on your hands and knees
Figure 1A

Figure 1B - Exhale and stretch your back
Figure 1B

Figure 1C - Exhale and stretch your back downwards
Figure 1C

  • Start on your hands and knees with your thighs perpendicular to the floor (Figure 1A).
  • Inhale deeply and slowly with the back straight but relaxed as much as possible.
  • Exhale and stretch your back by arching it upwards (arching cat position), while remaining relaxed; do not hold your breath (Figure 1B).
  • Inhale deeply and slowly and come back to the starting position (Figure 1A).
  • Exhale and stretch your back downwards into a swayback (camel) position (Figure 1C).
  • Inhale deeply and slowly and come back to the starting position (Figure 1A).
  • Repeat the whole sequence (Figures 1A, 1B, and 1C) 3 to 7 times.

Exercises are recommended for back extensors:

The so-called “Birddog” exercise is suggested for improving the back extensor muscles without overloading or straining them. The degree of difficulty of this exercise can be customized to the starting ability of the person attempting them.

A. For people with a seriously deconditioned back:

  • Begin with the “all fours” position (Figure 1A).
  • Lift one hand off the floor and keep it up for a few seconds if you can do so.
  • Repeat the same with the other hand.
  • Still from an “all fours” position lift one knee off the floor and keep it up for a few seconds if you can do so.
  • Repeat the same with the other knee.
  • Repeat the whole sequence: left and right hand and left and right knee a few times (up to three times) if you can do so.

B. For the average person:

Step One:

From the “all fours” position (Figure 1A):

  • Breathe in.
  • Squeeze your abdominal muscles.
  • While exhaling, raise one arm in front of you until it is parallel to the floor; (Figure 2).
  • Hold the arm extension while slowly exhaling over 4 to 7 seconds.
  • Breathing in, return arm to the starting position.
  • Repeat the same with the other arm.
  • Alternate arms, and repeat exercise several times, up to ten (five for each arm) repetitions if you are able to do so.

Figure 2 - While exhaling, raise one arm in front of you
Figure 2

We suggest starting with the arm exercises because they are easier and less challenging for maintaining your balance. When you can do that easily, progress to the next step that involves raising a leg.

Step Two:

From the “all fours” position (Figure 1A):

  • Breathe in.
  • Squeeze your abdominal muscles.
  • While exhaling, push one leg backwards and upwards until it is parallel to the floor, with the ankle in a naturally relaxed position (Figure 3).
  • Hold the leg extension while slowly exhaling over 4 to 7 seconds.
  • Breathing in, return your leg to the starting position.
  • Throughout this whole motion look toward the floor to keep the neck in line with the spine.
  • Repeat the same motion with your other leg.
  • Alternate legs and repeat this exercise several times, up to ten (five for each leg) repetitions if you are able to do so.

Figure 3 - While exhaling, push one leg backwards and upwards
Figure 3

After mastering the alternate leg raises add another motion:

  • As you are pushing your leg backwards, raise the opposite arm in front of you, until it is also parallel to the floor, without losing your balance (Figure 4).
  • Hold this position while slowly exhaling over 4 to 7 seconds.

Figure 4 - As you push your leg backwards, raise the opposite arm in front of you
Figure 4

Important points:

  • Keep your abdominal muscles mildly squeezed while raising and holding the extension of your limbs.
  • Keep your spine in a line to maintain neutral spine alignment; do not raise either leg or arm above the horizontal line.

Exercises are recommended for abdominal muscles:

A common exercise for abdominal muscles is the curl-up. However, there are many ways of performing this manouevre and some of them can be harmful and injurious, especially those which involve excessive bending and twisting. One example is the exercise where additional weights are used in order to speed up the development of the impressive so-called “six pack”.

Based upon the concept of “sparing the back” endorsed by Stuart McGill we suggest the following:

Curl-up

Starting position (Figure 5A)

  • Lie on the floor with your hands placed under the lumbar area to preserve a neutral spine position (Figure 5A).
  • Keeping one leg flat on the floor, flex the other knee, and raise the foot off the floor until your lower leg is parallel to the floor (Figure 5B).
  • Repeat 4-7 times, then switch to the other leg.
  • Repeat this exercise several times, up to ten (five for each leg) repetitions if you are able to do so.

