<< Back to Back Facts

Purpose: To help understand how your body works and why nursing home workers get back injuries.

Task 1:

Read the following story.

You are a nursing assistant taking a break. Your co-workers are talking about Marion. Marion hurt her back while transferring a resident who she has worked with daily for three years.

Some workers are saying that Marion is careless sometimes and that her injury didn't come from the job.

Other workers speak up. They say that they too have had pain from lifting and transferring residents. They say that something is wrong with the job because too many people are getting hurt.

1. What kinds of tasks does Marion have to do on her job that may have hurt her muscles, ligaments or discs? List 6 examples. Look at factsheets #1, #5, #6 and #7 for help answering this question.

2. What are the first signs that a back injury is starting? List 5 examples. Look at factsheets #3 and #4 to answer this question.

Task 2:

Please refer to factsheets #2 and #9 to answer these questions.

1. What does the word "ergonomics" mean?

2. How can ergonomics help us to prevent back injuries in nursing homes? List 3 ways.

Fact Sheet 1

Good technique is not enough

Many nursing homes have classes on proper lifting techniques. These classes talk about bending your knees, keeping your back straight, keeping the load close to your body, and using your legs. These are good principles. But lifting people is different.19

The best lifting techniques don't always work when what you are lifting is a person. It is difficult to use good body postures all the time when lifting dependent nursing home residents. Why?
  • Residents can fall, slip or jerk when you least expect it. You can be thrown off balance by the sudden change in weight.
  • Residents can be confused, scared or uncooperative, making it diffcult for them to follow your instructions.
  • A combative resident may be diffcult to hold in the proper position for lifting and transferring.
  • Equipment and furniture get in the way. The weight of the resident can't always be held close to your body.
  • In a confined space like a resident's bathroom or at an awkward angle, you can't always stand with your legs apart.
  • Not everyone has the strength in their legs to lift from their legs.
  • Many lifting techniques require two people. Often you are working alone.
  • Lifting a resident with another nursing assistant who is taller or shorter can be physically stressful.
    These situations can put a big strain on your muscles, ligaments and joints.20
Fact Sheet 2

All about ergonomics

There is one new word we will be talking about from now on in this workbook. That word is ergonomics (ur-guh-NAWM-ics).

The word "ergonomics" comes from the Greek word for work. Ergonomics is the science of work and the study of how people and jobs fit together.

We will use ergonomics to look at how to design nursing home work to fit nursing home workers.

Ergonomics includes:
  • Designing equipment that is easy to use.
    Example: Transferring a resident with an electric lifting device.
  • Inventing new equipment that will take the strain out of the job.
    Example: A shower chair that also fits over the toilet. The resident can be toileted and showered without being lifted or transferred between these tasks.
  • Organizing work in new ways.
    Example: Storing items that you use daily on the easy-to-reach shelves instead of near the floor or above your shoulders.
  • Changing how tasks are done.
    Example: Transferring a dependent resident with two people.
Ergonomics helps us to stop injuries from happening, such as:
  • Back pain from lifting and transferring residents.
  • Wrist pain from pulling transfer sheets or turning worn or broken bed cranks.
  • Strain injuries from holding the weight of a resident who slips to the floor, or from reaching above the shoulders for linens or equipment.
Ergonomics helps us to understand which job tasks and body movements can hurt us and find safer ways to do these tasks.
  • Lifting a resident who has fallen to the floor.
  • Transferring a resident from the toilet to a wheelchair.
  • Lifting a bag of wet linens.
An ergonomic program is a plan to prevent back sprain and strain injuries from happening in the first place. It should include:
  • Regular inspections of your workplace. It's important to find all the hazards in your facility that could lead to strain and sprain injuries.
  • Training for everyone on how to prevent injuries.
  • A plan to get injured workers the care they need.
  • Safe staffing levels so workers don't get hurt lifting heavy residents alone.
  • The most useful and safe lifting devices to use with residents.
Ergonomics is smart science and common sense. Some job tasks are easy to do and some make you hurt. Your body has natural limits. You are not superwoman/man.

