Episode 4 - Back Injuries at Work
Select tabs below to read the show notes or the full transcript of this episode.
.Episode Summary
The statistics surrounding back injuries among adults is alarming and reflects how grave this problem is in society today. About 80% of adults will experience this type of injury, and at least 1 million of recorded cases are caused by manual labor, with trailer truck drivers as the top type of workers suffering from it. Even employees who sit still at their desks for at least 8 hours in a day can sustain these injuries too. Low back pain, which is the leading cause of disability, is common among office workers. Dr. Sanjiv Lakhia talks about the prevalence of back injuries among those in the workforce, and what people are doing to cause them. He discusses how incorrectly pushing, pulling and lifting objects, as well as bending your back and twisting your waist, can lead to serious consequences. If you can’t avoid doing manual labor, especially if your job calls for it, then it’s important to know how you can safely execute your tasks to prevent injury. Dr. Lakhia also shares practical tips and strategies to keep in mind as you go about your work day. These include checking your posture, stretching, and using equipment like footrests. Further, he stresses the importance of being proactive at preventing back injuries from happening in the first place by using common sense and taking care of your health at home.
Key Moments In The Episode
Every episode of Back Talk Doc includes a Health Matters segment intended to provide actionable health information you can immediately put into practice in your life. This week, Dr. Lakhia shares Consumer Lab, an online tool that he uses to check the authenticity and true effectivity of nutritional supplements. This independent company conducts its own evaluations and provides results that may have been overlooked by regulating bodies. (05:50)
Links Mentioned In The Episode
Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.
The statistics surrounding back injuries among adults is alarming and reflects how grave this problem is in society today. About 80% of adults will experience this type of injury, and at least 1 million of recorded cases are caused by manual labor, with trailer truck drivers as the top type of workers suffering from it. Even employees who sit still at their desks for at least 8 hours in a day can sustain these injuries too. Low back pain, which is the leading cause of disability, is common among office workers. Dr. Sanjiv Lakhia talks about the prevalence of back injuries among those in the workforce, and what people are doing to cause them. He discusses how incorrectly pushing, pulling and lifting objects, as well as bending your back and twisting your waist, can lead to serious consequences. If you can’t avoid doing manual labor, especially if your job calls for it, then it’s important to know how you can safely execute your tasks to prevent injury. Dr. Lakhia also shares practical tips and strategies to keep in mind as you go about your work day. These include checking your posture, stretching, and using equipment like footrests. Further, he stresses the importance of being proactive at preventing back injuries from happening in the first place by using common sense and taking care of your health at home.
Key Moments In The Episode
- Top occupations that report cases of back injuries - 02:03
- Other effects of back injuries at work - 03:40
- Preventing workplace back injuries - 11:35
- Questions on ergonomics - 14:49
- Tips when lifting heavy objects - 16:36
- Most important strategy in preventing back injuries - 16:51
- Advice from the physical therapy department - 17:08
- Things to avoid doing - 17:43
- Why prevention and personal fitness is important - 18:14
Every episode of Back Talk Doc includes a Health Matters segment intended to provide actionable health information you can immediately put into practice in your life. This week, Dr. Lakhia shares Consumer Lab, an online tool that he uses to check the authenticity and true effectivity of nutritional supplements. This independent company conducts its own evaluations and provides results that may have been overlooked by regulating bodies. (05:50)
Links Mentioned In The Episode
- Top statistics on workplace back injuries
- Preventing workplace back injuries, University of Virginia
- Ergonomics plus exercise handout
- Dynamic stretching warmup routine video
- Vitamin D review
Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.
Intro: 00:00 Welcome. You are listening to Back Talk Doc, where you'll find answers to some of the most common questions about back pain and spine health, brought to you by Carolina Neurosurgery and Spine Associates, where providing personalized, highly skilled and compassionate spine care has been our specialty for over 75 years. And now it's time to understand the cause of back pain and learn about options to get you back on track. Here's your Back Talk Doc, Dr. Sanjiv Lakhia.
Sanjiv Lakhia: 00:35 Welcome to episode four of Back Talk Doc. Again, I am your host, Dr. Sanjiv Lakhia. I'm a board certified specialist in physical medicine and rehabilitation, and we're often referred to as physiatrists. For those not familiar with our medical specialty, physiatry is a nonsurgical field, a hybrid of sorts between neurology and orthopedics. In my day-to-day practice at Carolina Neurosurgery and Spine Associates, I focus most of my clinical time on the evaluation and treatment of spine disorders, mostly the neck and low back, along with orthopedic assessments.
