Feature

Low Back Pain Among Radiologic Technologists

Joey C. Bergeron, BSRT(R)(CV), Master of Science in Radiologic Sciences Program; Donna Lee Wright, PhD, Associate Professor, Radiologic Science; Jeffrey Killion, PhD, Associate Professor, Radiologic Science Midwestern State University, Wichita Falls, Texas
Joey C. Bergeron, BSRT(R)(CV), Master of Science in Radiologic Sciences Program; Donna Lee Wright, PhD, Associate Professor, Radiologic Science; Jeffrey Killion, PhD, Associate Professor, Radiologic Science Midwestern State University, Wichita Falls, Texas
Many individuals who suffer from low back pain often continue performing their normal daily tasks without understanding the direct cause of their pain or realizing which treatment option may work best. These individuals may never truly recover from acute low back pain, and may also develop a chronic low back pain syndrome and subsequent permanent disability. Therefore, understanding information about the incidence, causes, and management of low back pain may aid in the prevention of this condition, and therefore increase work productivity. Incidence of Low Back Pain In recent years, low back pain has reached epic proportions, based on the number of people affected and the impact on healthcare costs. Current figures indicate that the incidence of low back pain in the United States is between 75% and 85%, with an annual prevalence rate somewhere between 15% and 20%.1 Amazingly, only 10% of patients affected by low back pain are responsible for 80% of the total economic impact on healthcare systems. Therefore, many businesses, schools, and organizations must be keeping healthy back practices paramount in the daily activities of their employees, students, and participants.2 Approximately 40% of the workforce today will experience low back pain within the year and about 15% of these individuals will suffer from chronic low back symptoms lasting longer than one year.3 Overall, low back pain is the leading cause of long-term disability among employees younger than 45. This figure correlates to about 101.8 million days absent from work annually and $50 billion in direct medical costs for the treatment of low back pain.4 Therefore, low back pain remains a primary focus among national healthcare authorities, political activists, and department managers.5 Even though much of the U.S. workforce may suffer from acute and chronic low back pain, there exists a greater prevalence of this condition in both construction workers and allied health professionals. Carrying heavy loads, frequent bending/twisting, and whole body vibration have been blamed for the correlation between these specific groups and low back pain. Researchers have found that 36% of all low back pain symptoms experienced by nurses have been during patient handling. Consequently, nurses who participate in the direct transport of patients experience low back pain 37 times more frequently than those who do not.6 Therefore, many medical facilities have implemented training programs to instruct proper body mechanics for lifting, pulling, and transporting patients.7 Low Back Pain The exact cause of low back pain has never been scientifically demonstrated. However, much of the literature indicates bad posture is the predominate cause of low back pain in otherwise healthy individuals. Proper alignment of the spine is crucial when walking, sitting, and sleeping to support ligaments, tendons, and disks in the lumbar area. Any deviation in proper posture relating to these daily activities puts the spine in a vulnerable position for injury.8 Other leading causes for low back pain noted in the literature are presented both as occupational and recreational. Among the more prevalent causes are improper lifting, pulling, and running. Similar to posture, proper body mechanics are required when preparing to lift heavy objects.5 Smoking has also been documented as a precursor to low back pain in many individuals. In the advanced stages of lung disease, a persistent cough only aggravates a present low back injury.9 Similar to individuals who do not smoke, people who perform a regular regime of exercise have been proven to both avoid low back pain and assist in the healing process.10 A smaller, but undeniable cause of low back pain in individuals is the psychosocial element. Multiple studies have examined the effects of job demand, work control, and environment on individuals suffering from low back pain.11 Clinical outcomes at six months reflected minimal low back pain among the group of participants who exhibited focus and satisfaction in their job tasks.12 Current Low Back Pain Therapies Regardless of low back pain causes or symptoms, there are many different therapies. All of the available therapies for low back pain are generally classified as either non-invasive or invasive. Many experts feel that treatment options should progress dependent on symptom presentation. Therefore, the gradual introduction of rest, stretching, and NSAIDs (non-steroid anti-inflammatory drugs) should begin the healing process of acute low back pain.13 The subacute period of low back pain is defined as any sustained low back pain lasting longer than 3 weeks. During this period, consultation with a physician, chiropractor or osteopath is recommended. Muscle relaxants, NSAIDs and rest are the treatments of choice. The subacute period of low back pain is often an indication that the individual may have a condition which involves more that just the muscles, tendons, and ligaments within the lumbar anatomy. Therefore, immediate attention by a medical professional should be sought. Chronic low back pain is classified as persistent symptoms after 6 weeks that require other therapies to alleviate the pain. Physical therapy, chiropractic manipulation, and prescription drugs are the most favorable non-invasive therapies for chronic low back pain. Usually, invasive therapies are reserved until all of the non-invasive measures have been pursued without success.14 Surgical revision, steroid injections, and electrostimulation comprise the three most common methods of invasive treatment for chronic low back pain. Surgical treatment for low back pain is often considered the most aggressive treatment option once steroidal injections and electrostimulation have proven unsuccessful in alleviating symptoms.9 Management of Low Back Pain Once either non-invasive or invasive therapies have been performed for low back pain, management techniques exist to ensure future symptoms will not occur. The main management techniques described are proper diet, rest, posture and stretching exercises developed specifically for low back pain. Many of the pain management techniques published for low back pain are meant for frequent practice during and after therapy. However, even if these techniques are performed at the onset of pain, positive results have been documented.8 Sleeping at least 6 to 8 hours every night is recommended to allow relaxation of spine and support structures within the lower back. Research studies have found that manufactured support rolls, pillows and cushions aid in the healing process of low back pain. Careful consideration should be taken, however, when selecting these sleep aids for the relief of low back pain. Experts suggest the use of a mattress with medium firmness for proper alignment of the lumbar, thoracic, and cervical spine without added stress to other parts of the body. Lumbar rolls are also beneficial to reinforce proper posture while sitting at an office desk or driving a vehicle.8 Finally, stretching exercises have been highly successful for individuals seeking freedom from low back pain. Feelings of pride, accomplishment and success often accompany an individual’s completion of these stretching exercises for alleviation of low back pain. Most importantly is that these exercises do not exclude those individuals who have already been treated for low back pain. Regardless if individuals have already been treated with non-invasive or invasive therapies, they can use these stretching exercises in tandem with their current therapies for the continued treatment of their low back symptoms.10 The ability to treat low back pain without the direct assistance of a medical professional may seem a daunting task. However, with the aid of personal management literature, thousands of individuals have already experienced freedom from low back pain without being dependent upon costly medical professional services. Managers should