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17 September 2008

Nursing doesn’t have to be a pain in the back!

By Dr Kevin Lau
Featured in Singapore Nursing Journal

As a nurse, you probably bend and lift patients and equipment many times a day. This repetitious activity makes you vulnerable to a common occupational hazard: back, neck, or joint injury. Of the most common problems I see in practice is low back pain due to degeneration of the spine. Any of the spinal discs can be injured or undergo degeneration; but because of their location, discs in the lower spine are subjected to the greatest weight-bearing stress and are most likely to slip or be compressed.
What is Disc Degeneration?

As we grow older and less active the tough elastic tissue of the disc begins to lose its fluid. The loss of fluid thins and weakens the disc making its function as a shock absorber for the spine ineffective.

Although the discs BEGIN to degenerate after about 25 years of age, everyone SHOULD be able to complete his entire life span with no discomfort from this aging process. It is when the degeneration speeds up beyond normal that a person is likely to have trouble. The fast-weakening disc begins to bulge like a weak wall on an automobile tire and gradually protrudes into the spinal canal to press against nerves and cause pain.
What Causes Speed-Up of Degeneration?

Even young persons may suffer from disc degeneration due to poor nutrition. This is not malnutrition in the sense of what we eat. It has to do with starved disc tissue. Every cell of the body must be fed correctly in order to maintain its proper function...and the disc is no exception. The disc must absorb its nutrition from the fluids which surround it.

The disc may get some of its food through osmosis, but adequate absorption of nutrients takes place when the disc is in a state of accordion-like motion. When in motion it squeezes the surrounding fluid in and out, much like the action of a sponge. Some of the factors affecting disc nutrition are in-activity, poor posture, stress, weak muscles, injuries, muscle spasms, and fixation (two adjoining vertebrae moving as one).
What Can Be Done?

Fortunately, 95% of all disc cases can be managed through modern chiropractic methods. Years of research and experience in disc cases qualifies the doctor of chiropractic as the doctor of choice in acute and chronic disc problems. In my practice I truly believe in teaching patients how to become independently healthy and strong. The key to preventing the low back is to strengthen core stability muscles, such as you abdominals. While the abdominals conjures up images of a six pack, the most important core stability muscle is the transverse abdominus, which acts as a natural weight belt, keeping your insides in. This muscle is essential for trunk stability. Here are a few core stability exercises to help strengthen the low back.

Exercises for Developing Torso Stabilization

1. Training the Core: This exercise involves recruiting the transversus abdominis, pelvic floor and deep muscles of the lower back. Breathe deeply while sitting in a chair or lying down with the knees comfortably bent. When exhaling, visualize pulling your navel toward your spine and contracting your pelvic floor. Activation of the pelvic floor helps co-contract abdominal stabilizers. If you put your fingers on the inside of your hip bones, you should feel this contraction. Be aware that you want to keep the rectus abdominis and glutes relaxed. Once you feel comfortable with this exercise, work on intervals of holding the pelvic floor/transversus contraction while breathing normally. Begin with three sets of 10-second holds and progress from there. Activate these muscles as you carry out other exercises.

2. Press and Reach: Lie on a mat face up, placing your hands at your sides. Bend your legs and lift them off the floor so your knees are aligned directly over your hips. Slowly lower your feet toward the floor in an alternating fashion. You can increase intensity by straightening your legs as you lower them and/or lifting your arms off the floor (try reaching one or both arms above your head). Perform 12 to 15 slow repetitions. Note: The goal is to control your low back from arching toward the ceiling; focus on keeping your navel parallel to your spine.

3. Side Bridges: With knees bent, lie sideways on a mat, making sure your shoulders, hips and knees are aligned. Lift your hip off the floor, propping yourself onto your elbow and the side of one knee. Your elbow should be directly under your shoulder. Make sure you are not allowing yourself to sink into your supporting shoulder. Hold this position for up to one minute while breathing normally. Try two to three sets and repeat on the opposite side. To progress, straighten your legs, propping yourself onto your feet. Note: A common postural mistake is to gain stability by pushing your hips behind you. Concentrate on maintaining proper alignment.

