Adrian_Sampath_Research_2017_How Does a Radiographer's Job Specification Influence Their Body Posture to Cause Back Pain

College of Science, Technology & Applied Arts of Trinidad & Tobago
DEPARTMENT OF HEALTH SCIENCE AND TECHNOLOGY
INDIVIDUAL ASSIGNMENT COVER PAGE
ASSIGNMENT TITLE: Final Research Submission
ASSIGNMENT SUBTITLE:
COURSE CODE: RADG 483
COURSE TITLE: Research Methodologies 3
CRN: 31631 SEMESTER: 3 (2016/ 2017)
STUDENT NAME: Adrian Sampath
STUDENT ID: 00040384
PROGRAMME: BSc Radiography
DATE OF SUBMISSION: 23 rd July, 2017
LECTURER’S NAME: Mr. Ricardo J. Rodriguez
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Table of Contents
Introduction ........................................................................................................................... 4
Topic ............................................................................................................................................ 5
Problem Statement .................................................................................................................... 5
Project Scope .............................................................................................................................. 5
Objectives ................................................................................................................................... 5
Literature Review ............................................................................................................... 6
What is Back Pain? .................................................................................................................... 6
1. Sciatica. ............................................................................................................................. 6
2. Low Back Strain. ............................................................................................................... 6
3. Night time Back Pain. ....................................................................................................... 6
What is Poor Posture? ................................................................................................................ 6
Poor Body Posture and Radiography ....................................................................................... 6
Time vs Health; Benefit vs Risk ............................................................................................. 6
Poor use of the Radiographic Table ...................................................................................... 6
Wearing the Correct Shoes .................................................................................................... 7
Moving and lifting Clients ....................................................................................................... 7
Bad Posture during Portable Cases....................................................................................... 7
Bad Posture in Surgical Cases ............................................................................................... 7
Back Pain in Health Care Literature. ................................................................. 8
Back Pain and the Quality of Work. ........................................................................................... 9
Back Pain Management ........................................................................................................... 10
Methodology ........................................................................................................................ 10
Research Design ...................................................................................................................... 10
Analysis ..................................................................................................................................... 11
Time period of Data Collection ................................................................................................ 11
Questionnaire Data .................................................................................................................. 12
Questionnaire Finding .......................................................................................................... 12
Observational Finding .............................................................................................................. 12
Chi Square Testing ................................................................................................................... 13
Testing Hypotheses .............................................................................................................. 13
Sample Check list ........................................................................................................................ 14
Identifying Primary Muscles Used to Move the X-ray Tube ...................... 16
Head and Neck Extension .......................................................................................................... 16
Upper Extremities Major Muscles ............................................................................................. 16
Upper Back ................................................................................................................................ 16
Identified Areas of Muscle Strain .......................................................................... 16
Further Neck Pathology .......................................................................................... 17
Military Neck .......................................................................................................................... 17
Stress Fracture of the Cervical Spine ..................................................................................... 17
Spondylolisthesis ................................................................................................................... 18
Primary Muscles Involved in Bending Forward ............................................. 18
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Table Top Work ......................................................................................................................... 18
Lower Posterior Back ............................................................................................................ 19
Lower Anterior Abdominal Region ....................................................................................... 20
Lower Back Muscle Strain .......................................................................................... 20
Further Pathology Lower Back ......................................................................... 21
Herniated Disc ....................................................................................................................... 21
Muscle Spasm ........................................................................................................................ 21
Osteoporosis .......................................................................................................................... 22
Sciatica ................................................................................................................................... 22
Further Lower Limb Pathology................................................................................ 22
Wrong Type of Shoes ................................................................................................... 22
Different Types of Feet ............................................................................................. 23
Normal Foot .......................................................................................................................... 23
Supinated Foot...................................................................................................................... 23
Pronated Foot ....................................................................................................................... 24
Further Ankle and Foot Pathologies ............................................................... 24
Athlete’s Foot ........................................................................................................................ 24
Bunions .................................................................................................................................. 24
Ingrown Nails ......................................................................................................................... 25
Heel Spurs .............................................................................................................................. 25
Increased Chance of Developing Osteoarthritis at Knee....................................................... 25
Kidney Stone............................................................................................................................. 25
Lead Aprons ...................................................................................................................... 25
Prevention ............................................................................................................................. 26
Moving the X-Ray Tube ............................................................................................................. 26
Table Top Work ......................................................................................................................... 26
Theater ...................................................................................................................................... 26
Exercise to reduce Neck pain and enhance muscles flexibility and
strength ................................................................................................................................. 26
Neck Exercise Program ................................................................................................................ 27
Exercise ..................................................................................................................................... 28
Exercise to reduce Lower Back Pain and enhance muscles
flexibility and strength ................................................................................................ 29
Proper Bending Technique ...................................................................................................... 29
Proper Lifting Technique .......................................................................................................... 30
Exercise ...................................................................................................................................... 31
Discussion .............................................................................................................................. 33
Benefits ..................................................................................................................................... 33
Risk ............................................................................................................................................ 33
Reference……………………………………….………………………………………………………………………33
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Introduction
Adrian Sampath
00040384
Radiography is used to diagnose clients and radiographers must obtain those images in the
shortest time possible. As a student in radiography, it was observed that have some client
positioning was done completely different from what was practice in the labs and different
from what was seen in textbooks. Sometimes radiographers moved their clients on their own
to help quicken the process to acquire the x-ray images, so the client can move to the next
stage of treatment after radiology. It is very admirable to seek out the clients’ best interest,
but those actions accumulate into a long term problem for radiographers.
There is an ongoing outcry that radiographers suffer from back pain. Though patient care
assistance (PCAs) are available, they are not totally reliable to be on standby for their clients
because they multitask in the trauma setting especially. Radiographers also practice short cut
methods, to help shorten the clients time spent in radiology, but little consideration was noted
about the long term effects of performing those substandard routines. Radiographers, seem
to neglect the aid of some equipment designed to help prevent those short cut methods
because in trauma, some client cases do not conform to any textbook protocol and time is
very critical for those clients in life and death situations, resulting in those equipment not
being used.
