What Do We Know About Interventions to Prevent Low Back Injury and Pain Among Nurses and Nursing Students? A Scoping Review

Study background Back injuries are common among nurses worldwide with lifetime prevalence of lower back pain ranging from 35% to 80%, making nursing a profession at great risk for back injuries. Purpose This systematic scoping review explored and mapped existing evidence regarding the prevention of low back injury and pain among nurses and nursing students. Methods Using a scoping review methodology, six databases were searched initially in September 2017 and updated June 2020. Studies investigating interventions designed to reduce back injuries and pain among regulated nurses and student nurses, published in peer-review journals and written in English, were eligible for inclusion in this review. Quantitative, qualitative, and mixed methods studies of regulated nurses, nursing students, and nursing aides were included. Two independent reviewers screened, critically analysed studies using a quality appraisal tool, extracted data, and performed quality appraisals. Results Two searches yielded 3,079 abstracts and after title, abstract and screening, our final synthesis was based on 48 research studies. Conclusions Forty years of research has demonstrated improvements in quality over time, the efficacy of interventions to prevent back injury and pain remains unclear, given the lack of high-quality studies. Further research, using multi-dimensional approaches and rigorous study designs, are needed.

An analysis of pre-season risk factors for low back injury in high-school baseball pitchers: a prospective study

Pitching motion requires whole-body coordination; therefore, poor control of the lower extremities, pelvis and trunk may cause shoulder and elbow injuries. However, few studies have described the relationship between the shoulder joint function and low back injury in high-school baseball pitchers. A total of 128 healthy high school pitchers underwent pre-season medical checkups, where their shoulder range of motion and shoulder strength were measured. The participants completed a self-recorded daily questionnaire regarding the presence of low back pain. Pitchers were divided into injured and non-injured groups. Low back injury was observed in 13 participants (13.4%). In the injured group, horizontal adduction on the dominant shoulder was significantly less than in the non-injured group. A logistic regression analysis showed that horizontal adduction on the dominant side was a significant independent risk factor for low back injury during the season. It is important to recognize that restriction of the shoulder function not only causes shoulder and elbow injuries but can also risk low back injury.

An Analysis of Pre-Season Risk Factors for Low Back Injury in High-School Baseball Pitchers: A Prospective Study

A pitching motion requires whole-body coordination; therefore, poor control of the lower extremities, pelvis and trunk may cause shoulder and elbow injuries. However, few studies have described the relationship between the shoulder joint function and low back injury in high-school baseball pitchers. In this study, 97 high-school baseball pitchers who underwent pre-season medical checkups were enrolled and their shoulder range of motion and strength were measured. The participants completed a self-recorded questionnaire regarding the presence of low back pain and were divided into injured and non-injured groups. The statistical analyses were performed to identify the independent risk factors for low back injury. Low back injury was observed in 13 participants (13.4%). In the injured group, horizontal adduction on the dominant shoulder was significantly less frequent than in the non-injured group. A logistic regression analysis showed that horizontal adduction on the dominant side was a significant independent risk factor for low back injury during the season. It is important to recognize that restriction of the shoulder function not only causes shoulder and elbow injuries but can also risk low back injury.

Comparing the risk of low-back injury using model-based optimization: Improved technique versus exoskeleton assistance

Although wearable robotic systems are designed to reduce the risk of low-back injury, it is unclear how effective assistance is, compared to improvements in lifting technique. We use a two-factor block study design to simulate how effective exoskeleton assistance and technical improvements are at reducing the risk of low-back injury when compared to a typical adult lifting a box. The effects of assistance are examined by simulating two different models: a model of just the human participant, and a model of the human participant wearing the SPEXOR exoskeleton. The effects of lifting technique are investigated by formulating two different types of optimal control problems: a least-squares problem which tracks the human participant’s lifting technique, and a minimization problem where the model is free to use a different movement. Different lifting techniques are considered using three different cost functions related to risk factors for low-back injury: cumulative low-back load (CLBL), peak low-back load (PLBL), and a combination of both CLBL and PLBL (HYB). The results of our simulations indicate that an exoskeleton alone can make modest reductions in both CLBL and PLBL. In contrast, technical improvements alone are effective at reducing CLBL, but not PLBL. The largest reductions in both CLBL and PLBL occur when both an exoskeleton and technical improvements are used. While all three of the lifting technique cost functions reduce both CLBL and PLBL, the HYB cost function offers the most balanced reduction in both CLBL and PLBL.

EARLY SPORT SPECIALIZATION IN YOUNG FEMALE FIGURE SKATERS

BACKGROUND: Understanding the association between sport specialization in young athletes and injury continues to be an important goal of sports medicine specialists. However, studies focused on females were scarce. Additionally, studies dedicated to sport specialization in the performing artistic athletes, including figure skaters are deficient at this time. Purpose: 1) To investigate the prevalence of sport specialization in a cohort of female figure skaters, and 2) to determine if low back injury is more common in specialized female figure skaters compared to female figure skaters who are not classified as specialized. METHODS: Cross-sectional survey study design was used. Questionnaire data was collected from three major figure skating clubs in the Greater Boston area. Female figure skaters (age range: 5 to 22 years) were asked the following questions based on established sport specialization criteria: 1) Do you solely perform figure skating?, 2) Did you quit other sports to focus on figure skating?, and 3) Do you participate in figure skating more than 8 months/year? Status of specialization was defined as a “yes” answer to all 3 questions while “no” to any of the 3 questions was labeled as non-specialized. All participants were asked about a history of low back injuries, including muscular spine pain, stress fracture (spondylolysis/spondylolisthesis), disc protrusion/herniated disc, sciatica, and spinal cord injury. Descriptive statistics and chi-square analyses were performed, with p ≤ 0.05 as the critical statistical value. RESULTS: A total of 132 female figure skaters (mean age: 14.0±4.0 years) were analyzed. Approximately, 85% (112/132) of female figure skaters solely participated in figure skating and 54% (71/132) quit other sports to focus on figure skating. Almost all of the female figure skaters (99%) (131/132) engaged in figure skating lessons/practices > 8 months/year. About 62% (82/132) of figure skaters were classified as specialized, and 38% (50/132) were classified as non-specialized. There were no significant difference in low back injury history between the specialized female figure skaters (25.6%, 21/82) and non-specialized female figure skaters (24.0%, 12/52, p=0.836). CONCLUSION/SIGNIFICANCE: The majority of female figure skaters in this cohort were classified specialized, and almost all female figure skaters participated in figure skating more than 8 months of the year. Although no association with low back injury was found based on status of specialization, more research is needed including effects of training volume on injury risk in female figure skaters.

The Use of Negative Acceleration as Accessory Force during Lifting

Objectives. Injury associated with lifting, especially low back injury, is a big problem in industry that accounts for loss of work and high medical expenses. Studies of biomechanics of lifting provide a basis for optimization of lifting. The aim of the study was to further investigate the role of the upward force due to negative acceleration during a lift. Methods. Nine healthy subjects lifted an empty box and a box with additional load of 10, 20, and 25 lb. Kinematic data were recorded during the lifts and accelerations were calculated, and angular positions of the trunk and knee were obtained during the lifting when negative accelerations were used. Results. Negative acceleration assisted the quadriceps when the thighs were at approximately 90° and the hips when the trunk was rotating toward standing position. Negative acceleration was present during lifts of different loads. Conclusion. The outcome of the study suggests that enhancing the use of negative acceleration could be a strategy to improve the quality of lifting and minimize a probability of low back injury.