Proper Lifting, Pushing,
To Prevent Strains, Sprains, and Lower Back Pain
William J. Becker
Florida Cooperative Extension Service/Institute of Food and Agricultural Sciences
University of Florida, Gainesville/John T. Woeste, Dean for Extension
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Proper Lifting, Pushing, and Pulling
To Prevent Strains, Sprains, and Lower Back Pain
William J. Becker*
Injuries resulting from overexertion while par-
ticipating in some activities, such as lifting, pushing,
and pulling, are among the more frequent types of
occupational injuries in the United States. They hap-
pen to both men and women, and to workers of all
ages. These kinds of injuries, along with accidental
slips, trips, and falls, can result in sprains, strains,
hernias, and lower back pain. Except for headaches,
these types of injuries are the most common medical
complaint in the country. Furthermore, they are sec-
ond only to colds as the greatest cause of lost work-
days in the general workforce.
Back injuries, alone, cost American industry $10-14
billion in workers' compensation costs and about 100
million lost workdays annually. Add the costs of her-
nias, sprains, and strains to other body parts, and it is
evident that these types of impairments are the major
accident cost in the workplace.
This problem is severe in Florida agriculture. There
are in excess of 3,000 serious injuries to agricultural
workers annually. Over 2,000 of these are the result of
improper lifting, pulling, and pushing, or from slips,
trips, and falls. Of these injuries, nearly 1,000 are
sprains and strains, and approximately 50 percent are
to the back. Most of the remaining sprains and strains
are to joints of the lower or upper extremities: the
knees, ankles, hips, wrist, elbow, or shoulder.
As shown in Table 1, the percentage of serious
injuries in agriculture, caused by lifting, pushing, and
pulling range from a low of 43.5 percent in livestock
production to a high of 65 percent in horticultural
production occupations. The vast majority of these
serious accidents results in sprains and strains.
Another important cause of sprains and strains is
slips, trips, and falls. These account for 12 percent in
horticultural service occupations and run the gamut to
32.1 percent in livestock production occupations.
Workers' compensation costs for these serious
accidents range from an average of $3,647 in live-
stock production occupations to $6,899 in horti-
cultural service occupations. Such accidents cost
Florida's agricultural industry over $10 million dollars
annually. Add to this the pain and suffering, and the
disruption to families and businesses, and it becomes
apparent that prevention of these problems needs to
In two occupational areas -- fruit/vegetable pro-
duction and general farm production -- sprains and
strains comprise nearly 50 percent of all serious acci-
dents, as shown in Table 2. This table also indicates
that in all the occupational areas, 45-55 percent of
serious sprains and strains are to the back. These
figures provide evidence that those conditions or act-
ivities which result in sprains and strains are a major
safety problem in Florida's agricultural occupations.
Table 1. Types of accidents in the various occupational areas, leading to serious sprains and strains, and costs.*
Percent of Accidents
Occupational Lifts, pulls, pushes Slips, trips, falls Average cost
area (overexertion) (all types) Other per accident
Livestock production 43.5 32.1 24.4 $3,647
Fruit, vegetable production 47.0 28.0 25.0 3,771
General farm production 51.9 30.4 17.7 5,373
Horticulture production 65.0 17.0 18.0 6,274
Agricultural services 51.0 23.0 26.0 5,340
Livestock services 60.0 26.0 14.0 6,034
Horticultural services 51.0 12.0 37.0 6,899
*Based on 1987 statistics provided by the Florida Division of Workers' Compensation.
William J. Becker is Associate Professor, Extension Safety Specialist, Agricultural Engineering Department,
IFAS-0361, University of Florida, Gainesville, 32611-0361.
e- 33 !nff1
The portions of the upper extremities most frequen-
tly experiencing a serious sprain or strain are the
shoulder and wrist. For the lower extremities, the
knee is most frequently impaired.
Some terms used throughout this publication are
defined as follows:
* Acute pain is usually a one-time condition that often
improves and disappears within a few days to a few
* Chronic pain is a persisting condition that reoccurs
from time to time.