Radiographers tend to overlook the harm those short cut methods would have on their bodies,
which can cause sciatica, ligament tears or even compressed fractures in the spinal column.
(Back Pain Health Centre, 2016). Those are some of the common risk involved with bad body
posture and this would eventually reflect in the system used to acquire those images reducing
the client care, affecting the total quality system in the health care facility. To address this,
this research will be conducted to help identify reasons why radiographers have back pain
and determine a feasible solution in the form of an exercise program.
Radiographers needs be made aware that this comprise to acquire a diagnostic image in
shortness time possible is degrading their quality of life with poor body posture and degrading
the quality of the service they provide. Once the awareness is raised, the result of this research
would have a structured and workable exercise program that will help tone supporting
muscles to accommodate for the lack or strain in use and the exercise program will also be
developed to help eliminate bad posture, causing a rise in client care and boosting the overall
quality of the service radiology provides.
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Topic
Adrian Sampath
00040384
Does a radiographer job specification influence their body posture to cause premature back
pain?
Problem Statement
Radiographers position their clients to get the images necessary for diagnostic purposes
however, positioning the client may sometimes require a radiographer to bend, lift or adopt a
bad body posture in an attempt to get the images in the shortest possible time. The long term
effect this has on the radiographers’ body is back pains which adversely affects the quality of
system to acquire the diagnostic images in the shortest time.
Project Scope
This research will compare radiographer’s body postures in general x-rays to body postures
from the Clinical Human Factor Group with observational methods. Questionnaires and
interviews are tools which will also be used, to help identify any additional causes that may
contribute to bad posture at work. After identifying all possible causes, a suitable exercise
program will be developed to help diminish the causes for bad body posture and enhance the
quality of the system to produce diagnostic images in the shortest possible time.
Objectives
1. To determine if radiographers have bad body posture positioning clients for an x-ay
examination.
2. If radiographers practice bad body postures, identify causes for bad body posture and
which procedure has the highest link to radiographers back pain.
3. To develop an exercise routine which will reduce the likelihood for poor ergonomic.
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What is Back Pain?
Literature Review
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According to (Back Pain Health Centre, 2016) back pains can be classified according to the
nature of the discomfort. It is sub categorized into the following:
1. Sciatica.
It is caused by irritation of the root(s) of the lower lumbar and lumbosacral spine due
to lumbar spinal stenosis, degenerative disc disease, spondylolisthesis or muscle
spasm. Though they all can have different natures, they all have bad body posture in
common.
2. Low Back Strain.
This happens when a series of muscles and ligaments in the lower back holds the
bones the spinal vertebral column in place allowing painful or little movement. These
muscles become inflamed by stretching them too far, causing tiny tears in the tissues,
which causes the muscles to weakened, so they may not be able to hold the bones in
the spinal vertebral column in place, correctly. The spine becomes less stable, causing
the low back pain.
3. Night time Back Pain.
This is a special type of lower back pain that could indicate a serious problem with the
spine area that may have occurred from heavy lifting causing a compression fracture,
or natural bone degeneration or spinal stenosis.
What is Poor Posture?
Poor posture is the posture that results from certain muscles tightening up or shortening while
others lengthen and become weak which often occurs as a result of daily activities.
Poor Body Posture and Radiography
Radiographers tend to step away from proper body posture while on duty for a number of
reasons. Below is a list of those reasons.
1. Time vs Health; Benefit vs Risk
A radiographer’s duty in the health care system is to obtain high quality x-ray images of
suspected pathology in clients that visit the department with a referral card. (Bontrager &
Lampignano, 2010) To the untrained eye, a radiographer duty seems simple, but there is a
standard that each image must meet to be of diagnostic quality and to obtain those images
the radiographers must position the client in the fastest possible way. By thinking and
positioning the client in the fastest way to obtain those images, the radiographers tends to
step away from proper body posture in an effort to quickly get the x-ray images. With the
practice of poor body posture, the radiographer tends to suffer from premature back pains.
2. Poor use of the Radiographic Table
To reduce the time taken to expose the client to the x-rays to get the images needed, the
radiographic table is not used the way it was design to be used. One of the main reason the
radiographic table move up and down is to get the table at waist height for the radiographer,
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so the radiographer does not need to bend excessively when the imaging receptor needs to
be changed. (Carlton & Adler, January 13, 2012) Practicing that poor body posture by bending
over the radiographic table like that for each case will greatly increase the likelihood for back
pain or irreversible damage to the vertebral column.
3. Wearing the Correct Shoes
Radiographers needs to wear flat base, comfortable leather shoes, not just for safety against
spilled body fluids or potential physical trauma but to cushion each step taken while walking
or running while on duty. It is very unfortunate that some radiographers chose stylish shoes
over comfortable shoes. In our anatomy, we have most nerve ending in the sole of our feet
and a radiographer is always on their feet, so poor shoe choice can result in nerve damage
that causes lower back pains or damage weight bearing joints (ankle and knees) according to
(Stephen Goldberg, 1979)
4. Moving and lifting Clients
Sometimes in an accident and emergency setting, a trolley case is brought in with the PCA
(Patient Care Assistance) and their essential duty is to move the client from the trolley to the
radiographic or adjust the client on the trolley (Ehrlich & Daly, 2015). However, sometimes
the PCA brings the client into the room and leaves, leaving the radiographer to move the client
alone and it is a difficult task to do since time is extremely critical for the client. It is the
radiographer decision to move the client or wait till the PCA returns, but the fact that it is and
accident and emergency setting, the radiographer uses better judgement to move the client
alone in some cases. Radiographers are not trained to move clients so there is a high
possibility that the radiographer uses a bad posture while moving the client which has a high
possibility of damaging the lower back causing pain.
5. Bad Posture during Portable Cases
The poor body posture the radiographers practice is not confined to general x-rays, since they
are rotated in the department. During portable x-rays, a mobile x-ray unit is pushed from
storage to the wards which can take a really long time getting there. Again, the radiographer
may not use the proper body posture to move the equipment from one area to the other,
pushing and pulling the heavy unit to each destination. While on mobile duty, the radiographer
must wear protective shielding, which means the radiographer is wearing a heavy lead apron
according to (Bontrager & Lampignano, 2010). Wearing the heavy lead aprons for long periods
while moving the equipment, adds a tremendous strain to the radiographer’s lower back.
