Physiological Overview

This diagram shows the sections of the spine.

The spine is a curved column of vertebral bodies that act as a
support for about half of the weight of the body, with the other
half supported by the muscles. The flexibility of the spine
allows the body to bend forward, sideways, and, to a lesser
extent, backward.
The cervical spine (neck C1 through C7) has seven
vertebral bodies. These vertebrae are the smallest in the spinal
column.
The thoracic spine (upper and mid back T1 through
T12) has 12 vertebral bodies. This level has very little motion
because they are attached to the ribs and sternum (breastbone).
Because there is little motion in this level of the spine it is
usually not a source of chronic pain.
The lumbar spine (lower back L1 through L5) has five
vertebral bodies. This level extends from the lower thoracic spine to the sacrum (bottom of the
spine). The vertebral bodies are stacked on top of each other with a disc in between each one.
These vertebrae are the largest in the spinal column.
Each vertebra has a bony arch that is positioned so that the space they enclose is, in effect, a
tube, the vertebral canal which protects the spinal cord. Between each vertebra is a disc that is
described as having a tough outer core with a jelly-like substance inside. Its primary function is
to act as a shock absorber. But, if the disc is injured or starts to degenerate due to age, it can
become painful.
Injury, stress, and poor postural habits can cause progressive loss of motion and weakness in
muscles in the spine, which in turn limits movement, resulting in structural and muscle
dysfunction. The body can develop and maintain adjustments for lack of flexibility and strength,
but only for a while. These inefficiencies can take their toll on the body, with more and more
bone and muscle breakdown.
Since stressed muscles are more susceptible to injuries, it is recommended that you develop
habits that reduce the pressure placed on the back.

How Age and Normal Wear and Tear from

Daily Living Affect Your Back
There are many factors that can contribute to back pain. Many of these can be due the natural
aging process as well as the wear and tear we give our back throughout our daily lives. Here are
a few items that can contribute to this.
Osteoporosis
This is caused by decreased bone mass resulting in fragile bones. Fragile bones are more likely
to break. The Osteoporosis and Related Bone Disease National Resource Center reports that
osteoporosis is responsible for approximately 700,000 vertebral fractures. Aging is normally
associated with osteoporosis. At about age 30, maximum bone density is attained. After that
point, bones slowly start to lose density or strength. Bone density is affected by heredity, diet,
sex hormones, physical activity, lifestyle choices, and the use of certain medications. Men have
larger, stronger bones than women, which explains, in part, why osteoporosis affects fewer men
than women. The disease is often progressive.
Cervical Stenosis
As we age, disks in our spines can start degenerating. As this degeneration progresses, our
vertebras create tightening of the spinal canal. This progressive tightening and pinching of the
spinal cord leads to the lack of coordination of the extremities. A sign of this is shooting pain in
our arms and legs as well as impaired motor skills.
Cervical Disc Herniation
As we get older, discs in our spines might also start to lose water content, making the discs less
effective as a cushion. As this deterioration continues, the outer layer can also tear. The gel
center, known as the nucleus, can be ejected from the disc, through a tear, into the space
occupied by the nerves and spinal cord. By pressing against the nerves it will cause pain,
numbness, tingling, or weakness in the upper and lower extremities.
Cervical Spondylosis
As bony overgrowths or spurs grow on the spine, arthritis of the neck may
result causing problems with ligaments and disks. This can narrow the
spinal canal and compress the spinal cord and nerves to the arms. Injuries
can also cause spinal cord compression.

A stiff neck can occur when your head is in one position for too long.

What else can cause neck and back pain?

Muscle strains
can cause mild pain. Stiff necks can occur from keeping your head positioned too long in one
position. Soreness can also be caused by external factors, such as whiplash from a vehicle
accident. Muscle strains are different from age degeneration of the back as they are short lived
and improve with time.
Rheumatoid arthritis
involves inflammation in the lining of the joints. This can lead to instability in the upper cervical
spine that can endanger the spinal cord.
Meningitis
is an infection of the brain and spinal cord linings. Meningitis can have many causes and may be
contagious. This disease can kill in hours if not treated. Symptoms of meningitis are severe
headaches, stiff neck, sensitivity to bright light, fever, vomiting, drowsiness, and rashes over
different parts of the body.
Spinal cord tumors
are abnormal growths of tissue that can form on the spinal cord and cause pressure on sensitive
tissues and impair function. Tumors are caused by out-of-control growth among cells. In a small
number of individuals, tumors may result from specific genetic disease (e.g., neurofibromatosis,
tuberous sclerosis) or from exposure to radiation or cancer-causing chemicals.
Facet Joint Syndrome
Facet joints are the connections between the vertebras in the spine. They enable you to bend or
twist. They can become inflamed from an injury or from arthritis. This causes headaches,
impaired movement of the head, and twisting of the back. One sign is walking in a hunched over
position.
Pregnancy
In approximately 80 percent of women who are pregnant, back pain is prevalent. Usually this
pain is localized, but the site may vary. Pain can be due to a combination of mechanical,
metabolic, circulatory, and psychosocial factors. It has been thought that some pain is due to
some alteration in blood flow to the pelvic musculature and ligaments, as well as hormonal
changes.