* Lower back pain can be the result of damaged liga-
ments or muscles, but it can also be the result of
ruptured or slipped discs, arthritis, stress, or other
* Serious injury, as used in this publication, is one
which causes the employee to miss one week of
work or more.
* Sprain is defined as the stretching or tearing of liga-
ments from a sudden or violent twist of a joint.
* Strain is defined as the stretching or tearing of mus-
cles from a sudden or violent action.
Causes of Injuries
A joint in the human body -- be it a finger, wrist,
elbow, shoulder, hip, knee, ankle, or toe -- is a place
where two or more bones meet. The bones are held
in place by ligaments and muscles. Excessive stress
on the joint from lifting, movement, or other trauma
can cause excessive stretching or tearing of the mus-
cles (strain) or ligaments (sprain), resulting in acute
Looking at the human back (Figure 1), there is a
column of 33 vertebrae separated by small, round
discs filled with a thick fluid, all held together by liga-
Figure 1. Area of the back which is frequently
injured, resulting in lower back pain.
ments and muscles. If the ligaments and muscles are
weak, the vertebrae and discs can become misa-
ligned, usually in the lower back (at the belt line or
below). With excessive lifting, a sudden fall, or other
traumatic action, a disc can rupture or slip. Over
years of back abuse, or with aging, the discs may
simply "wear out" and the individual may live with
chronic pain for years.
Table 2. Body parts most frequently affected by sprains and strains
Percent of all Percent
Occupational which are sprains Upper Lower Other
area and strains Back extremities extremities locations
Livestock production 33.2 45.0 20.9 27.5 6.6
Fruit/ vegetable production 46.5 45.0 21.0 27.5 9.0
General farm production 46.8 46.0 22.6 21.3 10.0
Horticulture production 30.3 46.0 20.0 24.0 10.0
Agricultural services 40.0 48.0 17.0 22.0 13.0
Livestock services 39.0 50.0 10.0 22.0 8.0
Horticultural services 42.0 55.0 12.0 26.0 7.0
Back pain caused by a muscle strain or a ligament
sprain will normally heal within a short time and may
never cause further problems.
As early as the 1930s, researchers pointed out that
80-90 percent of all accidents result from the "unsafe
acts of persons" as opposed to "unsafe mechanical or
physical conditions." Human failure, they indicated, is
the primary cause of accidents. People must assume
the responsibility to prevent them.
Human failures are in three major areas:
Cognitive: thoughts, attitudes, and opinions.
Psychological: feelings and emotions.
Physiological: strength, reaction times, and health.
Combining these human failures compounds the
risk of injury. If we "think" (cognitive) that lifting a
bulky, 100-pound object is safe, if our "macho" ego
emotion (psychological) encourages us to prove it,
but our strength (physiological) fails, the result can be
a serious back injury, caused not by the heavy object,
but by human error. Our beliefs, our feelings, and our
own physical limitations get us in trouble.
Poor physical condition, poor posture, lack of ex-
ercise, and excessive body weight contribute to the
number and severity of sprains and strains. Degen-
eration of the spine, due to aging, is also a major
contributor to lower back pain, but it is frequently mis-
diagnosed as a sprain or strain. Only four percent of
all serious back injuries are true sprains, strains, or
fractures. Most are the results of degeneration of the
spine caused by aging and self-abuse. Most back
injuries, however, occur in people 24 to 40 years old.
There is little evidence that heavy vs. light work af-
fects back problems. Indeed, it appears that individ-
uals who regularly do heavy work have fewer back
problems. Dr. David Imrie, a noted back specialist, in
his book Goodbye Backache said, "If you go to un-
derdeveloped countries where people work much
harder physically than we do, you hardly hear of
backaches. You have to wonder if the problem is not
that people these days do too much, but too little."
Execution and body maintenance are more important
than how much the body lifts or moves. It seems that
back injuries, sprains, strains and degenerative pro-
blems are associated more with physical conditioning
and body mechanics. Back injuries can be minimized
by 1) better physical conditioning, resulting in strong-
er muscles to hold the spine in proper alignment and
2) less body weight for the back to support.
