By Adam Reid - this article originally appeared circa July 2009 on the now defunct ADVANCE for Nurses website
The high incidences of back pain amongst nurses is well documented. Beside discussions between those in the field, dozens of websites and books exist on the subject along with many articles in journals such as this. According to U.S. Department of Labor Bureau of Labor Statistics(1), nurses and other medical attendants accounted for roughly 20% of all days away from work cases in 2006, mainly as a result of sprains and strains of the torso muscles.
A study by the University of Alberta’s Faculty of Rehabilitation Medicine(2) on this subject found that 65 percent of orthopedic nurses and 58 percent of ICU nurses develop debilitating low back pain at some point in their careers. As the lead author of the 2006 study stated, "Nurses suffer from work-related low back pain more often than workers in other professions."
Due to the nature of the job, it seems that most nurses have resigned themselves to living with some level of discomfort. Those that refuse to accept this malady as permanent often try various methods to reduce pain and increase quality of life. The majority of those methods offer varying degrees of relief, but none of them attack the problem from where it stems. This article will address that issue, along with a solution.
Ineffective Solutions
During this discussion of the commonly used methods to deal with the problem of back pain within the nursing profession, it is important to state now that the use of patient lifts within 'zero-lift' hospital policies would be a great aid to nursing in general, and the issue of back pain in nurses specifically. However, this policy is currently used in few hospitals (roughly 5% as of 2007(3)), and, very importantly, the use of these lifts will not aid those already injured. So while it would be a mistake to call the use of these lifts 'ineffective', it is not a stretch to call them 'incomplete' insofar as the ideal solution.
Additionally, lower back problems do not result only from sudden impact possible during patient lifts, but also the repetitive nature of the job with regard to standing, bending, and holding certain positions during a shift, and the totality of such within a week, a month, and a career. The typical ergonomic recommendations are quickly forgotten during a moment of crisis, and are hard to maintain during a long shift.
In attempts to relieve discomfort and improve functional ability (which includes vocational activities), nurses may choose from many methods. If staying within the traditional medical establishment, a doctors visit will frequently lead to physical therapy. However, this 'therapy' usually consists of a series of stretches and/or easy exercise on ineffective tools. For reasons discussed shortly, most do not receive benefit equal to the time committed.
For those moving outside of the traditional medical establishment to 'alternative' methods, various options exist. Chiropractic, acupuncture/acupressure, reiki, yoga - all of these seem to have 'some' merit depending on whom one speaks with (i.e., most people know someone who swears by one of these methods). However, none deal with the problem at its core as identified next.
The Problem
In the cases where both the traditional and alternative methods 'help', it is mostly likely the result of the injured area returning to normal on it's own. For those with lower back problems, it has been verified that roughly 80% of injuries heal naturally. Of the remaining 20%, something else is needed. Nurses, due to the chronic nature of lower back pathology across the board, would typically fall into this 20% field.
The reason the lower back is so susceptible to injury - both in nursing and in the general population - is that the muscles that support the lumbar spine are extremely weak. Upon reflection this should be clear; after all, if these muscles were extremely strong, the likelihood of injury or general discomfort would be minimal. However, sometimes the simplest solutions are the least likely to be arrived at, and in this is the case with lower back problems.
The reason for this weakness is overuse. Every action the human body makes relies on the activation of the spinal muscles to maintain posture and efficiency of movement. Consider how often one adjusts one's positioning while sitting at a desk, or while standing for an extended period of time - the muscles of the lumbar spine are working non-stop. And while this work is far from challenging, since the spinal muscles are typically comprised of predominately fast-twitch (and fast to fatigue) fibers, everyday activity results in overuse. In fact, once past the 2nd decade of life, the spinal muscles begin to atrophy.
Regardless of diagnosis, the issue stems from weak lumbar musculature. The chance of disc slippage, rupture, degeneration, etc., would be limited if the support system for the spine were strong enough to withstand most of the strain placed upon it.
The Solution
So if the problem is weak and atrophied musculature, the solution would be to strengthen the area. However this is easier said than done. Because of the nature of these muscles, most attempts at strengthening bypass the weak lumbar muscles and engage the stronger hips and thighs. Only the MedX Lumbar Extension machine is capable of isolating the lumbar muscles - by fixing the pelvis in place during exercise. Due to multiple patented restraints, the locking of the pelvis is exclusive to the MedX machine.
This exclusivity is not to be overlooked. Oftentimes, a user has attempted exercise therapy via traditional means (hyperextensions, Cybex/Nautilus mis-named 'lower back' machines, etc.), but to no avail. However once the MedX machine is implemented there is a noticeable improvement in quality of life via increased function and decreased pain. To drive this point home, other equipment use - even when seemingly becoming stronger on said equipment, i.e., increasing the resistance level used - does not strengthen the lumbar muscles.
The medical version of the MedX Lumbar Extension machine includes a computer hook-up that is able to test strength at various points of the users range of motion. It is also able to quantify and remove stored energy torque, and the effects of of gravitational forces via counterbalancing the torso - aspects that are necessary to accurately test strength. In cases where an individual has been tested on a MedX machine, used another tool for the purpose of aggressive strengthening, and then been tested again on the MedX after several months, none of the users showed any increase in strength of the lumbar muscles - while many were in fact weaker.
