trudy@spinenetwork.com

Back Pain:  How to prevent it and how to deal with it.
By Charles Cox, Overdrive, Apr. 95

John Ferguson, independent owner-operator and former Overdrive Trucker of the Year, drives about 120,000 miles a year. He knows that with every click of the odometer, his spine deteriorates just a little bit more.

Ferguson knows he doesn't have to strain his back or injure it to have chronic back pain. He knows that, over time, the constant jerking, bouncing and vibration his back is subjected to sitting behind the wheel all day takes its toll on his back and causes pain. In fact, just sitting behind the wheel of a big rig all day is the number one cause of chronic back pain in truckers.

Ferguson is careful how he moves and lifts; he's careful how he sleeps. He's even rigged a device inside his cab, allowing him to take the weight off his back as he drives down the road.

"Sitting for long periods of time is one of the most difficult things for people's back to endure," says Dr. Kenneth Light, founder and director of the San Francisco Spine Center at St. Francis Memorial Hospital in San Francisco. "Sitting at the wheel of a truck for long stretches puts a lot of pressure or force across the joints of the spine. Over time, as the spine wears and the disks narrow, the joints are put under compression, and that's what causes the back to ache. The sitting posture accentuates the stress in that area, and that's why you have back pain," he says.

"Every vibration from the road is transmitted to the spine," Light continues. "When you're young and just starting out, you probably won't even notice it. But after years of driving, that constant vibration will take its toll on the back."
According to the National Back Injury Network, back injuries represent the single largest cost for work-related injuries in the trucking industry, accounting for 25 percent of all injuries. In addition, back problems of all kinds account for a large percentage of total downtime for truckers.

According to Light and other spine experts, there are some practical things you can do if you suffer from back pain, as well as some tips to avoid it.

Protecting Your Back

• Give your back a rest. One of the best things a driver can do for his back, is to stop at least once every two or three hours to stretch and move about to reduce the effects of long periods of sitting.  One stretching exercise you can do in the bunk is to lie on your back, hug your knees, pull both legs into the chest and hold for a count of six. Repeat 5 to 10 times. In addition, Light says, "Just walking around the truck a few times with your hands clasped behind your neck will help get the kinks out.  "When you sit for long periods, the muscles and ligaments tense up and cause spasms, which make whatever degree of pain you already have even worse," he says. "Stretching reduces both the amount and intensity of those spasms."
• Lose the pot belly. "Holding a 50 pound weight in front of you is the equivalent to 1,500 pounds of stress across the bottom disc in your spine," Light says. "Think of what that means for someone with a big pot belly."
• Posture. According to Dr. Alvin M. Stinson, a Birmingham, Alabama, physician who specializes in lower back problems, being aware of your posture is very important. " "If a person has poor posture, it's only a matter of time before they have back problems."
• Push; don't pull. Be very careful when you have to pull on an object to move it. "Pulling creates more strain on the body than pushing," Light says. Sometimes, however, an object is in a corner or against a wall and has to be pulled, at least enough to get behind it to push. If possible, get help to pull something.
• Lifting. Stinson says using the correct body posture when lifting is also very important. "When you lift anything, place your body as close as possible to the object to be lifted," he says. "Spread your feet out to where they're about even with your shoulders. When you actually lift the object, start out in a squatting position, with your legs bent slightly, and let them do the work instead of the back."  The closer you hold the object to your body, the less force it puts directly on the spine. "Holding the object away from the body creates a lever arm that multiplies the force working against the spine."  Light says people either lift the wrong way or lift things that are too heavy for them. "My advice is that if you are over 40 years old, you should think long and hard about lifting anything over 50 pounds," he says. "That's very difficult, because at this point, your physical body is aging faster than your mind. Your mind still thinks you're a young man, capable of throwing a 100-pound sack of potatoes over your shoulder, but the joints in your spine react otherwise, because they have aged quite a few years. They can withstand just so much stress before they break down. And when you go over that amount of stress, you'll have a back injury that could put you out of the trucking field forever."
• ·Don't jerk. Jerking motions are one of the biggest causes of back problems. Light suggests when you pull into a place to load or unload, do some kind of warm-up motions before actually securing the load or lifting anything weighing more than 25 or 30 pounds.
• Exercise. "The better overall condition your body is in, the less likely you'll have back problems," Stinson says. "That means having some sort of regular exercise program. Any safe exercise is good for the body, but some aerobic exercise seems to work best for lower back pain. I recommend walking because it's so safe. A regular walking routine not only helps strengthen the back muscles, but also it helps you to maintain your weight. It provides heart-healthy benefits as well."
  "One exercise we really like to see drivers do are those that firm up the abdomen, "Light says. "The stomach muscles are major supporters of the spine, so if they are firm and strong, the less likely you are to develop back problems." He recommends stomach crunches. They're like the traditional sit-ups, but instead of lying flat on the floor, bend the knees and, resting your arms on your chest, raise your head and shoulders 6 inches off the floor. Hold for a count of six and repeat 10 to 15 times.
  Another exercise he recommends is what is called the McKenzie exercise. This exercise involves arching the back backwards. Lying on your stomach, with forearms resting on the floor or firm mattress, raise up on your elbows and gently stretch backward, and hold for a few seconds. Repeat the exercise four or five times.
  Physicians and physical therapists recommend specific exercises for specific problems. Light cautions, however, that an exercise that works for one person doesn't necessarily work for another. He advises to stop any exercise immediately that makes the pain worse.
• In the cab. The seat itself is important. "A seat that's in good shape and firm and cradles the body is best," Light says. If the seat frame isn't firmly anchored to the truck and it moves around even slightly, that movement can aggravate back pain. If the cushion part of the seat is worn, think about replacing it. If you can afford it, replace your seat with one specially made for lumbar support. Ask your truck dealer for names of seat manufacturers.
  Adjust the seat so it's as close to the steering wheel as possible. If you sit too far away from the wheel and must reach out for your pedals, it causes you to arch your back. If you have to arch your back over a prolonged period of time, that's the kind of posture that accentuates back pain and soreness. Sit close enough to the wheel so you don't have to arch your back to reach the pedals or other instruments while your back is placed firmly against the back of the seat.
  A good substitute for a high-tech seat, according to Light, is to place a small pillow or cushion or rolled up towel between you and the seat in the small of your back to use as a lumbar support.
• For females only. It's important for women drivers in their middle years to have a diet rich in calcium. As women age, changing hormones result in inadequate calcium, making bones more brittle and more prone to fractures of the spine.

