Low Back Pain Relief

Low Back Pain Relief

Back pain accounts for $50 to $100 billion spent per year in the U.S.A. alone, and it accounts for about one fourth of Workers' Compensation claims.

Low back pain is one of the most common reasons for medical visits. Two of every three people have suffered from low back pain at some time in their lives. Low back pain is one of the most commonly cited problems for lost work time in industry. Studies have shown that people in occupations that involve prolonged periods of sitting experience a high incidence of low back pain. Researchers have shown that sitting for one hour results in significant changes in the lumbar intervertebral discs.

Poor sitting posture is considered to be a major contributing factor in the development and perpetuation of back and neck pain. Epidemiologic studies have shown that individuals in occupations that involve prolonged periods of sitting experience a high incidence of low back pain.

Sitting for one hour results in significant changes in the mechanical properties of the lumbar intervertebral discs. Different sitting postures clearly resulted in changes in cervical spine position. Lumbar and pelvic position should be considered when control of cervical posture is desired.

The second theory regarding correct sitting position contends that maintenance of the lumbar lordosis, or a lordotic posture (inward curvature of the lumbar spine) is important. To this end, the use of a lumbar support during sitting is frequently advocated.

Ergonomics is the science of fitting jobs to people, including anatomy, physiology, and psychology. Ergonomic design is the application of this body of knowledge to the design of the workplace (i.e., work tasks, equipment, environment) for safe and efficient use by workers.

Ergonomic risk factors that can lead to musculoskeletal disorders and pain include: Repetition, force, awkward postures, static postures, contact stress, motion of body segments (shear), compression, and vibrations.

The Buttpillow™ Ergo relieves and prevents back pain while sitting by minimizing ergonomic risk factors such as awkward postures, static postures, contact stresses, and vibrations. It also elevates the peri-anal area with the patented cantilever support system for prevention or relief of hemorrhoidal or other pressure-related problems. The Buttpillow™ Ergo helps the sitter avoid awkward postures and static postures by allowing the user to sit in two doctor recommended task-appropriate positions. The Buttpillow™ products can be used to sit in four different positions. If used in task-appropriate postures, most of the ergonomic risk factors sitting workers experience are greatly-reduced.

The correct combination of backrest and seat angle places the spine of the sitter in a neutral position to relieve and prevent back pain.

To further reduce static postures, the Buttpillow™ cushions can also be used as lumbar supports or upper back supports. By changing position every two hours, you can greatly reduce the risk of back pain or other musculoskeletal pain caused by sedentary posture.

The Buttpillow™ Ergo reduces repetitive forward bending when used in the forward slant position during forward leaning tasks. Forward bending has been clearly recognized as a risk factor for low back pain. Altered movement patterns of the lumbar spine and hips during forward bending may help explain why forward bending is a risk factor for the development of low back pain.

Studies have shown that police officers and truck drivers both have a high incidence of back pain and other musculoskeletal disorders. In one study, police officers were shown to have twice the number of health disorders found in the general public over a 12 month period,. Driving involves static postures and another potentially damaging risk factor, vibrations.

Reports show those people with herniated intervertebral discs often have a history of an activity or occupation involving repetitive forward bending. Experiments done indicate that combined flexion and twisting or bending of the spine reduces tissue tolerance of the intervertebral discs, predisposing them to rupture.

With the increasing forward slant of the seat surface, the lumbar spine moves towards its natural curvature (lumbar lordosis). With decreased lordosis, caused by activities such as sitting on a flat surface (with a trunk-thigh angle less than 90 degrees), or slouching, pressure increases over the butt bones and tail bone with resultant pain.

The Buttpillow™ Ergo can minimize static (sedentary) postures by allowing the user to alternate between the backward and forward slant positions. The user should sit in the forward slant position when doing forward leaning tasks. When doing tasks that allow the user to lean back, the backward slant position is recommended. The Buttpillow™ Ergo can also be used as a lumbar support or an upper back support.