Sanjiv Lakhia: 01:06 Additionally, as an osteopathic physician with a background in integrative medicine, I have a passion for promoting health and wellness in my patient population. It is my goal that this podcast helps to break down complex spine issues into simplistic terms that are easy for you to understand. I hope this information arms you so that when you go in to see your doctor to discuss your back issues, you have a better understanding about what's going on and hopefully this can assist you in your decision making process.
Sanjiv Lakhia: 01:34 In today's episode, I want to tackle an issue that I see daily in the office and that is workplace back injuries. If you're listening today, there's a high probability that you or someone you know has missed time from work in the last year due to a low back injury. On this episode, we will start by breaking down some very important statistics with regards to workplace back injuries, just to set the background for you, and then transition towards strategies to help you prevent injuring yourself at work.
Sanjiv Lakhia: 02:02 So let's get right into it today. Thank you again for listening and let's get going with the important statistics surrounding back injuries at work. Number one, about 80% of adults are estimated to experience a back injury at some point in their lifetime. So that's a staggering statistic and it's what really drives our business at Carolina Neurosurgery and Spine associates and what makes this topic relevant to you today. More than 1 million back injuries are sustained in the workplace every year, and 80% of these injuries are associated with manual materials handling tasks. And I will define that as lifting, bending, pushing and pulling.
Sanjiv Lakhia: 02:39 Six occupations account for more than a quarter of the ergonomic back injuries with tractor trailer truck drivers suffering the most. And let me list for you some occupations that have the highest potential for back injury at work. Number one, as I mentioned, is heavy and tractor trailer truck drivers; number two, laborers and freight workers; number three, stock and material movers; number four, nursing assistants; number five, janitors and cleaners; and six on the list is registered nurses. So for all you nurses out there that I work with, you're probably nodding your head as it's a full contact sport, and we'll talk a little more about why that is. And number seven is maintenance and repair workers.
Sanjiv Lakhia: 03:22 So, that's quite a list of occupations. All of those have in common that if you're in that field or occupation, you're largely making your money through your effort, your labor and your sweat equity, and learning how to do that safely is going to be key and we're going to review that shortly. Back injuries are the most common reason for non-attendance in the general workforce, after the common cold, that really translates for employers into missed time from work and it's quite costly.
Sanjiv Lakhia: 03:50 This is why at Carolina Neurosurgery and Spine Associates, we're often approached by large employers in the community to develop programs to help reduce their costs related to spine injuries. And building on that, low back pain is the single leading cause of disability worldwide. Those that suffer back injuries often average about 12 days of missed time off of work before they can get back to work. And I would say that number fluctuate significantly. Simple lumbar strains typically resolve within two to six weeks, but lumbar disk herniations, bulges, pinched nerves, I've seen this often require weeks, if not months before you can get back to full functional status and return to work at a full duty status.
Sanjiv Lakhia: 04:35 Additionally, workers in the healthcare industry sustain four and a half times more overexertion injuries than any other type of worker. This includes nurses, this includes patient transporters, phlebotomists, and I would really break that down more into the hospital environment, but also in the outpatient clinics, there's quite a lot of bending, lifting and twisting. Even the simple tasks such as checking a blood pressure can require an awkward position for you if you're not doing it correctly that can strain your low back.
Sanjiv Lakhia: 05:04 Work-related back injuries and illnesses are caused predominantly by lifting of materials, sudden movements, whole body vibrations, lifting and twisting at the same time or bending over for prolonged periods of time and even repetitively throughout the day. This all translates into big money. More than $50 billion are spent each year trying to treat workplace back injuries. So I hope that provides a little bit of a background with regards to how significant this problem is in our country, and how important it is that you learn proper workplace ergonomic techniques, strategies to protect your back throughout your workday, and we're going to jump right into those strategies shortly after this.
Sanjiv Lakhia: 05:50 In today's health matters segment, I'd like to discuss a website that I find to be very useful in my day-to-day practice. The website is called consumerlabs.com. I'll frequently be approached by patients when they come in with a grocery bag full of supplements, and I'm asked how to tell if these supplements are any good. It's a good question.
Sanjiv Lakhia: 06:12 The nutritional supplement industry in this country is a multibillion dollar industry, and while there are some regulations that surround it, I like to consider it the wild, wild west. When you go out to the grocery store, the health food store or the pharmacy and you pick up a bottle of vitamin D or some other herb or supplement, how do you really know that what's on the label is in the bottle? Let me give you a little background though on the current state of affairs with respect to regulation of the nutritional supplement industry.