Chiari malformation
It is an uncommon, complex, neuromuscular deformity that is present at birth. The brainstem
normally sits in a funnel-like cavity just above the spinal cord. Chiari malformation occurs when
the brain stem is displaced downward into the funnel, thus causing pressure on this part of the
brain and spinal cord. Although this is found in children, it more frequently causes problems in
adults. Because of the complexity, symptoms can vary but include: headache; dysphagia; pain
from neck radiating through arms and back; hoarseness; numbness; visual disturbance;
unsteadiness; loss of consciousness; nausea; vomiting; dizziness; nosebleeds; fast or slow heart
beat; high or low blood pressure; ringing in the ears; hearing loss; depression; shortness of
breath; and fatigue.

Poor Posture
Sometimes people suffer from back pain because of their lifestyle and are careless about proper
posture practices. Preventative steps to help eliminate back problems should include back
exercises and learning proper sitting and standing techniques. These methods should be applied
at home, at work, and when participating in recreational activities.
Poor posture can lead to back pain.
Many things can contribute toward back pain. The way you sit in your chair, the
position you sleep in, the way you walk, the way you hold yourself when standing,
footwear, and the type of clothes you wear can all affect the way your back feels.
Its important to find the best positions for these and other daily activities to reduce
the stress and improve your body mechanics. Stand up straight, chin up, shoulders
back, and hold in you tummy. How many times have you heard that in your
lifetime? Following that advice can keep your body in line and your lower back
will get the support it needs.
The sitting position can be very harmful for your back if not done correctly. Sitting habits that
could cause you back pain include lounging in your seat and crossing your legs. You spend quite
a bit of time sitting, and it is important that you develop comfortable but proper positions. Make
sure your feet rest on the floor or use a footstool to take the pressure off your back. Your chair
should have a firm back, and try and to take a break from your chair by standing up to stretch or
walk
around.
If you spend time on the phone and need your hands free, then a telephone headset can be used to
eliminate the need to cradle your phone between your shoulder and your ear. This can relieve the
discomfort caused by neck strain.
Underlying Causes of Back Pain

The absence of back exercises or poor technique

Poor body mechanics

Extended periods of sitting or standing

Muscle inflexibility

Stress

Poor work habits

Never over-stress yourself when exercising. Check with your doctor before starting any exercise
program to get recommendations on regiments. Your exercise plan should take your age, level of
fitness, schedule, and comfort level into account. The old adage no pain, no gain is not true
when exercising the back muscles.

Injuries
A back injury, such as a slipped disk, is seldom the result of a single
event.
Back injuries are probably the most complex type of injuries, simply
because they seldom result from a single event. Unlike most injuries
where the root cause can normally be determined from a specific
event or circumstance, such as a trip or fall, the cause of a back injury
can be cumulative in nature. For example, what could appear to be a minor mishap subjected to
stress, repetitive motion, and heavy physical activity, can be further aggravated by other events
and over time (months or years) lead to a major injury. Unfortunately, a common approach or
assumption is to associate a back injury with the most immediate activity of the injured which
often can lead to an erroneous conclusion of improper lift technique.
Several factors, some measurable to an extent, can contribute in varying degree to an increased
risk of a back injury. Excessive stress, especially in some individuals, seems to be commonly
associated with all types of injuries and multiple studies have confirmed that the higher the stress
level, the higher the risk of an injury. The application of force or activities requiring repetitive
motion are probably the most obvious and also most often associated with either the onset or
ultimate cause of a back injury. Another common perception is that these two factor (force and
repetitive motion) are confined only to an industrial physical environment where routine lifting,
pushing, pulling, and moving heavy objects would be expected. However, this not always the
case, many back injuries are not necessarily in a physical environment only, but also occur from
routine exertion and repetitive motion from lesser activities in what could be captioned as the
office environment.
Aging and normal wear and tear of the spine will also take a toll on the spinal system. For
example, many lower-back injuries are actually the result of spinal degeneration caused by
diminished blood supply that can often start as early as the age of 20. Furthermore, spinal discs

do not have nerve endings which complicates matter, in that, there are no early warning signs of
spinal degeneration. Although disc degeneration is a natural result of the aging process, it can be
delayed or minimized by proper care, diet, and exercise.
The back provides the foundation and structure which the rest of the body relies on for balance
and support. Proper back care is a lifetime endeavor that requires commitment and common
sense that leads to an old adage, Take care of the back and it will take care of you.

