US Dept of Labor. Bureau of Labor Statistics. April 2002. Number and Median Days of Nonfatal Occupat

1
Why Patient Lifting
Leads to Spinal Injury in Nurses
Anne Hudson, RN, BSN
Healthcare workers combined suffer more
musculoskeletal disorders than any other
occupation .
Work-Related MSDs for 129 Occupations
Truck drivers 1st 45,327
CNAs 2nd 44,660
RNs 6th 12,074 62,332 MSDs
to HCWs LPNs 18th
5,598 138 above first place
US Dept of Labor. Bureau of Labor Statistics.
April 2002. Number and Median Days of
Nonfatal Occupational Injuries and Illnesses with
Days away from Work Involving Musculoskeletal
Disorders by Selected Occupations, 2000. Table
12, p1. www.bls.gov.
2
Nurses lift an estimated 1.8 tons per shift
83 of nurses work in spite of
back pain 60 of nurses fear a disabling
back injury
Kate Tuohy-Main. 1997. Why Manual Handling
Should be Eliminated for Resident and Carer
Safety. Geriaction. 15,10-14. Karen
Worthington. Dec 2001. Stress and Overwork Top
Nurses Concerns. American Journal of
Nursing. 101(12), 96. Photo Bernice Owen.
February 1993. "Back Stress Isn't Part of the
Job. American Journal of Nursing. 93(2),
48-51.
2
3
38 of nurses suffer work-related back injuries
requiring time away from work 12 of nurses
considering leaving nursing due to low back pain
at average age 39
Bernice D. Owen, PhD, RN. April 1989. "The
Magnitude of Low-Back Problem in Nursing."
Western Journal of Nursing Research. 11(2),
234-242.

• Manual patient handling
• Extremely hazardous Substantial risk of
  causing a low-back injury whether with one or
  two patient handlers."

W.S. Marras, K.G. Davis, B.C. Kirking, P.K.
Bertsche. 1999. "A comprehensive analysis of
low-back disorder risk and spinal loading during
the transferring and repositioning of patients
using different techniques." Ergonomics. 42(7),
904-926. 3
4

National Institute for Occupational Safety and
Health
Workplace Safety and Health
3,400 N Established Safety
Limit for Compressive Force to Lumbar Spine

D.W. Badger. 1981. Work Practices Guide for
Manual Lifting. Pub No 81-122. US Dept of Health
Human Services, Public Health Service, Centers
for Disease Control and Prevention, National
Institute of Occupational Safety and Health,
Division of Biomedical Behavioral Science.
124-125.
N Newton, unit of force required to impart
acceleration to mass
5
Effect of Forward Flexion on Lumbar Discs
.
.
of Increased Pressure
Relative loads on lumbar discs during various
positions
Lying Standing Bending Bending
Bending
slightly arms out arms out twisting
Pressure to discs Lowest 2
x 3 x 4 x 5 x pressure
lying
down
of lying down
http//www.spineuniverse.com/displayarticle.php/ar
ticle1500.html
6
Excessive force can injure discs over time
Force of 100 lbs to lumbar spine
with lifting 10 lbs held away
from body
Force of 100 lbs
10 lbs
7
Forward bending and lifting Never safe
Spinal discs especially vulnerable maintaining
weight of upper body in bent posture plus lifting
weight of patient
8
Forward bending and lifting - Required with
manual patient handling

• Lateral Transfer Said to cause more nurse
  injuries than any other single patient move

9
Compressive Forces to Lumbar Spine
Pull Up in Bed Two-person Hook (under axilla)
5,655 - 6,069 N Thigh shoulder 6,480 -
6,570 N Draw sheet 3,820
- 3,903 N
Easiest method exceeds 3,400 N safety limit
One-person hook 9,172 N
Approaches point where 90 of population
can be expected to suffer vertebral
endplate fractures
W.S. Marras, K.G. Davis, B.C. Kirking, P.K.
Bertsche. 1999. "A comprehensive analysis of
low-back disorder risk and spinal loading during
the transferring and repositioning of patients
using different techniques." Ergonomics. 42(7),
904-926.
10
Safe lifting limit 51 lbs for men, 46 lbs for
women One-time lift of 75 lbs high risk for MSD
hazard -


NIOSH
Three decades of body mechanics have not reduced
back injury among nurses because patient lifting
exceeds safety limits for weight compressive
force to spinal discs
One-Person Hug Lift 6,336 N
Two-Person Lift with Gait Belt4,600 to 4,895 N
W.S. Marras, K.G. Davis, B.C. Kirking, P.K.
Bertsche. 1999. "A comprehensive analysis of
low-back disorder risk and spinal loading during
the transferring and repositioning of patients
using different techniques." Ergonomics. 42(7),
904-926.
11
Pathophysiology of Cumulative Trauma Injury
to Spinal Discs
Discs may be injured by heavy lifting over time
without perception of pain to a point!

• Absence of nociceptors in nucleus of disc where
  
• injury typically begins
• May be no warning signs as injury increases
• Severe pain may be first sign of extensive
  injury
• reaching nerves in annulus of disc

U.S. Department of Labor. Occupational Safety
and Health Administration. Federal Register. 29
CFR. Part 1910. Ergonomics Program Final Rule.
Section E. Disorders of the Low Back.
November 14, 2000. Pp. 68468-68483. Online
http//www.access.gpo.gov/su_docs/fedreg/a001114c.
html. Scroll down to OSHA, Rules. Select pp
68461-68510. Scroll down to p 68469, Sec E.
12
Exceeding tolerance limits of compressive forces
to spinal structures can lead to

• Serious injury
• Disability
• Loss of Career

Many hospitals do not provide Permanent Light
Duty for work-injured nurses
/Ex-
RN
Use of lift equipment and friction-reducing
devices reduces effort and prevents injuries
Safer for nurses. Safer for patients.
Work Injured Nurses Group USA. www.wingusa.org.

8-4-03