'On the Web' is an internet-based supplement that provides additional web content to supplement the material in Concepts of Fitness and Wellness. Browse through the whole document to explore web content related to this concept. If you know the specific 'On the Web' number or page number of the web icon in the text you can click on the direct link you are looking for below. Click here to access the other Online Learning Center resources available from the McGraw Hill Website (http://www.mhhe.com/corbin7e).

The material available here is for the exclusive use of students and instructors using the Concepts-based textbooks. All rights reserved (McGraw Hill Higher Education).

On the Web - Concept 11

Web11-01: Standing Posture and Back Care

Web11-02 - Seated Posture and Back Care

Web 11-03: Ergonomics

Web 11-04: Prevention of Back Problems in Worksites

Web 11-05: Microtrauma and Repetitive Motion Injuries

Web 11-06 - Lumbar Problems and Stages of Herniated Disks

Web11-07: Core Strength and Stabilization

Web11-08: Resistance Exercise for Back Health

Web11-09: Healthy Back Test

Web11-10: Supplemental Exercises for Back Health

Web11-11: Web Resources

Web 11-12: Supplemental Readings

Web11-01: Standing Posture and Back Care

The spine is not a stiff straight column but rather a series of three natural curves that form an S-shape. The natural curves allow your ears, shoulders, and hips to all fall into a straight line so that you can maintain proper alignment. As described in the text, strong, flexible muscles are needed to help maintain the natural curves. Poor posture can also lead to pain and serious injury in the back. You are most at risk for back pain if:

• your job requires frequent bending and lifting
• you must twist your body when lifting and carrying an object
• you must lift and carry in a hurry
• you are overweight
• you do not exercise regularly or do not engage in recreational activities
• you smoke

There are a number of web resources that can help make you more educated about back health.

• Medline Plus (http://medlineplus.gov/) is an educational division of the National Library of Medicine (a division of the National Institutes of Health). They provide valuable information on a variety of topics. Click here to see Medline Plus information on back pain.
• The National Institute of Neurologic Disorders and Stroke also provides a number of resources related to back pain and back care. Click on the Fact Sheet to learn more about your back.
• Many people consider chiropractic to address back pain but consumers should be cautious about pursuing this type of option as the scientific basis for this type of treatment is not well established. The technique emphasizes the use of "manipulations" and "adjustments" to treat the symptoms but these may not resolve the underlying problem. The National Center for Complementary and Alternative Medicine (www.nccam.nih.gov) has produced an informational web site to educate consumers about chiropractic. Individuals interested in this treatment should be sure to read this type of information.
• Read a summary on the principles of good body mechanics from SpineUniverse.com
• Read a summary on the role of posture from Spine Universe.com
• Read through a series of articles on back health from the Cleveland Clinic that are posted on the SpineUniverse.com webpage.

Web11-02 - Seated Posture and Back Care

Many back problems are caused by (or made worse by) poor sitting posture. The NIH Division of Occupational Safety has informational links on proper sitting posture.

Web 11-03: Ergonomics

Human factor engineers and specialists in the field of ergonomics work to develop equipment and devices to improve our efficiency and safety. A major consideration is to design equipment and to facilitate work patterns to reduce risks for chronic injuries or repetitive trauma injuries.

The Office of Research Services - Division of Safety is a branch of the National Institute of Health that provides specific information on ergonomics and potential applications for worksites. Visit the web page at http://www.nih.gov/od/ors/ds/ergonomics/index.html. A separate webpage on their site provides specific details on what to look for in an ergonomically designed office chair http://www.nih.gov/od/ors/ds/ergonomics/ergochair.html. Another web page provides a listing of office equipment suppliers that specialize in ergonomically designed equipment, chairs and desks. This page would be a useful starting point for looking for ergonomic equipment. http://www.nih.gov/od/ors/ds/ergonomics/officeequip.html

For additional information on human factors engineering or ergonomics visit the following websites:

• Human Factors Institute - http://hfes.org/
• Cornell University - Ergonomics Webpage - http://ergo.human.cornell.edu/
• International Ergonomic Association - http://www.iea.cc/

Web 11-04: Prevention of Back Problems in Worksites

The prevention of back problems is an important goal in many worksite health promotion programs. Back pain is one of the top reasons that employees seek medical care and it is also one of the primary causes of long term disability as well as absenteeism. Most employers today cover the majority of health care costs for their employees. Employers also lose productivity in their staff if employees are absent or on disability. By reducing medical claims/disability related to back problems and absenteeism related to back pain companies save money. Therefore, there are major economic incentives for companies to work to promote back health among employees.