Sanjiv Lakhia: 06:41 They are regulated to some degree by the FDA and the FDA really defines supplements as an addition to your food and your diet, and supplements are meant to be in addition to your diet, not a primary means of obtaining your nutrition, and they are regulated. The Dietary Supplement Health and Education Act of 1994 defines supplements as a subset of food, so they're regulated as such. And as is the case with foods, the FDA regulates a type of ingredients allowed in dietary supplements and the types of claims that can be made about an ingredient or product.
Sanjiv Lakhia: 07:19 The FDA also has detailed requirements for the labeling of dietary supplements, such as nutritional labeling, labeling the allergens, among other things. And while dietary supplement manufacturers must ensure that their products are safe prior to marketing, the FDA also has several post-marketing responsibilities to ensure the safety of dietary supplements. Among these is the enforcement of the final rule of The Dietary Supplement Current Good Manufacturing Practices that was released in 2007 and really became effective in 2010.
Sanjiv Lakhia: 07:53 The purpose of this is to establish uniform standards needed to ensure quality throughout the manufacturing, packaging, labeling and storing of dietary supplement products. So there is some regulation in place, but the enforcement of it is questionable at best, and it leaves the average individual really to try and figure some things out for themselves.
Sanjiv Lakhia: 08:13 And that's where this website, consumerlabs.com, comes into place, and I've been using this off and on for about 10 years and the company has been in existence for about 20 years, and really what it is is an independent third party company that looks at supplement products across the board and evaluates them for several things, such as purity and verification that the strength of the product on the label is actually a strength in the bottle.
Sanjiv Lakhia: 08:42 And this is a fantastic service for the average individual, and you can go online and subscribe, become a member, and you'll receive newsletters. You'll receive updated evaluations of all the different supplements on the market, quality issues such as the labeled amount, purity. Additionally, they look at the ability of a supplement to break apart for absorption once it enters your gastrointestinal track. This is excellent information to have when you're trying to evaluate the effectiveness of your supplements in your cabinet.
Sanjiv Lakhia: 09:10 How do they do this? Well, they use various chemical processes such as gas chromatography. They also use liquid chromatography and other techniques in the lab to evaluate products and determine if what the company states about the product is actually true. So let me give you an example, on their website currently they do a breakdown of vitamin D, and there's hundreds of vitamin D products on the market. And they actually found a couple of brands that did not produce the results they are advertising.
Sanjiv Lakhia: 09:41 One in particular that I found surprising was the Thorne basic bone nutrients product. Now Thorne is well known supplement company that has a tremendous reputation. It's used across multiple organizations, particularly the Institute for Functional Medicine. Many doctors in that organization recommend Thorne products and I myself have used and prescribed Thorne products. I consider Thorne to be a highly reputable company.
Sanjiv Lakhia: 10:08 However, an evaluation of the Thorne basic bone nutrients product determined that it contained only 69.7% of its claimed amount of calcium and vitamin D. So, on the bottle is 500 international units of vitamin D, but they only found roughly 350 international units, and it only had about 2.2% of its vitamin K, which is quite disappointing because the vitamin K in the product is essential to the absorption and the utilization of the vitamin D. How would you know?
Sanjiv Lakhia: 10:43 It's a good company, excellent reputation. I think you need to arm yourself with more information. So if you are using supplements in any capacity, whether it's to support your joints or your bone health or your spine health, take a look a consumerlabs.com and we'll put a link to this company in the show notes. It's probably well worth the membership. A typical bottle of a supplement can range anywhere from $20 to $50 a month, if not more. So spending about $20 to $25 a month to have the ability to sort of audit what's in your cabinet is well worth the money.
Sanjiv Lakhia: 11:20 Let's dive back now into our topic today regarding workplace back injuries. I have briefly outlined some very important statistics to really establish how this is a major problem in this country. Well, let's get into some information that can help you prevent the injury.
Sanjiv Lakhia: 11:35 Number one, I think the first thing you can consider if you have an occupation that puts your back under a lot of stress is to check your posture, and the posture can include multiple areas. You want to look at your head and neck position, your sitting posture, you're standing posture as well as your posture when you're at a computer workstation. The sitting posture in general, you want to keep your head balanced and naturally relaxed over your shoulders. You want to keep your shoulders slightly retracted and your elbows at about a 90 degree position.
