Back Safety

What is Back Safety?

Low back pain is a common issue affecting many people and is a major reason why people go to the doctor. It’s a major cause of disability worldwide and has a significant impact on both healthcare costs and society. In fact, around 70% of people will experience low back pain at some point in their lives, and this costs the American healthcare system $87 billion every year.

This problem is particularly severe among healthcare professionals, especially nurses. Nurses are more likely to experience low back pain than people working in heavy industries, with the lifetime occurrence rate being as high as 90%. Additionally, once a nurse experiences low back pain, there’s a 70% chance that it will come back.

Low back pain can negatively impact nurses’ lives. It can affect their happiness, job satisfaction, and overall quality of life. It can also lead to chronic pain, increased healthcare costs, reduced productivity, more sick days, and job burnout. This level of physical strain can lead many nurses to consider leaving their jobs. In a survey conducted in 2001, over 40,000 nurses from five different countries participated, 39% of them reported that they were considering leaving nursing within a year because of the physical demands of the job.

What Causes Back Safety?

Nursing is a physically demanding job that often requires heavy lifting, such as moving or repositioning patients. Out of all professions, nursing sees the most amount of heavy lifting involved. This makes nurses particularly susceptible to injuries to their musculoskeletal system – especially in their lower back. Nurses who frequently move, lift, or reposition patients are seen to have a higher risk of lower back pain compared to those who don’t have to do these tasks.

Working long hours or overtime can make these physical demands more intense, increasing the risk of musculoskeletal issues. High stress in the workplace, little social support, and lack of job control also contribute to incidents of lower back pain among nurses.

Research has also shown a link between daily nursing activities like patient care, which includes dressing and bathing patients, and lower back pain. Though these tasks may not seem physically demanding, they, along with other regular duties like standing and walking, are responsible for 80% of the total back stress experienced by nurses. Only 10% is due to heavy lifting. So these everyday tasks can be significant risk factors for developing back pain.

Nearly a quarter of nurses also suffer from poor sleep caused by fatigue, stress, perceived exhaustion, and musculoskeletal pain, which can further increase their risk of lower back pain. The average age of a nurse in the U.S. is about 47, and with age, the susceptibility to such physical stress and resulting health issues may also increase.

Other factors like obesity and smoking, common issues among nurses, could contribute to the higher rates of lower back pain in healthcare professionals. But most often, the major contributors to lower back pain in nurses are aspects like long working hours, patient handling and demanding schedules.

Risk Factors and Frequency for Back Safety

Back pain is a common issue among healthcare workers, particularly nurses and operating room staff. Studies show that 40-50% of these professionals experience back pain each year, and 80% will have it at some point in their lives. In a study conducted in 2019, the one-week occurrence of lower back pain (LBP) was highest in nurses (57%), followed by doctors (50%), and physical therapists (36%).

In the US, 47% of nurses reported suffering from back problems during the past year. In comparison, the yearly incidence of lower back pain for nurses in Australia, England, the US, and France was found to be between 29% and 59%. However, the rate of lower back pain among Filipino nurses was much higher, estimated to be 80% annually. These findings suggest a significant difference in lower back pain prevalence among nurses in developed and developing countries.

• The availability of equipment and resources to aid in lifting patients can influence the rates of back pain among nurses.
• Nurses are less likely to report lower back pain if their workplace provides support teams for lifting patients.
• Nurses who have not received education on low back pain reported higher pain levels.
• Among the nursing specialties, nurses working in internal medicine and pediatric intensive care units experienced higher average pain levels.
• Female nurses reported higher pain levels than their male counterparts.
• Nurses over the age of 34, those with a chronic disease, and those with abnormal body mass index (BMI) also reported high pain levels.

However, accurately determining the exact number of nurses suffering from LBP is challenging. Many nurses may not report symptoms due to fear of job loss, potential retaliation, or the belief that experiencing pain is an expected part of their job or aging.

Signs and Symptoms of Back Safety

When doctors are trying to diagnose the cause of pain, they often use the SOCRATES method, which considers eight important aspects of pain: Site, Onset, Characteristics, Radiation, Associated factors, Timing, Exacerbating Factors, and Severity.

