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Back Injuries

Your entire body is supported by your spinal column. The spinal Column is made up of 30 separate bones called vertebrae, all linked and supported by a series of tiny muscles. Small pads called discs are situated between each vertebrae and act like shock absorbers to cushion pressure. The spinal column is wrapped by a system of nerves. The spinal system has three natural curves:

Cervical - From the base of the neck to the brain
Thoracic - Situated from the middle to the lower back
Lumbar - Located from the lower back to the buttocks area.

These three curves need to be kept in natural alignment in order to prevent discomfort.

Any movement, or series of movements, which places abnormal stress or abnormal loading on the spine can injure it. This may be a sudden overload, if, for instance, you overbalance while lifting a very heavy weight. Or it may be a cumulative overload, if you repeatedly pull or lift a weight at an awkward angle.

In principle, your back is a very strong structure. It can withstand a great deal of pressure. Equally, in certain situations, it can become vulnerable to strains. Often, the strain is caused by pressure or loading that seems trivial, and below the normal strength of your back. Sports which combine twisting movements in the spine with heavier compressive loading, like rowing, judo and rugby, carry the double risk of sudden, traumatic, back injuries, or the more gradual kind.

It is usually possible to identify a triggering factor for your back pain, even when the injury appears to have no particular cause at first sight. You may have changed your equipment, or your style of play; you may have been doing more of your sport than you were used to; you may have been feeling back stiffness due to fatigue; you may have over-twisted or over-loaded your back without a preparatory warm-up; you may have developed a faulty technique through carelessness in handling, lifting or carrying heavy weights; or a leg injury may have affected your back posture.

Back pain, whether sudden or gradual, may be felt in one localised area of your back, or it may feel widespread over the whole lower back. If the injury is sudden, it is likely to cause a severe stab of pain, which may subside quickly or may persist. A more gradual pain usually starts mildly, but builds up to the stage of causing real discomfort. You may find that certain movements or positions aggravate your pain, while others relieve it. You may feel that your back hurts, whatever you do, but careful analysis may show that in certain positions you can relieve your pain. You have to be aware of cause and effect: poor posture may ease your pain temporarily, but make it worse as soon as you straighten up. Easing pain through twisting your back is likely to make your pain progressively worse over a space of time. Your back may hurt when you are at rest; when you cough; when you turn over in bed at night. But it may stop hurting when you lie flat; when you are walking around; when you bend forwards, backwards of sideways; or if you hang from a bar by your hands, and take the weight off your feet.

You may also feel pain in one or both legs, associated with your back pain, and which gets worse when your back is moved in certain ways, for instance when you are sitting in an easy chair, or when you bend forwards. The leg pain may be directly traceable to your back, so that you feel a line of pain spreading down from your lower back into your groin, or down the back of your leg. The pain may spread only to your knee, or it may go right down to your foot. This kind of leg pain may come on without an obvious link to your back, making you think that you have a localised muscle strain in your leg. Although referred pain in the leg related directly to a back strain, or sometimes to a hip problem, it can come on when you do not have noticeable pain in your back. Because of the complex structure of your spinal joints, there are many different tissues which can be damaged in a back injury. A severe compression injury, like a fall from a height, can crush the body of a vertebrae. A severe twisting injury can fracture the bony arch at the back of one of the vertebrae. Any of the ligaments guarding the spinal joints can be strained by abnormal movements. The small or larger muscles in your back may be strained by over-stretching or over-contraction. If a spinal joint is damaged, the muscles over it usually go into spasm, to fix the joint in a kind of natural splint. This stiffens that part of your back, creating even more pain if you then try to move it against the limitating factor of the tightened muscles. If you try to force movement, you may tear the muscles, adding to the original damage done in the injury.

The discs between your vertebral bones can be damaged in a variety of different ways. The danger of disc damage increases as you get older, because the strong outer part, the annulus fibrosus, begins to degenerate at any time after twenty-five years, while the nucleus pulposus begins to lose its pliability and water-holding capacity as early as in middle age. Minor damage to the outer part of the disc can be no worse in its effect than a strain to the ligaments covering the joints. But major disc damage is a much more serious problem. A rise in pressure over a degenerated disc can push the disc out from between the vertebrae, or it can create enough pressure to push the nucleas through the annulus, cracking its outer ring. Usually the broken disc protrudes backwards, so that it encroaches into the spinal canal, and lodges against the nerves there. This can cause severe and unremitting pain in your leg, in the pathway of the pressurised nerves, although the pain may be milder and intermittent. The cause of this major injury can be minor; a degenerated disc may be disrupted by simple activities like coughing when you are bending forward, or lifting even a light weight with your back bent.

It is totally impossible for you to identify which of the various spinal structures has been damaged in any particular injury. This is a matter of specialist diagnosis.

* If there is any danger at all that your back might have been broken in a very severe, traumatic injury, you should not be moved at all until specialist help arrives and you can be transported to hospital. Apart from back pain, the main signs that your back may have been broken are numbness, tingling or pain in your legs, and a feeling of total weakness in your trunk and legs.

* If the injury is less drastic, but very painful, ice can be applied to your back. You should refer to your local casualty department or your doctor as quickly as possible, in case you need X-rays or other investigations.

* In the initial stages of a painful back injury, the more you lie down and keep the weight off your feet, the better. If possible, lie flat, and avoid propping your head up on pillows, or curling up on your side.

* If you have to sit down, especially at work, you must make sure that your back is well supported, preferably on soft cushions.

* You must avoid any activities which cause pain in your back. General exercising is best started with swimming.

* Your return to your sport should start with gentle jogging, building up to sprinting, and then sprinting and turning, and shuttle running.You must always remember to warm-up thoroughly before any exercise session; warm-down afterwards, and shower quickly, rather than sitting around getting chilled.

Prevention and Lumbar Conservation when lifting loads
Here are some helpful tips when lifting and carrying a load:

- Examine the load for grease, oil, sharp edges and other hazards.

- Know your limit and halve it; estimate the weight and divide the load or get help if the weight is more than you can comfortably handle.

- Plan your path and make sure that it is free of obstructions.

- Consider how you will set down the load-- before you lift it.

- Stand close to the load with your feet spread apart (at about shoulder width), with one foot in front of the other for balance.

- Do not twist your body to get into position.

- Squat down and tuck in your chin, while keeping your back as straight as possible.

- Grasp the load firmly.

- Lift with your legs by slowly straightening them.

- Return your back to a vertical position.

- Turn only with your feet; do not twist your torso while you are lifting or carrying a load.

- Avoid, if possible, lifting a load from below your knee level or from above your shoulder level; both maneuvers, unless done carefully, create great stress on the disks in the lumbar region.

- Carry the load close to your body.

- Avoid, if possible, any lift where the loads' center of gravity is more than a few inchesout from your belly; the stress on the lumbar region multiplies quickly as the center of gravity moves out from the spine.

- The squat down, lift with the legs maneuver does not come naturally to most miners and it is more tiring than the traditional bent-backlifting technique. Yet, its one great virtue--protection of the lumbar spine--makes it a maneuver well worth the extra effort.

- Pace yourself. Take many small breaks between lifts if you are lifting a number of things.

- Don't overdo it--don't try to lift something too heavy for you. If you have to strain to carry the load, it's too heavy for you.

- Look around before you lift and look around as you carry. Make sure you can see where you are walking. Know where you are going to put down the load.

- Avoid walking on slippery and uneven surfaces while carrying something.

- Don't rely on a back belt to protect you. It hasn't been proven that back belts can protect you from back injury.

Reference Source 91,92

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