Musculoskeletal disorders

Musculoskeletal disorders in general account for 40% of all NHS sickness absence, according to NHS Employers. The Health and Safety Executive (HSE) reports that in 2019-20 there were 63,000 new or long-standing cases of these conditions in the health and social care sector in England, Scotland and Wales. Across all sectors, almost 9 million working days were lost to work-related musculoskeletal disorders in the same period.

Organisational culture and health and safety climate in the workplace and human factors all contribute. Older workers are at greater risk than their younger colleagues.

A nurse’s back problems may also be the physical manifestation of other, less obvious issues that together indicate a working life spent under pressure.

Nurses’ risk factors

As part of 2020’s Back Pain Week, BackCare produced an education and prevention resource called Back Pain in Nursing, which lists the risk factors that can lead to back problems.

They include:

Some or all of those pressures will be familiar to many nurses, so the high prevalence of back pain in the profession is hardly surprising.

The situation is improving though. Jacqui Smith is editor of The Guide to the Handling of People, published by BackCare and in its sixth edition. A physiotherapist by background, she says there is greater awareness in the nursing profession of safe moving and handling techniques.

The equipment available to support nurses and carers in moving patients has also evolved, according to Ms Smith.

‘This has made the delivery of care that involves moving and handling potentially much less hazardous,’ she says.

But she distinguishes ‘safer’ practice from ‘safe’, suggesting there are no absolutes. The risk of injury remains where staff are not properly trained, or where equipment is not immediately available.

The consequences of back injury can be far-reaching. BackCare says that as well as having to manage the pain, possibly long term, people affected by back injury are more prone to depression, anxiety and sleep disorders.

Know your back: 10 top tips

The Chartered Society of Physiotherapy (CSP) says fresh research is constantly challenging beliefs about back pain. Here are ten things you need to know:

1 Your back is stronger than you think Back pain is common and rarely dangerous. ‘The spine is a strong and stable structure and not easily damaged,’ says the CSP

2 You rarely need a scan – and it can do more harm than good Seeing perfectly normal changes can cause people to avoid helpful activities such as exercise

3 Avoid bed rest, stay in work and resume normal activities gradually Prolonged rest for people with lower back pain leads to higher levels of pain and greater disability

4 Do not fear bending or lifting Bending and lifting can lead to a strain or sprain but it is important to get the body used to moving in ways that are comfortable and efficient

5 Exercise and activity reduce and prevent back pain Start slowly and build up the amount and intensity of what you do. And do not worry if your back is sore to begin with

6 Painkillers will not speed up your recovery and there is no strong evidence on their benefits ‘Exercise is considered the preferred option,’ says the CSP

7 Surgery is rarely needed A non-surgical option that includes exercise and activity should always come first. In the medium- and long-term, results for back surgery are no better than for non-surgical interventions

8 Good quality sleep matters Sleep reduces stress and improves well-being ‘making you less susceptible to the triggers of pain and helping you to cope when it does occur’

9 You can have back pain without any damage or injury Physical or psychological factors can cause back pain, and often a combination of the two, but ‘all pain is 100% real’

10 There is no need to worry if your back pain doesn’t clear up quickly But if it’s not better after 6-8 weeks, seek help from your GP or physiotherapist

Source: Chartered Society of Physiotherapy

Managers’ role in prevention

The RCN, in its guidance on moving and handling, highlights the legal requirement for managers to provide a safe working environment.

And the HSE says reducing the risk of back injury begins with identifying causes and deciding whether they can be avoided or changed.

Some may regard injury prevention through the learning of safe moving and handling techniques as a one-off box-ticking exercise. But the COVID-19 pandemic laid bare that fallacy, says Ms Smith.

Treating huge numbers of sick patients demonstrated that correct technique evolves according to changing need. Learning must be continually updated to ensure the protection of staff and patients.