Jobs need to be changed so that workers don't get hurt. Workers come in all sizes, shapes and abilities. One size does not fit all.

Proper lifting skills and back exercises are very important. But they are not enough to prevent injury. Overwork, too much lifting, and lifting in awkward ways can lead to back injuries. That is why many nursing home workers get hurt on the job.

Fact Sheet 3

Listen to your body

Pay attention to those first aches and pains. Your body tells the truth. Learn to listen to it. This is the only way to stop an injury from damaging your back. Pay attention, and don't "turn your back" on:
  • Aching
  • Sharp pain
  • Dull pain
  • Pain that comes and goes
  • Hot, inflamed feeling
  • Tingling
  • Unusual tightness
  • Unusual muscle weakness and fatigue.

Fact Sheet 4

Bit by bit

Many debilitating back injuries result from smaller injuries over long periods of time. Injuries that happen bit by bit are called cumulative trauma injuries, cumulative trauma disorders, or CTDs. With CTDs, the damage gets worse over time. Sometimes you can't feel it happening to you. You don't feel any pain. Or maybe just a little bit-no big deal. All of a sudden, one single movement can trigger serious back pain.

It's up to you to pay attention to the small signs of trouble before they grow. Go get help before your back pain becomes crippling.

Fact Sheet 5

"Back"ground: How your back works

What do you need to know about your back to help you prevent injury?

Your back:
  • Holds you up
  • Supports the weight of your trunk
  • Keeps your head up
  • Lets you move easily
Twenty-four movable back bones, called vertebrae, are stacked, one on top of the other.
  • Shock-absorbing cushions between each vertebra, called discs, provide the padding.
  • Bands of sturdy tissue called ligaments hold the vertebrae in place.
  • At the bottom of your spine, vertebrae are joined together forming a sturdy base. This holds up the rest of your body.
  • Passing through a hole in each bone of the spine is your spinal cord which carries messages from your brain to your muscles and organs.
  • Muscles as attached directly to the vertebrae by tendons. These muscles keep your back stable, hold good posture, and enable you to move around. Stretching these muscles too far can cause back pain.
Your back has a few natural curves forming an "S" shape. These curves are important to balance out the weight of your body and keep your head held up straight.

Fact Sheet 6

What's the cause?

When your lower back hurts, all you know for sure is that your back hurts. Frequent bending over and lifting heavy or awkward loads puts pressure on the spine. This can injure your muscles, ligaments, or tendons. And that hurts.

Back problems are hard to diagnose. That is why it is important to keep track of all pain felt at work and to see your doctor.

  • Can be damaged by sudden or unexpected movements.
    Example: Catching a resident who falls while walking.

  • Can be strained by twisting.
    Example: Lifting a resident using just one side of your body.

  • Can be fatigued (get very tired) by overwork.
    Example: Manually transferring many residents in one day.

  • Can be fatigued by awkward postures.
    Example: Bending over to feed a resident.

  • Can be fatigued by holding one position too long.
    Example: Feeding or bathing a resident.

  • Can be weakened by repetitive movements.
    Example: Turning cranks on a bed or hoist.
Recovery: Injured muscles tan take from six to eight weeks to heal.

  • Can be damaged by sudden movements.
    Example: Transferring a combative resident.

  • Can be damaged by exertion in uncomfortable postures.
    Example: Reaching and lifting a resident from a geri chair to the bed.

  • Can be injured by holding awkward positions for a long time.
    Example: Bathing or caring for a resident in a stooped position.
Recovery: Injured ligaments can heal within a few weeks if proper care, rest, and treatment are received.

Both muscles and ligaments can become scarred or weakened through repetitive lifting, pulling, pushing, and straining. These weak links prevent the back from maintaining its natural curves and shape.

  • Can get injured by the same job tasks and body movements that injure muscles and ligaments.
  • Can slip out of their normal position or rupture. This puts pressure on the spinal nerves.
  • Can wear out and allow the bones of the back to grind together. Nerve damage can result.
These injuries are extremely painful. Some disc problems can improve without surgery.

Strain and sprain injuries that hurt the muscles, ligaments and tendons can also damage the discs.

