Hurt Back? Here Are Some Options

Lynda Lampert, RN

Are you part of the 52 percent?

According to the American Nurse Association, 52 percent of nurses report experiencing chronic back pain. Unfortunately, 12 percent of nurses report they are leaving the profession due to back problems, further exacerbating the nursing shortage and short staffing issues. Making the matter worse, 38 percent of nurses reported taking time off due to back and musculoskeletal injuries.

Since back problems in nurses are so prevalent, you may wonder what the options are for treatment. Are you going to need back surgery? How effective are chiropractors? Can physical therapy really help? To answer these questions, three experts in each field weighed in with their opinions on how they treat back injuries, how they can help you, and how you can use their skills to help you get back on your feet again..

Physical Therapy

"Physical therapy is the best way to treat back pain," stated Dr. Adrian Miranda by phone interview. Adrian Miranda, PT, DPT, OCS is a physical therapist, Orthopedic Certified Specialist, Director of Clinical Residency Education TOURO College, Doctoral Candidate at Texas Tech University, and host of Move Well TV, available on Roku, YouTube, and his website, adrianmiranda.net.

The causes of back pain in nurses are multifactorial. "Nurses are on their feet all day long. The spine is an accordion and standing squeezes all the fluid out of it. The discs get compressed. The facets joints are affected, and supporting muscles get shortened," explains Dr. Miranda

Back pain can actually be caused by several issues in the mechanics of the lower body. Dr. Miranda states, "Weak core muscles are a chronic problem we see in lumbar back pain. We also see weak ankles and gluteal muscles. These other muscles share responsibility and help protect the spine. If the supportive muscles are weakened, the muscles available will be used, such as spinal muscles.".

He recommends some ways to combat this situation. "First, get into a horizontal position whenever you get the moment. Second, perform a cobra stretch whenever you can." This stretch comprises laying flat on your stomach and resting your body on your elbows. As you become more flexible, you can move to your hands and give the lower back a full stretch.

You can perform a few other stretches, as well. You can carefully bend backward as much as is comfortable and then rock forward as much as you can. In addition, side to side bending, when not overdone, can help stretch the lumbar muscles, as well.

Dr. Miranda has seen many nursing patients, and this is his experience: "Usually, something else is causing the lower back to be painful. The other muscles are not pulling their weight, and the lumbar spine is often the victim of weakening muscles elsewhere in the lower body."

Physical therapy is often considered conservative treatment for back problems, but Dr. Miranda thinks it should be given more time. "Spinal fusions and conservative measures do not show significant difference after five years. I feel spinal surgery should only be used when a tumor or fracture is present. When the patient can't move their leg or peripheral neuropathy is involved, surgery may be called for. Chronic back pain can almost always be treated with conservative measures."

Chiropractors

Lots of legends, mysteries, myths, and outright lies surround the profession of chiropractic. From the voodoo cracking monster to the doctor who tells you to ignore all advice but their own, chiropractors have gotten a bad rap unnecessarily. In fact, chiropractors and physical therapists often work closely together, though there are distinct differences.

Chiropractors are known for "adjustments" to the spine. Dr. Sarah Jacobs of HealthSource Chiropractic explains it this way in a telephone interview: "Chiropractic is about looking for bones that are stuck and fixated. We try to get them moving, also looking at the pelvis for balancing the lower body. Adjustments are like WD-40 into a rusty hinge. The crack you hear is like breaking a vacuum seal on a jar."

Dr. Jacobs sees many nurses in her practice. "There are two types of problems. First is lower back pain that occurs after standing for long periods of time, causing hip pain, and then upper back pain. Second, lower back pain can occur due to bending over, lifting, and straining."

She continues, "More times it is repetitive and cannot be isolated to one instance of moving someone. Being on your feet all day, standing over beds, and bending are often major causes of chronic back pain."

How do chiropractors help with lower back pain? "Typically, we use chiropractic adjustments, physical therapy modalities, electric stim, cold laser treatment, spinal decompression, traction, and progressive rehabilitation. We also use exercise to stabilize the core and study the patient's biomechanics," relates Dr. Jacobs.

Another problem is something Dr. Jacobs calls muscle amnesia. "Researchers are finding that with lower back pain, our brain inhibits the latissimus muscles. This inhibition doesn't come back unless they are rehabilitated, The same can happen to the core and glut muscles. Glut amnesia occurs when they are inhibited. Since these are muscles that support the lower back, there are muscle imbalances all the time. It's about reprogramming the brain-muscle connection."