6. Bad Posture in Surgical Cases
In surgical cases, where the radiographer is using a C-arm unit for the entire duration of the
procedure, the c-arm is the trickiest of all to maneuver (GE Medical System Guide for Mobile
C-Arm, July 2003). Other than the obvious reasons, there is no room for error in positioning
the C-arm or hitting anything in the theater room according to (Bontrager & Lampignano,
2010). The radiographer must also wear the heavy lead apron for the entire surgical
procedure, be ready at all times for the doctor and be able to assume awkward postures to fix
the c-arm in place over the client’s body part for the doctor and move it back quickly as
possible without hitting any object since the environment for the client is strictly sterile.
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Back Pain in Health Care Literature.
Adrian Sampath
00040384
Chronic and acute back pain affects more than one employed department in the health care
environment. Proper body posture is essential for decreasing back pain in healthcare workers
who have history of chronic low back pain. Some employees have a history of no trauma or
injury to their back prior to working in the health field.
(Melinda Jaromi, 2016, p. 1) wrote about how health care providers suffer from chronic back
pains and tried to teach to reeducate using “spine friendly” body postures. The purpose of the
study was to measure the effectiveness of a spine training program (Back School) in staff who
have been living with chronic low back pain. It was hypothesized that active therapy,
ergonomics and education called Back School will significantly decrease the pain intensity
levels and improve the body posture of the study participants. (Melinda Jaromi, 2016, p. 1)
(Melinda Jaromi, 2016, p. 2) had also wrote that how back pain was induced by not only by
patient care activities but by bad posture in general. It was also noted that chronic low back
pain is defined as a persisting pain that exists for more than 12 weeks and has a number of
causes. Most often the cause is bad body posture in general or improper body posture during
patient care activities, such as when lifting or mobilizing patients. Proper body posturing and
decreased back pain can be achieved by the application of several different therapies. The
results and effectiveness of these therapies were reported in several of the recent studies.
Furthermore, literature search showed a wide range of active and passive therapies. During
passive therapies, patients do not take part actively in the therapy, for example, massage,
manual therapy, electrotherapy. Active therapies are methods in which patients take part
actively, for example, exercises for muscle strengthening and spine mobilizing, spine
conscious lifestyle therapies. One of these most effective active therapies is the Back School
program.
This essential says that the health care provides who was used in the training for Back School,
focus on their job without paying much attention to their own bodies. After the Back School
program, health care providers realized the effectiveness of training their back muscles or
have their backs treated with massages or therapies that would help relax the muscles that
are under strain which causes the pain.
It was also noted that Back School should be used regular to help medical staff in today’s
medical work force since it’s not does employ a time consuming act and it is relatively
inexpensive.
Results from Back School according to (Melinda Jaromi, 2016) stated how workers
participating in the BS program received theoretical and practical education to help identify
and practice the right body posture, which they could apply during their everyday work and
leisure activities. Furthermore, positive changes were identified in the body posture through
biomechanical movement analysis, recording positive changes in all parameters of body
posture. In the sagittal curves, like the kyphosis in thorax and lumbar lordosis, change was
more significant. Evidence-based medicine studies and guidelines report short-term positive
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effects of passive therapies on pain relief and recommend them primarily as complementary
therapy. The studies that compare active and passive therapies find active therapies more
effective than passive ones because of the beneficial of long-term effects.
The Back School had a successful result, has health care worker had a relive from their
chronic back pains and active therapies should be engaged more often since the study
showed that it has more beneficial long term effects for the individual.
Back Pain and the Quality of Work.
It was mentioned before that in radiography, a radiographer’s duty is to achieve high quality
diagnostic x-ray films in the shortest time possible, for the doctor to diagnose a clients
suspected pathology. However, if the radiographer suffers from chronic back pains, the
procedure may take a longer period of time or due to the discomfort the radiographer
experiences, short cuts may be applied to the procedure which can result in misdiagnosing
the clients or producing poor quality x-ray films.
According to (Lundberg, 2016) from the department of Psychology, Stockholm University,
Sweden wrote that musculoskeletal disorders, such as neck, shoulder and back pain,
constitute a major health problem in a large part of the world, causing pain and disability in
individuals and extensive costs for society in terms of sick leave, medical care, rehabilitation
and reduced productivity. Despite the fact that considerable resources have been invested in
improving working conditions in terms of ergonomic and reduced heavy lifting, pushing and
pulling, musculoskeletal disorders have remained a serious health problem.
Medical health care providers should be under performing since health care has a particularly
high standard. However, with various aids employed to help making clients transfer easier for
the radiographer or having motorized portable equipment, back pain is still an issue for
radiographers, and it eventually has a negative impact on the productive.
Deming who was a Leader in the Quality Revolution had a chain reaction which is still followed
today known as the Deming Chain Reaction. This here shows how quality of work affects other
things which contributes to opening or hiring to new jobs. (Quality Management Philosophies,
2016, p. 45) the chain reaction follows as:
“Improved Quality> Cost Reduce> Productive Improves> Better Quality of Service> Provide
more jobs.”
There is a high cost whenever an x-ray procedure is repeated. If consistent high quality x-ray
images are produced, then there is a lot of money be saved and it can be used and focused
on other projects to improve a radiographer’s work load to ensure staff is not burnt out and
they can get the time needed for therapies for their back pains. This helps the work
environment to grow and has to potential to motivate radiographers since their job would have
reduced work related stress.