The Guide to Clinical Preventive Services has conducted a comprehensive review regarding counseling and prevention strategies for back pain in worksites. The review provides an excellent summary of the latest research on back pain. The review states the following "Many back injuries are occupational in nature. Occupational back injury is clearly related to lifting and repeated activities. Persons in occupations that require repetitive lifting, such as nursing and heavy industry, are especially at risk. Based on national data, occupational groups with the highest estimated prevalence of low back pain (10.1-10.5%) include mechanics and repairers of vehicles, engines and heavy equipment; operators of extractive, mining, and material-moving equipment; and people in construction trades and other construction occupations." Click here to read the complete review.

Back care programs in worksites can include structured exercise programs, the use of ergonomic chairs and equipment as well as educational programs and awareness messages about proper lifting and carrying in the workplace. These back care programs are designed to help employees take better care of their back and thereby reduce the risk of back problems. Ultimately back care is a personal responsibility so a few strategies for reducing risks of back problems at work are provided below.

Back problems often occur when people use improper body mechanics during various physical tasks. Whether you are lifting and moving a person or a heavy object, the guidelines are the same:

• Plan ahead what you want to do and don't be in a hurry.
• Spread your feet shoulder-width apart to give yourself a solid base of support.
• Bend your knees.
• Tighten your stomach muscles.
• Position the person or object close to your body before lifting.
• Lift with your leg muscles. Never lift an object by keeping your legs stiff, while bending over it.

Avoid twisting your body; instead, point your toes in the direction you want to move and pivot in that direction. The Office of Research Services - Division of Safety provides specific information on how to maintain proper posture during various work related tasks. For additional information visit their website at http://www.nih.gov/od/ors/ds/ergonomics/wellbackhealth.html

Web 11-05: Microtrauma and Repetitive Motion Injuries

Many people are unaware of the many contraindicated exercises that are now considered "unsafe". While many people may perform these exercises on a regular basis with no apparent effects, the accumulated damage from these motions can compromise the functional integrity of the back, neck or other joints and lead to problems at a later time. Because it is often difficult to pinpoint the cause of back pain, many individuals ascribe many of these problems to "old age". By avoiding contra-indicated exercises, you can decrease your risk of having poor back health later in life. With respect to back health, most contraindicated movements involve hyperflexion or hyperextension movements. Hyperflexion causes the disk to bulge outward where it can impinge on the spinal cord. Hyperextension causes scraping and "wear and tear" on the facet joints that join each vertebral segment.

A number of contraindicated exercises are reviewed in the chapter. Many of these exercises and safer alternatives are also presented here to facilitate better awareness of these movements.

Technological developments in our society have engineered a lot of physical activity out of our normal day. Instead of active jobs that involve various physical tasks the majority of Americans spend their work day at a desk or computer workstation. Carpal tunnel syndrome is a debilitating overuse injury that is common among many office workers and computer users. Read the review of carpal tunnel syndrome by the National Institute of Neurological Disorders and Stroke. A fact sheet on carpal tunnel syndrome provided by the NINDS provides a number of additional links that can help users find reliable information on how to prevent and treat carpal tunnel syndrome.

Web 11-06 - Lumbar Problems and Stages of Herniated Disks

Many back pain problems occur in the lumbar region of the spine. This area of the spine is susceptible to injury because of the amount of weight that is supported in this region as well as thinner ligaments supporting this area. A general injury to this area of the spine is known as a herniated disc. The following table lists the more specific forms of injuries that can occur in this lumbar region of the spine.

