Introduction
Back injuries are very painful, difficult to heal, and may cause long term or permanent disability. After one back injury, you are more likely to experience another one sometime in your lifetime. It is important to learn techniques and procedures that may help prevent a reoccurrence.

Statistics
According to the National Institute of Occupational Safety and Health’s (NIOSH) Worker Health Chartbook, 2004, back disorders account for over 24 percent of all occupational injuries and illnesses involving days away from work. The Bureau of Labor Statistics http://www.bls.gov/iif/ reported 282,240 back injuries in 2004. Back injuries cost employers billions of dollars every year.

Anatomy of the Spine
The back is an intricate network of muscles, ligaments, disks and nerves. It is a delicate system with an enormous responsibility. The back carries most of the body's weight and includes the spinal column, the main pathway of the nervous system. The spine is the primary component of the back. The spinal column is one of the most vital parts of the human body, supporting the trunk and making all movements possible. It is made up of small bones called vertebrae. The vertebrae have two main functions; they bear the weight of the body and house the spinal cord. The vertebrae are stacked on top of each other to form a column. Between each vertebra is a cushion called the intervertebral disk. The disks are flexible pads that are tightly fixed between each vertebra and are referred to as the shock absorbers for the spine. The vertebrae are held together by ligament and muscles. Injuries to this complex system can be painful and disabling.

Several different muscle groups are important in maintaining and protecting a healthy back:
• Abdominal muscles
• Back muscles
• Buttock muscles
• Thigh muscles
• Hamstring muscles

Injuries
The lower part of the back holds most of the body's weight. Even a minor problem with the bones, muscles, ligaments, or tendons in the lower back can cause pain. Every time you bend or move, the disks compress with the motion of the spine. You put stress on the components of your back and spine every time you bend over, lift a heavy object, or sit leaning forward. Over time, damage can occur.

Some injuries that can occur include:
• Disk degeneration;
• Collapsed or herniated disks;
• Tears or strains in the ligaments and muscles;
• Bone spurs;
• Pinched nerves;
• Fractures; and
• Muscle spasms from stress.

The amount of force placed on your back under certain conditions can be significant. When bending over to pick up an item, tremendous pressure is put on the lower back. If you think of your back as a lever with the fulcrum in the center of the lever, it would take 10 pounds to lift a 10 pound object.

With the fulcrum shifted to one side, it takes more force to lift the object. The human back operates on a 10:1 ratio. Bending over to lift a ten pound object puts 100 pounds of pressure on your lower back. When you add in the 105 pounds of the average human upper torso, lifting a ten pound object puts 1,150 pounds of pressure on the lower back. If you were 25 pounds overweight, it would add an additional 250 pounds of pressure on your back every time you bend over.

Causes of Back Injuries
Back Injuries may be caused by:
• A single traumatic event, such as a slip and fall or a car accident;
• Other factors such as: genetics; age; being out of shape or overweight; having poor posture; bending, standing, sitting, or lifting improperly; tension, emotional problems or personal stress; pregnancy; tobacco smoking; poor physical condition; and sports or hobbies; and
• Cumulative trauma to the spine and related structures.

Certain actions, motions, and movements can contribute to back injuries such as:
• Heavy Lifting;
• Twisting at the waist while lifting or holding a heavy load;
• Reaching and lifting;
• Lifting or carrying objects with awkward or odd shapes;
• Working in awkward or uncomfortable positions;
• Sitting or standing for long periods of time in one position;
• Slipping on a wet floor or ice; and
• Sleeping in a bad position or on a mattress that does not provide appropriate support.

Back Injury Prevention
The best way to prevent back injuries is to reduce the strain placed on the back. There are some basic things you can do.

• Avoid lifting and bending when possible;
• Place objects off the floor;
• Raise or lower shelves. The best zone for lifting is between your shoulders and your waist. Put heavier objects on shelves at waist level, lighter objects on lower or higher shelves;
• Use carts and dollies to move objects, instead of carrying them. It is better to push an object than to pull; and
• Use cranes, hoists, lift tables, and other lift-assist devices whenever you can.