(Lundberg, 2016) had wrote in the literature, was that, there is a gender difference with back
pains. The female genders seemed to have more issues with their backs when compared to
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the male gender. Women usually report more musculoskeletal disorders than do men even
though the risk factors for women and men are the same and of the same magnitude. A
systematic review and found that for lifting, men have a higher risk of back complaints than
women, but for social support no evidence of a gender difference was found. A possible
explanation for the higher prevalence of back and neck/shoulder pain problems in women
could be the fact that women tend to have jobs with more risk factors. Examples are nurses
having to lift and handle patients, repetitive work at assembly lines and data entry. It has also
been found that women usually stay longer in these jobs compared to their male colleagues
and, thus, are exposed to these risk factors for a longer period of time. An additional possible
explanation is that women have less opportunities for rest and recovery due to unpaid work
responsibilities off work (for example household chores and children). Sex differences in
terms of muscular strength, muscle fiber composition and pain perception may also be factors
of importance for the higher prevalence of musculoskeletal disorders in women.
So in its essence, the female gender is genetic has a role to play in terms of the muscle
development and because they stay longer periods of time in a work environment. In
radiography, there is a lot more women radiographers than male radiographers too. Women
radiographers also tend to wear shoes that are stylish rather than what is recommended
which contributes to deterioration of the condition of the musculoskeletal system in the lower
back, which contributes to lower back pains.
Back Pain Management
At this stage, where chronic or acute back pain affects the radiographer, the best option is to
manage the pain instead of ignoring it and working with the pain because it issues can only
get worst.
Online journal article from (Searle & Spink, 2016) wrote that exercise has a beneficial effect
on chronic low back pain when compared with other treatments. Results from programs
consisting of coordination, stabilization and strength, resistance exercises have a small but
significant effect on reducing low back pain. Lastly based on current evidences,
cardiorespiratory exercise has no effect on reducing low back pain.
Those are some steps a radiographer can use in their personal time to help reduce their back
pains or reduce the causes that originate from muscles that cause the back pains. This would
efficient help to reduce possible causes for the pain thus work would be done at the required
standard necessary.
Research Design
Methodology
This research will be done at San Fernando General Hospital. Both the general x-ray and
accident and emergency departments. A checklist from the Clinical Human Factors Group
(CHFG) will be used as the standard for body postures, in the radiology department. During
general x-rays, the radiographer will be observed to compare to the standard on the checklist.
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This non-experimental, qualitative research design will be used to collect quantifiable data to
conduct the research. Questionnaires (see appendix) will be given to radiographers near the
end of the work shift to obtain more information about their awareness of bad body postures,
and if they can identify can reasons or justify themselves practicing poor body posture. Giving
the questionnaire at the end of the shift will reduce any bias recording from observing the
postures the radiographer uses to carry out their duties. The radiographer foot wear will also
be taken into account since it is recommended that radiographers wear the most comfortable
shoes for work. Bad posture can originate from the foundation, which is the foot wear is very
important, so it will be included since radiographers are on their feet most of the day. The
expected target of radiographers is 25 for both observational and questionnaire data
collections.
Data Collection Methods
The sampling methods chosen was to interview and observed radiographers’ ergonomics. The
interview was done to help identified radiographers’ outcries of pain and to find common
denominators of potential causes.
A human factor checklist was used to help see how well radiographers know their body to
determine if radiographers practice proper posture.
Observations were made in various departments with different radiographers’ working and
interacting with clients, primary equipment like the radiographic table and x-ray tube and
secondary equipment like weight bearing devices and general body posture.
No further data collection methods were used and all the data collected was analyzed and
statistics were used to find correlations with the data.
Analysis
The results from the observing the radiographers on duty and the information on the checklist
will be complied and analyzed. The results will be tabulated and represented graphically.
Statistically testing will be performed to determine if there is a link between body posture and
the job specification of a radiographer.
Collected Data
During the month of February, data was collected from San Fernando General Hospital,
Princes Town Health Facility and Siparia District Health Facility. Questionnaires and
observational methods were used to collect data from all x-ray departments. Limitations were
encountered but none had any direct impact on the results.
Table 1: Time period of Data Collection
Location Start Date Finish Date Total Time
Days
San Fernando General Hospital 13/Feb/2017 28/Feb/2017 8 9am-2pm
Princes Town Health Facility 7/Feb/2017 10/Feb/2017 3 8am-3pm
Siparia District Health Facility 1/Feb/2017 6/Feb/2017 3 8am-3pm
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Questionnaire Data
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A total of twenty completed questionnaires were collected from radiographers. According to
the collected results, radiographers suffer from back pains.
Questionnaire Finding:
1. All radiographers, senior and junior indicated they suffer from back pain.
2. All radiographers stated that back pain started shortly after they began to work as
radiographers.
3. 15% of the radiographers believe to have proper posture and 85% know they have
poor posture.
4. 70% of the radiographers indicated that theater work causes back pain and poor
posture. 30% of radiographers indicated table work caused back pain.
5. 100% of the radiographers agree that the equipment can be more user friendly to
make the positioning easier.
6. 80% of radiographers wear proper shoes to work and 20% wear shoes that are not
recommended.
7. 80% of radiographers are tired to do additional work after a shift and 20% after other
responsibilities to attend to.
8. 100% of radiographers indicated that in a stress relief program can help aid back
pains.
9. 80% of radiographers said radiography has a negative effect on body posture and 20%
said it has no effect.
Observational Finding:
Using the human factor check list, most observed cases had identifiable problems which lead
to poor body posture.
Table 2 showing total observed examinations with radiographers’ poor body posture.
Rooms/ Total Extremities Table Top Erect Bucky Bedside/ Total
observed cases
Portable
General /100 35 45 8 NA 88
Portable / 20 NA NA NA 18 18
Surgical / 4 2 2 NA NA 4
Accident& 40 45 23 NA 108
Emergency / 140
Total / 262 77 92 31 18 218
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X-Ray Room vs Procedure
X-RAY MODALITY
Total
Bedside/ Portable
Erect Bucky
Table Top
Extremities
218
108
4
18
88
18
0
18
0
31
23
0
8
92
45
2
0
45
77
40
2
0
35
0 50 100 150 200 250
NO. OF IDENTIDIED CASES
Total / 262 Accident& Emergency / 140 Surgical / 2 Portable / 20 General /100
Figure 1 Showing data collected from different x-ray modalities and highest areas where radiographers have poor posture.
