Staff back injuries: expert guidelines for prevention.

The American Academy of Orthopaedic Surgeons offers suggestions and illustrated exercises for avoiding this common -- and costly -- event

Those at greatest risk for back pain are individuals whose jobs require frequent bending and lifting. The nursing home staff fits this profile to a "T." For nurses and rehabilitation therapists, dietary, laundry, maintenance, housekeeping, and even the office staff, lifting and carrying everything from residents to heavy cleaning equipment to kitchen and office supplies is a daily fact of life in the nursing home.

What this costs the long-term care industry might be deduced from national data on back pain in general. For example, while most back pain lasts only a few days, one of every six people afflicted by it will experience severe pain lasting at least two weeks. The direct costs of insurance-compensated medical bills and payment for lost wages related to low back pain are estimated at more than $11.5 billion each year. That doesn't include the indirect costs of lost work time, administrative expenses and training replacements for disabled workers -- a form of "pain" with which nursing home administrators are all too familiar.

Now for the good news: As part of its nationwide injury reduction program, "Lift It Safe," the American Academy of Orthopaedic Surgeons (AAOS) has issued some simple guidelines on proper lifting technique, along with exercises to strengthen back muscles. According to the AAOS, following these preventive guidelines will result in substantial savings in health care costs. When properly applied to nursing home staff, they can also relieve a major administrative burden.

The AAOS guidelines can be posted in strategic locations throughout the facility (nurses' station, kitchen, laundry, rehab) as a reminder to staff. Further, with staff turnover in mind, instruction in proper lifting technique should be incorporated into orientation and inservices for every staffer whose job requires lifting or carrying residents or heavy objects.

Lifting Techniques

The guidelines begin with some general "dos" and "don'ts" of lifting and carrying.

The AAOS goes on to incorporate these general principles into guidelines for specific lifting and carrying tasks, as follows:

Turning a resident in bed: Using a draw sheet is one of the best ways to turn a resident over while in bed. First, adjust the bed height so it comes to your mid- or upper thigh. If safe for the resident, put the bedrails down. Cross the resident's arms over his or her chest, cross the resident's legs, and pull the drawsheet over the resident. Then, with one hand on the resident's hip and the other on the shoulder, turn the resident toward you.

Sitting a resident up in bed: If the resident is not strong enough to push up with his or her hands to a sitting position, place one of your arms under the legs and the other under the back. Move the resident's legs over the edge of the bed while pivoting the resident's body so that he or she ends up sitting on the edge of the bed. Keep your feet shoulder-width apart, your knees bent, and your back in a natural straight position.

Bed to wheelchair transfers: Place the wheelchair close to the bed and lock the wheels. Sit the resident up at the edge of the bed, as described above. Facing the resident and keeping your feet shoulder-width apart and your knees bent, position the resident's feet on the floor and slightly apart. The resident's hands should be on the bed or on your shoulders. Place your arms around the resident's back and clasp your hands together. Hold the resident close to you, lean back and shift your weight. Pivot toward the chair and bend your knees. Then, with both the resident's hands on the arms of the chair, lower the resident imo the chair.

Lifting belts fastened around the resident's waist are especially helpful in this type of transfer since they provide the caregiver with something to grasp when lifting the resident.

Chair to exam table transfers: Have the resident slide to the edge of the chair, making certain that the feet are planted firmly on the floor. Ask the resident to begin standing slowly as you support the chair with your hands. Once standing, have the resident pivot and step backward next to the table. Support the resident as he or she pushes up onto the table. A footstool can facilitate this process.

Exercises to Minimize Back Problems

The risk of back pain and injury can be reduced with exercises that make the back, stomach, hip and thigh muscles stronger and more flexible. The AAOS recommends that conditioning activities such as walking, swimming and bike riding be accompanied by exercises that specifically target these muscle groups. Instructive handouts will help encourage staff to try these muscle strengthening exercises. Better still would be a periodic "exercise inservice" in which staffers actually do the exercises as a group.

Staff should be reminded to discuss the program with their physicians and follow any medical advice before beginning the program. The exercises should be preceded by slow, rhythmic warm-ups or walking, and staff should be instructed to inhale deeply before and exhale during each repetition. The AAOS recommends that the exercises be done every other day.

Pain Recommendations

When acute back pain occurs, the AAOS recommends lying on your back for 20 to 30 minutes and applying ice packs to reduce initial pain and swelling. Physican-prescribed treatment may involve an initial brief period of rest, medication and exercise to prevent recurrence.

Brochure Available

The AAOS offers a free "Lift It Safe" brochure with information about back pain risk and prevention and guidelines for proper lifting. Call the AAOS at 1-800-824-BONES or send a stamped, self-addressed business size envelope to Lift it Safe, American Academy of Orthopaedic Surgeons, P.O. Box 1998, Des Plaines, IL. 60017.

DO:

* Plan ahead for lifting tasks.

* Position the resident or object being moved close to your body.

* Keep your feet shoulder-width apart to provide a solid base of support andmaintain balance.

* Bend your knees, tighten your stomach muscles and use your leg muscles to lift and/or pull.

* Maintain the natural curve of your spine and the proper alignment of your head and neck with your vertebrae.

* When carrying, point your toes in the direction you want to move and pivot in that direction.

* Always assess the resident or object being lifted and get help if the resident is too heavy or the object too awkward to handle alone.

* Remember that being overweight, smoking, smoking, and not exercising regularly places you at increased risk for back injury.

DON'T

* Lift a resident or heavy object in a hurry.

* Bend at the waist when lifting.

* Twist your body when lifting or carrying.

* Attempt to lift an object or person that is too heavy or awkward by yourself.

MUSCLE STRENGTHENING

1

Wall Slides to Strengthen Back, Hip and Leg Muscles

Stand with your back against a wall and place your feet shoulder- width apart. Slide down into a crouch with knees bent 90 degrees. Count to five and slide back up the wall. Repeat five times.

2

Leg Raises to Strengthen Back and Hip Muscles

Lie on your stomach. Tighten the muscles in one leg, raise it from the floor, hold for a count of ten and return it to the floor. Repeat five times with each leg.

3

Leg Raises to Strengthen Stomach and Hip Muscles

Lie on your back with your arms at your sides.

Lift one leg off the floor, hold for a count of ten and return it to the floor. Repeat five times with each leg. If this is too difficult, keep one knee bent and your foot flat on the ground while raising your leg.

Sit upright in a chair with legs straight and extended at an angle to the floor. Lift one leg waist high and slowly return it to the floor. Repeat five times with each leg.

4

Partial Sit-Up to Strengthen Stomach Muscles

Lie on your back with knees bent and feet flat on the floor. Slowly raise your head and shoulders off the floor and reach with both hands toward your knees. Hold for a count of ten. Repeat five times.

5

Back Leg Swing to Strengthen Hip and Back Muscles

Stand behind a chair with your hands on the back of the chair. Lift one leg back and up while keeping the knee straight. Return slowly. Repeat five times with each leg.

EXERCISES TO REDUCE BACK STRAIN

Lie on your back with your knees bent and feet flat on the bed or floor. Raise your knees toward your chest. Place both hands under your knees and gently pull as close to your chest as possible, without raising your head. Do not straighten your legs as you lower them. Start with five repetitions, several times a day.

Stand with your feet slightly apart. Place your hands in the small of your back. Keeping your knees straight, bend backwards at the waist as far as possible and hold for one or two seconds.

Lie on your stomach. Place your hands under your shoulders with your elbows bent and push up. Raise the top half of your body as high as possible, allowing your hips and legs to remain flat on the bed or floor. Hold for one or two seconds. Repeat ten times, several times