Heal Thy Back

Traditional veterinary work is damaging caregivers’ bodies. Learn what you can do about it.

December 1, 2024 | 

Issue: December 2024/January 2025

If your back is aching, give it a break.

While veterinary teams often have a “get ’er done” attitude, wrestling a Rottweiler during a nail trim sometimes comes with consequences for the caregiver. An achy-breaky back doesn’t have to be the norm, though, when dealing with squirming patients and other physically taxing tasks. You will suffer less posterior pain — and potentially extend your career — if you learn healthier habits and your employer invests in a few ergonomic upgrades.

Registered veterinary technician and dentistry specialist Mary Berg is no stranger to back pain, having suffered from a herniated disc, scoliosis and spondylosis. About five years ago, she underwent spinal fusion after years of working through the agony.

“I’ve suffered with back pain from the time I was in my early 20s,” Berg says. “And I just kept on getting dismissed by the doctors.

“We are all broken in some way.”

A common expectation is that veterinary team members should be able to lift or wrangle 40-pound dogs, carry 25-pound bags of pet food to a client’s car, bend over patients during exams, and stand on hard surfaces for hours on end.

So, what’s to be done to prevent on-the-job back pain and injuries? Let’s explore everything from no-cost solutions to a hospital remodel.

Freebies

These six easy-to-implement changes won’t cost a penny.

1. Move to Improve

Mindful movement, such as pre-shift or pre-patient stretching, reduces the chance of injury. Find a few gentle ways to warm up before the first appointment. For flexible team members, pain specialist and Colorado veterinarian

Dr. Robin Downing suggests loosening up with half squats, full squats or sitting back on your heels.

2. Get On the Floor

Dr. Yolanda Gray, a mixed-animal veterinarian in Fort Scott, Kansas, often works on the floor with big dogs. She recently underwent rotator cuff surgery and has had to compensate for her limited range of motion as she heals. After her surgery, she cut back many duties, including performing dental procedures and working with large animals, to protect her patients and herself.

“With rotator cuff injuries, you either have partial or complete tears of the supraspinatus muscle,” Dr. Gray says. “I also had a tear in my bicep tendon, so that made my recovery a little harder.”

Rotator cuff muscles connect the arm and shoulder blade, so an injury in that region can cause upper back pain.

A self-described farm girl, Dr. Gray is used to castrating horses and working with cattle in chutes. When she wakes up with aches and pains or muscle fatigue, she opts for saltwater bathing, Icy Hot and Tylenol. She also leverages ice packs, physical therapy and yoga. She doesn’t try to exceed her physical limits.

“We had a call recently to pull a calf, and there’s no way I could have done it,” Dr. Gray says. “Manipulating a calf takes a lot of upper body, and I knew it was a tail-first breech birth.”

Dr. Downing, the hospital director at The Downing Center for Animal Pain Management, recommends Fear Free [bit.ly/4gmXlf0] and Cat Friendly Practice [bit.ly/3XsL4xk] handling techniques to avoid struggles with patients. Not only are those methods better for the pet, but they also reduce the injury risk to team members.

Dr. Downing, who has suffered back problems, prefers to work down low with larger patients.

“With big dogs, I see them on the floor,” she says. “This means minimal restraint and allowing them to participate in their own care. And that goes for the little ones, too. We’re all about making sure we give them as much agency as we can in choosing how they interact with us. So, whatever we have to do, we do it in a way that minimizes their resistance and their escalation into fear, anxiety and stress.”

Larger dogs in pain might not want to be lifted onto an exam table, so an orthopedic foam bed might be a better option for getting them into a recumbent position.

“We need to remind ourselves that it is torture for them if we pick them up,” Dr. Downing says. “And that puts us in the line of strike with their feet or with bites. These are avoidable bites.”

3. Obey Lifting Rules

Forty to 50 pounds is the threshold for when a two-person lift might be best. “Mandate No. 1 is to learn to do it,” Dr. Downing says. “Mandate No. 2 is to learn to cooperate with the other person and do a countdown. It’s not just heave-ho.”

4. Mental Health Matters

Your mindset before you enter the exam room to see a potentially fractious patient can help protect your back, Berg says. “What can you do for yourself in one, two or five minutes to support your personal well-being?” she asks. “Understand you have to take care of yourself if you take care of animals.”

5. Sit Well

When you get into a seated position, make sure your feet are flat on the floor. Your knees should be lower than your hips. Berg recommends using a rolled-up towel to support your arms.

6. Rest and Reset

If your back is aching, give it a break. Pushing through the pain might be tempting, but a seven- to 10-day respite can be the key to healing. A break might sound impossible from a staffing perspective, but how long are you willing to suffer?

Low-Cost Solutions

The following two options won’t break the bank.

1. Mats, Rugs and Pads

Consider installing anti-fatigue mats where you commonly stand in one place, such as in the pharmacy or laboratory. “These can be quite helpful in helping people not develop things like aches in their hamstrings or plantar fasciitis,” says Dr. Downing, who is also a diplomate in the American Academy of Pain Management.

If your practice uses mats, try to recall when they were purchased. How old are they? If you can’t remember, it’s time for replacements.

An effective alternative is an indoor-outdoor commercial area rug with rubber backing. You often see those carpets in office foyers and receiving areas, but Dr. Downing uses them in exam rooms for these two reasons:

• They provide dogs with purchase on what might otherwise be a slippery floor.
• They provide cushion for team members who want to kneel and get back up without slipping.

Heather Lewis, who co-owns the veterinary architectural firm Animal Arts, says washable rugs can create a homier look during floor work. They are also great in comfort and consultation rooms.

In some cases, getting down on one knee might be safer and easier on your back when you examine a patient or reposition yourself. If you have painful or sensitive knees, consider using a gardener’s pad.

