Dynamic Chiropractic
June 14, 1999, Volume 17, Issue 13
Upper Extremity Injuries in the Trucking Industry

Everyone knows that long haul truck drivers suffer from low back pain. I was surprised to discover during my nearly four years as a truck stop chiropractor that many truck drivers also suffer from injuries to the upper extremities. These upper extremity injuries seemed so prevalent that I became curious about them. Just how many truck drivers suffer from those upper extremities and why? To answer these questions for myself, I conducted a records-based study. I'm writing this article to present my findings to other interested chiropractors.

There are approximately eight million commercially licensed drivers in the United States. Of this number, approximately 2.5 million are long haul truck drivers. The long haul truck drivers are usually the ones that find their way to my office, and so they are the group I considered for my study. It's logical to assume that this group of drivers will have a higher degree of work related injuries than short haul drivers, due to their long hours in the truck and less than ideal living circumstances. The trucking lifestyle does not allow for easy access to chiropractors and other health care providers. Consequently, many injured drivers never obtain the treatment they need.

Two hundred patient files were chosen at random. All of these patients were long haul truck drivers. Of the 200 drivers studied, 111 (55%) presented with upper extremity complaints. Of the 111 injured drivers, 93 were male and 18 female. The study included 160 males and 40 females, allowing us to calculate that 45% of the female drivers and 58% of the male drivers presented with upper extremity injuries. This data clearly shows that the lower back is not the only region of the truck driver's body prone to injury.

The 111 upper extremity complaints can be broken down to single and multiple areas of complaint. Forty-nine of the 111 patients had multiple areas of complaint, with a high prevalence of scapula and shoulder pain, arm and hand tingling. I find this statistic alarming.

The likely causes of these extremely prevalent injuries include: pulling the fifth wheel pin; lowering and raising heavy truck hoods; slipping while exiting the truck; sleeping on one's side in a bouncing vehicle; lowering the landing gear; unloading trucks; driving with one elbow supported on the window frame; and habitually resting the hand on a constantly vibrating gearshift lever.

Some explanation is needed. The fifth wheel pin is a heavy metal pin that fastens the truck tractor to the trailer. To disengage the tractor from the trailer, the driver must lean underneath the trailer on top of the wheels and pull up and outward on the pin. This pin can be extremely difficult to remove, and the position required to do so is one of mechanical disadvantage. Anterior/inferior subluxations of the humeral head and supraspinatus rotator cuff damage are common injuries correlated with this behavior. Lateral epicondylitis and medial epicondylitis are also common resulting injuries.

The engine hood of an 18-wheel truck is both high off the ground and heavy. The average truck hood weighs approximately 300 pounds. To raise the hood, the driver stands on the front bumper and leans his/her body weight on the handle. Naturally, this would put strain on the upper extremities.

Slipping on the truck step and grabbing the hand bar to break a fall, is among the most common causes of upper extremity injury to truck drivers. The rotator cuff, elbow and A/C joint are damaged during this type of fall.

Team drivers live in a constantly moving vehicle. One driver is often sleeping on the bunk behind the seats while the other drives. The bunk is not wide, but the trucker often is, making a side posture the only comfortable position for sleep. Often the head is resting on the extended arm. A moving truck not only vibrates but bounces. Impact trauma to the vulnerable shoulder of the relaxed and sleeping victim is common. Arkansas, Louisiana and Tennessee seem to have roads that are especially likely to cause injury in this manner. I'm tempted to mail thank you letters to the governors of these states for sending me so much business.

Truckers refer to the support legs on the trailer as landing gear, since they must be lowered to disengage from the tractor and raised to haul the trailer. This raising and lowering is accomplished by means of a hand crank. This action causes repetitive stress-type injuries, most often to the elbow and wrist. Any driver who was once a yard dog (a worker in a truck yard responsible for swapping trailers between trucks) seems to have a greater propensity for elbow and wrist injury.

Unloading a truck is self-explanatory. All kinds of injuries are likely to occur to a sedentary, out of shape driver who has to "lump" or "fingerprint" (trucker-speak for handling) a load.

Postural habits, such as leaning the left elbow on the window frame or resting the hand or wrist on the gear shift lever, expose the extremities to injury.

All of the above behaviors cause injuries. Truck drivers are likely to engage in several, if not all, of the behaviors every day of their working lives. It's only a matter of time until the upper extremities become symptomatic. Educating truck drivers on the dangers of such injuries seems to be a fairly effective approach. Health care providers must be on the lookout for upper extremity injuries in their truck driving patients, who may not complain about their injuries even though they are in pain. Many people still believe that chiropractors only treat the spine, and they fail to mention other troublesome areas during an exam.

If a truck driver walks into your office, examine the upper extremities. Treating injuries early is always better than waiting until the patient can't perform the job. Truck drivers are very important to our way of life. Everything you buy at a store or use daily is brought to you via a truck. Keeping truck drivers on the road is good for them -- and for the rest of us.