How to Prevent Back Pain for Nurses and Healthcare Workers

How to Prevent Back Pain for Nurses and Healthcare Workers

Aching, sore backs are some of the common ailments healthcare workers and nurses face in the daily course of their work. What are some ways that you can prevent back pain?

by Grace Koh

From having to shift patients from the bed to a wheelchair, or assist with your patients’ daily activities of living like showering or getting changed, the job of a healthcare worker can be physically strenuous. Though such an active job may keep you fit, there is a higher risk of getting back injuries and back pain as well.

In a study which surveyed 107 healthcare workers including nurses and therapists, 70% of them reported to have back pain and can be a costly affair. The Workplace Safety and Health (WSH) Institute estimates that work-related musculoskeletal disorders, such as back pain, and other ergonomical problems result in a loss of $3.5 billion a year to Singapore, which is approximately 1% of Singapore’s GDP. With such a high proportion of healthcare workers enduring back pain in their jobs, what are some ways to address and prevent this? 

Common causes of back pain among healthcare workers

First, it is important to understand how back pain occurs among healthcare workers. Why are there so many healthcare workers complaining of back pains and what kind of healthcare jobs are most at risk? 

How does back pain in nurses and healthcare workers happen? 

It is firstly crucial to understand the scope of work in different healthcare jobs which can lead to back pain. The nature of healthcare jobs and its duties means that healthcare workers face a wide array of potential occupational hazards affecting the back’s muscles, tendons, discs, and ligaments. Healthcare workers face a higher risk for injuries and recurring health issues. Healthcare workers’ daily job duties may involve: 

  • Heavy manual lifting with transferring and repositioning patients
  • Having to move supplies and equipment without help 
  • Enduring awkward postures and positions such as holding objects in a surgical procedure
  • Having to bend down consistently 
  • Pushing and pulling patients in wheelchairs, transferring them from place to place 
  • Having to use certain vibrating tools and equipment for long periods of time 
  • Having to stand or sit for long hours 

These duties repeat themselves over time daily, and the repetitive recurrence of these may lead to a cumulative trauma disorder (CTD). CTDs are caused by repetitive motions, overuse and strain, which develop gradually over weeks, months, or even years. This could lead to chronic back pain, or an ache that never goes away even with rest, and can affect the quality of life of healthcare workers as well. Back pain is no small matter as it can lead to further consequences, such as a ‘slipped disc’. The pain from a slipped disc can be felt in the lower back, but can also be felt in the lower parts of the body, such as the buttocks, thigh, calves, feet, and toes. Sometimes this pain is accompanied by pins and needles, and numbness and weakness. 

Knowing these, which jobs are most at risk? Nurses, physiotherapists, nursing aides and therapy assistants have daily job duties which involve many of the above movements. Not forgetting our other healthcare heroes as well, such as healthcare attendants who assist with changing bedsheets, and moving huge trolleys of heavy equipment.

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Types and symptoms of back pain

Some common types of back pain include:

  • Lower back pain 
  • Strained muscles 
  • Herniated (or ruptured) discs 
  • Pulled and/or torn ligaments 
  • Degradation of the discs in the spine due to the excessive strain on the back 

The most commonly affected parts of the body with back pain are the back and the shoulders. Strains and sprains were also the most commonly reported types of back pain as well by healthcare workers in America, according to America’s Occupational Safety and Health Administration.

Symptoms of back pain include: 

  • Back pain and stiffness
  • Numbness felt at the back, arms of leg 

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Diagnosing back pain

Usually, back pain is diagnosed by a doctor. If you decide to see a doctor to examine your back pain, the consultation will consist of a discussion of your symptoms, and a physical examination. There is typically no need for further testing with X-rays or scans when diagnosing back pain unless your back pain lasts for more than six weeks, or if you have had an injury or suffered a blow to your back, or if your doctor suspects a further underlying cause for your back pain not related to injuries or movement-related causes.

If further examinations are done, X-rays, magnetic resonance imaging (MRI), or a computerised tomography scan (CT scans) may be employed. This helps your doctor to view detailed images of the inside of your body, so that he or she can draw a clearer conclusion about what is going on inside of your body. 

Alternatively, some symptoms lead to very likely conclusions of back pain, and one may self-diagnose back pain and try treatments to alleviate the pain. However, do not go too long without a medical professional’s input on back pain, especially if the pain persists for more than six weeks. 