In addition, doctors also take into account any “red flags” that can signal more serious conditions. These red flags can be identified by asking about history of trauma, cancer, weight loss, night pain, whether the person is older than 50, fever, IV drug use, recent infection, previous surgery, urinary retention, numbness in the saddle area, brittle bones (osteoporosis), steroid use, morning stiffness, improvement with exercise, leg pain, worsening pain when walking but relieved by sitting and numerous other factors.

Doctors can use tools like the Start Back Tool or the Orebro Short Musculoskeletal questionnaire to identify any psychological barriers, known as “yellow flags”, that could hinder recovery.

The physical examination typically checks for symmetry in body posture and walking, muscle wasting, flexibility in bending and turning, sensation to touch and pinpricks, muscle strength, reactions to reflex tests, any signs of tenderness, and a variety of specialized tests such as the straight leg raise, the femoral stretch test, and FABER’s test.

Diagnosing low back pain can be difficult since it often does not have an identifiable cause, and traditional tests may overlook the strength and endurance of the specific muscles in the back. A couple of special tests can be conducted to check for weak back muscles:

• The prone instability test: This test starts with the patient standing on one end of the examination couch. The patient then lowers their torso onto the couch while holding onto the sides for support. The examiner presses on the lower back to find any tender spots. The test is considered positive if there is less pain and tenderness when the patient lifts their legs off the ground, which uses the back muscles more.
• Prone Plank/Bridge: In this test, the patient lies face down and holds their entire body off the couch/mat using their forearms and toes, effectively making a plank pose. The time men and women can hold this position gives an indicator of their muscle strength.
• Supine Bridge: In this test, the patient lies down with their back on the mat and lifts their lower body, keeping their shoulders down. Again, the duration for which men and women can hold this position provides a measure of their muscle strength.

Testing for Back Safety

In most cases of lower back pain (LBP), a simple physical check-up is all that’s needed unless there are serious warning signs. Basic x-rays of the spine don’t typically add much to the diagnosis, so they’re not recommended unless there’s been an injury. The best way to evaluate LBP in patients with nerve-related issues is through an MRI scan.

Early identification is important for patients suffering from conditions like ankylosing spondylitis, a type of arthritis that affects the spine. These conditions can often be diagnosed late. Stock-standard symptoms like the gradual onset of back pain lasting more than three months, stiffness in the morning, and relief with non-steroidal anti-inflammatory drugs (NSAIDs) can suggest these conditions.

If these symptoms are present, further investigation should be done with HLA B27 and C Reactive Protein tests. Clean x-rays of the spine, or MRI scans of the sacroiliac joint (where your spine connects to your hips) may also be necessary to establish the diagnosis.

Treatment Options for Back Safety

Preventing lower back pain is primarily divided into five categories – primordial, primary, secondary, tertiary, and quaternary prevention.

Primordial prevention aims to lower risk factors for everyone to reduce the incidence of disease. It targets lifestyle behaviors and social conditions that can lead to the disease. For lower back pain, this could mean creating spaces for exercise like walkways, gyms, and recreational parks, or educating people about healthy habits such as diet and weight control, or limiting alcohol and tobacco use.

Primary prevention focuses on preventing the disease from emerging in the first place among people who are at risk. Techniques for lower back pain could involve providing aids for lifting heavy items, training in proper lifting techniques, and making sure there are dedicated teams for lifting heavy objects at places like hospitals.

Secondary prevention is about diagnosing the disease early in individuals who may not yet show noticeable symptoms. It heavily involves screening, and in terms of lower back pain, this might mean closely monitoring and responding to incidents like injuries from lifting heavy items, providing early rehabilitation, and preventing presenteeism (people still coming to work even when they’re unwell).

Tertiary prevention seeks to lessen the impact of a disease once it has advanced. It aims to reduce the effects of the disease on a person’s life and productivity. Techniques for lower back pain could involve physical therapy, cognitive-behavior therapy, and changing job roles to avoid recurrence.

Quaternary prevention is a relatively new category, focusing on preventing harm from medical procedures. In relation to lower back pain, this could mean avoiding unnecessary tests and risky procedures for people who might not be sick, or who have mild, self-limiting diseases. For instance, MRI scans that might bring up age-related changes rather than actual ailments, causing unnecessary worry.

