Avoiding Drivers Back Pain

To anyone involved in the bus and coach industry it will probably come as no surprise that driving is has been identified by the Health and Safety Executive as one of the occupations most likely to lead to no-injurious back problems. Indeed it has been found that drivers who cover over 25,000 miles a year average 22 days off with sickness compared with just over 3 days for low mileage drivers. The underlying cause may not be the actual number miles driven or even the vibration the long distance driver is exposed to. Indeed train drivers, who are exposed to less vibration than road vehicle drivers, are twice as likely to report low back pain. The main causal factor appears to be long duration sitting, for which our bodies were not designed. It has been found that people whose occupations involve sitting for long durations can suffer almost as much lower back pain as people whose job involves frequent lifting.

Why does sitting lead to back pain?

The pain seems to originate from ruptures to the discs separating the bones of the back. These ruptures can be quite small so they do not impinge on any nerve roots and so do not directly cause the pain but can lead to mis-alignment of the articulating joints, which can lead to pain. This may also lead to additional pain due to muscle spasm as a result of the original pain. Long term sitting has two effects that can result in these small disc ruptures. Firstly, because the discs do not have a blood supply they are dependent on movements of the spine to squeeze nutrients in and out. These movements may not occur when sitting for long periods so the discs may become deprived on nutrients. Secondly, the bones of the spine are held in position by ligaments connected between each bone. These are flexible but very strong fibres that stretch a small amount under tension. When relaxed, however, they do not recover their original length for several hours. Driving with a slumped posture will place the ligaments at the rear of the spine in tension so that, after a few hours, the joints of the back are unstable, leaving the discs vulnerable to rupture if the back is twisted, for example when getting out of the vehicle, or if loads are lifted.

Reducing the risks of back pain

This explanation of the causes leads to two primary preventative measures: to reduce the duration of sitting and to ensure a good driving posture that avoids slumping in the seat.

Reduce the duration of sitting

The service bus driver may have opportunities to get out of the driving seat and take mini exercise breaks during a shift and ideally should be encouraged to do so at every opportunity where the bus will be stationary for a few minutes. The driver should be encouraged to leave the vehicle and walk around.

Dean Southall Consultancy

dean.southall@btconnect.com

0115 937 6868

Regular exercise breaks at appropriate intervals are not be feasible for the long distance coach driver, but some of the same benefit could be obtained by slight changes in driving position while maintaining the essential elements of a good driving posture. Slight adjustments to the seat base and back can achieve this but it is important that these can be made safely while driving, which is probably only feasible with electrically operated seats. The long distance coach driver needs take special care when twisting the back and or lifting after a long period of driving, for example when unloading passenger luggage for the under-floor compartments However, the opportunity for rest breaks or postural adjustments does not override the need for a good driving posture in the first place.

Maintaining good posture

The optimum posture is one in which the shape of the drivers back when standing is maintained when sitting, particularly the inward lumbar curve in the lower back. Most seats currently installed in buses and coaches are of a high ergonomics standard and will provide good driver support and posture. Two aspects that can sometimes be less than ideal are the lack of lumbar adjustment and a seat base that is too long for drivers with short legs. The latter forcing the driver to sit slightly forward in the seat and lose the support of the lower seat back. Proper adjustment of the seat is key to maintaining good posture and the aim is to ensure that the lower back stays in contact with the seat back while driving. If the driver slides forward in the seat the pelvis will rotate slightly and the lumbar lordosis (inward curve at the base of the back) will be reduced. This places greater strain on the supporting ligaments so that they will stretch and offer less support to the bones of the back as described above. Drivers should be instructed in the procedure for adjusting the seat: adjust the fore-aft position of the seat so that the clutch pedal (or accelerator in automatic vehicles) can be fully depressed without the lower back moving forward in the seat, adjust the seat base height so that there is enough clearance between the front of the seat cushion and the underside of the thigh just behind the knee to slide the fingers with ease, with the back in full contact with the seat back check that there is enough clearance to easily slide the fingers between the front edge of the seat base cushion and the calves (drivers with very short legs may need to use a auxiliary back cushion to achieve this), check that the seat base slopes downward slightly at the rear to help prevent the driver from sliding forward in the seat, (this is especially important in seat where the base angle is adjustable), next the seat back angle should be adjusted, dean.southall@btconnect.com 0115 937 6868

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the backrest should be adjusted so that it provides support as high up the drivers back as possible while turning the steering wheel, i.e. that the driver does not have to lean forward, (typically the backrest will be at about 20o), the backrest should have a slight backward lean, so that the angle between the back and the thighs is more than 90o, but not so much that it results in the driver sliding forward in the seat, backrest adjustment should be made in conjunction with steering wheel adjustment for those vehicles equipped with this facility. Finally, check that other equipment used while driving does not affect the driving posture. Check that mirrors are adjusted so that they do not require more than a simple head movement. Re-adjust the seat slightly if necessary to avoid twisting the reach the gear selector or park brake.

The role of the bus or coach operator

Given the scale of the problems associated with professional driving it is in the interests of all operators to develop a strategy to avoid back pain. This will require a number of ongoing actions that should include: ensuring seats are ergonomically optimised (size and shape of the base and back cushions and the range of adjustment provided), ensuring equipment (e.g. ticket machines) and tasks (e.g. handling luggage) are designed to minimise lower back twisting and loading, reviewing maintenance procedures to confirm the drivers seat is regularly inspected and maintained (checking seat cushions are not damaged or crushed, seat mountings are secure, adjuster mechanisms are clean and undamaged so they are easy to operate throughout their full range), instructing drivers on driving posture and seat adjustment, implementing a structured risk assessment for back problems which would initially include an assessment of current seats and a driver discomfort survey.

These points are of course only a starting point and further information will be needed to both develop the overall strategy and to identify the details actions. Some sources for more information are provided below.

Sources of further information

Backcare. The Charity for Healthier Backs. 16 Elmtree Road, Teddington, Middlesex, TW11 8ST.Phone: (44) 20 8977 5474 Fax: (44) 20 8943 5318.Registered as National Back Pain Association, Charity No.256751. Website: www.backcare.org.uk
Chartered Society of Physiotherapy 14 Bedford Row, London, WC1R 4ED

Chartered Society of Physiotherapy.14 Bedford Row, London, WC1R 4ED.Tel: 020 7306 6666. Fax: 020 7306 6611. Website: www.csp.org.uk

Dean Southall Consultancy

dean.southall@btconnect.com

0115 937 6868

Health and Safety Executive. Tel: 0845 345 0055. Website: www.hse.gov.uk/msd/backpain Peacock B and Karwowski W. (Eds). Automotive Ergonomics. Taylor and Francis, London. 1993. ISBN 0 7484 0005 2. Croner Publisher. This article first appeared in Bus and Coach Briefing

Dean Southall Consultancy

dean.southall@btconnect.com

0115 937 6868