Web11-07: Core Strength and Stabilization

The topic of "Core Strength" has received considerable publicity in recent years. The information is not really new but has instead been promoted or marketed in somewhat new ways. The marketing of the concept of "Core Strength" is readily apparent by the number of websites (.com) devoted to the topic and the number of classes that are available for building "core strength". The concept and basis for "Core Strength" is sound in that it implies a need to build strength and muscle endurance in many of the postural muscles that support the trunk. Improving the strength and endurance of these muscles (particularly the abdominals) may help to reduce back pain.

Some specific information on Core Strength and sample exercises are provided below from the "About.com" website (http://exercise.about.com/cs/abs/a/coreandposture.htm): Readers interested in additional information should consult a physical therapist or a licensed expert in strength and conditioning.

Core Muscles
The major muscles of your core include:

• Transverse Abdominis (TVA)-The deepest of the abdominal muscles, this lies under the obliques (muscles of your waist). It acts like a weight belt, wrapping around your spine for protection and stability. Target Exercise: Plank
• External Obliques-These muscles are on the side and front of the abdomen, around your waist. Target Exercise: Arm Sweep
• Internal Obliques-These muscles lie under the external obliques, running in the opposite direction. Target Exercise: Crossover Crunch
• Rectus Abdominis-The Rectus Abdominis is a long muscle that extends along the front of the abdomen. This is the 'six-pack' part of the abs that becomes visible with reduced body fat. Target Exercise: Crunch
• Erector Spinae -The erector spinae is actually a collection of three muscles along your neck to your lower back. Target Exercise: Back Extension

As highlighted in the Technology Update section of this concept, physical therapists have begun using biofeedback devices to assist with core stabilization. A new tool on the market is called The Stabilizer and it helps provide feedback to patients and therapists about postural changes during exercise. Information can be found at the Backtrainer.com.

Web11-08: Resistance Exercise for Back Health

Back health has become a major concern for consumers. Because of this there has been increased attention given to the development of back exercise machines for commercial fitness centers. There are now whole lines of machines that are designed to either rehabilitate or strengthen back musculature. One line of machines is manufactured by a company called MedX (www.MedXonline.com). One machine called the EXL specifically targets the lumbar muscles by restraining the pelvic muscles from assisting during the movement. This isolation helps to strengthen the lumber muscles and reduce risks of back problems. Click here to see a description of the EXL machine. One advantage of these machines over other back exercises is that they allow for "pelvic stabilization" so that the stimulus for the exercise is mainly on the lumbar musculature.

Swiss Ball exercises are also effective for improving core strength and back health. These large inflatable balls come in different sizes and can be used to help provide resistance for a wide variety of movements. A major advantages of the Swiss Ball for these types of exercises is that the amount of resistance can be easily controlled by the user. Examples of some commonly used exercises with the Swiss Ball are shown below. There are a number of suppliers of physioballs. Consumers are encouraged to shop around to learn more and to find ones that best fit their needs.

• Physioballs from the International Alliance of HealthCare Educators (IAHE) - http://www.iahe.com/controller/IaheProductList?category=Physioballs.
• Physioballs from The Gym Ball Store - http://gymball.com/products.html
• Physioballs from the Equipment Shop - http://www.equipmentshop.com/Product2.asp?CategoryID=1
• Physioballs from Wolverine Sports - http://www.wolverinesports.com/trainingballs.html

Web11-09: Healthy Back Test

A variety of back machines are also used in clinical settings to evaluate back health. These machines can measure strength at different joint positions and allow for more detailed assessments of back health. Irregularities in strength curves at specific ranges of motion can help clinicians determine potential causes of back pain. An imbalance between the abdominal muscles and the back muscles puts greater strain on the back and can contribute to back pain. See examples of normal and abnormal strength curves below (provided by the MedXonline website).

Because clinical testing may not be possible for all people and may be too late (ie after back pain already has occurred), the book provides a risk assessment tool called the Healthy Back Test. The Healthy Back Test provides a quick diagnostic screen to identify individuals that may be at risk of back problems. The tests are to be conducted as part of lab 13B. While the test cannot be used as a perfect diagnostic tool or to predict risk of back pain, it can indicate some degree of weakness or poor flexibility that may predispose you to risk. Complete each of the seven tests and then use the rating scale below to rate your back health.