As with most back pain specialists, Dr. Jacobs has some opinions about spinal surgery. "There is a time and place for surgery. Chiropractic is a gateway to see if we can get patients functioning better, but some need something more aggressive. I think it is best if we can avoid surgery. Fusion causes segments of the spine above and below to take a beating. Sometimes, though, surgery is really needed. We want to try everything conservative first, and then patients can go to surgery. My goal to keep them out of the surgeon's chair."

Despite the differing opinions of the experts, Dr. Jacobs says there is a sense of collaboration between the providers. "We often refer between medical professionals. We want them to seek out the best treatment for them because they want to get back to doing what they love. Once a patient starts feeling better, we can focus on exercise, nutrition, supplements, strength training, and flexibility."

Finally, there is a mental component, too. "Mindset is very powerful. If you are experiencing low back pain or are going through a preventative route, remain optimistic. It easier to help make people well when they are invested in the treatment."

Spinal Surgeon

Spinal surgeons are often feared by anyone who has a back injury. Some patients feel that they will jump directly to fusions or other surgeries, and some fear the results of those surgeries to their back. Surgery on the spine, particularly spinal fusion, is a controversial topic, and each expert has weighed in with their opinions. But what about the surgeons themselves?

Dr. Ty Thaiyananthan, neurosurgeon and founder of BASIC Spine in Newport Beach, CA, is a nationally known expert in the treatment of the spine. During a telephone interview, he stated his opinion this way, "Surgery is the option of last resort. Every patient requires different strategies. It depends on what the patient has and the treatments that have been pursued. A herniated disc with foot drop might mean that you need surgery or it will get worse. There is no universal algorithm, and surgery is completely the option of last resort. We use every other reasonable method to heal the back."

Unfortunately, Dr. Ty sees a great deal of nurses in his practice. "The majority of nurses suffer from acute back issues, such as from transferring a patient. They will present with musculoskeletal pain or an acutely herniated disc. These usually result from transferring a patient from one bed to another bed, flexing forward, or straining." He states, "Nurses' spines are often comparable to those of professional athletes."

He adds, "Nurses tend to work through the pain to get the job done. The collateral damage is that they injure their spine. They need to understand to take care of themselves to prevent injury."

Fusions are probably what most patients think about when they consider surgery on their spine. However, new research has found that it may cause more harm than good. Dr. Ty explains, "The trend now is toward motion preservation. We want to alleviate pain without doing surgery. For nurses, this may mean refraining from duty for 6-8 weeks. Fusions aren't a perfect surgery, and we now tend to use decompressive procedures. You are never 100 percent again after fusion, and you will need to be monitored over time. There will always be residual pain."

The thinking about spinal surgery has definitely changed in the past 10 to 15 years. Dr. Ty says, "The focus is not to alter the biomechanics of the spine. We want to decrease pain while not changing the spine. Minimally invasive surgery, such as a foraminotomy can relieve nerve root compression. Like high blood pressure, changing your lifestyle is important, too. I would rather focus on a treatment plan to physical therapy and chiropractic to maintain spine health."

Fortunately, there are now decompressive and minimally invasive surgeries available that can reduce pain without changing the spine. Dr. Ty is a leading surgeon in these procedures. "We go after extruded fragments with decompressive surgery. With microdiscectomy, there is a chance of herniation after the fact, and you still need to limit activity. The tear in the disc is still there until it scars over, which is usually over a few months."

Non-invasive forms of spinal decompression are helpful, as well. Back specialists can use traction beds controlled by a computer that gently pull the vertebrae apart, improving the health of the disc, and getting it back into alignment. These treatments help to rehydrate the disc, avoid surgery, and usually show improvement of the problem on follow up MRIs."

Even with decompression, though, problems can arise. "Spinal decompression helps to reabsorb disc, but in some cases, the discs don't reduce with treatment. The herniations can dry out, and serial MRIs show that the disc is receding because it is dehydrating. During this process, the disc can calcify, causing sciatica. It may need to be removed if symptomatic."

In the end, no matter what type of back specialist you choose, be sure to choose one that is dedicated to conservative measures first. From stretching to adjustments to decompression therapy, the solution for back pain isn't always spinal fusion surgery. In fact, it very rarely is the answer.

Other specialists are also trained in healing the back, and you may find them on the staffs of your back specialists. For instance, massage therapists, sports medicine doctors, and osteopaths can also provide valuable insight and assistance with your back pain.

Many nurses experience pain in their back, and the solution is to not ignore it. If you are feeling achiness after a shift, go to one of these specialists. Most of them have preventative measures that can keep you pain-free and at the bedside for as long as you want to be there.

References

American Nurse Association; Handle with Care Fact Sheet

Hurt Back? Here Are Some Options

Physical Therapy

Chiropractors

Spinal Surgeon

About Lynda Lampert, RN

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