Preventing Back Pain in Healthcare Workers

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Back Injuries and Back Pain are Common among Some Healthcare Workers

Healthcare workers with jobs that require them to move or lift patients are at high risk for musculoskeletal disorders (MSDs). Other healthcare workers, such as those who work in laundries, kitchens and environmental services also have a high risk for back injuries, as are those healthcare workers who must lift, push, and pull objects.

Back injuries are the most common job-related health problem among people working in healthcare. These back injuries can include:

low back pain
herniated discs
strained muscles
pulled and/or torn ligaments
Disc degradation associated with excessive strain on the back

The most common symptoms include back pain and stiffness. Numbness in the back, arms or legs can occur. Many healthcare workers with back problems struggle with decreased mobility, which can interfere with their ability to work, take care of their families, or engage in activities of daily living.

Nursing aides, orderlies and attendants had the highest rate for MSDs in 2010, according to OSHA. That year, more than 27,020 of these healthcare professionals reported an MSD. This works out to an incidence rate of 249 MSDs per 10,000 workers, and this is more than seven times the average for all industries. The incidence rate of MSD in construction workers was only 85 per 10,000 workers that year, in comparison, and the incidence rate of musculoskeletal disorders in laborers and freight movers was only 154.9 per 10,000 workers.

Strains and sprains were the most common injuries reported to OSHA, and the shoulders and lower back were the most commonly affected body parts. The injuries are most often the result of overexertion while handling patients, usually while performing heavy lifting associated with transferring and positioning patients.

Musculoskeletal disorders are keeping more nursing aides, orderlies, and attendants away from work compared with other workers. OSHA reports the incidence rate for MSD cases with days away from work rose 4 percent for other workers in 2010, but skyrocketed 10 percent in aides, orderlies, and attendants.

The overall incidence of MSDs among healthcare workers will likely rise as patients become heavier with the growing obesity epidemic. In the 1990s, less than 15 percent of people living in the United States were obese. More than 36 percent of U.S. adults now have obesity, according to the Centers for Disease Control and Prevention (CDC). Aides, orderlies, and attendants of today must do much heavier lifting than did their predecessors.

This heavy lifting takes a toll on workers and on the institutions that hire them. MSDs cause considerable pain and disability for workers. OSHA says that as many as 20 percent of nurses who leave direct patient care positions do so because of potential risk for MSDs. The pain of MSDs can reduce productivity, interfere with attention to detail, and increase the worker’s risk for further injury.

Employers struggle with higher expenses, disability compensation, and potential litigation associated with back injuries. Direct and indirect costs of back injuries alone cost an estimated $20 billion annually.

Tips for Preventing Back Pain in Healthcare Workers

Identify high risk institutions, industries and procedures

Some institutions and industries have a higher risk for back injuries because they involve a great deal of patient handling tasks. These institutions include:

Long-term care facilities providing skilled and non-skilled nursing care, such as nursing homes and rehabilitation centers
Acute care facilities, including hospitals, clinics and outpatient care centers
Home health care workers

Other healthcare workers are at higher risk for back injuries, such as physical therapists and x-ray technicians.

Certain procedures carry a higher risk for back injury. Transferring patients between the bed and a chair presents special risk for injury, for example, as can moving a patient up in bed.

Healthcare workers can reduce their own risk for back injuries by properly indentifying high-risk institutions, industries, and procedures.

Identify situations presenting the potential for back injuries

Use proper body mechanics

Use proper body mechanics while moving or transferring patients. The rules of good body mechanics include:

Keeping the lower portion of the back in its normal position at all times during the lift or transfer
Staying as close to the patient’s bed as possible to reduce excessive reaching
Stepping to the side or pivoting rather than twisting the body
Positioning the feet to create a solid, comfortable, wide base of support while lifting
Keeping the head upright and shoulders up
Pushing up from the knees and using the body’s own momentum to aid in lifting the patient

Good body mechanics are particularly important while pushing or pulling patients or heavy equipment. To push safely, the healthcare worker should:

Stay close to the patient or object being pushed
Place one foot in front of the other
Flex the elbows and lean towards the patient or object
Shift body weight from the flexor to the extensor muscles of the legs
Use leg muscles to apply pressure, rather than using other weaker muscle groups
Provide rest periods during long jobs to prevent fatigue

To pull safely, a healthcare worker should incorporate the same body mechanics as when pushing, except he or she should lean away from the patient or equipment while pulling.

Employ lifting teams

Use a team approach for lifting. Each member of the lifting team should use proper body mechanics, utilize a lifting device, and work together with the patient and other members of the lifting team to ensure a safe lift.

Employers can reduce the risk of injury by scheduling enough staff so that healthcare workers can team up for heavy lifts. For maximum protection against injury during manual lifts, employers can even prohibit single-person lifts.

Use patient transfer and lifting devices as needed

Proper body mechanics help reduce injury, but even the best manual lifting techniques are not as safe as using a patient transfer or lifting device. These devices safely and efficiently move patients between beds and chairs without the need for manual lifting techniques. These devices help control the risk of injury to both staff and patients; they also make lifting, transferring, repositioning and movement of patients easier.

Employers should invest in patient transfer and lifting devices, and implement policies that encourage workers to use the devices instead of moving patients manually. For best results, employers should encourage worker participation in the assessment and implementation process of patient transfer and lifting devices. Workers should use the devices properly and provide feedback about their use. Enlisting the cooperation and engagement of patients can increase patient safety and comfort while enhancing their sense of dignity.

Use other equipment to reduce workload on the back

The use of other equipment can reduce the risk for back injuries among healthcare workers. This equipment includes:

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
Devices for lateral transfer between two horizontal surfaces, such as from a bed to a gurney
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

Implementing just some of these measures can reduce the risk for back injury and pain among healthcare workers. Nurses, nursing aides, orderlies, and other medical professionals who want to reduce their risk for MSD should talk to their supervisors about implementing safe handling programs, lifting teams, and lifting devices in their institutions.