2. Other Equipment

Working with a patient on the floor can be difficult ergonomically, especially as we age. Therefore, consider purchasing:

Rolling treatment stools, preferably those that are height-adjustable and have locking casters. Dr. Downing’s neurosurgeon suggested she use one at work before her spinal decompression and fusion surgery. “I said to him, ‘I don’t think you know what I do or how I do it. I get on the floor in the exam room. That is how I see my big patients.’ He suggested a hydraulic stool with a lowest setting of 18 inches.”

• Large ottomans so you can sit with the patient.
• Mobile lift tables.
• Physical therapy mat tables.

Here’s a tip to benefit team members and pets: Housed animals that see another patient being treated or examined can become stressed. Therefore, install a half wall, screen or curtain between the cages and floor area. Lewis recommends screens that are short enough so team members can easily peer inside.

Investments

Here are two ideas that will cost more than a few dollars but will further support your back.

1. Fix the Floor

How and where you stand makes a huge difference. If you can afford some remodeling, Lewis recommends installing rubber or resilient vinyl flooring. Both types offer cushioning underfoot and help reduce reverberant noise.

Lewis is a fan of rubber for these reasons:

• Some rubber flooring is naturally antimicrobial.
• Rubber maintains a high coefficient of friction when wet or dry.
• Rubber is resilient and comfortable to sit or stand on for longer periods.

The downside: A rubber surface might not be sanitary enough in a health care environment. It also requires a pH-neutral cleaning agent. Check with the flooring manufacturer for recommendations.

“The rubber floor, at 7.5 millimeters, is a little thicker than the 2-millimeter vinyl you may use elsewhere in a hospital, so reducing strips at transitions might be required,” Lewis says.

2. Give Yourself a Lift

If you use a hydraulic lift table for small dogs or cats, Dr. Downing recommends sitting in a drafting chair to ensure a positive posture and to bring your chest to the animal’s level. An eye-to-eye posture also reduces fear in patients.

“The beauty of the chair is that it will go quite low and quite high, and it has a footrest,” Dr. Downing says. “If we are going to be ergonomically sensitive and sensible, we want to make sure whatever seating we use is going to protect us from injury.”

Berg, a charter member of the Academy of Veterinary Dental Technicians, appreciates animal hospitals that invest in hydraulic tables. They may be lowered or raised to bring a patient closer, especially during dental and anesthesia procedures.

Berg also has had luck with saddle-style chairs that come with a footrest.

The bottom line is you have many ways to support your back, and a solution that works for someone else might not be right for you. Caring for your physical and mental self is all about curiosity and experimentation.

ALIGN TO FEEL FINE

Sure, you stand every day, but are you doing it correctly?

As a yoga therapist, the three areas of pain I see most often involve the lower back, upper back and anxiety. They are inextricably connected, so you need to correct all of them to build a solid foundation for your physical, mental and intellectual health.

Here’s an exercise:

Imagine your feet as the foundation of your structure. Everything about the way you sit and stand is built off your two lower limbs.

Take a moment to stand up and find the spot behind your big toe. Then, turn your attention to the space behind your pinky toe. And finally, locate the center of your heel. Focus on these three points and notice whether you can balance your weight evenly without folding your feet inward toward the arches or outward. See if you can move your feet until they feel comfortably separated. Start to engage your abdominal muscles and “zip” your belly button toward your spine.

For guidance on how to stand pain-free, check out my YouTube video at bit.ly/4f7RIAi.

AT HIGH RISK

A study of back safety in human medicine, posted at bit.ly/3XFgjq4, stated: “Of all health care workers, nurses and operating room staff have the highest rates of back pain. The annual and lifetime prevalences in these groups are 40-50% and 80%, respectively.” Another study [bit.ly/4goyzeu] concluded: “Age, body mass index, lack of regular physical activity, occupation and patient-related factors, body posture at work, and stress are the factors associated with lower back pain by health care personnel.”

GET BACK TO WHERE YOU WERE

You can train your brain to think about back issues differently. Dr. Robin Downing and Mary Berg recommend:

• Not rushing. Going slower, even when another patient is waiting, helps prevent injuries.
• Investing in an adjustable office chair with good spinal support. Berg prefers a saddle-style chair and footrest when performing dental procedures.
• Getting a massage. Don’t think of it as a luxury. After all, you can’t take good care of pets if you’re in pain. Finding relief will help you help pets more effectively.
• Practicing meditation. While it won’t eliminate pain, it can help you mentally process it. When we carry stress, we feel it in the body, including the upper and lower back.
• Permitting yourself to seek medical care. People sometimes push through pain because they don’t want to be away for a medical appointment, but that compounds a physical injury with a mental health issue.
• Equipping yourself. When operating a mouse, use wrist support to prevent carpal tunnel syndrome.

ROOM TO WORK

In critical care and emergency practices, having dedicated floor space for crashing  or injured animals can be crucial for the patients and team members. If carving out an open area is difficult, Animal Arts architect Heather Lewis recommends having tables that can be folded, rolled or pushed out of the way.

Provide at least a 5-by-6-foot space for the pet, technician and client, Lewis says. More is better.

Dr. Robin Downing of The Downing Center for Animal Pain Management says rolling tables provide maximum flexibility and can serve as emergency gurneys.

“I’ve only had a handful of opportunities,” she says, “but each time, they have been critical in transporting patients from the vehicle to our practice safely, without hurting the patients or ourselves.”

When you’re in the hero pose, you sit back on your heels and keep your hips above the knees for better spinal alignment. The pose allows you to offer on-the-floor pet care and to easily reach the patient.

A padded hydraulic table can bring a veterinary professional and patient to eye level, reducing physical strain on the caregiver.

Fonte: todaysveterinarybusiness.com