Driver Lifestyles

A Driver's Worst Enemy: Back Injuries

In 1999 back muscle strains and spinal injuries cost American businesses $37 billion in medical bills, worker's compensation benefits and lost productivity.

Another $56 billion was lost to a variety of repetitive stress injuries. By law, injured workers do receive compensation, but, also by law, worker's compensation benefits are always less than the victim's regular earnings.

I know a truck driver--a Georgia native--who suffered two broken legs, a fractured arm, and a ruptured disc in a highway accident...he's attempting to feed five kids and a 70-year-old mother on monthly benefits of $544. The point I'm trying to make is that it's to everybody's advantage to prevent lost-time accidents.

My friend's accident wasn't his fault--his rig was struck head-on by a drunk driver. According to a spokesman for the National Council of Compensation Insurance, however, fully 68% of all workplace injuries are preventable.

Placing blame is easy; "fingerprinting" 14,000 pounds of freight after an 800-mile drive is difficult. And parking overnight on darkened inner city streets at 2:00 am in the morning is insane--but we do it, don't we - it comes with the job.

Besides, office workers haven't earned any bragging rights, either. Topping the U.S. Department of Health and Human Services list of preventable injuries is a condition called carpal tunnel syndrome. While everyone is susceptible, the majority of CTS victims are white-collar workers.

If you want to get a rise out of an insurance agent, ask him to discuss CTS--he won't confuse it with PMS, I promise you. CTS accounts for 48% of workplace injuries; its average cost per worker's compensation case is $29,000.

No one is indestructible-- Superman thought he was, and he died.

You, or the guy sitting beside you, may be a heartbeat away from a crippling industrial accident. Elbows, wrists, knees, shoulders, backs, fingers and toes, necks and ankles, every inch of every body is vulnerable.

Not even your skin is safe.

But we have to draw the line somewhere. I'm not going to discuss chemical burns or objects falling on your head, for instance. This article will be devoted to injuries that plague truck drivers. Though separated into sections, everything in this article applies to everything else.

Since it was mentioned last, let's begin with a discussion of carpal tunnel syndrome. Don't skip this section--as I'll explain in a minute, truckers are susceptible.

Ii's all in the wrists.

Repetitive stress injuries are caused by overuse. If you vegetate for eight hours each day while drumming your fingertips continuously on a desktop, you'll develop carpal tunnel syndrome. CTS results from pressure on a nerve which passes into the hand via a sheath under a ligament at the front of the wrist. It can be quite painful.

Although nine out of ten CTS sufferers are either secretaries or data processors, because it's caused by overuse, blue-collar workers are hardly immune. Brick masons, mig welders, jackhammer operators, you name it, if you breathe oxygen and work with your hands (who doesn't?), you're vulnerable to carpal tunnel syndrome.

Ten years ago CTS was a rarity. In the old days, typists were forced to hit the carriage return at the end of every line and stop periodically to insert fresh sheets of paper. Other "inconveniences," such as having to erase typing errors, provided built-in breaks. Nowadays, typists just sit and pound away, hour after hour.

No secretary would willingly trade a PC for a manual typewriter, but the computer age has certainly increased the stress her body must endure. Fifteen years ago, few trucks had power steering. Remember, guys? Back then, you had to manhandle a rig. We had no choice, we had to steer with our arms and shoulders. Today? Heck, a six-year-old could navigate my '94 Freightliner through a tight turn.

Riding down the road, I generally prop my forearm on the windowsill, wrap two fingers around the steering wheel, and guide with my wrist; I seldom switch hands. A mile of driving, even on an interstate, requires hundreds of minor course corrections. Therefore, as a result of my driving habits, I am susceptible to repetitive stress injuries. For similar reasons, so are you.

Treatment

Carpal tunnel syndrome begins as a tingling sensation in the fingers. The worst pain usually strikes at night, when the hands are completely relaxed, so the victim may not even associate the problem to his or her job. Within days, however, the tingling evolves into pain.

According to Betty Stephens, an owner/operator who has the condition, CTS pain usually isn't debilitating--it won't make you scream out in agony, but neither does it ever go away. "Most of the time CTS is like a toothache in your wrist," Betty says. "You know--a dull, annoying throb. But when it gets really bad, all you want to do is sit and cradle your hands in your lap." As with every other illness, the best cure for CTS is an ounce of prevention. Once the condition becomes chronic, it's hell to get rid of.

