1. Back Injury Prevention
Sponsored by the American Red Cross
and Los Angeles Valley College Staff Development
Patty Melody, M.A.
Health and Physical Education Instructor
October 19, 2005 11-12pm in PMRC

2. Disclaimer
This wellness seminar is not intended to substitute a consultation
by your doctor. If you have been experiencing any neck or back
problems you should seek advice from a physician immediately.
Also, if you are starting an exercise program consult with a health
care provider before beginning your program.

3. Agenda
 Introduction to Back Injuries in the U.S.
 What is a Back Injury?
 Back Anatomy and Physiology
 Are you at risk?
 Risk Factors for Back Pain
 Prevention – Good Posture, Exercise, Eat
Healthy, Ergonomics

4. Introduction to Back Injuries in the
United States
 4 out of 5 adults in America (80%)
 Leading result of accidents (<45 years old)
 Workplace injuries and illnesses 20% due to
back injuries
 Annual costs $20-$50 billion dollars in workers
compensation, lost days of work, reduction in
worker productivity, higher insurance rates, and
long-term disability claims

5. What is a Back Injury?
 Defined as damage to the spine or to its
supporting structures that house and
protect the spinal cord. This can result in
mild fatigue or a dull ache or could be
more serious. A physician should always
be consulted for a diagnosis or referral.

6. Back Anatomy and Physiology
 The Spine: 33 oddly
shaped bones called
vertebrae (divided into 4
naturally curved sections)
 1) Cervical (7)
 2) Thoracic (12)
 3) Lumbar (5)
 4) Sacrum and Coccyx (9)

7. Your Back Anatomy is
responsible for various
functions:
 Cervical (7) – supports the neck, tilts,
bends and turns the head
 Thoracic (12) – supports the mid-back,
ribs and is limited in flexibility
 Lumbar (5) – supports the lower back
and carries most of the body weight.
Under constant stress when you sit,
stand and to some extent when you lay
down on your back.
 Sacrum and Coccyx (9) – 5 fused
vertebrae in the sacral region and 4
fused vertebrae in the coccyx region.
Responsible for positioning of pelvis
and therefore the rest of the spine.
Can be altered by excess weight,
pregnancy, lordosis or poor body
mechanics.

8. The Bones and
Discs of the Spine
 The vertebrae are the
bones of the spine that
collectively support the
entire body’s framework.
 Each vertebral bone is
separated from its
neighbor by a disc. The
discs are in the anterior
(front part) of the spine.
 The discs allow
movement and cushion
shocks.

9. Each Vertebral
Bone
 The vertebral body
provides the surface
against which the
discs rest.
 The spinal canal
provides the foramen
(hole) where the
spinal cord is housed
and protected.

10. Each Vertebral Disc
 The vertebral bones are separated
from one another by intervertebral
discs.
 The discs provide flexibility and
absorb impacts and shock.
 The discs consist of two parts.
The inner area is the nucleus and
the outer area is called the
annulus. It is described like a jelly
donut.
 The nucleus, or inner core of the
disc, consists of a gelatinous
material. The outer ring, or
annulus, is the strongest portion,
like a tire. When there is a rupture
or herniated disc the annulus may
be torn.

11. The Motion
Segment
 Every two vertebral bones are
separated from one another by
a disc.
 The two vertebral bones and
the disc together make one
motion segment.
 The strong fibers of the
annulus and the posterior facet
joints prevent excessive
movement.
 The spine can bend and
extend because there are
many motion segments which
act together.

12. Spinal Cord and
Nerves
 The spinal cord begins at the base
of the brain and runs down the
spine to the low back.
 Between every two vertebral
bones, two nerves exit the spinal
canal (one on the left and one on
the right).
 When there is damage to a disc,
or the facet joint or the vertebral
bone there can be too much
movement resulting in pain,
inflammation and possibly more
damage.
 Fusion surgeries are sometimes
recommended for excessive
movement.

13. Are you at risk? Pg.6
 Do you carry heavy items?
 Are you more than 20% overweight?
 Do you stand or sit in one position for 30 minutes
or more?
 Do you cradle the phone between your ear and
shoulder?
 Do you sleep on a mattress that is too hard or too
soft?
 Do you wear improper footwear?
 Do you perform tasks requiring frequent bending?
 Do you reach for items above your shoulders?
 Do you carry children?
 Do you lift heavy objects off the floor?