Treatment of Results:
Table 3 below show statistics of examination with poor body posture. (Observed Values)
Rooms General Portable Surgical Accident& Emergency Total
Poor Posture 88 18 4 108 218
Good Posture 12 2 0 32 46
Total Cases 100 20 4 140 262
Chi Square Testing:
This test will provide the information necessary to determine if poor body posture is either
dependent or independent relation with the different modalities in x-ray procedures.
Testing Hypotheses
Ho: There is no association between poor body posture and x-ray work, therefore it is
independent
H1: There is an association between poor body posture and x-ray work therefore it is
dependent.
Using:
1. Level of significance at 10%
2. Degree of freedom = (ROW – 1) (COLUMN -1) = 3
3. Critical Value = 6.25 X 2 CRIT
Table 4: Expected Values:
83.2 16.6 3.3 116.5
17.6 3.5 0.7 24.5
To determine whether Ho is accepted or rejected, the formula
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(OBSERVED/EXPECTED) 2 / EXPECTED is used to give X 2 CAL 6.58
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Therefore, X 2 CAL 6.58 >6.25 X 2 CRIT
In conclusion, there is enough evidences to support H1 at 10%, therefore there is an
association between x-ray work and poor body posture.
Sample Check list
Name: ____________________________________ Date: ______________________
Fill in the blank.
Complete each of the following statements with the appropriate word or words from the
word bank. Use each word only once. Some of the words will not be used.
Arms Feet Muscles Trunk
Bending Injury Neck Waist
Fatigue Legs Transfers
1. Good body mechanics is important to prevent _____INJURY______ and ____FATIGUE___.
2. When performing ____BENDING_____ it is very important to have good body mechanics.
3. The largest and strongest muscles in the body are located in the ______LEGS____
and____NECK_____.
4. A human's base of support are the ______TRUCK_______.
5. Bending at the _____WAIST_________ is never a good idea when lifting heavy objects.
True or False.
Write T (true) or F (false) for each of the following statements.
6. __F___ If my back doesn't hurt, I must be doing everything correctly.
7. __F___ Back pain is unavoidable.
8. __F___ When lifting heavy objects, it is best to lift quickly and turn by twisting the upper
body.
9. ___F__ If you know your body, almost everything can be lifted alone.
10. __T___ Pulling residents or clients out of bed is better than lifting them.
11. __T___ The person you are transferring should relax while you move him or her.
12. __T___ The lower back is your most important body part.
13. __T__ Being overweight doesn't affect lifting or transferring.
14. __T___ Residents or clients should stretch before you lift them.
15. __F___ Abdominal muscles support your spine when you lift.
16. __F___ Base of Support is an alternative rock and roll band.
17. __T___ Good posture is also known as body alignment.
18. __F___ The natural curves of the spine are the cervical, thoracic, and lumbar curves.
19. __F___ The muscles in the hands are used to lift heavy objects.
20. __F__ Bending from the waist prevents strains and fatigue.
21. __T__ Good bed positioning will help a resident or client maintain joint range of motion.
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22. __T__ Always transfer toward the resident’s or client’s strong side.
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23. __T__ By using your body weight, not your back, when moving someone you will help
prevent injury to yourself.
24. __T___ Relaxation techniques and regular breaks provide no benefit to avoiding fatigue
and injury.
25. __F__ Never use slow, smooth motions or tell residents/clients you are about to move
them as this will scare them.
26. __T__ Posture exercises can build strength and muscle flexibility.
27. __T__ When completing a two person transfer, communication between the two
caregivers is the least important part of the task.
Multiple Choice.
For each of the following statements, write the letter of the answer that best completes the
statement.
28. __A___ When lifting a load, you should:
a. gets close to the load and tighten the abdominal muscles.
b. stands three feet away and tug hard.
c. both.
29. __B___ When turning you should:
a. moves the upper body only.
b. moves the whole body.
c. neither.
30. __C___ When transferring weak persons from a bed to a wheelchair you should:
a. uses your knees to brace against their knees to prevent their knees from buckling.
b. locks the wheelchair.
c. both.
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Identifying Primary Muscles Used to Move the X-ray Tube
1. Head and Neck Extension (Zehr, 2017)
a) Splenius Capitus
b) Cervicis
c) Semispinalis
d) Spinalis
e) Semispinalis Capitus
f) Upper Trapezius
g) Longissimus Cervicis
h) Levator Scapula
2. Upper Extremities Major Muscles:
a) Biceps
b) Triceps
c) Deltoids
d) Major pectoral
3. Upper Back:
a) Upper Trapezius
b) Splenius Capitis
c) Levator Scapulae
d) Rhomboids
e) Erector Spinea
f) Lower Trapezius
Figure 2 showing labelled muscles involved in extension of the
head and neck
Figure 3 showing labeled muscles of the upper back involved
while moving the x-ray tube
Identified Areas of Muscle Strain
a) Trapezius
b) Splenius
c) Levator Scapulae
d) Erector Spinae
Figure 4 Showing primary areas of muscle strains of moving
the x-ray tube in the head the neck region
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Further Neck Pathology
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1. Military Neck (Asher, 2017)
Military Neck is a pathological condition of the cervical spine in which an individual has an
extremely straight neck as if he or she is standing in attention. It is actually a bony deformity
of the cervical spine. This pathology can happen to a radiographer who extends the neck on
constantly while ‘detanting’ the x-ray tube. Constant extension of the neck is a criteria of
developing military neck.
Figure 5 Comparing a normal to abnormal
2. Stress Fracture of the Cervical Spine
If the muscles in the neck are stiff and inflamed, the cervical spine would be under server
strain. The muscles would be more tense reducing it elasticity causing the additive strain at
its articulations mostly at the cervical spine, where the fracture can happen. Most stress
fractures happen in the front of the vertebra. When the fractures add over time, the anterior
part of the bone can collapse. The back of the vertebra is made of harder bone, so it stays
intact. That creates a wedge-shaped vertebra, which can lead to the stooped posture known
as dowager's hump or clinically called kyphosis.