Back pain treatment options 

There are a variety of options for treating back pain

Avoiding situations of repetitive motions and overuse

The repetitive motion of doing bed transfers for patients daily can result in wearing down of your muscles. When this happens, a twinge in the back muscles can be felt. This could be a sign to relook the act of a bed transfer – perhaps enlisting the help of a colleague or caregiver, doing a variety of jobs besides bed transfers,  or even informing colleagues about your back pain to see if any modifications can be made to daily duties.

Taking medication to ease pain

Painkillers can be purchased from most drug stores to help relieve back pain. Be careful not to become over reliant on them.

Doing specific rehabilitative exercise  

In the case of back pain, rest isn’t necessarily the best. Instead, gentle exercises for the back pain is – it can help to work out the kinks in the back, and build support for the spine and improve flexibility. Do arrange to see a physical therapist or a physiotherapist to design an individualised set of exercises. 

Applying therapies involving temperature e.g. heat and cold therapy

Using heat and cold therapy can help with back pain. The heat can help to relax the muscles around the lower back and provide relief, while using cold packs targeted at a specific area helps to reduce blood flow to the region such that the swelling is eased and there is less pain. Do make sure not to put ice directly on the skin, as it might cause a cold burn. Wrap an ice pack or bag of frozen vegetables in a cloth or towel first before use. A warm bath or hot shower may be a good idea for easing back pain as such. Alternating between hot and cold therapies can help as well – follow the rule of ice first, heat later. 

Getting sufficient shut-eye 

We all know sleep has many benefits – but who knows a simple act of staying on the bed could aid in recovering from back pain as well. We may have experienced the aftereffects of sleeping with poor posture – a crick in the neck or perhaps aching joints. Adjusting sleeping posture can help to reduce strain on the back. Using a full-length body pillow, or putting a pillow between the legs and drawing them up can help especially for individuals who sleep on their sides. 

Moreover, sleep is a time to repair muscles and swollen joints, so ensure a minimum of eight hours of sleep per night, to reap all the benefits of sleep. 

Tips on preventing back injuries 

Prevention is better than cure, as the old adage goes. This is true for back pain as well. So what can be done to prevent back injuries?  

Ensuring appropriate lifting and bending technique 

Good posture is everything in injury prevention – ensure proper lifting and bending techniques. As a rule of thumb, aim to keep the ears, shoulders, and hips aligned when sitting, standing, and walking. To lift heavy things correctly, use the hips and knees for power while keeping the back straight, and slowly come to stand. This will help to protect the back and prevent further injury to compound on the back pain. 

Core-building exercises

When the core muscles are not strong enough, additional stress is applied to the spine as it supports the body, and creates additional risk of back injury. Consider including some core-strengthening exercises to help build up the core. 

Wearing the right shoes

Like Cinderella, the perfect fit of shoes led her to prince charming – and for someone with back pain, the right shoes provide protection and support from back pain by supporting the wearer’s back well. For healthcare staff, a key factor in back support would be about the choice of shoes. Consider the following when purchasing a new pair of kicks: 

  • How comfortable the shoes are: Several factors weigh in for comfort. Consider the weight of the shoe. Heavy shoes mean more strain on the feet, and can also be uncomfortable to walk around in. Also, it is important to choose a pair of shoes with good cushioning made for long distances and can withstand weight shifts (while bending down to perform bed transfers for patients for example). A good fit is important too, as sliding about in a pair of shoes too big could risk a fall and hurt the back as well.  
  • Support and stability: Select shoes that offer excellent ankle and back support. Evaluate factors such as the shoe’s heel height, shape, construction/design, and material.
  • Anti-slip shoes: Select a shoe with good grip, to avoid the increased possibility of tumbles and falls at work, and risk injury to the back. 
  • Shoe’s design and shape: Besides functionality, a pair of shoes should be aesthetically pleasing to one. Also, consider the main use of the shoe – if it’s for ward rounds or moving about at work, something simple may suffice.
  • Personal factors: If someone has bunions, wide feet, flat feet, or other foot issues, this could affect the type of shoes for the wearer. Consult a podiatrist and check in with a doctor first on whether special modifications are required for the shoes. 