4. Body Ball Crunches: If torso curls are your true passion, try them on a body ball. Using a ball is much more unstable than using the floor. Therefore, stabilizers will come into play as you try to control your movement. Sit on the ball, then walk your feet out until the ball is under your low-to-mid-back. Move through the torso curls in a slow, continuous motion, lifting your shoulder blades off the ball while your lower back remains on the ball. Guard against pulling on your head and neck. Perform one to three sets of 12 to 15 curls.
Prevention key to a healthy spine

The greatest tip I can offer to anyone suffering from low back pain is to not ignore it! Pain is necessary to prevent further damage into joints and alerts us that something is not right. As in most cases, prevention is to key to having a healthy spine as you head into your older years. Timing is critical in muscle, ligament, and joint injury because healing begins immediately after the damage. If activity is not started soon, usually between two and six weeks, then injured tissues may not recover their flexibility, strength, and ability to function (i.e., to do what they are designed to do). After losing flexibility and function, the healed tissues become weak. Even small movements can then lead to re-injury and to a chronic back problem and eventually degeneration. Just as your teeth need to be brushed daily to keep it in top notch, your spine also requires its maintenance. A large number of spinal problems I see in practice could have been prevented with proper treatment immediately after the initial injury.

Protect yourself from strain and disability by following the simple tips.
Pain is a warning sign. Your body is telling you that you have already or are about to cause damage. If what you are doing hurts then STOP. Do not try to push through the pain.

Regular exercise is important to help maintain mobility and strength. It should be done without pain and it should be done regularly. Brisk walking, swimming and cycling are all excellent exercises, but you should do what is suitable for you and what you enjoy.

You should warm up your body before any form of physical activity, whether it is nursing, sports or gardening. This prepares the body for action and helps to prevent injuries.

Cooling down and stretching after exercise or physical activity is just as important as a warm up. Never "bounce" your stretches and do it gently without pain.

You don't have to lift something heavy in order to hurt your back. Picking up something light incorrectly is far more likely to hurt your back than picking up heavy objects correctly. Lifting things away from your body is also likely to cause damage. When you pick up anything, no matter how heavy, get it as close to your body as you can and keep your back as straight as you can and don't twist with it.

Whether you are at home, at work or in the car, prolonged sitting causes load on the discs and weakness of the muscles. Get up and move every now and then, even if it is only for a minute. The body is designed for movement not for slouching in front of the TV or driving for hours on end.

So called "comfortable chairs" do not do your back any good. They are usually too low, too soft and the seat is too long with a rounded back. They force you to slouch and sit awkwardly which puts stress on your back. Choose a chair that is supportive, allows you to sit up correctly with your feet flat on the floor. The right bed is also important. Beds can be too hard. The base of the bed should be firm and the mattress should be soft enough to mould to the contours of your body but be firm enough to give you support in the right places. Futons are not good for most backs and the word "Orthopaedic" when applied to beds means absolutely nothing.

Sleep in a comfortable position. On your side in the "foetal" position is usually the least stressful on your back. Sleeping on your front puts most stress on your back and neck and can lead to trouble. Using a pillow of the right height which supports the neck is also important.

All drugs have side effects so they should be used wisely. The use of pain killers (paracetamol, cocodomol etc.) and non steroidal anti-inflammatory drugs (nurofen, brufen, diclofenac etc.) only helps to mask the symptoms and not to sort out the problem.

If you have a long term problem, whether it is just "niggly" or disabling, or if you have a recurring problem, then chiropractic treatment can probably help. Chiropractors can usually give you marked relief from pain and discomfort and improved quality of life as well as decreasing the likelihood of a recurrence.

Being a nurse is a rewarding and life changing role, but it also has its physical stresses. For a nurse to be successful in being a caregiver it is essential that you take care to the most important person in the world… YOU! For it is only when we are healthy, happy and pain free are we as health professionals able to better serve our patients.

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