Sanjiv Lakhia: 12:04 You want to sit back in your chair for support and if possible, have an ergonomic work chair. You want to make sure your feet are settled on the ground. Try not to cross your legs or ankles and just sit in a relaxed position. If you need to, you can prop your foot up on a stool in front of you if that alleviate some tension on your low back.
Sanjiv Lakhia: 12:21 Standing posture is quite similar if you're working at a counter and doing repetitive tasks. One tip I like to share with patients is keep a stool in front of you. You can alternate putting your foot up on the stool and that also will alleviate some pressure on your lumbosacral spine and your lumbar disk. Another strategy in addition to maintaining a neutral posture is to stretch.
Sanjiv Lakhia: 12:42 There's good data that workplace programs that involve pre-work stretching, help prevent injury, and the stretches don't have to be complicated. Simple stretches such as knee to the chest, gentle body twists, hamstring stretches, all of these can be done before you begin your shift just to provide some circulation and stretch the muscles, tendons, ligaments, and fascia.
Sanjiv Lakhia: 13:05 Now, there are some companies that have looked at this research and invested in formal programs, but you don't really need to have that available to take advantage. I always recommend start out in the morning, part of your morning routine, get the blood flowing. Start with a little bit of like cardio work, whether it's a brisk walk, jumping on a fitness trampoline or using an elliptical machine, and then follow this with a gentle stretching program.
Sanjiv Lakhia: 13:30 In my book, Back Talk, I do reference a couple of home DVD programs that can be useful. One of them is a yoga program and the other one is a Pilates program, so you're welcome to check those out. If you go to the website, backtalkdoc.com, you could pick up the book, and it has a lot of good resources that you can utilize.
Sanjiv Lakhia: 13:48 You can stretch throughout the day as well. Even on the course of my workday, if I'm seeing 20 to 30 patients per day, I'll try and stretch about every hour or so, and that can involve just some basic hamstring stretches and dynamic stretches are more effective in this manner and reduce your risk of injury. A dynamic stretch is one where you're stretching a muscle or tendon while you're moving versus a static stretch where you're laying on the ground.
Sanjiv Lakhia: 14:11 So an example of a dynamic stretch can be, and the standing position bring the knee as a chest and you can alternate this both legs. You can also do dynamic hamstring stretches and dynamic spine twists. I'll put some video links in the show notes to give you an example if you want to try this during your work day. It's always good to ask questions though before you go into a situation where you know you're at risk for injuring your back.
Sanjiv Lakhia: 14:34 For example, if you have to lift something real heavy or something that just seems dangerous. The University of Virginia has a real nice ergonomics questionnaire on their website and we'll link to this in the show notes. I want to go through some of these questions with you because I think you'll find them useful.
Sanjiv Lakhia: 14:49 Number one, you want to assess situation at work and ask yourself the following questions. Is the load too big, too bulky or too heavy? And common sense can apply here. Typically, if it's more than a third of your body weight, it's probably time to ask for help. Also, ask yourself, can you slide it instead of lifting it, and remember, it's always better to push an object than it is to pull an object.
Sanjiv Lakhia: 15:12 Another great question is the load height located inside your safe lifting zone, so what's the safe lifting zone? The safe lifting zone is between your knees and shoulders. If the load is below knee level, bend your knees and lift with your legs. If the load is above your shoulders, use a stool or a ladder or ask for help. Better yet, go ahead and rearrange the contents on the shelves so that the heavier and more frequently needed items are placed on the mid level shelves. And if it's just too, too heavy, ask a coworker for assistance. If it looks like you're going to have to bend and twist your body to reach the object, you should probably readjust the object or your position before you do this, trying to eliminate that if possible.
Sanjiv Lakhia: 15:52 Do you need equipment to help move the object? Hand trucks, forklifts, dollies? All of these should be available for your use and they use the leverage. Reduce the strain on your body and prevent injury. Again, have you stretched your muscles or warmed up before you lift? Definitely do this every day if he can. I often hear in the office, workers talk about slips and falls when they're lifting heavy objects, so make sure you have slip resistance shoes on.
Sanjiv Lakhia: 16:19 Another thing is clear your pathway before you move an item. It doesn't do you any good to try and lift an object and once you have it engaged correctly, realize that you have a box or something else in your way, which will required you to put the object back down and increase your risk for injury. A few more tips here that you might find useful. When you do lift, remember, plant your feet firmly. Get a stable base. Bend at your knees, not your waist. Tighten your abdominal muscles to support your spine. Get a good grip and use both the hands and keep the load close to your body.
