How to protect your back and knees from the rigors of nursing

There’s no doubt that a nurse’s job can be challenging. In addition to the daily demands of treating a multitude of sick patients, documentation, troubleshooting and comforting concerned family members, you must also deal with the daily physical demands of the job. Standing on your feet for long periods of time, moving and lifting patients, performing repetitive movements and standing and twisting in awkward positions can result in injuries to the back, knees, feet and ankles.  

In fact, according to the Department of Labor’s Bureau of Labor Statistics, nurses experience more than 35,000 back and musculoskeletal injuries each year. This places nurses in one of the top fields in which they are most likely to be injured – ahead of factory workers, construction workers and other jobs involving physical labor.  

That's why we've pulled together three physical therapy experts to provide their best advice for nurses or anyone with a job that requires a lot of daily movement: 

• Jessica Niemann, PTA, M.Ed, physical therapist assistant program director, Clarkson College  
• Jessica Wissink, PT, DPT, physical therapist 
• Elisa Bowcott, PT, DPT, physical therapist 

You can help reduce the risk of injury and protect the longevity of your career by following these on-the-job guidelines and tips.  

Shoe wear  

When selecting shoes that you’ll be wearing on the job, realize that you will likely need to give up fashion for fit and comfort. A good pair of tennis shoes with a thick, flexible sole and arch support is my first recommendation. Avoid clogs and always wear shoes with a back to prevent the foot from slipping in the shoe. Shoes designed for running offer the greatest variety of fit and support. Choose between three shoe categories to find the best fit for you.  

• Cushioned shoes are lighter and will provide a good amount of shock absorption. If you don’t need a lot of support through your arch to be comfortable or if you are having trouble with aching in your knees, hips and low back – these shoes might be a good choice  
• Stability shoes are good for a large majority of people. They still offer a fair amount of cushion and shock absorption but also provide some mild to moderate support through the arch. This shoe may “hold up” better than a cushioned shoe. If someone is questioning what category of shoe to choose, this is a safe bet for most people 
• Motion control shoes are good for those that have trouble with shoes breaking down too quickly or need a large amount of support through the arch to be comfortable. Typically, these shoes have less of a “cushioned” feel and are a heavier, more solid shoe. They are designed with extra support through the midline to improve stability of the foot and reduce pronation  

Also, don’t forget to change your shoes out as they begin to show signs of wear on the bottom tread to ensure they provide you the best support and stabilization possible. If you have specific foot concerns, consider seeing a physical therapist or podiatrist for specific shoe and/or orthotic recommendations to accommodate any existing issues.  

Body mechanics 

Proper body mechanics is critical when lifting or repositioning patients to conserve energy and prevent injury. If you are sure that you do not need the assistance of lifting equipment, adjust the bed so that the patient is near your center of gravity  (in line with your belly button) and position your feet shoulder width apart to reduce the amount of strain on the low back. When lifting, maintain an upright posture and bend at the hips and knees, not at the back. Remember to tighten your abdominal muscles when beginning the lift and exhale as you progress through the lift to stabilize and protect the back.  

Avoid twisting whenever possible to prevent sudden jarring of the spine. Instead, shift your entire body from left to right, similar to a lunging motion. 

Also avoid heavy lifting and repositioning when you are physically tired and/or are near the end of a long shift. Muscle fatigue can result in the use of poor body mechanics and is a common cause of muscular and soft tissue injuries. 

Use of available lift support devices 

When you’re busy and feeling rushed, it’s easy to dismiss the use of help and try to do it all by yourself. But think about your longevity in the field. While you may be able to complete the task without noticeable injury, over time, constant lifting will create wear and tear on the joints and will eventually catch up with you.  

Every time you lift, you also expose yourself to the risk of developing small tears in the discs and end plates of the spine. Over time, these tears will grow scar tissue, which can block the flow of nutrients. This can result in quicker deterioration of the discs, which increases the likelihood of injury such as muscle strain or herniated disc. 

A good rule of thumb, when you need to lift 50% or more of a patient’s weight, it’s time to seek help. Of course, this rule will need to be adjusted depending on the weight of the patient.  

Whenever possible, get someone to help you or use lifting assist devices that are available to you such as transfer boards, ceiling mounts and mechanical lifts. It may require more time, but in the end, taking a little extra care will pay off in avoiding the need to take time off to “nurse” injury later on.  

Active lifestyle 

The importance of taking care of your own health including your diet, sleep, drinking enough water, maintaining a healthy weight and exercising, cannot be overlooked. Being just 10 pounds overweight increases the force on your knees by 30 to 40 pounds with each step. In addition to getting 30 minutes of cardiovascular exercise three to five times a week, you should also consider performing regular core and hip strengthening exercises, which will help reduce the stress on your back and knees. This video describes two exercises that strengthen both the core and hips. 

Remember, the key to good joint health is to prevent an injury from occurring in the first place. Once an injury occurs, this expedites the process of wear and tear on the joint and also increases the risk of reoccurring injury to the same area.