be aware of these techniques because increasing exposure to this type of personal management therapy for low back pain will prove beneficial to minimize costs to the healthcare system, while empowering individuals to become more conscience of their low back health. Survey of Radiologic Technologists Survey Design The survey consisted of 21 questions split into three specific categories: back pain characteristics, work patterns, and demographics. All survey questions included within this form used ordinal, nominal or Likert scales. The survey was exempted by the Midwestern State University Human Subjects Review Committee (#05120702) (Appendix B). The initial section, called Back Pain Characteristics, focused on questions pertaining to low back pain frequency, intensity, treatments, and work habits. The next section, work patterns, posed questions about work schedules (hourly/daily), type of lead apron worn during radiation exposure, and frequency of donning a lead apron. The demographics section asked general questions about age, gender, education, job experience, and health. Finally, respondents were asked to include any five stressors they thought contributed to low back pain on a daily basis. Interestingly enough, the most common responses were donning lead aprons, transporting patients, mental/emotional stress of healthcare duties, and physicians. Survey Sample One hundred surveys were distributed to a convenience sample of diagnostic radiology and cardiac catheterization departments in seven major medical facilities throughout southwest Louisiana. All of the surveys were delivered on December 19, 2005 with a due date of January 2, 2006. A total of 63 completed survey forms were returned for analysis. These 63 respondents represent approximately 19% of the total radiologic technology professionals who are employed within the five parish geographic areas. Results Back Pain Characteristics The first two questions in the survey dealt with frequency of back pain among respondents. The largest group, 30 (47%), stated they experienced back pain within the past five years, while 6 (9%) reported never having had back pain (Figure 1). Among the 47% of respondents who have experienced back pain, 18 (28%) experienced back pain at least once a month. The smallest group, 6 (9%) stated they experienced back pain on a constant basis (Figure 2). Of the respondents, 45 (71%) stated that their back pain was experienced in the lower back (L4 to S1) spine level. Only 3 (4%) of respondents experienced pain in their legs (Figure 3). Eleven treatment options were given to the respondents to evaluate which treatments those individuals had tried (Figure 4). Thirty-six (57%) of these respondents stated they used over-the-counter pain relievers. Examples given in the survey were aspirin and ibuprofen. Three (4%) of the respondents used more chronic back pain treatment options, such as chiropractic care or surgery, for treatment. All respondents who documented constant low back pain also chose chiropractic care or surgery for treatment. Regarding the frequency of therapies used, 18 (28%) of the respondents stated that they used their respective therapies at least once a week. The second most common response was never for 12 respondents (10%) (Figure 5). Work Patterns This survey only used responses from full-time radiologic technologists. Fifty-four (85%) of the respondents stated they work between 8“11 hours a day, 5“6 days a week (Figure 6). Lead Aprons Four different options were offered in the style of lead apron worn daily: full-length/front-only, front and back wraparound, skirt and vest, and other. Twenty-four (38%) wore skirt and vest style, while 21 (42%) stated they used full-length/front-only lead aprons (Figure 7). Thirty (47%) of respondents stated that their lead weighed over nine pounds, and 18 (28%) of respondents stated that their lead aprons weighed 3“5 pounds (Figure 8). Readers should note that the weight of the lead apron is probably related to the style of apron used. Eighteen (57%) of respondents stated that they wore their lead 5 hours or more a day, while 6 (9%) claimed to wear their lead aprons 4 hours or less a day. Also, the respondents were asked about the frequency of lifting and donning their lead aprons within an entire work period. Forty-five (71%) of respondents claimed that they placed their lead apron on at least five times daily, while 3 (4%) stated they donned their lead aprons less than three times daily. Demographics The first three questions within the demographic section of the survey obtained general information about gender, age and educational level of the respondent. The final six questions were focused on work responsibilities and overall health. Thirty-three (52%) males and 18 (28%) females participated in this survey. The largest group 18 (28%) of respondents were aged 25“29 and 50 (80%) were aged 25“44 (Figure 11). Respondents were given six options for educational levels (Figure 10). The most common educational background was hospital certificate (21, or 33%), but associate degrees and baccalaureate degrees were almost as prevalent. Figure 11 shows that the greatest number (57, or 90%) of the respondents had cardiac catheterization clinical responsibilities. Job experience levels were also evaluated and 36 (57%) stated that they have held their current position between 0“6 years, while 15 (23%) were employed in radiology for more than 10 years (Figure 12). The first health question posed by the survey involved smoking status of the respondent. Forty-eight (76%) of respondents did not smoke, while twelve respondents stated they smoked at least half a pack of cigarettes per day. Respondents indicated they had average level of fitness. The final section of the survey allowed respondents to voice their opinions regarding outside stressors which may contribute to back pain in their daily lives. The most common responses were donning lead aprons (50, or 80%), transporting patients (44, or 69%), mental/emotional stress of healthcare duties (12, or 19%), and physicians (9, or 14%). Discussion In examining the results of this survey, the experience of back pain, location of back pain, and clinical responsibilities all offer insight into the condition of low back pain among radiologic technologists. First, 57 (90%) respondents reported having back pain in the past five years. Similar incidence values were reported in a previous study of radiographers which reported an average 74.5% incidence rate of back pain.15 Some differences between that randomized study and this survey is both the number of respondents which participated and clinical responsibilities. Unlike the previous study, 90% of radiographers within this survey were employed in the cardiac catheterization laboratory. However, both reports signify that the profession of radiologic technology carries with it a high risk for the development of back pain. Secondly, 71% of the respondents reported the location of their back pain in the L4 through S1 location. This is an overwhelming indication of where the majority of pressure is exerted on the spine during daily radiologic science tasks. Yet another possible contribution to the location of back pain is that 48% of the respondents stated they wear lead aprons weighing nine pounds or more and that 38% of respondents wear their lead aprons for more than 5 hours each day. Compounding the weight of these lead aprons over the amount of time worn, the results may play a significant role in the development of back pain in the lumbar region. Currently, there is a large number of radiologic technologists who suffer from low back pain. The primary goal of this survey was to illustrate, within a small population sample, the incidence rates and some generalized characteristics of back pain among radiologic technologists who work in both diagnostic and cardiac catheterization laboratories. Conclusions that may be drawn from this survey are: all incidence rates of low back pain demonstrated within this survey are consistent when compared to available literature, low back pain is a common condition among radiologic technologists, and the weight of lead apron, along with time worn, may have a direct effect on the incidence of low back pain. Joey C. Bergeron can be contacted at joekei8954@yahoo.com
References
1. Hoiriis KT, Pfleger B, McDuffie C. A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain. Journal of Manipulative and Physiological Therapeutics 2004;27:388-401.

