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Treating Truck Driver Patients
By Chris Sorrells
Truck drivers are consistently near the top of the Occupational Health and Safety Administration’s list of professionals who take the most time away from work due to injury. An informal ACA survey backed this up by finding heavy-truck and tractor-trailer drivers to be the worst “back-breaking” professions. At first glance, the prolonged sitting in one position could easily create this problem. However, this is just one contributing factor.
Each driving job is unique, so consider which tasks each patient must perform. The actions of a garbage or delivery truck driver vary greatly from the actions of someone performing long-haul transport. A driver who leans out of a street-cleaning truck window will present with dysfunction different from that of someone sitting in a cement mixer all day. A detailed history is crucial to uncovering these hidden dangers.
A delivery driver who enters and exits the truck frequently may need to be taught to pivot in the seat before getting out to minimize twist in the spine. A good step mechanism can also help to reduce strain from repeatedly climbing into the truck. A street cleaner or forklift operator who always twists to one direction will need to be taught about muscle imbalances and stretches to counteract these forces. Consider where the controls are, and how their position affects the driver’s reach.
Discuss the Effects of Prolonged Sitting
Prolonged driving encourages slouching down into a rounded, C-shaped posture. This rolls the pelvis, creating strain in ligaments and increasing the pressure in the intervertebral discs. As the back rounds, the head comes forward, requiring the neck muscles to take over holding the head up. This static muscle contraction creates fatigue and strain, while limiting blood flow and nutrition.
A poorly positioned seat can create pressure areas and compromise leg circulation. Recently, truck seat manufacturers have realized the importance of ergonomics, developing many new options, including seats with extended lengths or widths, movable armrests and adjustable lumbar support. Often, however, drivers are unaware of how to properly position themselves and their seat. By taking five minutes to explain the basics of posture, sitting and the impact on the spine, you can empower them to take an active role in their recovery and increase compliance.
Encourage drivers to change the seat position slightly every hour to vary the stresses on their body. Be sure they understand where the ideal position is so they are not straying too far from it. Teach them to give their body a rest by leaving the truck and standing up or moving to a different position to complete paperwork.
Vibration, Temperature and Illumination
Another cause of back pain is vibration. Whole-body vibration exacerbates the risk of injury, as it increases contraction of the back musculature. Uneven pavement and bumps in the road worsen the vibration of the truck on the road, eliciting sudden contractions. Adding a gel cushion to the seat can help dampen vibration. In addition, remind drivers to lighten their grip on the steering wheel.
Climate-controlled cabs are comfortable, though drivers should be made aware of the impact of rapidly changing the temperature environment. Keeping a vest or jacket accessible, and using it consistently, can reduce muscle contraction in the back and neck caused by cold. Clenching the steering wheel for long sessions and then going into the cold to perform maintenance or secure the load compounds risks for carpal tunnel syndrome. In addition to frequently shaking out or changing hand position while driving, the use of gloves while working in cold weather should be recommended. Cold temperatures also increase the force people use to perform tasks, risking overexertion of muscle groups. Steering wheel covers can protect hands from prolonged periods of holding a cold wheel.
Poor illumination in the cab can lead to eyestrain and headaches. Advise drivers to adjust instrumentation lighting levels and add more lighting as necessary.
Reduce Other Risks
Switching from prolonged sitting to handling cargo, lifting and fitting hoses, or securing their load carry substantial risks. Instruct the drivers in proper lifting techniques and body mechanics. Teach drivers to give their body at least two minutes’ rest and perform some simple stretching before attempting these tasks after driving.
Life on the road also makes it easy to take on poor lifestyle habits. Irregular sleep schedules, poor access to proper nutrition, dehydration and lack of exercise are common in this line of work. Keep in mind the drivers’ unique circumstances and design exercise programs they can do in their cab or sleeping compartment. Pushing down into the seat to perform a chair push-up is a good example that unloads the spine while engaging arm and scapular muscles. Exercise when not on the road is also important to optimizing health.
Each one of us relies on truck drivers to deliver our clinic supplies, mail and food, and to maintain the roads we drive on. It is time for us to consider what we can do to help them.
ACA News Extra...
Adjusting the Seat
• Knees should not be higher than the hips.
• The front of the seat should not touch the back of the knee. Contact here will cause you to slide forward into a rounded posture.
• You should be able to depress the pedals all the way without twisting the back or moving away from the seat.
• If possible, adjust the lumbar section to provide gentle support.
• Slightly recline the back so the angle between the back and legs is approximately 110 degrees.
• Position the steering wheel to keep elbows as close to sides as possible, minimizing reach.
• Be sure instrumentation is easy to see.
• Adjust mirrors so you can see all mirrors without slouching or twisting. Use the mirrors as a cue to sit up when you slouch, instead of readjusting them.