Lifting
Proper lifting technique includes squatting and lifting with you legs.
Proper lifting technique is important but planning is the key. Planning
should place maximum emphasis on eliminating the need for manual
lifting whenever and wherever possible. This may mean taking a critical
look at where, why, and how the item or material is stored and where it is
stacked. In many cases, proper planning may eliminate the need for
repetitive movement of items or materials. When materials have to be
physically lifted, and when you lift on a routine basis, proper planning
would include attempts to mechanize the operation so that mechanical lift
devices can be used to lift and transport the material. Another technique, and especially where
mechanical devices are not feasible, is the use of a lifting team. This concept does not
necessarily completely eliminate the risk of an injury, but it does reduce the exposure somewhat,
in that, the agency can ensure adequate training and has a better control on the who, what, where,
and how lifting and moving is accomplished.
Realistically, however, there will always be occasions where individuals will find the necessity
and will perform a lift on a routine basis. For this reason, every agency should have training,
preferably during new employee orientation, for all employees on proper lifting body mechanics.
As a minimum, the training should cover the following:

Plan the lift, the route, etc., and size up the load;

Ask for help, especially for heavy or bulky items;

Keep your feet apart, comfortably staggered;

Squat to lift, do not bend at the waist, and lift with you legs;

Get a firm grip, and keep object close to the body;

Lift objects carefully using the leg muscles, do not jerk the load;

Keep your head up and look straight ahead while making the lift;

When walking maintain a straight posture; and

Lower slowly and smoothly in a squatting manner and do not twist

your body.

Bending at the waist while you lift puts unnecessary pressure on your back.
The Use of Back Support Belts for Back Injury Prevention
The proliferation of back belts in the last decade and a half has gained the attention of several
federal regulatory agencies in the recent past. Prior to their involvement, much of the research on
back belts and their effectiveness in injury prevention was conducted by independent
organizations, often market motivated. The usage of back belts is not forbidden and may, under
certain controlled conditions with proper training, have some merits in injury prevention.
However, OSHA, based on recent NIOSH research, does not recognize back belts as an effective
engineering control to prevent back injuries and specifically discounts them as an item of
personal protective equipment (PPE).

Driving
Anyone who operates a motor vehicle for long periods of time on a regular basis are at
risk of developing chronic neck, back, and shoulder pain. Long term sitting flattens the
natural curvature of the back and increases the pressure on the discs in the spine. Body
vibration caused by the movement of the vehicle (bumps and turns) stimulates muscle
activity in the spine and causes them to tire more easily.
Ergonomics for the operation of motor vehicles is intended to provide tips on how to
improve your overall health while behind the wheel. It is designed to help make the
interaction between the driver and the vehicle as comfortable and safe as possible since
sitting can place far greater stress on your lower back than standing or lying down.
Those most at risk of developing problems include:

bus drivers;

heavy equipment operators;

truck drivers;

forklift operators; and

long distance travelers.

When driving, make sure to sit straight, with your hips as far back against the back of
your seat as possible. This provides maximum driving comfort for most people. Keep
the drivers seat as close as possible to the steering wheel. This can help you eliminate
the strain that often comes from reaching out too far for the wheel. Leaning forward
causes the disc pressure to go way up while leaning back reduces the pressure.
It is important to support the natural curvatures of your spine when traveling long distances. The
lower back should have a slight curve inward to ensure maximum support and comfort. Sitting
for extended periods of time can warp the natural curve of your spine and cause muscles to
become fatigued. Changing your position every few minutes or stopping and walking around can
help relieve the stress placed on the spine while traveling.