Getting Professional Help

If you have recurring back pain and have tried to live with it, but instead of easing, it has become more persistent, you might want to consider some kind of professional treatment.
In the vast majority of cases, physical therapy is all that's required. In more severe cases, in-hospital treatment or even surgery may be required. The first step is to get an evaluation from a medical doctor. He or she will examine you and may even ask for X-rays or some other form of imaging.

If physical therapy is indicated, your doctor might refer you to a physical therapy facility. Physical therapists are highly trained people who have three times the schooling in anatomy than medical doctors. They treat people who've already had surgery to get them back to full function (rehabilitation). They also treat people referred by physicians who decide physical therapy is the main form of treatment.

They use hands-on therapy (massage) and design exercise programs specifically for your problem. Most larger hospitals today either have a physical therapy group on site or are affiliated with one in the same town.

Again, the first place to start is with your regular doctor. If you don't have one, call a local hospital and ask for references on an orthopedist who specializes in back or spine problems.

Also consider seeing a chiropractor. This group of professionals probably sees more truckers than any other. Most are reputable and do an excellent job of keeping truckers with back problems on the road. Their fees are relatively more affordable than those of medical doctors. The best way to find a good one is from another trucker who's had a positive experience.

Be wary of any physician who wants to do surgery right away. Stinson says only 10 percent of all back pain sufferers require surgery. He recommends getting a second opinion if any doctor recommends surgery. According to a recent article in Men's Health, each year, some 181,000 men undergo surgery to treat herniated discs. Most didn't need the surgery, and a third of them will suffer from back pain after the operation.

Remember, your spine gets a little more worn with each click of the odometer. When he first started driving, John Ferguson may or may not have known that fact. But years ago, something told him to take care of his back and it would take care of him. Today, Ferguson-and his back-are shooting for the 3-million mile mark

When To See A Doctor

Dr. Kenneth Light, founder and director of the San Francisco Spine Center at St. Francis Memorial Hospital in San Francisco, says that because everyone has a different tolerance for pain, complaints very widely from person to person. There are, however, some general guidelines to use to determine when you should see s doctor about your pain:

• You are finding it harder and harder to start work every day, or the pain and lack of mobility make it impossible to even go to work.
• You have to stop the truck every so often just to ease stiffness in your back or to relieve the pain by moving around.
• One or both legs feels weak.
• You have numbness or tingling in the hips, or one or both legs, or if pain travels down one or both legs below the knees.
• You have difficulty getting in a comfortable position when you go to bed at night or if the pain is severe enough to wake you up.

Many people who have slight to moderate back pain ignore the problem and continue to work. Light offers some insight into when it's OK to "work through" the pain.

"When you have aching or soreness in your back that's relieved by aspirin or Tylenol or by moving around, those are normal aches and pains people have as they get older," Light says. "Also, if you have mild stiffness or pain when you're sitting at a booth in a restaurant that's relieved by changing positions every so often, that's also considered normal if you're in your late 30s or older. In those cases, it's probably safe to work through the pain. But if your back pain is accompanied by pain in the legs or weakness or numbness in the legs or buttocks, or if pain wakes you up, you probably should see a physician."

Additional Information

The Spine Network of California is committed to informing the public as to how they can protect their backs and their health.  Further information about the network itself may be found here, and we are quite accessable at either trudy@spinenetwork.com or 1-888-673-4575.  An appointment can be arranged within 48 hours of your call.

The following readings may also be of interest to you: