More NurseWeek Features   Smoke-Free Zone   Nurses and patients tackle nicotine addiction   Bloodless Survival     Surgical techniques to use when transfusion drops out of the equation
An estimated 52% of nurses complain of chronic back pain, according to the American Nurses Association, with 20% requesting assignment transfers and up to 12% leaving the profession as a result of back injuries.

If you have an aching back, you’re not alone. An estimated 52% of nurses complain of chronic back pain, according to the American Nurses Association, with 20% requesting assignment transfers and up to 12% leaving the profession as a result of back injuries.

Because back pain affects so many nurses, it’s important that “you be aware you’re at risk,” says Lori Schaumleffel, RN, COHN-S. As coordinator of employee services at Mercy Hospital of Folsom (Calif.), she often deals with nurses who have back pain.

“If we lose nurses to back injuries, we’re losing a valuable resource,” Schaumleffel says. “While it may not knock you out of your career, it can be a hindrance throughout your life.”

Perhaps 80% to 90% of the time, the origin of back pain cannot be pinpointed precisely, estimatesMaj. John Childs, PT, PhD, a senior physical therapist and director of research at Wilford Hall Medical Center at Lackland Air Force Base, Texas, who has studied back pain and treatment extensively.

But certain risk factors increase the likelihood of back problems.

The physicality of many nursing jobs puts caregivers at high risk. Nursing aides, orderlies, and attendants ranked No.1 in the Bureau of Labor Statistics’ most recent (2002) compilation of the number of musculoskeletal injuries involving days away from work.

RNs came in seventh, following closely behind construction workers, assemblers, janitors, nonconstruction laborers, and truck drivers.

“Patients are sicker and bigger than they’ve been historically,” explains Schaumleffel, making nurses’ jobs more dangerous to their own health. The frequency of manual labor on the job also increases the risk throughout a career. “Back injuries are microtraumas — the damage accumulates over time,” she says. The more you work in awkward postures or lift heavy loads, the greater your risk.

But just getting older doesn’t necessarily bode poorly for your back. The prime incidence of the onset of back pain occurs between ages 30 and 50, Childs says. After age 50, the spine becomes stiffer, actually reducing the onset of back pain, assuming no arthritis is involved.

Bad habits also can increase the incidence of back problems. Although smoking itself does not cause back pain, it has been shown to be an independent risk factor associated with back pain, increasing its likelihood and delaying recovery, Childs says.

Being overweight and out of shape compounds the danger as well. “In general, most back pain is caused by your back being out of shape,” according to Childs.

Psychosocial factors also can affect the back. “Research shows that under stress, in certain personalities, muscles around the back will contract, causing back pain,” says Nancy Menzel, RN, PhD, APRN, COHN-S, assistant professor at the University of Florida College of Nursing, who has studied the psychosocial components of back pain in nurses. “In many instances, pain and stress are intertwined.”

Dealing with back pain

Although the incidence of back pain is high, particularly in the nursing profession, “the good news is that most people with back pain are going to be fine,” Childs says.

Bed rest may be indicated for the first 24 hours after onset of acute back pain, but “bed rest beyond two or three days has not been shown to be efficacious when compared to maintaining activity as tolerated,” advises Eunice Lau, MD, a board-certified physiatrist at Kaiser Permanente’s Hayward & Fremont Medical Centers and the spine clinic at their Union City Medical Office.

Inactivity can cause reduced muscle tone, decreased exercise tolerance, and weakening of the back muscles, compounding the problem, rather than improving the situation.

Acute lower back pain flare-ups are generally treated with nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen, Lau says. Muscle relaxants such as Flexeril (cyclobenzaprine) or Robaxin (methocarbamol) also can be prescribed in the acute phase.

In addition to medication use, a conservative treatment regimen includes activity modification, maintaining proper body posture, stretching exercises of the lower back and legs, and gradual transitioning to a lumbar strengthening exercise (LSE) program.

Research has shown that LSEs (generally prescribed in a clinical setting) can help reduce recurrence of back pain, according to Childs. “The theory is that spine muscles act as guide wires for the back,” Childs says. By working on strengthening your back, you improve the guidance system. “Almost all my patients go home with some trunk exercises and aerobic exercise suggestions.”

Other exercise may help, but has not been clinically researched as to its specific effect on reducing back pain. Aerobic exercise improves overall fitness and helps keep your weight down. Core exercises (low back/abdominal strengthening exercises) or Pilates (strengthening and flexibility exercises emphasizing proper body alignment and correct breathing) are similar to LSE in strengthening abdominal and back muscles.

Spinal manipulation remains controversial. Some studies show no difference between manipulation and conventional treatment. For some patients, spinal manipulation may reduce back pain. Childs just published a study in the Annals of Internal Medicine indicating that patients treated with high-velocity thrust spinal manipulation who met four out of five predictive criteria had a 92% chance of substantial reduction in pain within a week.