There is a considerable blend between these interventions. They can be further divided into those enforceable by individuals and those that can be implemented by health establishments.

Health facilities can set up interventions such as training in proper lifting techniques to prevent injuries and providing lifting equipment to reduce physical injuries. They can arrange lifting teams to assist with moving patients, provide education programs to help healthcare professionals be aware of their body movements and improve interaction with patients, or arrange comprehensive ergonomic programs to reduce patient handling injuries.

On the individual level, lifestyle health promotion, consuming a healthy diet, reducing weight, cessation of smoking, incorporating physical exercises, and cognitive behavior therapy could potentially reduce lower back pain.

What else can Back Safety be?

When it comes to diagnosing low back pain, doctors have to consider several possible causes. They generally fall into two categories: causes related to the spine, and causes not related to the spine.

Some spine-related causes:

• Injury (for example, sprains and fractures)
• Wear and tear over time (for example, herniated discs or narrowing of the spaces between spinal bones, which can pinch nerves)
• Inflammatory conditions affecting the spine
• Cancer that has spread to the spine or cancers originating in the spine
• Infections, such as those affecting the discs or bones of the spine

And some causes not related to the spine:

• Aortic disease, which can include problems like aortic dissection or an aneurysm
• Problems with the urinary system, such as kidney stones, tumors, or infections
• Gastrointestinal problems, including pancreatitis, pancreatic cancer, peptic ulcers, and gallbladder inflammation and infection

Doctors need to consider all these options to correctly identify the source of the back pain.

What to expect with Back Safety

In most cases, mechanical back pain tends to improve within 12 weeks. However, up to 33% of patients might still experience chronic symptoms. Even when acute symptoms go away, there is a 20-40% chance of the pain returning within the first year, and an 85% chance of it coming back at any time in a person’s life.

Various factors can affect recovery, including:

1. Depression
2. Having a Body Mass Index (BMI) over 25
3. Undergoing a compensation claim process
4. Smoking
5. Not being satisfied with your job
6. Being very fearful or avoiding certain activities
7. Doing physically demanding work

Possible Complications When Diagnosed with Back Safety

The biggest issue with low back pain is that it can become a chronic and disabling problem after an acute episode. The number of people experiencing low back pain, and the disability it causes, is growing. A 2015 study showed that low back pain accounted for more than 60 million years of disability, which was a 54% increase from 1990. While most people with low back pain experience short term episodes, for about 28% of individuals, the condition becomes chronic and accounts for 77% of the disability caused by low back pain. This disability is most pronounced in the working age group and affects people in both low and middle-income countries equally. For example, a survey in Zimbabwe found that low back pain was one of the top 5 health problems that limited activity, and another study in Nigeria found that over 50% of peasant farmers had to cut down their workload due to low back pain.

Around $50-90 billion is spent every year in the US directly on healthcare for low back pain. The total cost, including lost productivity and healthcare, is estimated to be around $635 billion annually. A large number of people suffering from chronic low back pain also have pain in other areas of their body and, in many cases, have other physical and mental health problems. The effects of low back pain combined with these additional health issues can lead to high healthcare needs and poor treatment outcomes.

A 2010 study in the US showed that women and older workers are more likely to develop low back pain.

• Psychosocial factors also pose potential risks including:
• The imbalance between work and family
• An unhealthy workplace environment
• Job insecurity

Preventing Back Safety

According to research, the best way to prevent back pain is to keep a healthy Body Mass Index (BMI) of under 25. A higher BMI is often linked with increased disability. To better manage back pain, people should stay active and avoid sitting out due to fear of worsening their back pain.

Another recommendation for managing back pain is to stop smoking. Studies show that smoking can make back pain worse. Additionally, educating patients about staying active, modifying certain activities, and returning to their normal routines as soon as possible has shown to be beneficial, especially when getting back to work.

Practicing good posture and proper lifting techniques are also very important in preventing back pain. Employers can help by making changes in the workplace that promote good ergonomics. Additional interventions include offering suitable rest breaks and paid time for employees to take part in physical exercises.