Checklist for Driving Comfort

Always sit in an upright position

Keep your knees higher than your hips

Adjust the rearview mirror for neck comfort

Reset seat back position occasionally

Use support behind low back for comfort

Gas and brake pedals should be within comfortable reach

Video Display Terminals (VDTs) and Your

Back
Sitting in front of your computer for long periods of time can lead
to neck and back pain.
As the computer made its way into the mainstream of both the
home and the workplace, it also introduced some potential hazards.
It now can captivate an individual for hours on end at a fixed
location and sets up a situation that is of significant concern
especially for those who work intensively with VDTs. Although a

number of adverse effects have been associated with the use of the computer and data entry,
sitting for long periods of time can lead to an increase of muscle tension and constriction of the
spine a situation that can eventually lead to neck and back pain. The field of ergonomics has
taken a multifaceted approach in identifying and mitigating computer-related injuries. However,
where the back is concerned, proper posture and frequent breaks are two well-known antidotes
for prevention of VDT-related back injuries. The human spine has a set of natural curves that
become distorted when sitting. The lower back, or lumbar region, that normally curves forward,
becomes bowed out. The backward tilting pelvis puts pressure on the intervertebral discs and
nerves, which over time can cause pain and discomfort. Furthermore, a prolonged and static
position will also add to the strain of the muscular skeletal system.
Most workstations require some form of modification or adjustments for the workers bodily
comfort. This is a subject that will be covered at length in the separate ergonomics topic.
However, for back injury prevention, proper posture and sitting comfort are equally important for
people who sit and work at their desks for a prolong period of time. It is, therefore, important
that an acceptable well-designed chair should be used with features that provide for adjustable
height, back rest, and arm support. The chair height and arm rest should be adjusted so that the
elbow can maintain a comfortable right angle supported by the arm rests. For maximum comfort
the person should be able to sit in a chair with his/her feet flat on the floor or on a footrest. Keep
your back straight and sit in an upright position with the back rest adjusted to conform with the
small of the back.
Stress can also be a source of back pain. Probably, the best antidote is to vary the day-to-day
routine with frequent rest breaks and exercise, both physical and mental.

Exercise
Spinal exercise, correctly performed, is one of the best measures you can take to
prevent spinal problems. Improving your posture through spinal exercises should be an
important part of your fitness routine. A strong spine requires your active participation in
a program that includes good nutrition, stress management, and exercise. Not only will
your spine be stronger and more flexible, which will make it more resistant to injuries,
but you will also look and feel better.
Causes Of Back Pain

Lack of proper back exercises

Poor posture

Incorrect body mechanics

Prolonged sitting or standing

Muscle inflexibility caused by ineffective back exercises

Stress

Poor work habits

Injury

Successful and appropriate back strengthening exercises can build stability to weak
muscles and are more effective if they are easy to learn, perform, and dont aggravate
other problems or worsen a current condition. Always consult your doctor before
beginning an exercise program.
Nutrition and Healthy Bones

All bones including the vertebrae lose strength over time and, because of this, are more
at risk for a compression or fracture injury resulting from a fall or routine everyday lifting.
However, by maintaining the proper bone density, much can be done to either delay or
slow down this inevitable process.
The main mineral in bones is calcium and one of its functions is to add strength and
stiffness to bones that provide the mainframe support for the body. There are a number
of ways of maintaining the proper calcium balance; however, intake of magnesium
seems to be the most effective and efficient means of increasing and retaining quality
calcium crystals. Magnesium, which has an affinity for and readily absorbs calcium, is
an essential vitamin found in fruits, vegetables, and whole grains. Bones also need
vitamin D to move the calcium from the intestine to the bloodstream and, ultimately, into
the bones. Aside from over-the-counter purchases and the consumption of fortified
foods, vitamin D is a natural by-product of the sun.
Of course, the most important approach to long-term health is a well-rounded, balanced
diet. Every ingredient we take in has some benefit to some part of the body. However,
excessive consumption of some ingredients, such as sugar and salt, can be
counterproductive and detrimental to your health. Both of these should be consumed in
moderate amounts. For example, excessive use of table salt can actually cause calcium
to be excreted through normal body fluids. One study revealed that adding a teaspoon
of salt to the diet of young women increased the amount of calcium lost through the
urine, causing a bone mass loss of 1.5 percent per year. Also, a well-balanced diet
should include moderate amounts of animal protein, and make certain you include two
vegetable servings with any protein meal.

Other chemicals should be completely avoided or limited as much as possible. Caffeine,

for instance, will also cause calcium to be excreted. Alcohol, which interferes with the
bodys ability to absorb calcium, can cause bones to become weak, soft, and brittle.
Smoking is certainly at the top of the no-no list. Cigarette smoke has been shown to
curtail estrogen activity, and anything that interferes with estrogen is very likely to
increase your chances of osteoporosis.