Rating scale to evaluate back tests

Web11-10: Supplemental Exercises for Back Health

While the specific causes of back pain are typically not known, one of the most common problems is an adaptive shortening of the muscles and tissues of the low back. Because of this, Robin McKenzie (one of the leading pioneers for the treatment of low back pain), has long advocated various back extension exercises for his patients. While back hyperextension is often a contraindicated position, many individuals report a diminishing of back pain following these stretches. The back extension position picture below is one of the more common exercises advocated by Robin McKenzie for his patients with this set of symptoms (see picture below). Read a review of the McKenzie Method published by SpineUniverse.com. The Office of Research Services - Division of Safety within the National Institutes of Health has a series of exercises to reduce back pain and improve back health. Visit the website at: http://www.nih.gov/od/ors/ds/ergonomics/exercisems.html

The graphics in the book provide descriptions for additional exercises. Additional details and video clips are presented below for different types of exercises:

Upper Body Exercises	<a onClick="window.open('/olcweb/cgi/pluginpop.cgi?it=gif::::/sites/dl/free/0073523593/419771/11_6.gif','popWin', 'width=NaN,height=NaN,resizable,scrollbars');" href="#"><img valign="absmiddle" height="16" width="16" border="0" src="/olcweb/styles/shared/linkicons/image.gif"> (0.0K)</a>
Trunk Exercises	<a onClick="window.open('/olcweb/cgi/pluginpop.cgi?it=gif::::/sites/dl/free/0073523593/419771/11_6.gif','popWin', 'width=NaN,height=NaN,resizable,scrollbars');" href="#"><img valign="absmiddle" height="16" width="16" border="0" src="/olcweb/styles/shared/linkicons/image.gif"> (0.0K)</a>
Lower Body Exercises	<a onClick="window.open('/olcweb/cgi/pluginpop.cgi?it=gif::::/sites/dl/free/0073523593/419771/11_6.gif','popWin', 'width=NaN,height=NaN,resizable,scrollbars');" href="#"><img valign="absmiddle" height="16" width="16" border="0" src="/olcweb/styles/shared/linkicons/image.gif"> (0.0K)</a>

Web11-11: Web Resources

American Back Care Company - www.americanback.com
BackandBodyCare.com - www.backandbodycare.com
MedX Online - www.medxonline.com
National Osteoporosis Foundation - www.nof.org
National Safety Council: back care - www.nsc.org