Figure 6 showing a stress fracture
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3. Spondylolisthesis (Hyde, 2017)
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Due the continuous extension of the head and neck to align the x-ray tube for a procedure, a
vertebra can slide forward over the bone below. Though it is common in the lower back, the
constant extension of the neck introduces spondylolisthesis has a potential hazard to the c-
spine region. Spondylolisthesis has a greater chance of happening if the spine has stress
fractures form the over used joint. The slip disc at any point in the spine can cause
compression of the joint spaces casing discomfort or reducing the mobility of the extremities.
Figure 7 Showing spondylolisthesis in the C-Spine region
Primary Muscles Involved in Bending Forward
Table Top Work
The table is lowered to allow a client to climb on and lay on the table, which would be raised
after to the radiographers’ waist height to avoid any bending. However, it was observed that
radiographers just raise the table to a fixed level and begin the procedure while bending
consistently.
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Figure 8 Radiographer not using the x-ray table correctly and raising the client to waist
height therefore bending to position client for the x-ray procedure
Lower Posterior Back
a) Iliocostal Muscle
b) Longissimus Dorsi Muscle
I. The Capitis Muscle
II. The Cervicis Muscle
III. The Thoracis Muscle
c) The Spinalis Muscle
I. The Spinalis Cervicis
II. The Spinalis Thoracis
Figure 9 Showing muscles of the lower back
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Lower Anterior Abdominal Region
a) Serratus Superior
b) Serratus Intermediate
c) Serratus Inferior
d) Rectus Abdominis
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Figure 10 Showing anterior muscles used for bending forward
According to (Lower Back Muscles, 2017) when a person is bending forward, the hamstrings
are tight, and the spine has to flex more to allow the spine to stretch while bending over. This
additional flexion takes the natural curve out of the lower back and places pressure on the
front of the discs between the vertebrae. This pressure can damage the discs and cause
serious problems such as bulging and herniated discs. A radiographer increases their chance
of vertebral damage with excessive bending and not using the table correctly.
Lower Back Muscle Strain
Two main reasons why lower back muscles are strained is because of poor body posture from
bending and excessive weight. When the muscles involved in bending (see figure 6) are over
used or under constant stress such as bending forward wrongfully. To lessen the pressure on
the lower back while bending, knees must be flexed, especially if hamstrings are tight. This
will allow the body to bend from the hip, not the lower back because of the potential for back
injury. Bending excessively over time reduces the spine natural curve causing more
complicated origin of the pain.
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Figure 11 Showing Common Muscle Points for Lower Back Pain
Further Pathology Lower Back
1. Herniated Disc
Not raising the x-ray table to waist height and bending to adjust the client on the table
greatly increases the chance to cause a herniated disc. A herniated disc commonly
referred to as a slipped disc or ruptured disc is where the cartilage between the
vertebral column is under too much stress which causes the cartilage to break or have
an outpouching appearance causing back pain. Continuing to work under this
condition can cause long term effects which will require surgery to repair the damages
at the specific vertebral level. (Lumber Herniated Disc, 2017)
Figure 12 Showing an MRI of the L-Spine with a Herniated Disk
2. Muscle Spasm
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A lower back spasm is a sudden and involuntary contraction, or uncontrollable
tightening, of a muscle in response to strain, overuse, weakness, or muscle pain
related to injury or a disorder. Back spasms often occur near the spinal cord or near
the nerve roots that lead in and out of the spinal cord. This can put pressure on one of
these sensitive nerves, causing quite severe pain. Muscle spasm of the lower back
typically involves the Erector Spinae muscles since those are the primary muscles used
when bending or under strain. When the muscle becomes tense, it loses a percentage
of flexibility due to inflammation, which adds unnecessary pressure to the lumber spine
which under stress can develop a herniated disc or in a worst case scenario a fracture.
3. Osteoporosis
This is a medical condition in which the bones become brittle and fragile from loss of
tissue, typically as a result of hormonal changes, or deficiency of calcium or vitamin D.
Diet and muscle stress also had a correlation with osteoporosis. Osteoporosis has a
greater chance to happen the older the anatomy is.
4. Sciatica
Muscle spasms, stenosis of the lumber region, poor body posture and wearing the
wrong shoe are some of the primary causes of sciatica. Sciatica usually affects only
one side of the lower body. Often, the pain extends from the lower back all the way
through the back of the thigh and down through the leg. Depending on where the
sciatic nerve is affected, the pain may also extend to the foot or toes.
Further Lower Limb Pathology
Wrong Type of Shoes
A radiographer stands and has quick movements while performing any x-ray examination.
Therefore, the correct foot wear is necessary. According to data collected, some radiographers
wear incorrect shoes for the job.
According to (Shamus, 2017), the wrong shoe can cause knee and hip pain due to excessive
pressures at certain points at the joints cause the cartilage at the joints to ware away faster.
Finding the correct pair of shoe depends on the individual’s feet because feet can be classified
into 3 different categories. Therefore, radiographers need to match their feet with the correct
type of shoe. By not wearing the correct shoe, radiographers run the risk of developing the
following pathology.
Figure 13 Radiographer wearing the wrong shoe while on duty.
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Different Types of Feet
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To reduce joint pain or injuries on weight bearing joints, wearing the right shoe is very critical,
however the right show depends on the individual’s foot. Feet are classified into 3 types, which
if not matched properly to the right shoe, more harm can be done than good. Feet are
classified as Supinator, Neutral and Pronators.
Figure 15 showing the external aspect of different foot types
Normal Foot
The weight is properly transferred with each step and there is no additional pressure to a
particular side of the foot. There is little to do, but a soft sole in a shoe can help cushion the
feet when walking or running.
Supinated Foot
According to (Sports Injury Clinic, 2017) supination is the natural movement of the foot when
walking, jumping and running, but in particular it is the movement of the ankle joint
Inversion is where the sole of the foot is turned inwards, plantar flexion is where the foot and
toes point downwards and adduction of the ankle involves the toes pointing across the body.
Combine all three movements results in supination.