Identify areas or jobs with higher risks and employ various measures

Some healthcare institutions involve a great deal of patient-handling risks, and hence run a higher risk of their staff acquiring a back injury or having back pain. These include:

  • Long-term care facilities such as nursing homes, and rehabilitation centres 
  • Acute care facilitates such as hospitals, clinics, outpatient care centres 
  • Home healthcare workers
  • Other healthcare workers such as nurses, physical therapists, physiotherapists etc

In workplace risk management, employers could identify potential areas where it is reasonable to expect higher risk of back pain, and seek to address these areas by implementing preventative solutions. 

Instill the culture of having lifting teams

Instead of going solo to lift a patient, consider using a team approach for lifting. Healthcare professionals can buddy up and ensure safe and proper lifting techniques, and reduce the strain by spreading out the load. Employers can also schedule sufficient staff on duty so there will always be more than one person to team up together to perform heavy work such as lifting. If desired, employers can even cast a ban on single-person heavy lifts to implement this in the organisation’s work culture. 

Employ the use of patient transfer and lifting devices

Proper body mechanics help to reduce injury, but even the best manual lifting techniques are not as safe as using a patient transfer or lifting device. These devices help to safely and efficiently move patients between beds and chairs without the need for manual lifting techniques. Some examples of patient transfer and lifting devices are: 

  • Overhead track lifts, which are ceiling-mounted devices that help transfer patients between the bed and chair
  • Portable total lifts that healthcare workers can move from room to room
  • Sit-to-stand lifts that help patients rise from a seated position
  • Reduced friction sheeting that makes it easier to slide patients to the top of the mattress
  • Transfer boards that make it easy to slide from a wheelchair to a bed or shower chair
  • Gait belts with handles that fit around the patient’s waist

Use proper body mechanics

Ensuring good body posture when transferring or moving patients helps to prevent back pains as well. The rules of good body mechanics include: 

  • Staying close to the patient’s bed to reduce excessive reaching 
  • Ensuring the lower portion of the back is in normal position at all times during transfer or lift
  • Stepping to the side or pivoting to transfer patient, rather than twisting the body 
  • Creating a wide base of support by positioning feet well 
  • Keeping the head upright and shoulders up
  • Using body momentum and pushing up from the knees to lift the patient, so as to use leg muscles to apply pressure versus other parts of the body which can be weaker 
  • Place one foot in front of the other when lifting
  • Rest after lifting patients to rest the back 

As the saying goes, ‘Take care of yourself before you take care of others’. As a healthcare worker, this is fundamental to enable you to best care for your patients.  Try out some of these tips and see if they help. 

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References
  1. BAYADA Home Health Care. (n.d.). 6 Nurse-approved Ways to Protect Your Back on the Job. Work-Life. https://blog.bayada.com/work-life/6-nurse-approved-ways-to-protect-your-back-on-the-job
  2. Çınar-Medeni Ö, Elbasan B, Duzgun I. Low back pain prevalence in healthcare professionals and identification of factors affecting low back pain. J Back Musculoskelet Rehabil. 2017;30(3):451-459. doi: 10.3233/BMR-160571. PMID: 27858698.
  3. Contributor, N. T. (2021, April 22). Back pain. Nursing Times. https://www.nursingtimes.net/clinical-archive/pain-management/back-pain-23-03-2009
  4. Ergonomical Problems Like Back And Neck Pains Cost Singapore $3.5 Billion A Year. (2022, April 18). 
  5. Core Concepts. https://www.coreconcepts.com.sg/article/ergonomics-problems-neck-pains-cost-singapore-3-5-billion-year/H, L. (2017, September 15). 
  6. Preventing Back Pain in Healthcare Workers | HealthGrad. Health Grad.Com | Get Started with a Career in Health. https://www.healthgrad.com/topics/preventing-back-pain-healthcare-workers/NHS website. (2022, February 9). 
  7. Treatment. Nhs.Uk. https://www.nhs.uk/conditions/back-pain/treatment/What You Need To Know About Back Pain. (2002, November 1). 
  8. WebMD. https://www.webmd.com/back-pain/understanding-back-pain-basics
About the Writer
Grace Koh
Apart from reading, singing, and plodding up muddy trails, Grace enjoys scribbling notes and thinking up a storm. She is particularly interested in community support for the special needs population, and learning and education.
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