Web 11-12: Supplemental Readings

• Agosti, R. Reduce Risk of Activity Induced Injury. ACSM's Health and Fitness. 2(2)(1998):28.
• Almeida, S. A. et al. Epidemiological patterns of musculoskeletal injuries and physical training. . Medicine and Science in Sports and Exercise. 31(8), 1176-1182, 1999.
• "Back Specialists Hit 'Inversion Fad.'" Medical World News 28(1983).
• Basmajian, J.V. Therapeutic Exercise. 5th ed. Baltimore: Williams & Wilkins, 1990.
• Corbin, C.B., & R. Lindsey. Fitness for Life. 4th ed. Glenview, IL: Scott, Foresman and Co., 1997.
• Guo, H.R., Tanaka, S., Halperin, W.E., Cameron, L.L. Back pain prevalence in U.S. industry and estimates of lost workdays. American Journal of Public Health, 89, 1029-1035, 1999.
• Kuritzky, L. & J. White. Low Back Pain. Physician and Sportsmedicine. 25(1)(1998):56.
• Kuritzky, L. & J. White. Extend Yourself for Back Relief. Physician and Sportsmedicine. 25(1)(1998):65.
• Liemohn, W.S., et al. "Unresolved Controversies in Back Management." Journal of Orthopaedic and Sports Physical Therapy 9(1988):239.
• Malmivaara, A., et al. "The Treatment of Acute Low Back Pain-Bed Rest, Exercise or Ordinary Activity." New England Journal of Medicine 332(1995):351.
• Nelson, B., et al. The clinical effects of intensive, specific exercise on chronic low-back pain: A controlled study of 895 consecutive patients with one year follow-up. Orthopedics. 18(1995):971.
• Plowman, S. A. Physical Fitness and Healthy Low Back Function. In Corbin, C. B. & Pangrazi, R. P. (ed.). Towards a Better Understanding of Physical Fitness and Activity. Scottsdale, AZ: Holcomb-Hathaway, 1999, Chapter 13.
• Pollock, M. L. & Vincent, K. R.Resistance Training for Health. In Corbin, C. B. & Pangrazi, R. P. (ed.). Towards a Better Understanding of Physical Fitness and Activity. Scottsdale, AZ: Holcomb-Hathaway, 1999, Chapter 14.
• Roach, K., et al. "The Use of Patient Symptoms to Screen for Serious Back Problems." Journal of Sports Physical Therapy 21(1995):1.
• Shipple, B. Relieving Low Back Pain With Exercise. Physician and Sports Medicine. 25(8)(1997):51.
• Shipple, B. Treating Low Back Pain : Exercise Knowns and Unknowns. Physician and Sports Medicine. 25(8)(1997):51.
• Wallman, H. Low Back Pain: Is It Really All Behind You? An Excellent 7-Step Abdominal Strengthening Program. ACSM's Health and Fitness Journal. 2(5)(1998):30.
• Walters, P.H. Back to the basics: Strengthening the neglected lower back. ACSM's Health and Fitness Journal. 4(4), 19-25, 2000.
• Williams, P.C. Low Back and Neck Pain: Causes and Conservative Treatment. Springfield, IL: Charles C. Thomas, 1974.
• U.S. Department of Health and Human Services. (1998). Healthy People 2010 Objectives: Draft for Comment. Washington, DC: U.S. Department of Health and Human Services, Objectives Chapter 16: Arthritis, Osteoporosis, and Chronic Back Conditions.
• Agosti, R. Reduce Risk of Activity Induced Injury. ACSM's Health and Fitness. 2(2)(1998):28.
• Almeida, S.A. et al., Epidemiological patterns of musculoskeletal injuries and physical training. Medicine and Science in Sports and Exercise, 31(8), 1182, 1999.
• "Back Specialists Hit 'Inversion Fad.'" Medical World News 28(1983).
• Basmajian, J.V. Therapeutic Exercise. 5th ed. Baltimore: Williams & Wilkins, 1990.
• Corbin, C.B., & R. Lindsey. Fitness for Life. 4th ed. Glenview, IL: Scott, Foresman and Co., 1997.
• Fredericson, M. Guillet, M., & Devenedictis, L. Innovative solutions to iliotibial band syndrome. Physician and Sportsmedicine. 28(2), 52-68, 2000.
• Knudson, D. Stretching: From Science to Practice. Journal of Physical Education Recreation and Dance. 69(3)(1998):38.
• Liemohn, W.S., et al. "Unresolved Controversies in Back Management." Journal of Orthopaedic and Sports Physical Therapy 9(1988):239.
• Liemohn, W. "Choosing the Safe Exercise." Certified News 2(1991):1.
• Liemohn, W., et al. "Criterion Related Validity of the Sit and Reach Test." Journal of Strength and Conditioning Research 8(1994):91.
• Liemohn, W., Haydu, T., & Phillips, D. Questionable Exercises. President's Council on Physical Fitness and Sports Research Digest. 3(8), 1-8, 1999.
• Lindsey, R., & C. Corbin. "Questionable Exercise-Some Alternatives." Journal of Physical Education, Recreation and Dance 60(1989):26.
• Lubell, A. "Potentially Dangerous Exercises: Are They Harmful to All?" Physician and Sportsmedicine 17(1989):187.
• Pope, R.P., R.D. Herbert, Kirwan, J.D. A randomized study of preexercise stretching for prevention of lower-limb injury. 31(2)(2000), 271-277.
• Reeves, R. K., E. R. Laskowski, & J. Smith. Weight Training Injuries: Part I. Physiciian and Sportsmedicine. 26(2)(1998): 54.
• Reeves, R. K., E. R. Laskowski, & J. Smith. Weight Training Injuries: Part II. Physiciian and Sportsmedicine. 26(3)(1998):
• Wallman, H. Low Back Pain: Is It Really All Behind You? An Excellent 7-Step Abdominal Strengthening Program. ACSM's Health and Fitness. 2(5)(1998):30.