When you first experience that tingling sensation in your wrists and fingers, don't hesitate: visit your regular doctor or, if you can't get to him, an industrial health clinic. At this point CTS can be cured with anti-inflammatory drugs; wait a wee bit longer, you'll require a shot of steroids in the carpal tunnel.

Lou Purvis, MD, a specialist in sports medicine, warns: "Corticosteroid injections do reduce joint inflammation and pain, but steroid therapy should be used sparingly, if at all. Repeated injections - and treatment usually requires more than one - of steroids act destructively on muscle collagen and ligament tissue."

For obvious reasons, surgery should be the last resort. The human wrist is tightly packed; one slip of the surgeon's scalpel could cripple a hand for life, and even if the surgery goes without a hitch, it may not totally eradicate the pain. Betty Stephens's wrists have undergone two operations, and she still takes a mild sedative before she crawls into the bunk.

Prevention

There are two recognized means of preventing CTS. Working out in the gym three days a week won't cure the condition; building a marathoner's endurance in your forearms won't prevent it. But interspersing work periods with short breaks may. (Switch hands, driver!)

Studies conducted by the National Institute of Safety and Health concur. Research shows that computer operators who stop and rest every 50 minutes experience reduced symptoms. No, no one is suggesting a five-minute snooze every hour on the hour. To the contrary.

One cause of repetitive stress disorders is reduced circulation to the effected area. During the rest period, data operators and typists are encouraged to stretch and flex their wrists and fingers.... To stand up and move around, to get the blood flowing, to "rest" the body with exercise. Sounds contradictory, doesn't it?

Here's why it works: during the first few moments of any physical activity blood is drawn into the working muscles, where it remains until the muscle is permitted a micro-second of relaxation. Capillaries are downright microscopic, and thin-walled.

As they stretch to accomodate an ever-increasing volume of blood, they begin to exert pressure on nerve sheaths and muscle tendons, causing them to rub one another raw.

It may prove difficult to stand and drive simultaneously, but you can wiggle occasionally without causing an accident, can't you? Flex your muscles one by one, starting with the toes and moving up the body.

Flex and relax, flex and relax - constrict each muscle group several times. During a two-second pause between contractions, blood will flow freely. If it does nothing else, iso-tension, as the technique is called, will help you to stay alert. (Try it! It's a better stimulant than a box of No Doz!)

The second preventive measure is to sit comfortably. Knees and hips flexed at a restful 90 degrees, wrists supported in some manner. We truck drivers have a lot of experience with this one. We are, in fact, expert sitters.

Don't bother rigging a wrist sling, though. Wrist supports are counter-productive for truckers. We need to use our wrists less by using our chests, arms and shoulders more. And, for God's sake, don't do like I do, do like I say: switch hands occasionally! Okay, now let's move on up the arm.

The Elbow

Funny, isn't it, how we take particular bodyparts for granted until they begin to shout, "Look at me! Look at me!" The way our bodies communicate, of course, is with pain. Considering the abuse heaped on it, the elbow joint is practically mute. I

ncreasing either speed of movement or lengthening the lever by extending the arm increases the load supported by the shoulder, elbow and wrist by an astounding 450 percent. In other words, a 20-pound load held at arms' length subjects the shoulder to 90 pounds of stress. Striking the "funny bone" is never funny.

It can, in fact, hurt like the devil. Fortunately, though, impact injuries to the elbow are rare. Most elbow injuries are brought on by overuse. (Yep, that word again.) I over-stressed my right elbow while preparing to compete in the 1985 Masters Mr. America; the darn thing still bothers me.

Lots and lots of people - all kinds of people, not just bodybuilders - have chronically sore elbows. A trucker does this, or maybe that, and notices a dull ache in his elbow. He shrugs it off, climbs aboard, shifts into gear, and drives on to his next stop, where he again struggles to unlatch a stubborn fifth wheel.

Because he tries to "work through the pain," it gets stronger by the day. By the time he decides to seek medical help, he's got a problem, one that may plague him for years.

Prevention

Crossing the elbow joint are a multitude of tendons and ligaments. Like the knee, the elbow is well lubricated by synovial fluid, and miles of minuscule capillaries feed its ligaments. Let me explain: muscles are composed of ligaments, and all ligaments end in an inelastic, fibrous tendon, which is then attached to a bone.