Another cause of strains and sprains is the practice
of lifting, pushing, or pulling when muscles are stiff or
at rest. Athletes never participate in rigorous activity
without first loosening up and stretching. They call it
"warming up." They are "waking up" their muscles and
increasing the blood flow to these muscles. Workers
should wake up their muscles before they begin work.
The design of work stations is another cause of
sprains, strains, and back pain. Workers should be a-
Pelvic tilt: Lie on your back with knees bent. Keeping your
back flat, firmly tighten your buttock muscles, hold for five
seconds, relax. Repeat this exercise five times.
Single leg raise: Lie on your back, knees bent. Slowly raise
your right leg while straightening it out, raise it as far as you
can. Hold for five seconds, then slowly return the leg to the
starting position. Repeat the exercise five times with each leg.
Knee-to-chest raise: Again lie on your back with the knees
bent. Raise your right knee to your chest, hold for five
seconds, return the leg to the starting position. Repeat the
exercise five times with each leg. Then repeat the exercise five
times raising both legs at the same time.
Half sit-up: Assume the same position: on your back, with
your knees bent. Slowly raise your head and neck till your
chin touches your chest. Continue raising, stretching your
hands to your knees. Hold for five seconds and then slowly
return to the starting position. Repeat the exercise five times.
____ ______ _1__1_1__ 1 1_1_1_1--- -- --------- -------_ - -------I_-____---- ------- ----------------_ 11 _--1--- 1-----__ 1 --------- _I--
ble to maintain proper posture while working. Pro-
longed sitting or standing, particularly in uncomforta-
ble positions, can cause muscle fatigue, which can
lead to leg and back problems. Work stations or prac-
tices which cause workers to stand, stoop, reach, or
twist improperly can also promote sprains and strains.
Attempting to lift or otherwise physically move one
heavy object, or repetitive moves of even light-weight
objects, are other causes of sprains and strains, as
are slips, trips, falls, and jumps.
Prevention of Injuries
Two methods of reducing sprains and strains are to
redesign the work area and to modify work practices.
Actually, it might be possible to eliminate the lifting,
pushing, and pulling entirely by available mechanical
means. For example, heavy items may be moved with
a forklift, conveyor, or hand truck.
Another design modification may involve changing
the size, shape, or weight of the container. This has
been done in many areas. For example, feed, seed,
and fertilizer bags in the 80- or 100-pound sizes are
no longer common. Nevertheless, many objects are
still difficult to handle. Easier, safer methods of mov-
ing or lifting materials should be sought constantly.
Work stations for workers who spend long hours
standing or seated must be designed to reduce stress
to the back and legs. A cushioned floor, a low foot-
rest that enables workers to raise and lower their legs,
and a work table of proper height are all important.
Seated workers should be at a height comfortable
for their work. The knees should be slightly higher
than the hips, and a footrest should be provided. The
seat should provide support for the lower back. Final-
ly, the work should be arranged to minimize stooping,
excessive reaching, and twisting at the waist.
Work Practice Modifications
Workers can modify their own work practices:
* Lift objects comfortably, not necessarily the quick-
est or easiest way.
* Lift, push, and pull with your legs, not your arms or
* When changing direction while moving an object,
turn with your feet, not by twisting at the waist.
* Avoid lifting above shoulder height. Use a step-
stool or ladder to move objects to these heights.
* When sitting, sit with your knees slightly higher
than your hips, with a firm backrest for your lower
back. Move, cross, and uncross your legs often.
* Sit in a vehicle as you sit in a chair, with your
knees slightly above your hips. Also, provide sup-
port for your lower back.
Straight back bend: Assume the standing position, feet no
more than six inches apart, arms to your side. Bend at the
hips and knees until thighs are parallel to the floor. Hold for
five seconds, raise to standing position. Repeat the exercise
Overall conditioning: If physical activity is not part of your
daily routine, regular aerobic exercise should be. Aerobic
exercise, such as jogging, walking, or swimming, will help
keep your body in condition.