The surface of a desk or a keyboard should be about elbow height (10). The feet should always be firmly placed on the floor or on a footrest to avoid pressure on the backs of the thighs which could lead to varicose veins. Frequent, task-appropriate changes of posture, every two hours if possible, is the best way to avoid many ergonomic risk factors that lead to pain.External compression and contact stress cause reduced blood flow to the compressed areas. Reduced blood flow and increased pressure within the muscles appear to be important predisposing factors to bodily injury.

The Buttpillow™ Ergo aids in the reduction of contact stress and external compression by using foam with low levels of shear and compressive stresses. It is topped with a layer of super-soft foam that envelops the buttocks to provide a larger contact area with resulting lower surface pressure. Studies have shown that sitting in a forward slant position transmits about 1/4 of body weight to the floor through the legs, not the seat.

The Buttpillow™ products help reduce the dynamic factors (motion) associated with a moving seat surface. It does this by allowing the user to sit in both the forward slant and backward slant positions (to avoid awkward postures) without tilting the entire chair.

The act of tilting a chair results in shear force caused by the skin and soft tissues sliding over the butt bones. On a tilting chair, the sliding of the skin over the butt bones causes shear unless the user tilts the chair, locks the chair in place, stands up, and sits back down again, or leans forward momentarily after locking the chair in place.

The Buttpillow™ Ergo and the Buttpillow™ Ergo, Jr. both have an 8 degree forward slant. When a seat surface is slanted 8 degrees forward, the shear force becomes 18 times less than the shear force experienced on a flat seat surface. This is because of the rotation of the pelvis.

The Buttpillow™ products minimize vibrations in the area of the buttocks, as foam naturally muffles vibrations. There are an increasing number of researchers whose work implicates prolonged exposure to driving as a risk factor for hemorrhoids, low back pain, and other musculoskeletal disorders. Police officers and truck drivers are particularly at risk.

Driving as a task involves prolonged sitting, a fixed posture, and vibration, any of which could directly lead to musculoskeletal trouble. In a survey of 2,000 U.S. Police officers, the number of health disorders reported over a 6 month period were similar to those found in the general public over a 12 month period.

Posture Tips To Help Avoid Low Back Pain

Sitting:

   The trunk including the neck and shoulders should be in a natural, upright, but relaxed posture (neutral position). The spinal column should not be bent severely, and flattening of the lumbar spine should be avoided (as in slouching).

   The seated person must be able to choose and change his (or her) posture. No posture can be maintained indefinitely.
   The body weight should be transmitted to the seat surface mainly through the buttocks. Weight transfer through the thighs should be avoided.

   A backrest should be provided so that the sitting person can at least temporarily lean back. Unfortunately, many persons do not have the opportunity to lean against a backrest during work.

   The height of a seat should be adjusted so that both feet can be firmly placed on the floor (or on a footrest) while the thighs are horizontal. The angle between the thighs and the trunk should be greater than 90 degrees. This can be accomplished with a forward-slanted seat surface.

   Hard surfaces cause the weight of the trunk to be transmitted to the seat through small areas which cause high local pressure and results in diminished blood flow which can cause numbness and even pain.

   Caution must be used in using the terms 'good and bad posture.' Frequent change in position may be the most critical element, not the adoption of one static position which is 'good,' in optimal posture.

  Sit on a straight-backed, firm, supportive chair.

  Sit for only short periods. Studies show you should at least stand up or change posture every two hours to avoid the development of pressure-related problems.

  Sit in a task-appropriate posture, and use pressure reducing cushions.

  When changing from a standing to a sitting posture, there is a flattening of the normal curvature of the lumbar (low back) spine by 50 percent. This position places increased pressure on the spine. Sitting for one hour has been shown to result in significant changes within the lumbar intervertebral discs.

  The loss of lumbar lordosis (the natural curve of the spine of the lower back) can be caused by slouching, sitting on a flat seat surface, or sitting without a lumbar support.

In a study testing seating postures that included flat and forward slanted seats, it was found that with increasing forward inclination of the seat, the spine moves toward normal curvature (lordosis). This is believed to reduce the risk of low back pain.