Sanjiv Lakhia: 16:51 This is a very important strategy. I often share this strategy with grandmothers who come in who injured their back lifting up their grandkids. Whatever you're lifting, it's better to bring this close to your body then reach far away, that reduces a lever arm and reduces the stress and strain across your spine.
Sanjiv Lakhia: 17:08 Our physical therapy department always emphasizes to our patients to lift with your legs, not with your arms and back, and try and keep a good neutral position. Keep your back upright. If you can, encourage a slight anterior pelvic tilt, it's going to protect your spine. That simply means rotating your hips a little bit forward, increasing slightly the arch in your back. This will reduce the flection and the compression of your lumbar disk and reduce your risk of herniation.
Sanjiv Lakhia: 17:34 Always, always, always remember to breathe when you're lifting heavy objects. If it requires you to hold your breath, then it's probably too heavy and you probably need to get help.
Sanjiv Lakhia: 17:43 A couple of things to remember as well that you shouldn't be doing. Don't bend over and lift from the floor if you can avoid it. Try not to lift and twist at the same time. That is a sure recipe for herniating a disk. Don't try and lift an object with one hand, and don't lift while you're reaching or stretching. Don't hold your breath while you're lifting, as well, that increases the intrathoracic pressure and can cause increased strain across your low back and try not to live from an uncomfortable posture. Get yourself comfortable before you engage added force.
Sanjiv Lakhia: 18:14 So I hope you found these tips helpful. The best strategy for assessing and evaluating back injuries in the workplace is to prevent them up front. Remember, working safely means using common sense. Make sure you have correct ergonomics if you're at the computer workstation, but also when you're lifting.
Sanjiv Lakhia: 18:34 Stay physically fit at home. I can't emphasize how critical it is to make sure you're staying well hydrated, eating an anti inflammatory diet and getting enough sleep. All of these will prevent your risk of injury and keep you out of the doctor's office and hopefully keep you pain-free.
Outro: 18:51 Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery and Spine Associates with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available carolinaneurosurgery.com.
Sanjiv Lakhia: 00:35 Welcome to episode four of Back Talk Doc. Again, I am your host, Dr. Sanjiv Lakhia. I'm a board certified specialist in physical medicine and rehabilitation, and we're often referred to as physiatrists. For those not familiar with our medical specialty, physiatry is a nonsurgical field, a hybrid of sorts between neurology and orthopedics. In my day-to-day practice at Carolina Neurosurgery and Spine Associates, I focus most of my clinical time on the evaluation and treatment of spine disorders, mostly the neck and low back, along with orthopedic assessments.
Sanjiv Lakhia: 01:06 Additionally, as an osteopathic physician with a background in integrative medicine, I have a passion for promoting health and wellness in my patient population. It is my goal that this podcast helps to break down complex spine issues into simplistic terms that are easy for you to understand. I hope this information arms you so that when you go in to see your doctor to discuss your back issues, you have a better understanding about what's going on and hopefully this can assist you in your decision making process.
Sanjiv Lakhia: 01:34 In today's episode, I want to tackle an issue that I see daily in the office and that is workplace back injuries. If you're listening today, there's a high probability that you or someone you know has missed time from work in the last year due to a low back injury. On this episode, we will start by breaking down some very important statistics with regards to workplace back injuries, just to set the background for you, and then transition towards strategies to help you prevent injuring yourself at work.
Sanjiv Lakhia: 02:02 So let's get right into it today. Thank you again for listening and let's get going with the important statistics surrounding back injuries at work. Number one, about 80% of adults are estimated to experience a back injury at some point in their lifetime. So that's a staggering statistic and it's what really drives our business at Carolina Neurosurgery and Spine associates and what makes this topic relevant to you today. More than 1 million back injuries are sustained in the workplace every year, and 80% of these injuries are associated with manual materials handling tasks. And I will define that as lifting, bending, pushing and pulling.
Sanjiv Lakhia: 02:39 Six occupations account for more than a quarter of the ergonomic back injuries with tractor trailer truck drivers suffering the most. And let me list for you some occupations that have the highest potential for back injury at work. Number one, as I mentioned, is heavy and tractor trailer truck drivers; number two, laborers and freight workers; number three, stock and material movers; number four, nursing assistants; number five, janitors and cleaners; and six on the list is registered nurses. So for all you nurses out there that I work with, you're probably nodding your head as it's a full contact sport, and we'll talk a little more about why that is. And number seven is maintenance and repair workers.