General Lifting Techniques
Everyone lifts, holds, carries, pushes and pulls on a daily basis whether it is during leisure activities or as a part of paid work. Manual material handling involves lifting light, heavy and awkward objects. Safe lifting is a critical aspect of daily activities and should be the focus of any manual material handling. Before you lift, remember the following:

• Wear supportive shoes;
• Use lift assists (hand dollies, carts, lift tables, forklifts);
• Carry all movements out horizontally (e.g., push and pull rather than lift and lower);
• Always use your body weight and not your feet when pushing;
• Try to have most workplace deliveries placed at hip height;
• Always keep objects in the comfort zone (between hip and shoulder height);
• Keep all loads close to and in front of the body;
• Keep the back aligned while lifting;
• Maintain the center of balance;
• Let the legs do the actual lifting; and
• Reduce the size of the material to keep it light, compact and safe to grasp.

Plan The Lift prior to lifting as follows:

• Size up the load, its weight, shape and position;
• Determine if the load is too large, too heavy or too awkward to move alone;
• Get help from a coworker or use a mechanical aid device to help with the lift when necessary;
• Decide on the route to take;
• Check for any problems or obstacles such as slippery or cluttered floors;
• Investigate the location where the load is going to be placed in order to anticipate any difficulties; and
• Always exercise or warm-up the back prior to lifting.

Squat Lifting should be done for a majority of all lifts. Squat lifting should be performed as follows:

• Stand as close to the load as possible;
• Move your feet shoulder width apart;
• Tighten your stomach muscles so you can tuck your pelvis;
• Bend at the knees, keeping your back straight and stomach tucked;
• Get a good firm grip on the load;
• Hug the load close to the center of your body;
• Lift smoothly with your legs gradually straightening the knees and hips into a standing position; and
• Avoid twisting your body as you lift.

Carrying Loads should be done as follows:

• Keep the load close to the center of your body to take full advantage of the mechanical leverage of your body;
• Do not change your grip on the load unless it is weight supported;
• Avoid twisting your body without pivoting your feet at the same time;
• If you must change direction, move your feet in that direction instead of twisting your trunk in that direction;
• Make sure you can see over the load; and
• Move carefully toward your destination.

Unloading Objects should be done the same way as lifting objects, but in the reverse order as follows:

• Slowly bend your knees to lower the load;
• Keep your back straight and the weight close to the center of your body;
• Allow enough room for fingers and toes when the load is set down;
• Place the load on a bench or table by resting it on the edge and pushing it forward with your arms and body; and
• Secure the load to ensure that it will not fall, tip over, roll or block someone’s way.

One Arm Loads are used when carrying items such as pails or buckets. Lifting and carrying one-arm loads should be performed as follows:

• Bend the knees and at the waist keeping your back straight;
• Reach for the load;
• Grasp the handle of the load firmly;
• Lift with your legs not your shoulders and upper back; and
• Keep your shoulders level while switching hands regularly to reduce overexertion on one side of the body while carrying the load.

Team Lifts are used when objects are too heavy, too large or too awkward for one person to lift. Team lifts should be performed as follows:

• Work with someone of similar build and height, if possible;
• Choose one person to direct the lift (e.g., “lift on the count of three”);
• Lift with your legs and raise the load to the desired level at the same time;
• Always keep the load at the same level while carrying;
• Move smoothly and in unison; and
• Set the load down together.

Overhead Lifts should be conducted as follows:
• When lifting or lowering objects from above the shoulders, lighten the load whenever possible;
• Stand on something sturdy such as a step stool or platform to decrease the vertical distance; and
• When you are lowering objects from above the shoulders, slide the load close to your body, grasp the object firmly, slide it down your body and proceed with your move.

Mechanical Aids
Special lifting equipment such as hand trucks, carts, dollies, forklifts, hoists and wheelbarrows can help move loads when they are too heavy, awkward or a coworker is not available. Although mechanical aids are used, safe lifting procedures should still be followed by maintaining the natural curvature of the back, using the legs for any lifting that is encountered and avoid twisting the back.

Take measures to avoid an injury;
• Stretch first - Take time to stretch muscles before starting. This will help you avoid painful strains and sprains.
• Slow down - Take it slowly. Allow more recovery time between lifts. Don't over work yourself.
• Rest your back - Take frequent, short breaks. Stretch.
• Sleep on a firm mattress. – The best sleeping position for many people is either on the back with the knees slightly elevated (by a pillow), or on the side with knees slightly bent.
• Get in shape - Strengthen stomach muscles, lose weight, and increase flexibility.