Mandatory manual handling training educates staff about the biomechanical principles of safe moving and handling, for example:

The aim is to reduce physical stresses and strains on the lumbar spine but also the entire musculoskeletal system (HSE [36]). For tasks that involve handling patients, these principles can be adapted to include the following:

Where tasks are more static in nature and/or involve leaning or reaching forwards (e.g. assisting a patient to roll over in bed and supporting them in side‐lying), a walk‐step stance combined with attention to neck posture can reduce stresses and strains on the cervical, thoracic and lumbar spine regions.

For these tasks as well as those that involve prolonged sitting or standing (e.g. theatre tasks or computer use), the position of the head in relation to the trunk requires particular attention. If the head is directly above the trunk, it weighs approximately 5.5 kg. However, leaning the head forwards by just 5 cm increases its effective weight to approximately 15 kg; increasing this to 7.5 cm increases its effective weight to approximately 19 kg; and tilting the head down to a 60° angle increases its effective weight to approximately 27 kg (Figure 19.5). This forces the muscles of the neck and shoulders to work considerably harder; increases the loading and therefore the physical stresses and strains on the joints, soft tissues and nerves in the cervical spine; and heightens the risk of developing neck and upper limb musculoskeletal disorders over time (Kapandji [38]). This is a particular risk with computer use, where this issue may combine with poor seating and/or postures, lack of lumbar spine support, and overreaching to access the keyboard or mouse (Figure 19.6).

It may seem inconsistent that bending and twisting the spine at a weekly yoga class is deemed beneficial whereas bending and twisting over a patient is high risk. The reason for this lies in repetition, as well as the potential for high forces. Risk factors for work‐related musculoskeletal disorders are multifactorial and can be summarized as follows:

Generally, none of these factors acts individually to cause injury; instead, injury occurs as a result of combinations of and interactions between these factors. Yoga may take your spine through the full range of movements a couple of times a week and improve your core strength, whereas a nurse may bend over a patient around 2000 times a day while also lifting, pushing and pulling at the same time (e.g. when lifting heavy legs into a bed, fitting hoist slings or repositioning patients in bed). Rather than improving flexibility and strengthening the core, adopting these compromised postures so excessively, especially when combined with high forces and psychosocial factors, may increase the risks of microtrauma and the development of cumulative musculoskeletal disorders over time (HSE [36]).

However, it is important to note that staff must not feel afraid to bend and twist; maintaining flexibility is very beneficial. The message is about reducing exposure to excessive bending and twisting during patient handling tasks, as well as reducing the accompanying high forces, for example by encouraging patient independence as much as possible, using equipment, adjusting working heights, using the strong leg muscles, and getting help to offload and share the physical stresses and strains. The Chartered Society of Physiotherapy (CSP) has published Back Pain Myth Busters ([15]), which is an evidence‐based guide to managing back pain and reducing fear; it also reinforces what the latest evidence says is best for the back when a person is experiencing discomfort. This includes not being afraid to bend and twist, keeping moving, and exercising regularly. Importantly, the CSP ([15]) also suggests that pain does not always equal damage. The message is always about balance – to minimize excessive bending, twisting and heavy physical work and to adopt a balanced approach whereby staff consider the needs of patients and the goal of care, but where they do not forget to consider themselves in the process. This must all take place within a holistic, safe system of work that considers and addresses physical as well as psychosocial risk factors, which are the responsibility of both the employer and the employees (HSE [36]).

Healthcare professionals can further reduce the risk of developing musculoskeletal disorders by looking after their own health and fitness in terms of having a healthy lifestyle, maintaining a healthy weight and exercising regularly to ensure that they are fit for what can be quite physically demanding work. Shift patterns and constantly changing routines can make regular exercise a challenge, so the secret is to find something that is enjoyable so that it does not feel like another chore. Many hospital physiotherapy departments offer on‐site staff yoga, Pilates or other exercise classes to make it easier for staff to get involved. Any exercise is better than none, even if it's simply parking your car further away from work and walking, or getting off the bus a couple of stops early.

In spite of this advice, those with pain or health concerns should always seek professional advice before embarking on a new exercise routine. Back care and musculoskeletal health require a 24‐hour approach, and safe principles need to be incorporated into home and leisure activities as well as work tasks for maximum effect (Smith [73]).