‘Nurses working in intensive care, for instance, had to learn new moving and handling skills. Proning patients – that’s high risk. You’re turning a poorly person from their back on to their front and, later, back again. You’re managing tubes and lines and ensuring you don’t put the patient at risk of shoulder injury, brachial plexus injury or skin injury.

‘There are many aspects. That’s an example of why moving and handling is a clinical skill.’

And, like any other clinical skill, moving and handling ‘is absolutely integral’ to good patient care, Ms Smith says.

She is keen to emphasise the benefits of correct moving and handling undertaken with the right equipment: staff are at less risk of musculoskeletal harm and patients are protected from accidents and injury.

‘What nurses often forget is that manual handling is not just thinking about themselves and how they keep safe but also what’s safest for the patient. You have to have this balanced approach.’

What characterises workplaces that have such an approach?

‘Organisations where you have up-to-date policy and proper systems for equipment, training, communication and risk assessment are much more successful at underpinning good practice,’ says Ms Smith.

The good news about back pain is that up to 98% of people recover from it quickly, according to the Chartered Society of Physiotherapy (CSP). Most back pain is treated successfully by staying as active as possible and taking over-the-counter painkillers if needed.

Do not ignore symptoms

But the CSP advises to consult a doctor if you experience the following symptoms in conjunction with back pain:

Although treatment for most back pain is relatively simple, to prevent future episodes it is worth considering pressures and stressors at home and at work.

The NHS advises that relaxing and staying positive is crucial in preventing back pain or stopping it becoming worse. The NHS website offers suggestions on ‘stress-busting’ and breathing exercises, as well as a video on simple back stretches.

How to reduce the risk of back injury among staff

Clinician training is essential to ensure equipment is used properly

Picture credit: Charles Milligan

The Manual Handling Operations Regulations place clear obligations on employers to ensure safer patient handling. They state managers must:

• » Assess the risk of back injury at work

• » Reduce that risk as much as practically possible

• » Provide training on safe practice

• » Supervise staff to ensure compliance

RCN moving and handling guidance

This says risk assessment should be generic and individual. Generic assessment covers the workplace and working environment – for example, safe staffing and the physical environment. Specific risk assessment looks at factors such as equipment needed for a particular patient and the number of staff required to support that patient.

Input from staff

The Health and Safety Executive recommends managers ask for input from staff about useful changes to workplaces and practices, and encourage workers to report problems at the first opportunity.

Exercises to help you avoid back problems

BackCare suggests the following to help prevent back injury and boost flexibility, strength and endurance. Start and end with stretches that target the back and neck.

• » Deep breathing reduces stress and helps you to feel calm and relaxed

• » Planking, usually for 15, 30 or 60 seconds or more, strengthens the core

• » Squats strengthen the whole body but by increasing strength around the knees and hips, they can also reduce back injury risk

• » Calf raises increase strength and flexibility

• » Lunges strengthen the legs and back

• » Hamstring curls help strengthen the legs

• » Plié squats – with feet a little more than shoulder-width apart and toes turned out – exercise all the lower body

• » Seated buttock clenches build strength in the buttocks as well as the core muscles

• » Shoulder shrugs, usually with dumb bells or a barbell, help develop back and neck muscles

Refer to BackCare resource: tinyurl.com/back-care-booklet

Find out more

NHS back pain treatment advice tinyurl.com/nhs-back-advice

BackCare charity backcare.org.uk

HSE: Human health and social work activities statistics in Great Britain 2020 tinyurl.com/hse-2020-stats

The Guide to the handling of people (Sixth Edition) tinyurl.com/HOP6-guide

RCN guidance on moving and handling tinyurl.com/rcn-moving-handling

HSE: Back pain advice tinyurl.com/hse-back-advice

Manual Handling Operations Regulations tinyurl.com/mhor-hse

HSE case study: Health services, equipment fit for purpose hse.gov.uk/msd/healthservice.htm

NHS Employers guidance on musculoskeletal health in the workplace tinyurl.com/nhsemployers-musculoskeletal