There are 5 major factors contributing to injuries.
1. Poor posture
2. Poor physical condition
3. Loss of flexibility
4. Faulty body mechanics
5. Stressful living and work habits

POOR POSTURE
Poor posture does more than look bad. It can cause muscle tension, stiffness, fatigue and backache. The goal of good posture is to maintain the 3 natural curves in your spine in normal, balanced alignment. The 3 curves are the cervical, thoracic, and lumbar curves. When these curves are maintained in balance, your body is most efficient, and you don’t have to exert energy just to fight gravity. For example, if my head is forward, the muscles in the back of my neck and shoulders have to work all day long just to hold my head up against gravity. This can cause significant muscle tension and strain.

Let’s look at sitting posture first, since it is often at fault. One way to help you find that position of good posture is to first slouch completely. Now sit up and exaggerate the low back curve as far as possible. Now relax the back to reduce the strain but don’t allow your back to flatten. Check to be sure your ears are over your shoulders and not out in front of you. This is balanced, “neutral” alignment.

Its important to sit in a chair that will support this good alignment. Many “stackable” type chairs were designed just for that–to stack well. But their “scoop” shape actually promotes slouching. A chair needs good lumbar support for the low back. Many chairs now have built-in support, but you can also buy a lumbar support pillow or use a towel roll. Look at all of the chairs you use throughout the day–at home (the recliner, couch, kitchen chairs), at work (any office chairs you may use), and don’t forget the seats in your car. They can often be culprits to promote poor posture.

In standing, there is a natural lumbar curve present. However, if we allow our abdominal muscles to relax, the lumbar curve can be excessive and low back pain can result. Its important to keep the abdominals tight and keep the lumbar curve in a natural position. If you stand a lot for your work, it is often helpful to rest one foot on a stool or drawer to maintain good posture. The height of the work surface is also important. If the surface is too low, you’ll be forced to stoop over, and if it is too high, there will be increased strain at the shoulders and upper back and neck region. Working with the neck and shoulders relaxed and the elbows at an approximate 90 degree angle is the best position to maintain good posture.

POOR PHYSICAL CONDITION AND LOSS OF FLEXIBILITY
You need strong muscles to hold the bones and joints of your spine in good posture. When you are out of shape and your muscles are weak, you are at greater risk for injury. A program of regular exercise at least 3 times a week is a major step toward taking charge of your overall health and wellness. Your exercise program could consist of walking, bicycling, swimming, lifting weights or a variety of other aerobic and strengthening activities. (Maybe here we can also show a few examples of specific exercises for the abs and back. Ex’s: pelvic tilts, partial sit-ups, and “the bird dog”).

One of the most overlooked aspects of a fitness program is flexibility. Tight muscles can cause your body to be out of balance and expose you to risk of injury. Let’s look at an example. Your hamstring muscles attach behind the knee, and run up the back of the leg to the pelvis. They attach to your “sit bones”. If your hamstring muscles are tight, they can pull the pelvis out of balance, which directly affects the strain on your low back. (Again here we could show an example of a hamstring stretch and talk about intensity and duration of stretching).

FAULTY BODY MECHANICS
The next contributing factor we listed at the beginning of the video was Faulty Body Mechanics. This includes the way we move our bodies in and out of all positions, and especially the way we lift. I think all of us have been trained at one point and time the proper way to lift. And we usually think of this only when we are lifting heavy objects. But proper body mechanics and lifting techniques should be used whether we are picking up a car engine or a paper clip.

Let’s go over the basics of good lifting. We want to maintain those natural curves of our spine throughout the lift. This means keeping the back straight and the abdominals tight. Use your legs, instead of your back, to power the lift. Keep your head up. Keep the load close to your body. This is important. If the load is held out away from your body, even a small weight can put an excessive strain on your low back. And make sure you move your feet instead of twisting at the back.

Now let’s look at some specific examples that might pertain to patient care. First let’s look at sitting transfers, such as bed to wheelchair or wheelchair to toilet. One of the most important aspects of patient transfers is to position the patient so that you have to do less work. This includes scooting the patient forward to the edge of the bed or chair. Try standing from a position where you are sitting way back in the chair. Now scoot to the edge and stand up, and see how much easier it is. Next, make sure the patient’s feet are positioned correctly. The balls of the feet should be directly under the knees or even back slightly. Try standing up from a chair with the heels below the knees. Now try it with the feet tucked back. By putting the patient’s feet in a good position, you are allowing his leg muscles to be at the best mechanical advantage to help you with the transfer. Also, keep in mind that we naturally come forward and up when we stand or transfer. If the patient’s weight is back and not forward, you will have to do all of the lifting. If you teach the patient to bend forward before coming up, his weight will transfer out over the toes, his bottom will come up easier, and you will have to do less work.

Remember your good back position during the transfer, and use your legs. Pivot your feet so that you don’t twist your back. Explain everything to the patient and transfer on the count of 3 so they can prepare and help as much as possible. Use equipment advantages if they are available. For example, if you are transferring a patient from the bed to a wheelchair, adjust the height of the bed so that you have an even or slightly downhill transfer. If the armrests of the wheelchair are removable or swing-away, get them out of the way so that the patient does not have to transfer over the top of them. Always make sure that the two surfaces that you are transferring between are locked into a stationary position. And if you are transferring a particularly difficult or heavy patient, get help.

Now let’s look at bed to stretcher transfers. Adjust the bed to the level of the stretcher. Make sure both the bed and stretcher are locked. Start as close as you can to the patient, even if that means putting a knee on the stretcher or you yourself kneeling on the stretcher. Move the patient in two stages. First to the edge of the bed, then over to the middle of the stretcher. Again, watch your good back mechanics and avoid slouching over to perform the lift. Use a draw sheet, a roller, or a slide board if available. And make sure everyone involved in the transfer is ready and knows her role. Count to 3 so you all move together.

STRESSFUL LIVING AND WORK HABITS
The last contributing factor we listed at the beginning of the video was Stressful Living and Word Habits. Let’s face it, we all have stress in our lives. But being in stressful situations can lead to greater chance of injury, since you are most likely to forget about maintaining good posture and using good mechanics during these stressful times. For example, if it gets very busy on the floor and a nurses aide has 50 things to do in 15 minutes, its easy to skip basic steps like raising or lowering the bed to a good height advantage. She therefore puts her back at risk of injury because of poor mechanics and posture. Take the time to make good posture and body mechanics a HABIT, so it will be one less thing to worry about during stressful times.

In summary, we want to stress the fact that you have much control over back injuries in the work place. Practice, practice, practice good posture and body mechanics always until they become second nature. Stay in shape and maintain your flexibility. And don’t take shortcuts during stressful times. We all have a responsibility to reduce the amount of on-the-job back injuries by doing our part.