Tendons are similar to cartilage in that both are poorly supplied with blood. So if you have chronically sore elbows, a tendon is probably the culprit. To prevent frictional fraying of the tendons that cross the elbow joint, the key word is warmth.

Don't try to lift a 500-hp Detroit diesel in a freezing rain. Come to think of it, don't try to lift a 500-hp engine in any weather. Know your limitations. Oh, and take frequent breaks.

Because your body's survival mechanisms shunt blood away from bodyparts that are exposed to cold, leaping out of your truck in December without a jacket is begging for an injury. Frigid temperatures may not bother you, but they sure as heck bother your knee, elbow, ankle and shoulder tendons and ligaments.

Treatment options

Rest is the most effective treatment for all injuries. Simply stated, if it hurts when you do something, stop doing it. Considering the elbow's role as the fulcrum of the arm, however, giving it a respite is no easy task!

I know how it is, believe me. When a thousand other truckers are waiting in line for your dock space and you've got another 600 boxes to unload, pausing to nurse an aching elbow is no option. But stop anyway. Tell the forklift operator you'll be back in a minute, go to your truck, cut a shirt into strips and tie one around your forearm, just below the offending joint.

Knee braces, forearm straps and wrist supports are worn by tennis players, All-Pro linebackers, golfers and other athletes with minor aches and pains, so why not you, huh?

The strap, usually nylon or some other soft, flexible material, acts as both a muscle support and a shock absorber. Straps and lifting belts don't cure anything, but then they aren't supposed to; their sole purpose is to prevent further injury while you do what you can't get out of doing.

When muscles are bruised or strained, they swell. The swelling is caused by blood leaking from burst capillaries into surrounding tissues. For some reason that doctors still don't fully understand, aspirin reduces swelling. Experiment.

Low dosages often work as well as large dosages, with less danger of irritating the stomach lining. Since the body quickly builds a tolerance to all medications, be prudent; the more you take today, the more you may need tomorrow. Use all over-the-counter medications sparingly.

The back

Backaches are commonplace in North America. My wife's back injury is severe; likewise, a ruptured disc has permanently disabled my best friend. Chances are, you know someone who has a serious back problem.

As I mentioned earlier, back injuries are all too prevalent. The spine is composed of 33 vertebrae. If these bones were welded together, we'd be stronger, certainly, but we wouldn't be able to bend and twist. God gave us flexibility at the expense of stability.

The muscles of the back are large and powerful, and they can be strengthened. But a spine is a spine is a spine. Though supported by hundreds of ligaments, the spinal column itself is weak.

When you lift a heavy object off the floor by rounding your spinal column, most of the stress falls on two vertebra (those above and below the "bend"). The result: a pinched disc and a howl of pain.

Back injuries may be far too common in America, but the vast majority are preventable! You have to take a commonsense approach. You can't get in a hurry while attempting to lift objects off the floor. I don't have the space to properly explain lifting technique. But we've all seen those safety posters; we know we're supposed to lift with our legs and arms, not with our spines. Do we listen? Heck, no!

But it's only a ten-pound box, and I'm a big, strong guy! What harm could it do? A powerlifter-friend, capable of 600-pound deadlifts, was laid up for two months last year because he rounded his spine while lifting a piddling fifty-pound dumbbell. So stop trying to impress one another with your manly (or womanly) strength. Lift it properly or leave it alone.

Treatment

Not so very long ago MDs and DCs (chiropractors) were passionate in their mutual dislike. Nowadays, they often share office staff. Perhaps the courts, the American people, and they themselves have finally realized that both occupations have a place in the scheme of things.

Since I'm not licensed to dispense medical advice, I hesitate to even tell you my preference. If you suspect you have incurred a spinal injury, visit the orthopedist or chiropractor of your choice, and be quick about it: all spinal cord injuries are serious. If you suspect that you've strained or "pulled" a muscle, however, take a few moments to read the sidebar titled RICE.

Scoliosis

When a truck driver takes an evening stroll, he watches other truck drivers negotiate tight corners. When Valdosta, Georgia chiropractor Ben Morris walks down the street, he looks at people's backs.

"It's horrifying," Morris says. "The number of adults with undiagnosed scoliosis is beyond imagination. Most of those poor people could have been helped if the condition had been diagnosed in time."

