INTRODUCTION:

Many times back pain can be directly traced to the ergonomic hazards of your job as a home healthcare worker.  
These hazards may include frequent bending, twisting, lifting, pushing, pulling, and other forceful or repetitive
movements.  Over time, these hazards can cause injuries known as musculoskeletal disorders (MSDs).  MSDs are
caused by repetitive wear and tear on tendons, muscles, related nerves and bones.  They may show up as pain or
injury in the back, neck, shoulders, elbows, wrists or hands.

You can prevent MSDs by applying ergonomic principles to the tasks you perform every day.  Ergonomics helps
you design your job to fit your body – this putting as little strain on your body as possible.
All healthcare workers who lift and transfer patients are at great risk for back injury.  According to the Bureau of
Labor Statistics, nurses and personal care workers (including home healthcare workers -  have a higher incidence
of injury on the job than do miners and construction workers.  In fact, the incidence of injury is more than twice that
of miners and almost 1.5 times higher than construction workers.  These injury rates are mainly due to the hazards
you face when lifting and transferring patients.

But as a home healthcare worker, your risk for back injury is even greater due to repeated lifting and transferring of
patients in the home environment.  You are at additional risk because you are usually working on your own.
When you lift or transfer a patient, the risk of injury to your body is caused by:
The mechanical stress of the lift
The awkward position of your trunk
The unpredictable movements of the patient
An awkward or crowded space

Due to unpredictable movements and the awkwardness of the load, a patient is riskier to lift and transfer than a box
of equivalent weight.  Crowded spaces and cluttered rooms also make it more difficult to lift and transfer patients,
thus increasing your risk for back injury.  The repeated lifting and transferring of patients can result in injury along
the length of the spine, in the neck, the shoulders, and the lower back.

PREVENTION OF BACK INJURY:
Despite all these risks, you can protect your back by following some simple safety principles and by using common
sense.  Your body is built to sustain big workloads, if you use your body safely.  Remember to:
Maintain good body posture.
Use safe body mechanics.
Use protective lifting devices.
ACT safely during the lift and transfer.
Keep physically fit.

PROPER POSTURE:
Maintaining proper posture puts the vertebrae and surrounding muscles in the best position to work safely.  Your
vertebrae are naturally aligned with a gentle curve inward at the neck (cervical area), a curve outward at the chest
(thoracic area) and another curve inward at the lower back (lumbar area).
To align your posture, take this stance: head up, shoulders back, chest out, stomach in, buttocks tucked.  Now,
tense your body muscles, and then relax them with some shaking motions.  Finally, let your body adjust to a neutral
position.  The neutral position is the safest position for your body during work.

SAFE BODY MECHANICS:
Keep a safe, neutral position during work.
Bend at your hips and knees, not at the waist.
Keep loads close to your body.  If you lift 50 pounds with your arms away from your body, the force of the load on
your back will equal 500 pounds.
During the lift, contract your stomach muscles to protect your back.  Use the force of your leg muscles to do the
work – not your back and arms.
Avoid twisting motions.  They misalign your back and increase the risk of injury.  Instead, take small steps and pivot.
Avoid overreaching, whether up, down or across.  Use a step stool to reach something high.  Organize materials
ahead of time for easy access.
Don’t lift objects placed above shoulder height or below the waist. Raise or lower yourself before lifting them, or
place the objects to be lifted at the safe height.
Always keep your working surface slightly higher than waist level to avoid back strain.
Don’t lift a load that is too heavy for you by yourself.  Find a way to lighten the load or arrange for a partner to help
you.

PROTECTIVE DEVICES FOR LIFTING:
Using patient transferring devices greatly relieve lower back stress and reduce s worker injury by:
Eliminating manual lifting and transfers
Reducing the number of patient transfers needed per task.
Eliminating manual transfers in a confined workspace such as a bathroom.
Protective devices include:
Transfer belts
Hoists
Walking belts with handles
Shower chairs
Repositioning devices
Weighing devices.

Your employer will train you to properly use the transferring devices needed for your bog.
Use a transfer belt to assist you when transferring patients, you cannot help you move them.  A makeshift belt can
be made with a sheet.  These belts enable you to hold on to a patient securely during the transfer.
Encourage the installation of trapeze bars and safety bars in areas where transfer occur to help protect you and
the patient.

SAFE LIFTING AND TRANSFERRING:

Because lifting and transferring patients pose the greatest ergonomic threat for home healthcare workers, learn to

  • ACT SAFELY
  • ASSESS
  • CREATE
  • TRANSFER

Assess the Situation for Hazards Before You Begin.
Identify hazards like crowded areas, very heavy loads and situations where special lifting assists are needed.
Observe the patients size, health condition, hearing or visual limitations and his or her ability to help.  A patient’s
assistance can make the difference between a manageable and a hazardous load and a hazardous load.
Talk to the patient through all lifts and transfers.  This helps the patient to feel less anxious and to cooperate with
you.

Create a Safe Workplace.
Create a big enough space for safely lifting and transferring the patient.  Decrease clutter.  Move furniture out of
the way.
Organize your space so that everything you will need is accessible.  Place equipment where it can be reached.  
Make sure the bed and chairs are stable before you begin lifting so that you avoid unpredictable movement.

