Massage & Bodywork

September/October 2012

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PRECIPITATING FACTORS There are a number of key factors that contribute to the occupational injury of nurses. Patient-care activities often require moving heavy loads, performing repetitive movements, standing for long periods of time, working in awkward positions, and working in the same position for long periods of time. These biomechanical challenges are a recipe for musculoskeletal disorder. Nurses often work 12-hour shifts and experience significant physical demands during their workday. Muscular fatigue can set in after many hours, leading to poor body mechanics and overwhelming the soft tissues from excessive demand. Fatigue is a key factor in the cause of many muscular and soft-tissue injuries. Not only are the soft tissues weakened from fatigue, but biomechanical force relationships around the joints change as muscles no longer work in balance with each other. Consequently, reduction of muscular fatigue during these long work shifts should be a key goal. In many cases, the physical demands of nursing activities exceed safety recommendations from the National Institute for Occupational Safety and Health (NIOSH). For instance, NIOSH recommends a safe lifting limit of 51 pounds for men and 46 pounds for women.6 There are no easy solutions for safe methods of lifting patients. However, new strategies, such as the use of lifting devices and lifting teams, are being employed, which decrease impact on a single individual. Lack of training in ergonomics and proper body positioning during work activities is also cited as a frequent cause of injuries. Intervention programs such as "back school" are valuable in teaching good mechanics and can greatly reduce injuries. Seldom mentioned is the detrimental effect of increased obesity on the physical demands placed on workers who must physically assist larger people. For nurses, a preponderance of heavy patients adds significant physical stress to a job that is already demanding. In addition, we have an aging population, along with an aging workforce. These factors all add up to produce intense physical demands that can lead to injury. Nurses often report increased increased disc pressure 2 Lifting patients (especially using poor mechanics) greatly increases disc compression. 3D anatomy images. Copyright of Primal Pictures Ltd. psychological stress as a primary factor contributing to their musculoskeletal injuries. There are clear correlations between workplace stress and the aggravation and perpetuation of musculoskeletal injuries. Once they become injured, nurses often have fear or concern about their ability to stay in the profession. These additional psychological stressors can lead nurses to go beyond their physical limit or ignore the signs of developing problems to protect their jobs. LUMBAR REGION INJURY As mentioned, low-back injury is the most common musculoskeletal complaint affecting nurses. A brief review of relevant anatomy and lifting mechanics sheds light on the reason for this problem. The primary lumbar extensor muscles, such as the quadratus lumborum, erector spinae, and multifidus, carry the vast majority of load during heavy lifting activities (Image 1). However, these muscles are not ideally designed for heavy lifting. The most effective way for a muscle to generate power as it moves a joint is for it to be located farther away from the joint's axis of rotation. Because the lumbar muscles lie very close and run parallel to the spine, they have a very poor mechanical position. As a result, it is easy for them to be overwhelmed. Muscular overuse, such as strains or acute spasm, and myofascial trigger point irritation are common occurrences from overload associated with patient-lifting activities. Lifting patients manually is not only dangerous for nurses, it is inefficient and dangerous for patients. Improper lifting can lead to bruising, dislocations, fractures, skin tears, or tube dislodgment if a patient is accidentally mishandled or dropped during lifting. As a result, several countries have initiated "no lifting" policies for nursing staffs, instead using manual lift-assisting devices to move patients.7 Visit the newly designed Log in. Explore. Enjoy. 107

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