Figure 5A - Lie on the floor
Figure 5A

Figure 5B - Keeping one leg flat on the floor, flex the other knee and raise the foot off the floor
Figure 5B

  • Without flattening or bending your lower back, curl up your upper body by raising your head and shoulders off the floor (Figure 6).
  • If you feel any neck pain, try curling up without bending your neck.
  • Otherwise, you can make the curl-up more challenging:
    • by raising elbows off the floor as well
    • by slightly squeezing your abdominal muscles before raising the torso

Figure 6 - Without flattening your lower back, curl up your upper body
Figure 6

recommended for lateral and oblique abdominal, and lumbar muscles:

These muscles are also important in stabilizing the spine and thus preventing episodes of low back pain.

The Side Bridge – a version for the deconditioned:

Starting position (Figure 7A).

  • While pivoting on the balls of your feet turn slowly toward the wall (Figure 7B), and keep turning (Figure 7C), until you acquire a position that is the mirror image of the starting one (Figure 7D).

Figure 7A - Starting position
Figure 7A

Figure 7B - While pivoting on the balls of your feet, turn slowing toward the wall
Figure 7B

Figure 7C - Keep turning
Figure 7C

Figure 7D - Keep turning until you acquire a position that is the mirror image of the starting one
Figure 7D

Figure 8A and Figure 8B show more challenging versions of the side bridge.

Figure 8A - More challenging variation of the side bridge
Figure 8A

Figure 8B - More challenging variation of the side bridge
Figure 8B

Final word to the wise:

  • Exercising every day, even if only for 15 -30 minutes, brings the most beneficial effects.
  • Keep the effort and exertion within your own comfort zone. The phrase “no pain, no gain” does not apply — do not follow it.
  • Do not exercise shortly after getting out of bed.
  • Add to your back exercises by doing a gentle cardiovascular activity such walking (the best), cycling or swimming.
  • Avoid exercising with additional weights. Instead, if you want to increase the intensity, increase the number of repetitions.
  • Be patient and stick with it. It takes time to feel the benefits of exercising.
 

Ergonomics 2

Ergonomics 2

SECONDARY RISK FACTORS

Environmental Conditions:

Cold Temperatures

People who work outdoors – on construction sites, doing avalanche surveys, or work on loading docks – face additional risk of injury aggravated by cold. Cold temperatures produce a reduction in the hands ability to feel (tissue sensitivity), function (dexterity) and grip strength. It also makes muscles and joints stiffer, and increases reaction time. As a consequence, workers must use greater force to grip and hold hand tools, which increases the risk of an MSI.

The effects of cold temperatures can be made worse by:

  • Not dressing appropriately for the environment and activity e.g. for physically active work, wear layers of clothing that can be removed as the worker warms up. For less active work, more layers may be needed.
  • Not keeping the head covered to retain body heat and not keeping the feet warm and dry.
  • Lifting or forceful exertion when chilled; stiff joints and muscles increase the risk of injury.

Vibration

Vibration affects tendons, muscles, joints and nerves. Vibration to a specific body part can decrease sensitivity and result in unnecessary increases in muscle contraction, which may lead to injury or fatigue of that part. Localized vibration from machines and hand tools can damage the nerves and blood vessels of the hands and arms. Whole-body vibration, experienced by people who operate heavy equipment such as truck and bus drivers, increases the risk of lower back pain and damage to the spinal discs. The body’s response depends on the duration, frequency and extent of the vibration.

The effects of vibration can be made worse by:

  • Machines and power tools that are not maintained. Well-maintained equipment minimizes vibration.
  • Not limiting exposure to vibration by failing to implement work practices and administrative controls such as task rotation and rest breaks.
  • Not wearing appropriate personal protection equipment where required e.g. vibration dampening gloves.
  • Simultaneous exposure to cold temperatures.

Illumination

Appropriate lighting and elimination of glare in the work area allows for adequate depth perception and contrast by the worker(s) when handling material such as when lifting and carrying objects. Improper lighting can be a contributing factor to a musculoskeletal injury. For example, poor lighting could cause the worker to misjudge weight and object shape resulting in inappropriate or poor lifting techniques.

The effects of illumination can be made worse by:

  • Lighting is not maintained e.g. replacing burned out bulbs.
  • Lighting in the work area was not designed for the type of work tasks being performed.

Characteristics of the organization of work

Work recovery cycles and task variability:

The objective of planned work recovery cycles and task variability is to avoid the onset of fatigue of specifi c muscles or body parts, which can put workers at an increased risk of injury.