Sanjiv Lakhia: 03:22 So, that's quite a list of occupations. All of those have in common that if you're in that field or occupation, you're largely making your money through your effort, your labor and your sweat equity, and learning how to do that safely is going to be key and we're going to review that shortly. Back injuries are the most common reason for non-attendance in the general workforce, after the common cold, that really translates for employers into missed time from work and it's quite costly.
Sanjiv Lakhia: 03:50 This is why at Carolina Neurosurgery and Spine Associates, we're often approached by large employers in the community to develop programs to help reduce their costs related to spine injuries. And building on that, low back pain is the single leading cause of disability worldwide. Those that suffer back injuries often average about 12 days of missed time off of work before they can get back to work. And I would say that number fluctuate significantly. Simple lumbar strains typically resolve within two to six weeks, but lumbar disk herniations, bulges, pinched nerves, I've seen this often require weeks, if not months before you can get back to full functional status and return to work at a full duty status.
Sanjiv Lakhia: 04:35 Additionally, workers in the healthcare industry sustain four and a half times more overexertion injuries than any other type of worker. This includes nurses, this includes patient transporters, phlebotomists, and I would really break that down more into the hospital environment, but also in the outpatient clinics, there's quite a lot of bending, lifting and twisting. Even the simple tasks such as checking a blood pressure can require an awkward position for you if you're not doing it correctly that can strain your low back.
Sanjiv Lakhia: 05:04 Work-related back injuries and illnesses are caused predominantly by lifting of materials, sudden movements, whole body vibrations, lifting and twisting at the same time or bending over for prolonged periods of time and even repetitively throughout the day. This all translates into big money. More than $50 billion are spent each year trying to treat workplace back injuries. So I hope that provides a little bit of a background with regards to how significant this problem is in our country, and how important it is that you learn proper workplace ergonomic techniques, strategies to protect your back throughout your workday, and we're going to jump right into those strategies shortly after this.
Sanjiv Lakhia: 05:50 In today's health matters segment, I'd like to discuss a website that I find to be very useful in my day-to-day practice. The website is called consumerlabs.com. I'll frequently be approached by patients when they come in with a grocery bag full of supplements, and I'm asked how to tell if these supplements are any good. It's a good question.
Sanjiv Lakhia: 06:12 The nutritional supplement industry in this country is a multibillion dollar industry, and while there are some regulations that surround it, I like to consider it the wild, wild west. When you go out to the grocery store, the health food store or the pharmacy and you pick up a bottle of vitamin D or some other herb or supplement, how do you really know that what's on the label is in the bottle? Let me give you a little background though on the current state of affairs with respect to regulation of the nutritional supplement industry.
Sanjiv Lakhia: 06:41 They are regulated to some degree by the FDA and the FDA really defines supplements as an addition to your food and your diet, and supplements are meant to be in addition to your diet, not a primary means of obtaining your nutrition, and they are regulated. The Dietary Supplement Health and Education Act of 1994 defines supplements as a subset of food, so they're regulated as such. And as is the case with foods, the FDA regulates a type of ingredients allowed in dietary supplements and the types of claims that can be made about an ingredient or product.
Sanjiv Lakhia: 07:19 The FDA also has detailed requirements for the labeling of dietary supplements, such as nutritional labeling, labeling the allergens, among other things. And while dietary supplement manufacturers must ensure that their products are safe prior to marketing, the FDA also has several post-marketing responsibilities to ensure the safety of dietary supplements. Among these is the enforcement of the final rule of The Dietary Supplement Current Good Manufacturing Practices that was released in 2007 and really became effective in 2010.
Sanjiv Lakhia: 07:53 The purpose of this is to establish uniform standards needed to ensure quality throughout the manufacturing, packaging, labeling and storing of dietary supplement products. So there is some regulation in place, but the enforcement of it is questionable at best, and it leaves the average individual really to try and figure some things out for themselves.
Sanjiv Lakhia: 08:13 And that's where this website, consumerlabs.com, comes into place, and I've been using this off and on for about 10 years and the company has been in existence for about 20 years, and really what it is is an independent third party company that looks at supplement products across the board and evaluates them for several things, such as purity and verification that the strength of the product on the label is actually a strength in the bottle.
Sanjiv Lakhia: 08:42 And this is a fantastic service for the average individual, and you can go online and subscribe, become a member, and you'll receive newsletters. You'll receive updated evaluations of all the different supplements on the market, quality issues such as the labeled amount, purity. Additionally, they look at the ability of a supplement to break apart for absorption once it enters your gastrointestinal track. This is excellent information to have when you're trying to evaluate the effectiveness of your supplements in your cabinet.