When standing, supination occurs as the foot rolls outwards, placing most of the weight onto
the outside of the foot and raising the arch. Supination is a normal part of the gait cycle
(walking/running) which allows the foot to form a rigid structure for propulsion.
Identifying Supinated Feet
1. Look at your feet when standing using a mirror. Is there a high arch on the inside of
the foot?
Figure 14 Showing the internal aspect of different foot
types
2. Look at your everyday shoes. If they are worn on the outside of the sole, especially on
the forefoot area, then supination may be excessive when you run
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3. The wet foot test. Wet your feet and walk along a section of paving and look at the
footprints you leave. A normal foot will leave a print of the heel, connected to the
forefoot by a strip approximately half the width of the foot on the outside of the sole. If
supination is a problem, the prints of the heel and forefoot will be connected by only a
thin strip on the outside, or may not even be connected, as shown opposite.
Recommendations
1. Purchase inner soles deigned for supination of the feet.
2. In critical cases, an orthotic device can be added into the shoe reducing supination
of the feet.
Pronated Foot
According to (Sports Injury Clinic, 2017) pronation occurs as weight is transferred from the
heel to the forefoot when walking or running and the foot naturally rolls inwards. A certain
amount of this is natural but in many people, the foot rolls in too much or over pronates.
When standing, pronation occurs as the foot rolls inwards and the arch of the foot flattens,
hence, the term often used to describe someone who over pronates as having 'flat feet'.
Identifying Pronated Feet
1. Look at your feet when standing (using a mirror) to look at the arch on the inside of the
foot. If there is not an arch and the innermost part of the sole touches the floor, then
your feet are over-pronated.
2. Secondly, look at your everyday shoes. If they are worn on the inside of the sole in
particular, then pronation may be a problem.
3. The wet foot test. Wet your feet and walk along a section of paving and look at the
footprints you leave. A normal foot will leave a print of the heel, connected to the
forefoot by a strip approximately half the width of the foot on the outside of the sole. If
your feet are pronated there may be little distinction between the rear and forefoot,
shown opposite.
Recommendations
3. Purchase inner soles deigned for pronation of the feet.
4. In critical cases, an orthotic device can be added into the shoe reducing pronation
of the feet.
Further Ankle and Foot Pathologies
1. Athlete’s Foot
These is a contagious fungal infection of the skin that causes scaling, flaking and
itching at the affected area. Normally sweaty socks and tight fitting shoes are primary
causes of this.
2. Bunions
This have a high possibility of appearing on the foot around the first digit due to a tight
or narrow front of the shoe.
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3. Ingrown Nails
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This is caused when wearing tight shoes or shoes with a narrow tip which cause serve
pain. The pressure of the shoe overtime causes the nail to eventually grow into the
flesh of the toe.
4. Heel Spurs
This happens when the underside of the heel bone starts to have an abnormal growth,
which becomes calcified. Tight shoes cause ligaments to constantly rub can increase
the growth of the heel spurs.
5. Increased Chance of Developing Osteoarthritis at Knee.
Weight bare such as standing or using the lead apron for prolonged periods of times
add an external force at the weighting joints, which are mostly the knees. At the knee
joints, there is a cartilage which prevents the bones at the joint from touching or
rubbing together. Wearing the wrong type of shoe or having additional weight on the
body causes the knee joint to absorb most of the shock which causes the cartilage to
wear away developing osteoarthritis at the knee much faster than the expected age of
developing osteoarthritis.
Kidney Stone
Kidney stones or renal calculi, are solid masses made of crystals. They usually originate in the
kidneys, but can develop anywhere along the urinary tract. The urinary tract includes the
kidneys, ureters, bladder, and urethra. Kidney stones can mimic back pain due to the location
the ureter and the urinary bladder. At that point, there will be severe pain in the side and back,
below the ribs. Pain that spreads to the lower abdomen and groin. (Steven, 2017)
Lead Aprons
Figure 16 showing a comparison of a normal knee (left) and a knee with reduced joint space (right)
Lead aprons are used to protect medical staff from unnecessary radiation exposure while
using a portable x-ray machine or the C-Arm in surgery. These lead apron may provide the
necessary protection but they are highly related to serve back pain. According to online journal
article (Pelz, 2017) a 15 pound lead apron can apply pressure of up to 300 pounds per square
inch on the intervertebral disc. It is recommended that a male should wear the lead apron of
a maximum of 10 per week and female should wearing it 8 hours per week main due to the
differences in the general threshold highlighted form the literature review. From the collected
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data from the hospitals, radiographers do rotate to do theatre work but data showed that the
specified time limited is exceeded of wearing a lead apron, since surgical cases are averaged
to be 6 hours a day. The Erector Spinae muscle would be under serve strain which will greatly
enhance the possibility of herniated disc or sciatica developing.
Prevention
Due to the specification and requirements a radiographer must comply to in order to provide
high quality diagnostic images, proper body posture and removing all identifiable hazards
which encourages poor body posture must be avoided. Working under stress and pain reduces
the quality of work being done and radiographers should do everything possible to minimize
the causes to repeat any exposure to any clients.
A radiographer should develop their muscles to reduce the chances of acquiring injuries from
working as a radiographer. Simple exercises and practicing the correct body posture over a
period of time will reduce the stress on muscles as they begin to strengthen and work
accordingly.
Moving the X-Ray Tube
Due to the design of the ceiling mounted tube, naturally to ensure the tube is aligned properly
to the bucky, the neck is extended to look. Once that is set up, they the client is called in to
begin the procedure. To avoid possible injuries or neck pains, simple neck exercises can help
the muscles (see figure 1) develop and reduce any further muscle strain which can be caused
from those actions.
Table Top Work
There is a reason the x-ray table can be raised at different levels. It is primarily to reduce the
need to bend forward and position the client. Once the table is at waist height, this completely
eliminates any bending and twisting, causes muscles of the lower back (see figure 7) to become
agitated, which causes a strain on the spine.
Theater
Standing on your feet for prolonged periods of time can be exhausting. Standing on your feet
for a long period of time with a lead apron on can cause damage to weak muscles which will
support the weight which can injuries to the lumber spine. Where the correct shoe to match
your feet and wearing a lead apron within the specified time limit can reduce the possibility of
injuries. Also simple exercise can also help muscles recover, develop and become more
flexible to manage the strain better reducing the likelihood of serve injury.