Work recovery cycles and task variably can include rotating jobs, performing tasks with different physical or mental demands, or a rest break. The need for recovery cycles and task variability depends on:

  •  the nature of the task,
  •  worker characteristics, and
  •  environmental conditions.

Fatigue increases the risk of injury. Risk of injury depends largely on the ratio of work period to work recovery cycles/task variably, that is, the recovery time compared to exertion. Risk control for work recovery cycles and task variably:

The demands of physical handling should be well below the normal exhaustion level for the worker. When developing work recovery cycles and task variability for a specifi ed task consider work rate, load weights and whether tasks involve vigorous or minor exertions.

To vary physical demands, consider alternating physical task with non-physical tasks, or long cycle tasks with shorter ones, or to a task where the demands on specifi c muscle and body parts are  sufficiently different. Ideally,workers should be given the flexibly to vary  type of tasks they perform.

Review the adequacy of work recovery cycles and task variability whenever there are changes in any of these factors:

  •  The requirements of a task
  •  Environmental conditions
  •  The work process
  •  Physical capacity of workers

Work rate:

Individual workers vary in the rates at which they perform the same task. Some individuals need longer periods to recover from physical work to prevent injury.

The more critical or physically demanding the task, the more desirable it is to let the worker set the pace, where possible. Just as important, where possible, is to avoid sudden increase in workload.

Planning the work rate will also involve consideration of work recovery cycles/task variability and staffing schedules.

Other Considerations

Risk Factors can overlap:

More than one risk factor can be present in a task. The more risk factors in the task, the greater the risk of injury. For example:

A worker bends forward from the waist to lift a box from the floor. The bending is an awkward posture (work posture) linked to the location of the box (out of proper lifting/bending* range?) on the floor (layout of the workplace). The box is wrapped with twine, which the worker grabs to lift the box (contact stress). If the worker repeatedly lifts boxes from the floor (repetition), or does similar lifting tasks all day (long duration, organization of work tasks), the risk of MSI is further increased.

Eliminating or Minimizing Risk Factors:

After identifying and assessing risk factors, the next step is to determine which control measures should be implemented, and which ones eliminate or minimize the risk of MSI. Ask the following questions when considering control measures:

  •  Can exposure to the risk factor be eliminated?
  •  How can the intensity/magnitude of the job duty be reduced?
  •  Can frequency of the job function be reduced?
  •  Can duration be reduced?

Control measures for eliminating or minimizing risk factors:

  • Engineering Controls
  •  Administrative Controls
  •  Personal Protective Equipment (PPE) Controls

Engineering controls

The purpose of engineering controls is to design (or change by redesign) physical aspects of the workplace or tools to reduce or eliminate employee exposure to ergonomic risk factors. Engineering controls are preferred over other control methods. They are relatively permanent and benefit anyone performing the job – not just the individual who experienced an MSI.

Some examples are: adjusting work heights, minimizing reach distances, changing the layout of workstations, using adjustable or angled tools or equipment and the use of carts and other conveyors.

Administrative Controls

Administrative control functions include determining appropriate policy, procedures, education and training activities that affect the individual worker and the work environment. These actions are intended to reduce the workers’ exposure to MSI risks. This can be accomplished by reducing the duration of exposure and/or slowing the onset of fatigue and discomfort. For example, by ensuring that repetitive or demanding tasks incorporate opportunities for rest or recovery breaks (e.g. allow brief pauses to relax muscles; change work tasks; change postures or techniques).

To be effective, administration controls require:

  •  support by management,
  •  education and training,
  •  employee awareness of risk factors, and
  •  monitoring to ensure effectiveness of program and compliance of WCB requirements.

Personal Protective Equipment

Personal protective equipment may only be used as a substitute for reducing MSI risk factors where engineering and administrative controls are not practicable. For example, workers may wear vibration-dampening gloves while using a chain saw or wear knee pads while working on their knees to install flooring.

MANUAL MATERIAL HANDLING

Manual handling (i.e. lifting, carrying, pushing and pulling) of heavy, bulky, and/or irregularly shaped objects during work tasks) can lead to possible musculoskeletal injures. Under these circumstances a worker is more susceptible to injury as these type of tasks often require using awkward body postures, which can place considerable physical demands on the body, especially the back. The following information lists potential causes of MSI where such tasks are performed, as well as, examples of ways to prevent injuries (control measures) while performing these tasks.