Many researchers recommend that seat surfaces should be slanted backward. Others suggest that the seat should be almost horizontal. The majority of researchers focus on the advantages of a seat surface with a forward slant.

It has also been suggested that a chair which can slant forward and backward would be best because it allows the sitter to change positions for different tasks. The Buttpillow™ Ergo allows the user to change from the forward-slant to the backward-slant position depending on the task, without causing shear..

  All researchers claim frequent change of posture to be a benefit while sitting. We encourage you to change posture every two hours. This will greatly reduce the risk factors that lead to back pain as well as many other musculoskeletal disorders.

Changes in posture during one hour of sitting were measured by a statometric method on ten subjects. Four seats were used, one horizontal and three with forward inclinations respectively of 5 degrees, 10 degrees, and 15 degrees.With increasing forward inclination of the seat, the spine moved toward lumbar lordosis.

A supplementary sample showed that 1/3 of the body's adaptation to the seat inclination took place in the spine and 2/3 in the hip joints.A tendency to a more vertical position of the trunk as a whole was observed on the 5 degree chair, but the posture of the cervical (neck) spine was not influenced by the seat inclination. A comfort evaluation showed the 5 degree forward inclination and the horizontal seats to be preferred.

Standing:

  Maintain good abdominal tone. Keep your abdomen flat while standing.

  When prolonged standing is necessary, alternate placing one foot on a step or a footrest for a few minutes at a time.

  Wear cushion-soled shoes for prolonged standing.

  Bending, lifting and carrying:

  Bend at the knees, not at the waist.

  Lift with the thighs (keep heavy objects centered close to abdomen).

  When carrying heavy objects, turn with the feet, not by twisting the trunk.

  When changing from a standing to a sitting posture, there is a flattening of the normal curvature of the lumbar (low back) spine by 50 percent. This position places increased pressure on the spine. Sitting for one hour has been shown to result in significant changes within the lumbar intervertebral discs.

The loss of lumbar lordosis (the natural curve of the spine of the lower back) can be caused by slouching, sitting on a flat seat surface, or sitting without a lumbar support.

In a study testing seating postures that included flat and forward slanted seats, it was found that with increasing forward inclination of the seat, the spine moves toward normal curvature (lordosis). This is believed to reduce the risk of low back pain.

Many researchers recommend that seat surfaces should be slanted backward. Others suggest that the seat should be almost horizontal. The majority of researchers focus on the advantages of a seat surface with a forward slant.

It has also been suggested that a chair which can slant forward and backward would be best because it allows the sitter to change positions for different tasks. The Buttpillow™ Ergo allows the user to change from the forward-slant to the backward-slant position depending on the task, without causing shear.

All researchers claim frequent change of posture to be a benefit while sitting. We encourage you to change posture every two hours. This will greatly reduce the risk factors that lead to back pain as well as many other musculoskeletal disorders.

Types of Back Pain

Transient
Self-limited; duration is hours to days; comes to medical attention when episodic (when an episode of pain occurs).

Acute
Generally defined as pain which lasts from a few days to a few months. Back pain with or without leg radiation is common. Experience and some evidence says that the majority of these problems are self-limited and resolve spontaneously. Duration is days to weeks; often seen by physicians. Standard treatments have little influence upon the natural history." Evaluation and treatment required for severe symptoms.

Persistent
Most commonly it is assumed that pain which persists for six months progressively leads to the chronic state, defined by preoccupation with pain, depression, anxiety and disability."Does not relent with time; high correlation with spondylitic (degeneration of the spine) disease; surgical intervention occurs mostly in this group.

Chronic (pain syndrome)
Lasts more than 6 months; worsens with time; associated with major co-morbidities (other conditions that also cause the same problem).

"The most common inflammatory condition to be associated with chronic back pain is rheumatoid arthritis. Back pain is usually not an early characteristic of the disease, so the diagnosis is known when back pain occurs.

"The second (most) common problem (associated with chronic back pain) is ankylosing spondylitis (a genetic degenerative disorder of the spine). This is a disease of males predominantly. Symptoms usually begin with back pain early in life, and a progressive history of constant back pain is typical."