Scoliosis, an abnormal lateral curvature of the spine, begins early in life. As Dr. Morris pointed out, lots of folks function normally with a minor degree of curvature. But it's a progressive disorder; the curvature tends to worsen with age. Even minor curvature can result in chronic low back pain.

When allowed to progress without treatment, the curvature can become so severe that it impedes the functioning of internal organs. If diagnosed in childhood, scoliosis can easily be corrected using conventional chiropractic methods. Once the scoliotic reaches adulthood, though, the condition is essentially incurable. So do your kids a favor: have them checked for the early onset of scoliosis.

Back injuries cost American business $30 billion dollars last year.

In July the National Institute for Occupational Safety (NIOSH) issued a press release which stated there isn't a shred of evidence that wearing back support belts lessens the number of back injuries. NIOSH director Linda Rosenstock said, "Unfortunately, because workers think they're protected, they may attempt to lift even more when wearing a back support belt, subjecting themselves to even greater risk."

You may not have a choice. Belt manufacturers have done an excellent job of self-promotion. Several fleets now require their employees to wear a support belt while "on the clock." There's nothing wrong with that; most knowledgeable bodybuilders and powerlifters don a support belt before attempting to set a new personal record. The moment the barbell settles on the rack, however, the belt goes back in the gym bag.

Ms Rosenstock fears that lifting belts may cause workers to become overconfident, and they may. But the greatest danger posed by all types of muscle supports is that they work too well. Look what happens to leg or arm muscles while they are encased in a cast: they atrophy...they shrivel up and die.

If the wearing of a back support belt has been incorporated into your job description, then by all means wear the darn thing. But wear it loosely until the extra support is needed.

For Muscle, Tendon Strain...RICE It!

RICE is an acronym for Rest, Ice, Compression and Elevation, the proper procedure for treating what are commonly called "muscle pulls."

Rest: When it hurts to move your shoulder, you probably won't go outside and toss a football around. But you may "test" the arm occasionally. Don't. Pain is a signal that something is wrong: pay attention.

The body heals itself...if you don't interfere too much with the process.

The remainder of the RICE first-aid plan is designed to restrain the swelling (edema) that accompanies tendon strains and ligament tears.

Ice: Applying ice to the injury site slows circulation into the injured area, which prevents blood from pooling in the surrounding tissues. Wrap the ice in a thin towel to protect the skin from freezer burn, and leave it on no longer than 15-20 minutes at a time. Begin using ice packs immediately after the injury is incurred and repeat the treatments periodically for 24-48 hours.

Compression: Binding the injury tightly (but not so tightly all circulation is cut off) is another way to control edema.

Elevation: Elevating an injured limb accelerates the flow of blood and waste products away from the injury.

Once the swelling subsides, the healing process can begin. Apply a heating pad or hot water bottle to the injury site, again for short periods only, continued intermittently for a day or two. When moving the muscle through a normal range of movement causes you absolutely no pain, the muscle is almost healed.

Notice I said almost. Complete recovery may take weeks, so don't go trying to lift a mountain just yet.

The importance of nutrition in the treatment of injuries can't be overemphasized. Carpal tunnel syndrome, for example, may be linked to a deficiency of vitamin B6. Texas physician John Ellis reports that, "Symptoms of carpal tunnel syndrome disappear when vitamin B6 is taken 200mg daily for three months." He claims a cure rate of 90 percent.

Calcium gluconate, magnesium, vitamins C, E, and the entire B complex aid in the prevention and cure of bone, muscle and tendon injuries.

Exercise is equally important. You know what they say: A sound mind in a strong body. A few years ago about 90% of all loads had to be "fingerprinted," going and coming. Now, I'm certainly not advocating a regression to those horrible days.

I agree with you that truck drivers should drive and lumpers should lump. (I don't mind work; I can watch someone else hump freight all day with no ill effects.) But you gotta admit the average trucker was in far better shape twenty years ago.

We need to get off our duffs and do more. We especially need to exercise our midsections. Weak abdominal muscles lead inevitably to injured backs.

I just thought of a perfect way to end this article.

Remember the old show Hill Street Blues "watch commander" who admonished his crew to "Be careful out there"?

Please, please, be cautious in everything you do. You have to be safety conscious. Or you'll eventually pay a steep price.