14. Causes of Back Pain
 Poor Body Mechanics

15. Causes of Back Pain
 Weak and Fatigued Muscles

16. Causes of Back Pain
 Overweight and Obesity

17. Causes of Back Pain
 Improper Footwear  Lack of Exercise

18. Causes of Back Pain

19. Causes of Back Pain
 Trauma

20. Clinical Causes of Back Pain
 Osteoporosis
 Cervical stenosis
 Cervical disc herniation
 Cervical spondylosis
 Rheumatoid arthritis
 Meningitis
 Spinal cord tumors and abnormal growths
 Facet joint syndrome
 Pregnancy
 Chiari malformation

21. Treatment Options
 Hippocratic treatment of spinal injuries –
“the rack” or using gravity to straighten the
spine
Maybe not…

22. Neurological Assessment Would
Include the Following:
 Medical History
 Dermatomes, Myotomes and Reflexes
(sensation, strength and reactions)
 Decide on further testing and outcome
 Possibly prescribe physical therapy or
other modalities (heat, ice, anti-
inflammatories or pain-killers, RICE)

23. Dermatomes
 Dermatomes is the area of skin served
by a particular nerve
 List of Dermatomes of Commonly
Injured Nerve Roots
 C5 – The area over the shoulder.
 C6 – The thumb and part of the
forearm.
 C7 – The middle finger.
 C8 – The smallest fingers and part of
the forearm.
 L4 – The thigh.
 L5 – The medial part of the calf and
foot, the big toe.
 S1 – The lateral part of the calf and
foot, the smaller toes.

24. Myotomes
Myotomes are muscles that are innervated by a
particular nerve.
List of Myotomes of Commonly Injured Nerve
Roots
 C5 – The deltoid muscle (abduction of the
arm at the shoulder).
 C6 – The biceps (flexion of the arm at the
elbow).
 C7 – The triceps (extension of the arm at
the elbow).
 C8 – The small muscles of the hand.

 L4 – The quadriceps (extension of the leg at
the knee).
 L5 – The tibialis anterior (upward flexion of
the foot at the ankle).
 S1 – The gastrocnemius muscle (downward
flexion of the foot at the ankle).

25. Reflexes
 Some, but not all, of the nerve roots have a
reflex. C5, C6 and C7 have reflexes. L4
and S1 have reflexes.
 For example, when the C6 nerve is pinched,
there is loss of the pronator reflex in the
forearm. When the L5 nerve is pinched,
there is no reflex loss. Not all nerves have a
reflex which can be tested.
 List of Reflexes of Commonly Injured Nerve
Roots
 C5 – Flexion at the elbow, biceps.
 C6 – Flexion at the elbow, brachioradialis.
 C7 – Extension at the elbow, triceps.
 C8 – Finger flexion.

 L4 – The knee reflex, quadriceps.
 L5 – No reflex.
 S1 – The ankle reflex, gastrocnemius.

26. Holistic Modalities

27. Prevention
Primary prevention –
Prehabilitation, Exercise, eat healthy, don’t
smoke, get plenty of rest, maintain proper
posture and mechanics at work or play, see your
doctor for regular check ups, wear flat shoes,
maintain healthy body weight, don’t lift more than
you can handle, don’t reach overhead
Secondary prevention –
Consists of primary prevention guidelines plus
the following: Consult a physician immediately,
Begin early rehabilitation, take pain medications
if needed and prescribed by your doctor, modify
movements that are painful
Tertiary prevention –
Consists of primary and secondary guidelines
plus the following: Continue consulting with your
physician, continue with physical or occupational
therapy, surgery may be given as an option

28. Resources
 The American Red Cross. Workplace Training
Module, Back Injury Prevention. Staywell, 2000.
 www.lieberson.com/en/neuro_medical_info/spin
al_anatomy.htm
 www.sorm.state.tx.us/training2/backsafety/backs
afety.htm
 http://en.wikipedia.org/wiki/vertebrae
 http://www.gpc.edu/~jaliff/axskel.htm
 http://siri.uvm.edu/ppt/yourbacklifting/sld002.htm