Osteoporosis

There is still an argument about whether osteoporosis alone can cause back pain. Many experts in spinal pain believe it can. However, the most common cause of intractable (without cure) pain with osteoporosis is compression fracture.

Those at risk include: Postmenopausal women, and anyone with other disorders of calcium and estrogen metabolism; heavy smokers; prolonged steroid users; and any patient with prolonged immuno-suppression.

Treatments For Osteoporosis

   Adequate analgesia: The role of long-acting narcotics is still controversial.
   Weight loss: Unproven but intuitively a good idea.
   Passive measures to correct specific areas of myofascial (muscle and connective tissue) tenderness and pain.

   Restore flexibility.
   Restore strength: Paraspinal (along the spine) and abdominal muscles first.
   Restore general conditioning.

   Teach posture and body mechanics.
   Teach how to do things without injury.
   Maximize function and return to activity.
   Educate to prevent recurrence.

Poor posture and, in particular, poor sitting posture, is considered to be a major contributing factor in the development and perpetuation of back and neck pain. The loss of lumbar lordosis and forward inclination of the head are generally considered to produce significant mechanical stress during sitting.

Different sitting postures clearly result in changes in cervical spine position. Lumbar and pelvic position should be considered when control of cervical posture is desired.

A Brief History of Low Back Pain

Thirty years ago, there was little information available about the epidemiology of low back pain and almost none regarding the cost of low back disorders. The data were limited to descriptive epidemiology of these conditions in the United Kingdom and Sweden.

No useful information has been collected in the United States other than the early occupational analyses of Rowe, (1969) at the Eastman Kodak Plant in Rochester, New York."

Today, major literature from virtually every developed country of theworld describes prevalence, incidence, risk factors, and natural history of low back pain and sciatica.

The basic premise is that low back disorders are extremely prevalent in all societies, and probably have not increased substantially over the past two decades. What has increased is the rate of disability, the reasons for which are uncertain. Not only has this phenomenon heightened the awareness of low back pain, but it has led to an explosion in costs.

Although a precise estimate is impossible, it is plausible that the direct medical and indirect costs of these conditions are in the range of more than $50 billion per annum, and could be as high as $100 billion at the extreme. Of these costs, 75 percent or more can be attributed to the 5 percent of people who become disabled temporarily or permanently from back pain - a phenomenon that seems more rooted in psycho-social rather than disease determinants.

The future challenge, if costs are to be controlled, appears to lie squarely with prevention and optimum management of disability, rather than perpetrating a myth that low back pain is a serious health disorder."

Ergonomics
The science of fitting jobs to people, including anatomy, physiology, and psychology. Ergonomic design is the application of this body of knowledge to the design of the workplace (i.e., work tasks, equipment, environment) for safe and efficient use by workers.
Up to 85 percent of the population will suffer from musculoskeletal pain.

Ergonomic risk factors that can lead to musculoskeletal disorders and pain include: Repetition, force, awkward postures, static postures, contact stress, motion of body segments (shear), compression, and vibrations.

The Buttpillow™ products can be used to sit in four different positions. If used in task-appropriate postures, most of the ergonomic risk factors sitting workers experience are greatly-reduced.

Ergonomics
by Darren Salinger, M.D., and Melanie Loomos, Inventor

The definition of ergonomics according to Taber's Medical Dictionary is: "The science concerned with fitting a job to a person's anatomical, physiological, and psychological characteristics in a way that enhances human efficiency and well-being." What Taber's does not say is that proper ergonomic positioning plays a key role in avoidance of musculoskeletal disorders.

Up to 85 percent of the population will suffer from musculoskeletal pain ...Musculoskeletal pain is a leading cause of health-care visits, particularly in primary care, sick absenteeism, and early pensions.Recent estimates show there are an average of 460,000 injuries annually which cost businesses $9.1 billion annually.

