Over 20 million Americans suffer from back pain caused by the derangement of an intervertebral disk. After the common cold, back pain is the second most common cause that Americans call in sick, costing businesses as much as $100 billion every year. With the goal of preventing this all-too-common ailment, NewYork-Presbyterian Hospital's Spine Center offers tips on avoiding back injury.

"The back is a complex structure with many delicate parts. But with some common sense—including proper lifting, good posture and exercise—it's possible to avoid common back pain," says Dr. Paul C. McCormick, director of the Spine Center at NewYork-Presbyterian Hospital/Columbia University Medical Center and professor of neurosurgery at Columbia University College of Physicians and Surgeons.

Lifting

· Make sure the object is properly balanced and packed correctly so the weight won't shift when lifted.
· Before you lift, test the weight of every object by pushing it—a small size doesn't mean a light weight. And get help, if you need it.
· Take your time lifting. Rushing will strain your muscles.
· Bend at the hips and knees, not the lower back. Maintain proper posture with back straight and head up. Use your legs to lift.
· Never twist. Keep the shoulders in line with the hips and face the object. Pivot at the hips, not the back.
· Get a good grip by using handles or gripped gloves. And avoid slippery or uneven surfaces.
· Keep the weight close to your body.
· Look before you lift to make sure you know where you're going to place the object.

In the Office

· In good sitting alignment, the feet are supported, the hips should be level with or slightly above the knees, the spine is vertical or slightly reclined, and a small arch in the lower back is maintained.
· If sitting at a computer, the shoulders are relaxed down away from the ears; the elbows are by the side, bent to about 90 degrees; the wrists are neutral (not bent up, down or away from each other), and the head is facing front without protruding forward.

Exercising, Stretching and Good Posture

· Regular cardiovascular exercise will make injury less likely.
· Do stretching and strengthening exercises to increase back and abdomen flexibility.
· Maintain good body weight and don't smoke.
· Maintain good posture, even while sitting. Don't slouch or hold your head too far forward. Hold in your belly to keep it from putting excess force on the spine.
· Sleep on a mattress that is firm, not sagging, but not too hard. Do not sleep on your stomach.

The vast majority of patients with lower-back pain improve by avoiding pain-provoking activities. Back pain is nearly always caused by strain or sprain of muscles, ligaments or soft tissue. Patients are not encouraged to stay in their bed for longer than 48 hours—lack of activity can delay recovery.

Indications that a serious injury has occurred include abnormal bowel or bladder function, bilateral sciatica (pain down both legs), weight loss, history of cancer, fever, IV drug use, steroid use, an older patient, fever and severe pain. In these cases, patients are referred for a diagnostic workup that may include X-ray, MRI and CT scan. 

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