Again, these types of activities should be done only with the approval of your physician.
ase Flexibility -----------.-----.... ..- .,
* If the job entails standing, stand straight. Avoid
bending at your waist. For prolonged standing, use
a low footstool for alternate resting of your legs and
for changing position. Wear comfortable, supportive
* When walking, maintain an erect posture and wear
slip-resistant, supportive shoes. Most slips, trips,
and falls can be prevented by wearing quality work-
shoes with slip-resistant heels and soles.
* When carrying heavy objects, carry them close to
the body and avoid carrying them in one hand.
* When heavy or bulky objects need to be moved,
obtain help or use a mechanical aid such as a dol-
ly, hand truck, or forklift.
* When stepping down from a height of more than
eight inches, step down backward, not forward.
Lifting Theories and Techniques
There are numerous lifting theories and techniques.
The most common and most frequently promoted is
the "straight-back, lift with your legs approach." But
after decades of promotion and training this approach
to lifting has not been widely accepted by workers,
and there is little or no evidence that it has reduced
the number or severity of injuries.
In more recent years, numerous other theories and
techniques have been promoted, criticized, and dis-
carded. There are hip-flexing, kinetic lifting, stooped
posture and pelvic-tilt techniques, among others, all
of which have both positive and negative considera-
tions. Presently, however, there is no one, best, lifting
method for all lifts.
Basically, there are seven rules for safe lifting which
have been developed over the years. Some of these
are similar to rules of the past; others are new and
different. They are presented below:
* Lift comfortably. Choose the position that feels
best, with or without a straight back.
* Avoid unnecessary bending. Do not place objects
on the floor if they must be picked up again later.
* Avoid unnecessary twisting. Turn your feet, not
your hips or shoulders. Leave enough room to shift
your feet to avoid twisting.
* Avoid reaching out. Handle heavy objects close to
the body. Avoid a long reach to pick up an object.
* Avoid excessive weights. If the load is too heavy,
get help or use a mechanical device, if possible.
Lift gradually. Lift slowly, smoothly,and without
Keep in good physical shape. Get proper exer-
cise and maintain a good diet.
Sprains, strains and lower back pain on the job can
be partially caused by practices at home. Some re-
Maintain a reasonable weight, eat nutritious meals
and exercise to maintain well-conditioned muscles.
Sleep on a firm mattress and avoid sleeping on
your stomach. When sleeping on your side or
back, bend your knees. Place a pillow under your
head, another between or beneath your knees.
When you awake, remember that your muscles are
still at rest. Gradually stretch your leg, arm, back,
and stomach muscles before getting up. Do some
more stretching exercises after you are out of bed.
Some exercises are provided in the following sec-
tion. Early morning is the recommended time for
these exercises, but any time of the day is better
than not at all. More important than the time of the
day is the development of a regular exercise pro-
gram. This is particularly important for individuals
who do limited physical work, but a regular exer-
cise program is also valuable for all individuals.
Think Before You Lift
There is one final important rule: Think before you
lift. It is better for workers to use their own common
sense than to teach them specific lifting, pushing,
pulling, walking, climbing, or jumping procedures.
This is not to imply that unsafe behaviors should not
be pointed out to others and corrected. For example,
"common sense" may tell certain people to jump
down from heights of several feet. Certainly, when
people exhibit this type of behavior, or when they
attempt to carry objects that are too heavy or too
bulky, the errors of their behavior should be brought
to their attention. Remember, you are the major cause
of your injuries.
Improving Your Physical Condition
There are some recommended exercises to streng-
then and increase the flexibility of important muscle
groups, particularly in the back, abdomen, and legs.
These exercises are not designed to increase
endurance, strengthen the heart or improve circula-
tion. To accomplish such goals, aerobic exercises are
required, such as fast-pace walking, jogging, dancing,
The exercises (pages 3-4) are designed to increase
flexibility, and strengthen and condition your muscles;
they need not be exhausting.
However, as with any exercise program, it is recom-
mended that they be conducted with the approval of
your physician. If any pain develops and persists,
medical attention should be sought immediately.
Treatment of Injuries
Muscle fatigue, cramps,and spasms are symptoms
that muscles have been overworked. This can lead to
the more serious problem of muscle strain or pull.
Rest, gentle massage,and the application of cold
packs for a short time can give relief.