Medical treatment of ailments thought to be connected with the sitting posture, sick leave taken by employees, and reduced work output highlight some of the economic aspects. The body posture of sedentary workers, especially in offices and of school children has long been a concern of orthopedists and physiologists.

Preventing disability and high cost disability cases may result in large economic savings. High risk people should be targeted for prevention programs. Until prevention is granted more resources, programs need to be relatively cheap. This suggests incorporating prevention programs into existing practice routines.

On the first day of spring, March 20th, 2001, President Bush signed a bill repealing the Occupational Safety & Health Administration's (OSHA) new ergonomic program. President Bush issued the following statement: "Together, we will pursue a comprehensive approach to ergonomics that addresses the concerns surrounding the ergonomics rule repealed today.

"For further information, visit OSHA's web site at www.osha.gov. To order a copy of the 618-page program standard, the superintendent of documents at the Government Printing Office (202-512-1800) charges $9.00 a copy, and there is a 30 to 90 day wait-list; or fax your request to OSHA's publications department at (202) 693-2498, or call (202) 693-1888."

Ari Fleischer, White House spokesman, said President Bush "believes that we can protect the health and safety of workers without passing a regulation that is terribly burdensome to the economy and to the small businesses on which their growth depends.

OSHA expected a $27,700 savings in direct cost for each musculoskeletal disorder prevented. OSHA estimated the cost to an employer would be an average of $250 per work station per year or $4.5 billion per year. U.S. businesses estimated complying with the ergonomic standard would have cost U.S. businesses between $18 billion and $120 billion per year.

The risk factors targeted by OSHA for the prevention of musculoskeletal disorders are:
  Repetition - High repetition may exacerbate the basic risk factors of force and posture.
  Force - The effort required to carry out or prevent a movement. It does not necessarily imply motion.
  Awkward postures - Generally conceptualized as postures deviated from a neutral position.
  Static postures - Usually defined as requiring isometric muscle force - exertion without accompanying movement.
  Contact stress - Leads to compression. Compression of tissues can result from exposure that is external or internal to the body.Sharp edges, poorly designed seating, etc., concentrate forces on a small area of the anatomy, resulting in high, localized pressure. This pressure can compress nerves, vessels, and other soft tissues, resulting in tissue-specific damage.
  Internal compression - Nerves, vessels, and other soft tissues may be internally compressed under conditions of high force exertions, awkward postures, static postures, and/or high velocity or acceleration of movement.
  Dynamic factors (shear)- Motion of body segments. High shear levels have been found to decrease the force needed to stop blood flow to an area of the body by one half.
  Vibrations
  Segmental vibration has been implicated in carpal tunnel syndrome.
  Whole body vibration is implicated in low back disorders and a host of less well-understood problems, such as hemorrhoids.

The Buttpillow™ Ergo reduces repetitive forward bending when used in the forward slant position during forward leaning tasks. Forward bending has been clearly recognized as a risk factor for low back pain. Altered movement patterns of the lumbar spine and hips during forward bending may help explain why forward bending is a risk factor for the development of low back pain.

Ergonomics research has shown that people with herniated intervertebral discs often have a history of an activity or occupation involving repetitive forward bending. Experiments indicate that combined flexion and twisting or bending of the spine reduces tissue tolerance of the intervertebral discs, predisposing them to rupture.

With the increasing forward slant of the seat surface, the lumbar spine moves towards its natural curvature (lumbar lordosis). With decreased lordosis, caused by activities such as sitting on a flat surface (with a trunk-thigh angle less than 90 degrees), or slouching, pressure increases over the butt bones and tail bone with resultant pain.

Typist chairs appeared in the 1890's, 20 years after the introduction of the typewriter. The typist seat was capable of sloping forward. A forward slope was also common in sewing machine chairs of the time.

Forward-inclining seat surfaces were proposed again in 1956 by Schlegel to attain this natural curvature of the lumbar spine (10). Most researchers claim a forward-inclining seat surface is an advantage when sitting.