Transferring the Patient.
Tell the patient what you plan to do.
When necessary, move the patient to the head of the bed for easier access and to align their weight.
Elevate the head of the bed to help you move the patient from a reclining to a sitting position.  Use pillows if
necessary.
Secure transfer belt onto the patient.
Put slip-resistant footwear on patent.
Place the transfer chair close to the bed or patient.
If a wheelchair is used, remove the armrest nearest the patient and remove both footrests so they won’t trip you.
Lock all wheels to control movement.
Move patient to the edge of the bed, couch or chair first to avoid unnecessary bending and awkward postures.  
Move one part of the patient’s body at a time.  First move the head and shoulders, then the buttocks and finally the
legs and feet.
Keep your knees and hips slightly bent, your head up, your back aligned and your stomach muscles contracted –
and stay low.
Get in close to the patient to a standing position by pulling on the transfer belt and straightening your knees.  With
debilitated patients, it may help to rock them back and forth to gain the momentum necessary to reach a standing
position.
With the patient standing, pivot toward the chair by taking small steps and staying close to the patient.  Don’t twist.
Lower the patient into the chair by bending your knees.  A patient may hold onto your waist or shoulders, but not
your neck.
Use smooth movements, not rough, jerky motions.

FITNESS:
As you probably know, keeping your body fit is one of the best things you can do to protect your back Strong
muscles, limber joints and overall fitness can keep you from hurting your back.  To keep fit, follow an exercise
program that includes:
Aerobic activity for at least 20 minutes 3 times per week.
Muscle strengthening exercises
Flexibility exercises.

Aerobic Activity
Brisk walking is excellent for your back.  Swimming is also good if you avoid taking strokes early in your training that
can injure your back, such as the breast stroke and butterfly.  Check with your doctor before starting a program,
especially if you have back problems.

Strength
Exercises that focus on strengthening your upper body, abdomen, pelvis and thighs will help to protect your more
vulnerable back muscles.  Using a weight circuit that isolates the muscle groups is an excellent method for
strengthening your body.  Make sure you breathe in and out evenly while exercising, keep your body in a neutral
posture and repeat each exercise 8-10 times per session.  Here are some exercises you can do at home:

Arms
Starting with arms straight out to the side at shoulder height, do the following exercises:
Make small circles with your arms.
Bend your elbows and bring your fists to your shoulders.
Bring your arms and hands together in front of you at chest height, bend your elbows, and lift elbows and arms
straight up in front of you for several inches and then bring down to chest level.

Abdomen
Lie on the floor with your knees bent, your feet flat on the floor, your arms bent at the elbows and your hands on
either side of your head.
Raise straight upward from your shoulders, keeping your head parallel to the floor so that you are looking straight
up at the ceiling.  Keep your lower back against the floor.
Lower to your original position.  Repeat with legs straight up in the air, hips bent at a 90-degree angle from the
floor.

Legs
Stand with back flat against the wall and feet about one foot from the wall.
Slowly sink down to a 45-degree angle.
Hold 10-15 seconds, then slowly slide back up.

Flexibility
Increase the flexibility of your back from the cervical to the lumbar areas with the following exercises:

Neck
Stand in a neutral posture, with your head facing straight forward.
Turn your head to one side and hold before returning to start – repeat on other side.
Bring one ear toward shoulder and hold before returning to start – repeat on the other side.
With two fingers, tuck chin toward chest and hold before returning to start.

Shoulders
Lie on the floor with knees bent, back pressed against the floor and arms across your chest.
Press shoulder blades together and against the floor.
Hold for 8-10 seconds and then relax.

Legs and Back
Lie on the floor with knees bent, abdomen contracted and lower back pressed against the floor.
Bring one bent knee into your chest with gentle pressure from your hands clasped behind your knee.  Hold for 8-10
seconds before returning to start.
Repeat with other leg.  Then repeat with both knees pressed toward chest and hold before returning to start.

PROTECT YOURSELF FROM HAZARDS
You can protect both yourself and your patient by evaluating the patient’s home for ergonomic hazards, assessing
the patient’s specific handling needs and developing a plan to safely handle that patient.  You can suggest
changes in the home but can’t demand them.  Not all patients agree to move furniture in order to make space more
workable, and some houses are too small to get furniture out of the way.  You will need to devise methods of lifting
and transferring when conditions are not the best.  Use lifting devices to help you.  Use a transfer belt for difficult
transfers.  Encourage the installation of trapeze bars and safety bars to help protect you and the patient.  Don’t lift
anything too heavy by yourself.  If you can’t lighten the load, arrange for a partner to help you.

Remember:
Patients can fall unexpectedly for any number of reasons.  If a patient starts to fall, don’t try to stop the fall.  Grasp
the patient and, getting as close as you can, guide the patient gently to the floor by bending your hips and knees.  
If necessary, get help to lift

SUMMARY
As a home healthcare worker, you are at a very high risk for back injury, due to the ergonomic risks of lifting and
transferring patients.  Many times, just taking a few minutes to follow simple precautions can spare you agonizing
back pain.  Evaluate each home for hazards and find ways to minimize those hazards.  Maintain good posture, use
safe body mechanics and protective lifting devices, ACT safely when lifting and transferring patients, and keep your
body fit so you can protect your back from injury.

It’s your back.  Don’t break it.

Revised 6/1/2016
BACK SAFETY - It's your back, don't break it!
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