Research Medical Center
August 22, 2013

William Rosenberg, MD, neurosurgeon in the Center for the Relief of Pain

by Linda Friedel | Reprinted courtesy of KC Nursing News

Sometimes nurses are the patient. Nurses make up a portion of John Brackle’s case load. He has more than a few.

“The nurse job is not easy,” said Brackle, DPT, outpatient supervisor for the therapy clinic at Overland Park Regional Medical Center. “They work 12-hour shifts three days in a row. Ninety percent of it is on their feet.”

Nurses come to Brackle for other kinds of pain, but back pain is common, he said. Nurses try to avoid back pain, he said. They are trained to know the proper way to lift and transfer, he said. However, it is difficult to sustain that know-how hour after hour, day after day during long shifts. They bend, lift and perform physical work. Their body gets fatigued by the third shift, he said.

“It’s hard to maintain the proper position,” Brackle said.

The spine, pelvis and sacrum are the affected areas. Once a nurse starts to forgo using proper techniques for lifting and moving, it causes muscle imbalance, he said.

“You create muscle imbalances, which in turn can cause malalignments in those joints,” he said.

A nurse will start using compensatory strategies throughout her day, using other muscles or improper muscles, he said.

“That’s where the pain comes out,” Brackle said.

Brackle tells his patients that his job is not to treat the pain or symptoms, it’s fixing the root of the problem. Usually the symptoms will fix themselves, he said.

“It’s a whole body thing,” Brackle said. “There are multiple joints involved.”

Backs can start hurting when walking, Brackle said. What is going on at the foot and ankle places stress on hips and backs. If one is off, then there is pain in that entire system, he said.

“It’s never a one-joint system,” he said.

Nurses often require two weeks of therapy to restore muscle imbalances. Brackle helps patients with exercises to maintain stability. He educates them on the proper training for bending, squatting, and function.

“It’s about finding ways they use their bodies every day and trying to make it more efficient, reducing stress on their body,” he said.

Brackle offers a few tips for preventing back pain. Take breaks. Sit down and rest when you can. Don’t bend with your back. Bend with your knees. Watch your posture when you are standing and sitting. Sit upright. Make sure your work station is ergonomically efficient.

“Don’t be afraid to ask for help when assisting heavy patients,” he said.

Shoes count. It is not the brand that makes a difference, Brackle said. It’s getting the proper shoe that provides good stability and good ankle support. Go to a shoe store where someone can fit you for a proper shoe. The goal is to stabilize the ankle, he said.

“Every problem the individual has is a problem that is individual to them,” Brackle said.

Advocate for equipment, such as lifts and devices. Then use the equipment, he said. There is no sense in putting strain on yourself or the patient, he said.

“When in doubt, get some help and use the equipment,” Brackle said. “Over time that can set you up for future injuries. We really recommend those proper mechanics now to decreases your risk of future injuries.”

Brackle believes in preventative care, he said.

“If you wait for pain, it’s too late,” he said. “If you wait until you have the pain, you already hurt yourself.”

Exercise is beneficial in preventing back pain, Brackle said. Any exercise is helpful, especially cardiovascular workouts. If you are not sure what kind of exercise is best, contact a personal trainer or physical therapist to learn how to safely exercise, Brackle said.

“Exercise helps with stability within the joints,” he said. “It’s going to help you perform your everyday task.”

Stretch before and after shifts. Exercise on days off to build stamina, strength, stability and endurance, Brackle said. Don’t forget to rest.

“Rest is just as important as working out,” he said. “Let your body heal. That way you’re ready to go for the next shift. Be sure you’re getting an adequate amount of sleep.”

Danny Laughlin, DPT with Laughlin Performance & Physical Therapy, sees many patients for back pain, including nurses. Laughlin says he makes sure his patients do some form of regular strength training. Like Brackle, Laughlin says posture is key in preventing back pain.

“There can be a lot of different causes of back pain,” Laughlin said.

Laughlin recommends consulting a physical therapist or massage therapist for back pain. Laughlin Performance & Physical Therapy does not offer massage therapy, but he refers patients out to others.

“Massage is a great tool in the overall management and taking care of your body,” Laughlin said. “Some people swear by it. It’s another tool for the tool belt in management of back pain.”

Laughlin uses manual therapy to correct back pain, then helps patients to develop a home program to manage it. Part of the home program is to address findings right then and there.

“We’ll continually alter and build their home program,” he said.

Creating a sustainable program is key in preventing back pain, Laughlin said. Regular stretching and exercising can make a very big difference in risk for low back pain, Laughlin said. No matter what the profession, he recommends five- to 10-minute workouts throughout the day during down time.

“It can do a lot for you to keep the right group of muscles during your shift,” he said. “We write little programs like that — five-minute desk workouts, keeping the right muscle groups and blood flowing. Keep the low back and hips loose during the day.”

William Rosenberg, MD, neurosurgeon in the Center for the Relief of Pain at Research, said smoking has been shown to contribute to degenerative back disease. Studies show that smokers have worse-looking spines, he said.

“The disc is ordinarily an oxygen-poor environment,” Rosenberg said. “You don’t want to deprive it of the little oxygen it gets. That accelerates the degenerative process.”

Maintaining optimal body weight also helps reduce back pain as does proper biomechanics such as lifting, he said. The weight of a large abdomen weighs the spine down from the front. Muscles in the back have to fight harder to keep you upright, he said. Rosenberg recommends walking over running, but if you love to run don’t stop, he said.

“Live right and eat right,” Rosenberg said.

Back pain is cumulative with life, Rosenberg said. Middle-aged people tend to have more back pain, he said. Then again, some people do not experience back pain. Look at long-term career planning, aiming at direction for something better for the back, he said. Because of trends in fewer innovations and expenditures in healthcare facilities today, Rosenberg said the single most important thing nurses can do to not get injured and to stay healthy is using the proper biomechanics, particularly with lifting. With time pressures and staffing pressures, sometimes nurses want to get the job done. Instead of asking to get enough people to move an obese patient, they want to do it themselves.

A life-long change may occur based on a decision that did not have to go that way, he said.

“An ounce of prevention is always worth a pound of cure,” Rosenberg said. “Take the time to do it right and take care of yourself.”