Incident Prevention Magazine

“I don’t know what I did to cause this injury, Doc. I’ve had lower back pain on and off for the past five years, but it’s never been like this before. All I did was reach under the boom for a roll of cable on the truck when I felt something give in my back and then felt shooting pain down both legs. What the heck happened?”

This is not an unusual story. When I used to practice as a chiropractic orthopedist, I heard similar accounts on a daily basis. Lower back pain affects utility workers in epidemic proportions. In 2004, my company surveyed 224 employees of a public electric utility, and the results revealed that more than one of every five lineworkers reported living with moderate to severe lower back pain on a weekly or daily basis. There are valid reasons why most lineworkers believe that lower back pain is just a consequence of the work they do, but the good news is that it doesn’t have to be that way.

The Mechanics of Back Pain
Most lower back pain is mechanical in nature, meaning it does not come from cancers, other diseases or infections. But it doesn’t necessarily come from performing physical work either. All physical work causes some daily microscopic wear and tear of your body, and the more a job requires you to do physically, the more wear and tear will occur. Before you start looking for another job, however, remember that your body is fully capable of repairing the vast majority of the wear and tear that occurs from demanding physical work. The painful conditions that most lineworkers experience in their careers occur because the balance between the amount of damage done each day and the repair that occurs each day gets thrown out of whack. How you position and move your body as you perform work dramatically affects how much wear and tear you sustain each day. Habitually working with stressful techniques can cause more microscopic damage on a daily basis than your body is capable of repairing. If it is not repaired, this microscopic damage accumulates over time and eventually causes painful conditions. “Cumulative trauma” is the name given to this slow accumulation of microscopic damage. As cumulative trauma increases over the years, the end results commonly are painful conditions, serious injuries and degenerative arthritis.

It’s 3 a.m. Once again the dull ache stirs you from sleep. The first time was at midnight. Now the ache in your shoulder is telling you it’s time to roll onto your other side. Hopefully this will be the last time this happens tonight.

For far too many lineworkers, this has become a nightly ritual. In 2004, Business Health Resources conducted a symptom survey of 224 overhead electric employees who worked for one public utility, and it revealed that 56 percent of them experienced shoulder pain a couple times a week or more often. Many experienced shoulder pain on a daily basis. Because shoulder problems are so common, most lineworkers have come to believe they are just part of the job. Are they really, or can they be prevented?

Shoulder conditions can occur as a result of acute trauma injuries like falls or car accidents, or they can occur from cumulative trauma, which is the slow wear and tear that takes place over time, usually due to performing repetitive and physically demanding tasks using stressful working postures. The problem with cumulative trauma is that as the damage accumulates, you always feel pretty good – right up to the moment you are in pain. It’s a sneaky problem.

To understand what leads to cumulative trauma, we first need to cover some basic anatomy of the shoulder joint. It is a loose ball-and-socket joint, making it highly mobile so we can put our hands wherever they are needed. The price we pay for all of this mobility, however, is a loss of structural stability.

If you place your fingers on top of your shoulder, the bony little lump you feel is the acromioclavicular – or AC – joint, which is the joint between the collarbone and your shoulder blade. It is the only bone-to-bone connection between your arm and the rest of your body. The AC joint is about the size of the joint at the base of your thumb, and yet it has to safely transmit all of the stresses from your arms to the rest of your body. This design makes the shoulder far more susceptible to wear-and-tear injuries, especially when it is subjected to abnormal stresses, like those that come from performing line work using stressful techniques.