The fact that such a tool exists to accurately test strength is the reason one can say with certainty that lower back problems stem from weak musculature. Upon first being used some 15 years ago after two decades of development, users recorded dramatic strength increases while concurrently decreasing pain. Literally 400% increases in strength were the norm - which does not happen unless the tested area is starting from below normal strength levels.
MedX manufactures a non-medical version of the lumbar machine for it's Core Spinal Fitness Systems line. This machine features the same pelvic restraint, but it's price tag (roughly 10% of the medical machine) makes it feasible for health clubs or private exercise facilities. Without the computer system, strength testing is not possible (although force gauges can be implemented) but strengthening via exercise is virtually identical.
Why every therapy clinic purporting to help with lower back injury/pain does not have even the less expensive MedX Core Lumbar machine is not understood by this author. True the pieces are expensive, and it is necessary to have a grasp of proper exercise technique and application - but ultimately it must come down to ignorance of the fact that such a tool even exists or a deeper philosophical flaw within the traditional therapy model beyond the scope of this article.
Implementation & Results
The reason for lower back pain and a solution have been introduced; but how to implement this tool varies slightly depending on the practitioner. In all cases, the lumbar muscles are already overworked from the wrong stimulus (read: repetitive, every day activity). Because of this, MedX exposure needs to be a shock to the system in the form of brief, infrequent, and hard exercise. Some facilities recommend twice weekly exposure, one or two sets each visit, while others recommend one session consisting of one set close to - but not reaching fatigue - once per week. This author has not noticed better results with the former application.
Most users report some degree of relief after the first session. Depending on the severity of injury, others may need more time. If the user is battling chronic pain, the level of discomfort in the days following exposure may be extreme at first. This is normal, and will diminish after a few sessions. It is important, however, that the sessions continue on a weekly basis and one is willing to push through some discomfort and perhaps anxiety stemming from a seemingly delicate area.
Typically within 6 months of aggressive strengthening, the user has reached a genetic limit for strength. At this point, less frequent 'maintenance' use can be implemented. However, what this means to the individual is to be determined on a case by case basis.
Cost Cutting Solution
Besides expensive surgery, the indirect costs resulting from lower back injury can and will add up quickly. According to the book Back Injury Among Healthcare Workers(4), these include:
Productivity losses due to an injured worker's absence and reduction in coworkers' productivity following the injured worker's return to work
Lost workdays: (wages x hours lost)
Lost time for managers
21% lost productivity of individual worker injured
Overtime paid to others during lost workdays
Personnel and training time to hire replacements
Cost of emergency treatment
Cost of light duty
Claims processing costs
Additional recruitment costs for dealing with the injury episode
Legal expenditures required to defend an employer from litigation
A hospital with a high level of WSMD (work-related musculoskeletal disorders) injuries may have to resort to over-employment in order to keep the business viable
In other occupations with high-risk of back pain, dramatic savings have been incurred by MedX implementation. For example, as documented in the Journal of Occupational Rehabilitation(5), 90% of participants initially reported mild to severe low back pain. After 6 months of once per week training:
80% reported reduction in pain
40% were pain-free within 3 months of training
One scheduled surgery was avoided
Estimated Savings: $149,000
The average Workers’ Compensation liability dropped from $14,430 per month to $380 per month
The significant increase in strength associated with the exercise program correlated with the greatly reduced incidence of back claims
In the health care industry, Minnesota paramedics(6) were split into two groups: MedX lumbar exercise and controls:
84% fewer injuries among exercisers compared to control group
Zero lost/restricted work days among exercisers compared to 64 among controls
Direct costs were $145 in the exercise group versus $16,471 among the controls
Employers have several options ranging from simply recommending MedX lumbar exercise to nurses, to including it's use in employee benefits, and even purchasing the piece for in-house use. Regarding the first, this could mean a preventative approach for all nurses, or a rehabilitative approach for those already suffering. Regarding the second, it could be arranged with each facility for monthly billing to occur based on the number of nursing visits, or for reimbursement after a block of time. While the third option would be costly (equipment purchase and necessary exercise supervision) keeping the MedX exposure in house could conceivably allow the employer to monitor and enforce employee use - keeping other costs down. Of course, there are a wide array of options, and the above listed are but a few examples.
Conclusion
While the issue of back pain in nursing is rampant, use of the MedX Lumbar Extension machine on a regular basis will alleviate this problem for the vast majority of users. Nurses and their employers are encouraged to investigate implementing MedX exercise therapy. It is not an exaggeration to state that no other method is as effective at back pain relief.
1) http://www.bls.gov/news.release/pdf/osh2.pdf
2) http://www.uofaweb.ualberta.ca/rehabmed/news.cfm?story=48579
3) https://media.scoopreprintsource.com/web_reprints/25476_prevent.htm
4) Back Injury Among Healthcare Workers; pp. 42-43
5) J Occupational Rehabilitation Vol 5 No 3 1995
6) Reported by Thomas E. Dreisinger, Ph.D., Prevention First, Minneapolis, MN, at the Spine Symposium 1998 in San Diego, California.