Sanjiv Lakhia: 09:10 How do they do this? Well, they use various chemical processes such as gas chromatography. They also use liquid chromatography and other techniques in the lab to evaluate products and determine if what the company states about the product is actually true. So let me give you an example, on their website currently they do a breakdown of vitamin D, and there's hundreds of vitamin D products on the market. And they actually found a couple of brands that did not produce the results they are advertising.
Sanjiv Lakhia: 09:41 One in particular that I found surprising was the Thorne basic bone nutrients product. Now Thorne is well known supplement company that has a tremendous reputation. It's used across multiple organizations, particularly the Institute for Functional Medicine. Many doctors in that organization recommend Thorne products and I myself have used and prescribed Thorne products. I consider Thorne to be a highly reputable company.
Sanjiv Lakhia: 10:08 However, an evaluation of the Thorne basic bone nutrients product determined that it contained only 69.7% of its claimed amount of calcium and vitamin D. So, on the bottle is 500 international units of vitamin D, but they only found roughly 350 international units, and it only had about 2.2% of its vitamin K, which is quite disappointing because the vitamin K in the product is essential to the absorption and the utilization of the vitamin D. How would you know?
Sanjiv Lakhia: 10:43 It's a good company, excellent reputation. I think you need to arm yourself with more information. So if you are using supplements in any capacity, whether it's to support your joints or your bone health or your spine health, take a look a consumerlabs.com and we'll put a link to this company in the show notes. It's probably well worth the membership. A typical bottle of a supplement can range anywhere from $20 to $50 a month, if not more. So spending about $20 to $25 a month to have the ability to sort of audit what's in your cabinet is well worth the money.
Sanjiv Lakhia: 11:20 Let's dive back now into our topic today regarding workplace back injuries. I have briefly outlined some very important statistics to really establish how this is a major problem in this country. Well, let's get into some information that can help you prevent the injury.
Sanjiv Lakhia: 11:35 Number one, I think the first thing you can consider if you have an occupation that puts your back under a lot of stress is to check your posture, and the posture can include multiple areas. You want to look at your head and neck position, your sitting posture, you're standing posture as well as your posture when you're at a computer workstation. The sitting posture in general, you want to keep your head balanced and naturally relaxed over your shoulders. You want to keep your shoulders slightly retracted and your elbows at about a 90 degree position.
Sanjiv Lakhia: 12:04 You want to sit back in your chair for support and if possible, have an ergonomic work chair. You want to make sure your feet are settled on the ground. Try not to cross your legs or ankles and just sit in a relaxed position. If you need to, you can prop your foot up on a stool in front of you if that alleviate some tension on your low back.
Sanjiv Lakhia: 12:21 Standing posture is quite similar if you're working at a counter and doing repetitive tasks. One tip I like to share with patients is keep a stool in front of you. You can alternate putting your foot up on the stool and that also will alleviate some pressure on your lumbosacral spine and your lumbar disk. Another strategy in addition to maintaining a neutral posture is to stretch.
Sanjiv Lakhia: 12:42 There's good data that workplace programs that involve pre-work stretching, help prevent injury, and the stretches don't have to be complicated. Simple stretches such as knee to the chest, gentle body twists, hamstring stretches, all of these can be done before you begin your shift just to provide some circulation and stretch the muscles, tendons, ligaments, and fascia.
Sanjiv Lakhia: 13:05 Now, there are some companies that have looked at this research and invested in formal programs, but you don't really need to have that available to take advantage. I always recommend start out in the morning, part of your morning routine, get the blood flowing. Start with a little bit of like cardio work, whether it's a brisk walk, jumping on a fitness trampoline or using an elliptical machine, and then follow this with a gentle stretching program.
Sanjiv Lakhia: 13:30 In my book, Back Talk, I do reference a couple of home DVD programs that can be useful. One of them is a yoga program and the other one is a Pilates program, so you're welcome to check those out. If you go to the website, backtalkdoc.com, you could pick up the book, and it has a lot of good resources that you can utilize.
Sanjiv Lakhia: 13:48 You can stretch throughout the day as well. Even on the course of my workday, if I'm seeing 20 to 30 patients per day, I'll try and stretch about every hour or so, and that can involve just some basic hamstring stretches and dynamic stretches are more effective in this manner and reduce your risk of injury. A dynamic stretch is one where you're stretching a muscle or tendon while you're moving versus a static stretch where you're laying on the ground.