Manual material handling examples:

  • manually loading and unloading material from vehicles, boxes or pallets
  • manually moving materials in warehouses, offices or outdoor work locations
  • stocking shelves, etc.

This section on material handling is divided into the following categories:

  • Lifting
  • Carrying
  •  Extended reaching
  •  Working heights
  •  Pushing/pulling

Lifting

Lifting of heavy, bulky, and/or irregularly shaped items can increase the risk of MSI’s. Lifting too heavy a load puts unnecessary strain on the body, particularly the back.Proper lifting techniques play an important role in ensuring no injuries occur while performing these tasks (e.g. hold object close to the body and lift with the legs not the back). It is important that lifting be performed between the shoulder and knuckles height.

Knuckle height is when the arms are straight down in front of the worker, the height above the floor where the knuckles of the hands are located is the lowest height a worker should be lifting from or bending down to. Lifting and handling materials above shoulder level or below knuckle level (particularly while bending or twisting) adds unnecessary stress to the spine and back muscles.

In some cases lifting may have to be performed from the floor level. Where a mechanical lift is unavailable and the material does not allow for the proper use of body mechanics, workers must be trained in proper lifting procedures (e.g. seek assistance from a co-worker).

Control Measures:

  • Restrict lifting to between knuckle and shoulder height.
  • Minimize frequency of lift.
  • Where possible separate the material into more manageable loads.
  • Don’t put a load(s) on the fl oor if it needs to be manually lifted again later.
  • When moving an item, test its weight before lifting.
  • Don’t overestimate your ability to handle heavy items.
  • Get as close as possible to loads and get a firm grip before lifting.
  • Position yourself so that you are facing your load.
  • Avoid reaching, twisting and bending.
  • Be sure of your footing before performing the lift.
  • Where feasible, provide lifting aids (lift tables, mechanical or powered assists, hoists, etc.) to move heavy or bulky loads.
  • Ask for assistance if in doubt.
  • Establish safe lifting work procedures and ensure workers are trained in them.

Carrying

Depending on the distance an object is carried,it’s weight and size, there may be unnecessary strain placed on the body for long duration’s, which can attribute to an increase of MSI. It is important to be aware that the weight that can be safely carried by hand is less than the amount that can be safely lifted. This is due to the fact that carrying involves holding the object for a longer period in combination of having to physically move it. The longer the holding time (i.e.distance of travel while carrying object) the less weight that can be carried; the limiting factor is fatigue of the grip and shoulder muscles.

The grade of the floor is also a factor – carrying uphill or downhill increases the strain on the body, especially on stairways.

Control Measures:

Eliminate the need to carry by:

  • Using a cart, dolly, or pallet jack.
  •  Using a conveyor.
  •  Rearranging the work place.
  •  Providing slides or tables between workstations.

If elimination of carrying is not feasible:

Reduce the weight by:

  •  Reducing the size of the object.
  •  Using lighter material for the object.
  •  Reducing the capacity of the container.
  •  Reducing the weight of the container itself.
  •  If unable to reduce the weight, ask for assistance to move the object.

Reduce the distance material is carried by:

  • Moving the operation closer to the previous or following operation.
  •  Using conveyors or rollers.
  •  Changing the layout of the workplace.

Note: If carrying can not be eliminated, provide proper handles on object to ensure a good grip and proper positioning of object when carried by worker(s).

Extended Reaching

Extended reaching occurs when workers are required to reach to heights or distances outside of the range from knuckle to shoulder height, and more than about 18 inches from the front of the body. This can require bending, twisting, stretching, and holding the arms up high or other awkward postures. In such postures, the weight of objects (and even of the body itself) creates greater stress on muscles and tissues due to the “lever effect”. Extended reaching can cause musculoskeletal injuries to the neck and shoulders.

Control Measures:

  •  Adjust work stations, fi xtures, parts, tools, etc. to put the most-used items within easy reach.
  •  Keep workplaces clear of obstructions which increase reaching.
  •  Use platforms, step stools or other such aids to reach locations above shoulder height.
  •  Support or counter balance tools that are used above chest level.
  •  Limit or avoid reaching to full arms length for or with loads, or exerting force with the arm extended.
  •  Provide turntables, to allow easy access from all side.