2. Deyo R, Mayer TG, Pedinoff S. An attack on low-back pain. Patient Care 1987;21:106-111.

3. Ammendolia C, Kerr MS, Bombardier C. Use of back belts to prevent occupational low-back pain. Canadian Medical Association Journal 2003;3:169.

4. Zepf B. Botulinum toxin for relief of chronic low back pain. American Family Physician 2001;64:133-135.

5. Woolf SK, Glazer JA. Low back pain in running-based sports. Southern Medical Journal 2004;97:847-851.

6. Hignett S. Work-related back pain in nurses. Journal of Advanced Nursing 1996;23:1238-1246.

7. Byrns G, Guang J, Mallory C. Low back pain among RNs. Professional Safety 2005:41-48.

8. McKenzie R, Kubey C. 7 Steps to a pain-free life. New York: Dutton, 2000.

9. Burn L. Back and neck pain: The facts. New York: Oxford, 2000.

10. Fishman L, Ardman C. Relief is in the stretch. New York: Norton, 2005.

11. Brulin C, Hoog J, Sundelin G. Psychosocial predicators for shoulder/neck and low back complaints among home care personnel. Advances in Physiotherapy 2001;3:169-178.

12. Williams RA. The contribution of job satisfaction to the transition from acute to chronic low back pain. Arch Phys Med Rehabilitation 1998;79:366-374.

13. Maharam L. A healthy back. New York: Holt, 1996.

14. Brownstein A. Healing back pain naturally. Washington, DC: Harbor Press, 1999.

15. Wright DL, Witt PL. Initial study of back pain among radiographers. Radiologic Technology 1993;35:283-289.