When Good Form Isn’t Enough – Protecting Nurses and Health Care Workers

Last week, NPR posted a really interesting article about the rash of injuries affecting bed side nurses. You can find that article here:

Even ‘Proper’ Technique Exposes Nurses’ Spines to Dangerous Forces

The article comes on the heels of a study that investigated the forces that the spine is exposed to with various lifting techniques taught to nurses in hospitals.

The study found that even when nurses used proper technique to help move patients, the amount of force placed onto the spine was enough to create serious injury.

Now there are a lot of variables that go into this puzzle:

1. Does proper form need to to be re-evaluated?
2. Is there proper form?
3. How does fatigue play a role? Of course nurses aren’t the only ones at stake here. Paramedics and other health care staff that play a role in patient transfer are all exposed to nasty compressive and sheering forces in the name of duty. While it may take years to get definitive answers to those questions, one thing we know is that a lot of people are going to have serious spine injury in that time period.

One thing is for sure, good form just isn’t enough.

How Do We Protect our Health Care Workers?

The obvious and safest option is to use technology and machinery to lift patients and transport them. In fact, many facilities use these devices for the care of patients with chronic illness.

The problem with this is that in the heat of an emergency situation (ER and paramedic transport), there isn’t time to wait for robots and lifting devices to get the job done. Split decisions have the be made, and seconds can make the difference between life and death.

Lifting devices are also space intensive and many hospitals aren’t prepared to to take on the spatial constraints from lifting devices.

At this time, waiting for lifting devices to save your spine just isn’t in the cards.

What Can You Do?

I’ve taken care of hundreds of nurses and paramedics during my career. While we cannot take their spines and put it in bubble wrap to guarantee it’s protection, there are a couple of rules that can help make a big difference.

1. A Strong Foundation – This is a concept I harp on day after day in my practice. The foundation of your entire body is the spine. A spine with a structural shift away from normal loses causes a loss in neuromuscular control that can make the spine weaker and more susceptible to injury.If you take the body and place it in a weak position, then you apply load (weight) to that weakened position, you have a recipe for increased injury.
2. Get Stronger – Even with perfect structure and perfect form, there is no substitue for being strong enough to carry a load.Unlike a gym rat, a nurse or paramedic has no choice as to what’s on their “bar”. Whoever is their patient becomes their lift for the day/evening. In a way, a health care worker, or anyone who does heavy lifting has to be prepared for anything.

The one consistent factor that I see in people in health care that make them more resiliant is strength. The nursing and paramedic staff that exercise their bodies outside of the work environment can get go through a program of structural correction and come out on the other side less likely to be injured.Just put yourself in the the shoes of a nurse. If you’re a 120 lb female nurse who has never lifted 200 lbs before, how many times will you be able to do that before your body gives out? On the other hand, if you’re a 120lb nurse who is deadlifting 200 lbs on a regular basis in the gym, your body is prepared for that patient who has fallen and can’t get up.

The Weight Lifter Mentality

When people think about weight lifting, one of their primary concerns is that it is dangerous for their spine, knees, and hips.

While professional weight lifters may tax their joints to harsh levels (no different than other professional athletes), developing the mindset and modified training of a weight lifter can be a true spine saver.

For purposes of strength training for occupational hazards like lifting, it’s about finding exercises that reflect the stress of the work. While bicep curls and may look nice, most people are not really looking for you to curl a 160 lbs unconcious human being.

A weightlifter would never pick up a weight without their bodies being primed to take the load. They approach the weight with a mentality that they must stiffen their trunk and find the most efficient way to lift a weight while minimizing stress on their body. You’ll also notice that weightlifters will take this approach to lifting anything. Whether it’s a barbell, a stone, a box, any large object is lifted with similar mechanics and approach.

One of the most important muscle groups to address are the posterior chain muscles (hamstrings, glutes, back muscles). These muscles help maintain spinal neutrality when you have a large amount of weight in front of you.

Here are some important lifts to to train. Remember, if you are not a regular weight lifter, Please, Please, Please get some outside help to monitor your exercise. Weight lifting is safe when you keep your self safe, and sometimes that requires some professional input.

1. Deadlifts – No exercise strengthens the back like the deadlift. It trains the body to pick up large loads and stimulates growth of the back, hamstrings, arms, abdominals, and hips. It is the most fundamental lift there is, and there is nothing as functional as picking something off the ground.It gets a bad rap from trainers who think it’s dangerous, but in the right hands, it is actually one of the most effective rehabilitation exercises there is. A properly instructed deadlift can also teach the lifter to hinge from the hip rather than bend from the spine which is critical for protecting the spinal structure. The weight should progress to heavy loads and low reptitions.
2. Russian Kettle bell swings – Different from the American Kettlebell swing that was popularized by Crossfit. The Russian swing does not involve the arms in full flexion over head, and instead are raised to shoulder level.When performed properly, the Russian swing keeps the spine in neutral and develops the skill of hinging from the hips. It trains explosive power from the hips while also developing the ability to maintain spinal stiffness over numerous repetitions. If the deadlift is king of overall strength in the posterior chain, then the kettlebell swing can help prepare the posterior chain for conditioning so that you can keep your strength over time.When you are a nurse or paramedic, you are asked to work over the period of long shifts. If you are strong at the beginning of a shift, but your body is drained with fatigue midway through the shift, you are definitely more likely to be injured. Developing a level of conditioning in the posterior chain is a key element to maintaining that. I suggest working with a trainer for developing a rep scheme and making sure you do this movement correctly. There are several moving pieces, and only people with a high level of body awareness can do this correctly without some coaching.
3. Unweighted/Weighted Back Extensions – Probably the most obvious way to address the muscles of your back. Using a back extension set up, you hinge from your hips, keep the spine neutral, and bend from the waist all the way down the end range to stretch the lower spine. As you come up, you squeeze your glutes and push the legs into the machine to engage the hamstrings as you come up to a neutral straight spine position.A weight can be held at the chest and increase the load against the hip and waist. While you will feel your lower back doing work, you should also feel a lot of burn in the hamstrings and glute muscles when done properly. Extensions without a weight can be donefor 10-12 reps for some conditioning. Developing lower back strength, you would do a weight that you can perform 7-8 times.

 Conclusion

We can’t always guarantee the safety of our health care workers. Perfect form falls woefully short for nurses and paramedics, so we have to find better ways to protect them. If you are going to be a bedside nurse or a paramedic, your spine is your livelihood. I strongly recommend having a chiropractor that you can trust, and getting specific training in weightlifting for strength.