Working Heights

Poor working heights in combination with any of the following can increase the risk of MSI:

  •  duration of work,
  •  repetition,
  •  high forces,
  •  weight,
  •  static loading, and
  •  cold.

If the work area is raised too high,the shoulders and arms must frequently be lifted upto compensate, which may lead to cramping and fatigue in the neck and shoulders.  If work heights are too low, the back and neck must be bent forward which can lead to neck and back pain or discomfort.

Ideally the height of work surfaces or the height of the worker’s position should be adjustable to allow the employee to work from an appropriate neutral position at all times.

Control Measures:

Work at an appropriate height by using:

  •  False bottom bins and lift tables to change the product height and reduce the need to bend or stoop.
  • Adjustable working platforms, stools, and ladders to allow for neutral positions of the limbs, neck and torso.
  •  Tilt tables (e.g. drafting tables) to bring work closer.
  •  Extended handles on tools.

Reduce the demand on the body by:

Limiting the period of time required to perform an operation that is overhead, to the side, or down low. This can be accomplished by changing tasks frequently (e.g. paper work that may be normally completed at the end of the shift could be done in intervals through out the day to allow the body to recover).

The right work angle keeps the shoulder in a more comfortable position.

Pushing/Pulling

The greater the force required to push or pull an object, the greater the risk of developing an MSI.  In general, pushing a load is preferable to pulling a load. While pulling a load, arm and shoulder extension and abduction (working behind the mid-line of the body) and twisting may create an MSI risk factor.

Posture is a key factor in limiting how much force can be exerted in pushing and pulling. With extended reaches, or other awkward postures, less force can be exerted. On the other hand, by leaning into a push or away from a pull, the operator can apply more force. For example, pushing a heavy hand truck down a long corridor is usually possible because the large muscles of the legs and trunk can be used. Moving the same hand truck in a tight space where upright posture must be maintained is more difficult because the smaller arm muscles must be used to maneuver it.

Push or pull force is affected by:

  •  Body weight.
  •  Height of the work (height of handles).
  •  Distance of force application from body, or amount of trunk flexion/extension.
  •  The amount of friction between the worker’s shoes and the floor.
  •  How long the force must be applied.
  •  The distance the object must be moved.
  •  The availability of a brace or structure for the worker to push against.
  • The texture of the floor surface e.g. carpet, smooth, slippery.
  •  Debris on surface areas.

Control Measures:

Eliminate the need to push or pull by using:

  •  Conveyor system.
  •  Fork lift.
  •  Slide, chute, etc.
  •  Powered carts instead of hand carts.

Reduce the force by:

  •  Reducing the weight or size of the load.
  •  Using wheels and casters.
  •  Improving the size, composition, tread, maintenance and swivel properties of wheels on carts.
  •  Using ramps.
  •  Regular maintenance of equipment and floor surfaces e.g. lubrication of equipment; keep floor surfaces clean and clear of debris.
  •  Redesigning the work area to minimize how far items need to be moved.
  •  Installing automatic doors.
  •  Making friction work for the worker– minimize the friction on the object (i.e. don’t push on carpets) and maximize traction for the worker by wearing appropriate shoes.
  • Providing well-designed handles in appropriate locations.

Dos and Don’t s- Ergonomic work station:

  • DO keep moving. Set an alarm to remind you if you need it! Sitting for long periods wreaks havoc on your spine and circulation. Get up, stretch, MOVE!
  • DO try to keep your body in a neutral posture, which creates the least strain on your body.
  • DO keep your desk clear so you’re not forcing your body to work awkwardly around clutter.
  • Look for an office chair with proper lumbar support that adjusts to your body.
  • A laptop raiser positions your laptop for optimum ergonomics while relieving eye and neck strain.
  • A monitor arm makes it easy to adjust the height and position of your monitor to reduce upper back and neck pain.
  • Use a footrest to reduce lower back pressure and increase blood flow.
  • A bright, adjustable light can reduce headaches, eye fatigue and neck strain.
  • Or try a standing desk to keep you moving! Less time spent sitting means less stress on your spine while increasing circulation and mental alertness.

DON’T use a desk or chair that’s not the proper height for your size. Everyone is different; find what works for you.

DON’T cradle your phone between your shoulder and ear.

DON’T keep your monitor too close or too far away, or hunch over a laptop. This can cause eye strain and headaches in addition to neck and back pain.

Ergonomics and Design

Manual Handling Safety