Fact Sheet 7

Snap, crackle, pop

Not all injuries hurt right away. Many everyday job tasks besides lifting put stress on the body even though no pain is immediately felt Sprain and strain injuries can occur from:
  • Heavy lifting
    Example: Lifting and transferring residents, carrying wet linens and garbage.

  • The application of force
    Example: Pushing and pulling wheelchairs, shower chain, and carts, as well as cranking beds and cleaning dunes.

  • Frequent bending, twisting and stretching
    Example: Showering residents, and removing objects from carts and from heights above your shoulders.

  • Awkward standing posture
    Example: Stooping to feed and bathe residents and to make beck

  • Sudden load bearing
    Example: Catching falling residents.

  • Repetitive work
    Example: Making beds, doing housekeeping tasks, and lifting.

  • Fatigue
    Example: Overwork due to understaffing, increased patient loads, mandatory overtime and job stress.

Fact Sheet 8

Exercise helps, but...

Keeping your back strong, stretched and healthy is a good thing to do. Good posture and mobile joints can prevent certain injuries. In addition, recovery from an injury can happen more quickly when your muscles are strong and flexible.

Remember: Hazardous working conditions can injure even the most athletic and well-conditioned workers. An exercise program can only reduce back injuries on the job if it is part of a comprehensive back injury prevention program.

Some exercises that will keep your back strong and flexible can be found in Appendix A of this workbook.

Fact Sheet 9

Chain reaction

Most back injuries in nursing homes come as a result of resident handling tasks and associated duties such as:
  • Lifting and transferring residents who are heavy, unpredictable or combative.
  • Lifting and carrying supplies and equipment.
You carry out these tasks often. When you are hurt and can't do your job, many others feel it too.

Who else is affected?
  • Resident care suffers when workers are hurting. The care and attention nursing assistants give residents play an important role in preventing bedsores and falls.
  • Co-workers often must work harder and longer.
  • Families of injured workers suffer financial and emotional strain when caring for an injured family member.
  • Employers must pay out more money for workers' compensation premiums. A typical nursing home with 100 workers pays between $50,000 and $100,000 a year in workers' compensation premiums.21
  • Taxpayers pay for most of the cost of running nursing homes. They pick up the slack when the cost of caring for disabled workers is placed on the larger community.

Fact Sheet 10

Back on track

Both management and workers have a role to preventing back injuries on the job.

It's management's responsibility to:
  • Provide a safe and healthy workplace.
  • Prevent known hazards.
  • Maintain adequate staffing levels.
  • Implement effective injury prevention programs.
  • Purchase and use lifting machines and devices.
  • Conduct effective training and education programs.
  • Provide proper medical care and treatment for injured workers.
  • Make sure workplace injury prevention programs are working.
It's your responsibility to:
  • Work with your health and safety committee to prevent unsafe conditions.
  • Listen to your body and report the first signs of back pain.
  • Take the best care possible of your back and your health.


"Back" talk: Why and how you can hurt your back at work

1. Jobs should be designed to fit the worker, not the worker to fit the job. This is called ergonomics.

2. Your body has natural limits. Some job tasks can lead to injuries when you go beyond these limits. Many strain and sprain injuries of the back are caused by repeated smaller injuries over a period of time. Most back pain is caused by injuries to the muscles, ligaments, and discs.

3. Your body tells the truth. It is important to pay attention to the very first signs of back pain before a small problem turns into a crippling injury. Report all back pain.

4. Lifting is not the only activity that leads to sprains and strains. Carrying, bending, twisting, pushing, pulling, and repetitive movements can also lead to strain and sprain injuries.

5. Using good lifting techniques is not enough to prevent injuries. It is difficult to use proper lifting techniques when transferring residents. Hazardous body movements need to be prevented.

6. Keeping your back stretched and healthy is a good thing to do. Stretching can prevent some injuries and reduce the time your body needs to heal after an injury. Exercises only help prevent injuries when they are part of a comprehensive back injury prevention program.

7. Resident care suffers when workers are hurting. Taxpayers, employers and family members must absorb the unnecessary expense. Everyone feels the strain.