Sanjiv Lakhia: 14:11 So an example of a dynamic stretch can be, and the standing position bring the knee as a chest and you can alternate this both legs. You can also do dynamic hamstring stretches and dynamic spine twists. I'll put some video links in the show notes to give you an example if you want to try this during your work day. It's always good to ask questions though before you go into a situation where you know you're at risk for injuring your back.
Sanjiv Lakhia: 14:34 For example, if you have to lift something real heavy or something that just seems dangerous. The University of Virginia has a real nice ergonomics questionnaire on their website and we'll link to this in the show notes. I want to go through some of these questions with you because I think you'll find them useful.
Sanjiv Lakhia: 14:49 Number one, you want to assess situation at work and ask yourself the following questions. Is the load too big, too bulky or too heavy? And common sense can apply here. Typically, if it's more than a third of your body weight, it's probably time to ask for help. Also, ask yourself, can you slide it instead of lifting it, and remember, it's always better to push an object than it is to pull an object.
Sanjiv Lakhia: 15:12 Another great question is the load height located inside your safe lifting zone, so what's the safe lifting zone? The safe lifting zone is between your knees and shoulders. If the load is below knee level, bend your knees and lift with your legs. If the load is above your shoulders, use a stool or a ladder or ask for help. Better yet, go ahead and rearrange the contents on the shelves so that the heavier and more frequently needed items are placed on the mid level shelves. And if it's just too, too heavy, ask a coworker for assistance. If it looks like you're going to have to bend and twist your body to reach the object, you should probably readjust the object or your position before you do this, trying to eliminate that if possible.
Sanjiv Lakhia: 15:52 Do you need equipment to help move the object? Hand trucks, forklifts, dollies? All of these should be available for your use and they use the leverage. Reduce the strain on your body and prevent injury. Again, have you stretched your muscles or warmed up before you lift? Definitely do this every day if he can. I often hear in the office, workers talk about slips and falls when they're lifting heavy objects, so make sure you have slip resistance shoes on.
Sanjiv Lakhia: 16:19 Another thing is clear your pathway before you move an item. It doesn't do you any good to try and lift an object and once you have it engaged correctly, realize that you have a box or something else in your way, which will required you to put the object back down and increase your risk for injury. A few more tips here that you might find useful. When you do lift, remember, plant your feet firmly. Get a stable base. Bend at your knees, not your waist. Tighten your abdominal muscles to support your spine. Get a good grip and use both the hands and keep the load close to your body.
Sanjiv Lakhia: 16:51 This is a very important strategy. I often share this strategy with grandmothers who come in who injured their back lifting up their grandkids. Whatever you're lifting, it's better to bring this close to your body then reach far away, that reduces a lever arm and reduces the stress and strain across your spine.
Sanjiv Lakhia: 17:08 Our physical therapy department always emphasizes to our patients to lift with your legs, not with your arms and back, and try and keep a good neutral position. Keep your back upright. If you can, encourage a slight anterior pelvic tilt, it's going to protect your spine. That simply means rotating your hips a little bit forward, increasing slightly the arch in your back. This will reduce the flection and the compression of your lumbar disk and reduce your risk of herniation.
Sanjiv Lakhia: 17:34 Always, always, always remember to breathe when you're lifting heavy objects. If it requires you to hold your breath, then it's probably too heavy and you probably need to get help.
Sanjiv Lakhia: 17:43 A couple of things to remember as well that you shouldn't be doing. Don't bend over and lift from the floor if you can avoid it. Try not to lift and twist at the same time. That is a sure recipe for herniating a disk. Don't try and lift an object with one hand, and don't lift while you're reaching or stretching. Don't hold your breath while you're lifting, as well, that increases the intrathoracic pressure and can cause increased strain across your low back and try not to live from an uncomfortable posture. Get yourself comfortable before you engage added force.
Sanjiv Lakhia: 18:14 So I hope you found these tips helpful. The best strategy for assessing and evaluating back injuries in the workplace is to prevent them up front. Remember, working safely means using common sense. Make sure you have correct ergonomics if you're at the computer workstation, but also when you're lifting.
Sanjiv Lakhia: 18:34 Stay physically fit at home. I can't emphasize how critical it is to make sure you're staying well hydrated, eating an anti inflammatory diet and getting enough sleep. All of these will prevent your risk of injury and keep you out of the doctor's office and hopefully keep you pain-free.
Outro: 18:51 Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery and Spine Associates with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available carolinaneurosurgery.com.