Columns, Operations, Patient Care, Trauma

Protect Your Back, Protect Your Job

All current literature regarding the prevention of back injuries seems to suggest the same thing. They often point to stress as a leading cause and recommend you find ways to reduce or eliminate it at work and at home. Well this is EMS, and that just isn’t going to happen.

Back pain is the second most common reason for a visit to the doctor, the fifth most common cause of hospitalization and the third most common reason for surgery. The most common type of back pain is a muscle spasm that occurs when your back spontaneously locks as a result of an awkward movement. The muscle spasms can be painful, annoying and debilitating. But, most of all, they demand your attention. If this happens to you, take it seriously because the chances for reoccurrence are not in your favor. At least half of us will suffer a repeat episode of similar pain within the same year.

If you’re looking for statistics on work-related back injuries in EMS, you don’t need a study. Just ask around. I bet you’ll find that pretty much everybody at some time or another has had a “bad lift” experience. You also have a good chance that any one of them has a Ibuprofen in their lunch cooler. Veterans in EMS gradually begin to taper off after five to 10 years, and few services are left with long-standing, experienced staff. This is a direct result of work-related back injuries.

Loosen up
The best approach to the prevention of back injuries is to identify its leading work-related contributors: Force, repetition, posture and stress. Simple lifestyle changes might be all it takes to extend your career in EMS and make it possible to lift your grandkids someday without wincing in agony.

For starters, I realize that regular strength training is a major lifestyle change and many people just aren’t ready to commit to that. If you fall into this category, more realistic alternatives can help you with overall back flexibility and strengthening of the key “patient lifting” back muscles. Try the next three back stretches at least three times a week either before or after your scheduled shift, and try the last one while at work. You should see a dramatic improvement in your flexibility and range of motion.

The Partial Sit-up: With your feet planted on the floor, slowly raise your head and shoulders just off the floor and hold that position for 10 seconds.

Knee-to-Chest Raise: Lie flat on your back. Slowly pull your knees toward your chest and hold it for 10 seconds. Repeat this up to 10 times.

Press-up: Lie stomach down with your pelvis touching the floor while propped up on your elbows keeping your arms close to your shoulders. Press up just enough to feel the stretch without pain and hold for 10 seconds. Repeat this up to 10 times.

Standing Back Extension: Clasp your hands together and raise them straight up over your head as high as you can, elongating the spine. Get on your tippy toes and really reach. Hold that position for 10 seconds. Your partner will think you’re nuts, but it will help stretch and realign your spinal column and its muscles. Do this after every significant or awkward lift.

Stretching isn’t just good for flexibility. It also encourages your muscles to relax. Major League pitchers are prone to pulled ligaments as a result of repetitive motions around their throwing arm and have to stay “loose” between innings to keep the muscles relaxed. The same is true with EMS and the types of lifting situations we are prone to in the field. Keeping “loose” between shifts reduces the wear and tear associated with repetitive lifting.

Mitigate the risks
Having said that, it’s just as important to mitigate the risk of back injury by taking care of your body and listening to what it tells you. If you’re lucky, your station has a swimming pool or 24-hour masseuse. But if you live on planet Earth like the rest of us, you probably spend countless hours in the close quarters sitting on cloth bucket seats. If you belong in the second category, you will benefit from the following tips:

  • Every 15 minutes, get out and stretch or walk around the truck for 30 seconds or so to allow your butt to wake up. If nothing else, it will help lower the risk of deep venous thrombosis and irritation of the sciatic nerve.
  • Drink lots of water! What does that have anything to do with preventing back injuries? When you’re dehydrated, your disks are reduced in volume and height. This brings them closer together. Disk compression leaves you more prone to disk bulging, and that is a bad thing. Evidence points to poor water intake and dehydration to greater risk of back injuries and sciatica. Men should consume roughly 3 liters (about 13 cups) of water per day and women about 2.2 liters (about 9 cups) of water per day.
  • Ask for lifting help. Don’t be that partner who insists on lifting the foot of the stretcher and carrying the 400-lb. patient without assistance. You’re not impressing me. When I see this I think, “That’s too bad, I really liked working with you.” There’s absolutely no shame in asking your partner, a police officer or firefighter to grab an end or help with a “four-point lift.” I see it as humble and intelligent, and you should too.

Those of us in EMS need to pay special attention to body mechanics on every lift and even closer attention to the warning signs before you find yourself looking for a new line of work. We need to keep our lifting techniques in check and covet one of our most vital biomechanical assets — our back. Most importantly, stay loose out there!

References
American Association of Neurological Surgeons; “Low Back Pain: Getting to the root of the problem”; Includes the National Health and Nutrition Examination Survey III
http://www.spineuniverse.com/displayarticle.php/article1455.html

Zhao F, Pollintine P, Hole BD, et al: “Discogenic origins of spinal instability.” Spine. 30(23):2621-30, 2005.

Dept. of Anatomy University of Bristol, Journal of Bone and Joint Surgery – British Volume, Vol 88-B, Issue SUPP_III, 378-379. “Spinal Instability Following Disk Dehydration and Injury.” F.D Zhao; P. Pollintine; A.S. Przybyla; P. Dolan; and M.A. Adams

Mayo Clinic: “Water: How much should you drink everyday?”
http://www.mayoclinic.com/health/water/NU00283

Mayo Clinic: “Back Pain at Work: Preventing aches, pains and injuries.”
http://www.mayoclinic.com/health/back-pain/HQ00955

U.S.National Library of Medicine: “How to Prevent Back Pain: Reference Summary.” http://www.nlm.nih.gov/medlineplus/tutorials/howtopreventbackpain/htm/index.htm