I am a nursing supervisor just transferring from a medical-surgical ward to the neonatal intensive care unit (NICU). On the med med-surg ward, preventing back injuries was a big focus. Even though the patients are smaller on the NICU ward, I'd like to implement ways to help the nurses prevent episodes of back pain. What kind of steps should I take?

If we could find a way to prevent back pain, it would save many people the pain of the condition as well as the expense of treatment. Many studies have been done trying to find a successful answer to back pain prevention.

In a hospital setting such as you are talking about, small patients may not be the biggest challenge. Standing on their feet for long hours, moving beds or other equipment, and lifting supply boxes may be the greater challenge.

Many health care programs have invested time and money in teaching preventive lifting techniques and working out shared lifting responsibilities to reduce lifting. Some programs offer advice on manual materials handling. Studies aren't showing that these methods really bring about a change in the number of back injuries, episodes of back pain, or sick days lost due to back pain.

What they have found is that health care workers who exercise routinely are less likely to take sick days. In one study where half the workers were from the health care industry, lower work absence (28 days) was reported in those who exercised compared with control groups (155 days) over the same period of time (13 months).

Most of the studies focused on abdominal and back extensor muscle strength, power, and flexibility. The most successful exercise programs were supervised, consisted of 45 to 60 minute sessions, and took place twice a week. The length of time patients met ranged from three months to a full year. The patients in the exercise groups had stronger abdominal and back muscle strength.

Exercise appears to be a better way to reduce the risk of back injury and/or episodes of back pain -- even better than no lift policies, ergonomic training, and mechanical lifting. In fact, exercise was also more effective than shoe inserts, back supports, stress management, or back education.