Other researchers recommend that the seat surface should be sloped backward; still others suggest that the seat should be almost horizontal (flat). One researcher, Kroemer, suggests an adjustable seat surface that can be changed from a forward slant position to a backward slant position to make it possible for people to change their position depending on the task at hand.No such thing as the healthful sitting posture exists; and, consequently, no chair good for all purposes will ever be designed.

The Buttpillow™ Ergo can minimize static (sedentary) postures by allowing the user to alternate between the backward and forward slant positions. The user should sit in the forward slant position when doing forward leaning tasks. When doing tasks that allow the user to lean back, the backward slant position is recommended. The Buttpillow™ Ergo can also be used as a lumbar support or an upper back support.

The surface of a desk or a keyboard should be about elbow height. The feet should always be firmly placed on the floor or on a footrest to avoid pressure on the backs of the thighs which could lead to varicose veins. Frequent, task-appropriate changes of posture, every two hours if possible, is the best way to avoid many ergonomic risk factors that lead to pain.

External compression and contact stress cause reduced blood flow to the compressed areas. Reduced blood flow and increased pressure within the muscles appear to be important predisposing factors to bodily injury.

The Buttpillow™ Ergo aids in the reduction of contact stress and external compression by using foam with low levels of shear and compressive stresses. It is topped with a layer of super-soft foam that envelops the buttocks to provide a larger contact area with resulting lower surface pressure. Studies have shown that sitting in a forward slant position transmits about 1/4 of body weight to the floor through the legs, not the seat.

The Buttpillow™ products help reduce the dynamic factors (motion) associated with a moving seat surface. It does this by allowing the user to sit in both the forward slant and backward slant positions (to avoid awkward postures) without tilting the entire chair.

The act of tilting a chair results in shear force caused by the skin and soft tissues sliding over the butt bones. On a tilting chair, the sliding of the skin over the butt bones causes shear unless the user tilts the chair, locks the chair in place, stands up, and sits back down again, or leans forward momentarily after locking the chair in place..

The Buttpillow™ Ergo and the Buttpillow™ Ergo, Jr. both have an 8 degree forward slant. When a seat surface is slanted 8 degrees forward, the shear force becomes 18 times less than the shear force experienced on a flat seat surface. This is because of the rotation of the pelvis.

The Buttpillow™ products minimize vibrations in the area of the buttocks, as foam naturally muffles vibrations. There are an increasing number of researchers whose work implicates prolonged exposure to driving as a risk factor for hemorrhoids, low back pain, and other musculoskeletal disorders. Police officers and truck drivers are particularly at risk.

Driving as a task involves prolonged sitting, a fixed posture, and vibration, any of which could directly lead to musculoskeletal trouble. In a survey of 2,000 U.S. Police officers, the number of health disorders reported over a 6 month period were similar to those found in the general public over a 12 month period.

A study published in 1969 entitled, "Ergonomics in the Design of Office Furniture," done at the Aerospace Medical Research Laboratory, Wright-Patterson Air Force Base gives the following pointers that still apply today:
  The trunk including the neck and shoulders should be in a natural, upright, but relaxed posture (neutral position). The spinal column should not be bent severely, and flattening of the lumbar spine should be avoided (as in slouching).
  The seated person must be able to choose and change his (or her) posture. No posture can be maintained indefinitely.
  The body weight should be transmitted to the seat surface mainly through the buttocks. Weight transfer through the thighs should be avoided.
  A backrest should be provided so that the sitting person can at least temporarily lean back. Unfortunately, many persons do not have the opportunity to lean against a backrest during work.
  The height of a seat should be adjusted so that both feet can be firmly placed on the floor (or on a footrest) while the thighs are horizontal. The angle between the thighs and the trunk should be greater than 90 degrees. This can be accomplished with a forward-slanted seat surface.
  Hard surfaces cause the weight of the trunk to be transmitted to the seat through small areas which cause high local pressure and results in diminished blood flow which can cause numbness and even pain."

All Buttpillows have additional features in patent-pending status, and were created by Ms. Melanie Loomos, inventor, and tested by Darren Salinger, M.D., OB/GYN after a comprehensive review of the medical literature and four years of research and development. (Patent Number 6,018,831)