If the problem is tension, minor stress,or pain in the
back, the back-stretching exercises shown may be
There are times to seek medical attention for sprain,
strains,and lower back pain. Some of these are:
* When your employer requests that you seek med-
* When the pain/problem does not show significant
improvement by the third day.
* When the problem reoccurs with more frequency or
* When the pain moves to other body locations.
* When a numbness or tingling sensation is felt.
* When respiratory, digestive,or urinary symptoms, or
a fever, accompany the pain or problem.
The first step in the treatment of more serious
sprains, strains, and back pain is a positive, get-well
attitude. Treatment should be under the direction of
competent medical professionals, and will usually
include ice therapy treatment, gentle massage,
stretching exercises, aspirin to relieve pain and re-
duce inflammation, and return to light-duty work as
soon as possible. Such treatment should result in the
vast majority of workers returning to full-duty employ-
ment in a minimum amount of time.
Bedrest or immobilization of sprained or strained
muscles or joints may relieve the pain, but often bed-
rest results in the weakening of the immobilized mus-
cles and a significantly increased recovery time.
Obviously, serious muscle, ligament,or back injuries
may require more extensive treatment, possibly in-
cluding surgery and long-term rehabilitation.
Lifting, pushing, and pulling activities cause serious
injuries in Florida agriculture. These injuries are nor-
mally sprains and strains to the joints of upper or
lower extremities or to the lower back. Degeneration
of discs and vertebrae cause much lower back pain.
Additional causes of sprains and strains are slips,
trips, and falls.
Redesign of the work station and work practices is
probably the most effective method of reducing these
types of injuries.
The physical condition of the worker, as a result of
proper nutrition, and posture, along with an exercise
* Back Extension: Stand in a comfortable position, then
place your hands in the lower back area (between your
waist and buttocks) and bend backward as far as you can,
comfortably. Hold this position for one minute. Relax and
repeat three or four times.
* Lower Back Flexion: Sit on a straight-back chair and lean
forward as far as you can, attempting to rest your chest on
your knees. Hold this position for three to five minutes.
* Back Rest: Lie flat on your back placing the lower half of
your legs (calves) on a chair, sofa or bed. Stay in this
position for fifteen minutes.
program to increase muscle strength, flexibility,and
condition, are probably more important than the lifting
Finally, comfortable lifting, pushing, and pulling
avoids unnecessary bending, twisting, and reaching,
and reduces sprains, strains, and back injuries. It is a
matter of "Think before you lift." Remember, your
actions cause injuries; your actions can prevent them.
Benson, J.B. "Control of Low Back Pain", Professional
Safety, Vol. 32, No. 9, September, 1987. pp 21-25.
Heinrich, H.W. Industrial Accident Prevention.
Imrie, D. Goodbye Backache, Arco Publishing, Inc.,
James, D. "A Multi-Disciplinary Approach for Reduc-
ing Back Injury Disability," Professional Safety, Vol.
30, No. 9, September, 1985. pp 17-23.
Jones, D.F. "Back Injury Prevention-Are Our Programs
Adequate", Professional Safety, Vol. 30, No. 2,
February, 1985. pp. 18-24.
Rowe, M.L. Backache at Work, Perinton Press, 1983.
Snook, H. "Aproaches to the Control of Back Pain in
Industry: Job Design, Job Placement and Educa-
tion/Training". Professional Safety, Vol. 33, No 8,
August, 1988. pp 23-31.
COOPERATIVE EXTENSION SERVICE, UNIVERSITY OF FLORIDA, INSTITUTE OF FOODAND AGRICULTURAL SCIENCES, John T. Woeste, Director,
in cooperation with the United States Department of Agriculture, publishes this information to further the purpose of the May 8 and June 30, 1914 Acts of
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to race, color, sex, age, handicap or national origin. Single copies of extension publications exudingg 4-H and youth publications) are available free to Florida
residents from county extension offices. Information on bulk rates or copies for out-of-state purchasers is available from C.M. Hinton, Publications Distribution
Center, IFAS Building 664, University of Florida, Gainesville, Florida32611. Before publicizing this publication, editors should contact this address to determine