Exercise to reduce Neck pain and enhance muscles
flexibility and strength
Note that this exercise program can help develop muscle in the neck and upper back, and
has a potential to reduce pain caused from extension of the neck and strained muscles,
however if the pain has clinical indications of nerve compression or compromised cervical
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vertebra, then this exercise program should not be used and a more in-depth medical
evaluation should be done.
Neck Exercise Program
DESCRIPTION: There are many different reasons for developing neck pain. Not only can the
pain be present in the neck itself, but symptoms such as headaches or pain, tingling, and/or
numbness into the upper extremity, can be related to the neck.
Injuries: Sports-related injuries, car accidents, or falls can cause a neck sprain (often
called “whiplash”). When the neck is forced to move beyond the normal range of
motion, muscles, ligaments, and other soft tissues are stretched. This may cause
pain, swelling, and limited motion.
Posture: The spine needs to be in balance with the line of gravity. Weak musculature
of the trunk and neck or poor postural alignment (head forward, repetitive leaning
over, hunched shoulders, or looking in one direction) can create muscular fatigue,
joint compression, or musculoskeletal imbalances. This may result in tightness or
pain.
Stress: Stress can contribute to holding patterns in the neck by contracting the
neck/shoulder muscles. This may aggravate or prolong healing of an existing neck
injury.
Wear and tear: With age, the spine undergoes changes in the discs and joints which
can be exacerbated by lifelong poor posture. The degeneration of the discs and joints
often creates stiffness or swelling, and may cause impingement of the nerve root at
one or several levels in the spine.
TREATMENT: Neck injuries must be rehabilitated in order to prevent re-injury or a chronic
problem. There are many things to consider that will help, regardless of the reason for the
neck pain.
1) Postural Awareness
Maintain proper postural alignment throughout the day in order to decrease any strain
created on the neck.
2) Control Swelling and Pain
With an acute injury (first 2-3 days) start with:
Rest: Lie down on your back with a thin pillow or lie down on the side with a thicker pillow
to support the neck. This will relieve the pressure and relax any tight muscles.
Ice: Use a bag of crushed ice or frozen vegetables for 20 minutes.
daily. The ice will help decrease swelling and muscle spasms.
Repeat 4-5 times
3) Encourage Pain-Free Movement:
After an injury, the neck will become stiff. Gentle movements starting as soon as
possible will help to regain full range of motion, reduce pain from swelling and muscle
spasms, and prevent your muscles from becoming weak.
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4) Relaxation and Stretching:
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After the acute phase, it is necessary to relax and stretch the neck muscles. A massage
or lying down and applying heat before stretching exercises will assist in relaxing sore
muscles and increasing the circulation in the general area. To self-massage, gently
rub your neck with your fingers for several minutes. Alternatively, heat can be applied
for 10-15 minutes by taking a warm shower, using a moist warm towel, or using a
heating pad. Stretching exercises can help to relax the neck muscles and restore
range of motion.
5) Strengthening and Stabilizing the Neck
To regain/maintain good posture, your neck needs the support of neck, shoulder, and
trunk musculature.
6) Prevention
Exercise
Practice healthy body posture. Place your work at eye level to avoid awkward
postures. Take frequent breaks and do stretching and range of motion
exercises.
Sleep on a firm mattress. Use a thin pillow to lie on your back or a thick pillow
to lie on your side. This will keep your neck in alignment with the spine. Avoid
sleeping prone.
Due to the nature of the work, identified areas in the upper back and neck were recorded. (see
figure 3) therefore exercises mentioned are to help deal with the identified areas.
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Figure 17 Showing stretches which can help develop muscles in the neck and upper back and help increase muscle
flexibility
Exercise to reduce Lower Back Pain and enhance muscles
flexibility and strength
Note that this exercise program can help develop muscle in the lower back, and has a
potential to reduce pain caused from bending forward at the waist, wearing lead apron for
extended periods of time causing stressed and strained muscles, however if the pain has
clinical indications of nerve compression or compromised lumber vertebra, then this exercise
program should not be used and a more in-depth medical evaluation should be done.
Proper Bending Technique
Once the x-ray table is at waist height, there is little to no reason why a radiographer should
bend. However, if you must bend, you should do it correctly.
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Figure 18 showing the correct method to bend
Bending correctly will require the muscles in the legs to be strong and well devolved so the
pressure is not focused on the lower back region.
Proper Lifting Technique
Lifting clients and moving heavy items from the floor is a requirement as a radiographer. The
proper lifting technique should always be used to reduce any possible muscle strain to the
lower back region.
Figure 19 showing how to correctly lift any item
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Exercise
Piriformis Muscle Stretching Exercise
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The piriformis muscle runs from the posterior aspect of the femur to the sacrum. Tightness in
this muscle has been linked to sacroiliac joint dysfunction and even sciatica-type pain along
the sciatic nerve. To stretch the piriformis, lie on supine and cross the involved leg over the
other. With both knees bent, place both hands together under the knee of the other leg lower
leg), and gently pull the bottom leg toward the chest and hold both thighs closely until a stretch
is felt in the buttock area.
Instruction
A. Hold 30 seconds
B. Repeat 1-2 times per day
Psoas Major Muscle Stretching
Figure 20 showing how to stretch pisiform muscle
The Psoas Major muscle attaches to the front portion of the lower spine and can greatly limit low
back mobility when having spasm. It often is one of the sources of low back pain in clients who
have difficulty standing for extended periods or kneeling on both knees. This muscle can be
stretched in a half kneeling position. Rotate the leg outward and tighten the gluteal muscles on the
side being stretched. Next, lean forward through the hip joint rather than bending through the
lumbar spine.
Instructions
A. Hold 30 seconds
B. Repeat
C. 1-2 times per day
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Figure 21 showing how to stretch the Psoas Major
Erector Spinae Muscle Stretching
The Superman exercise requires no equipment and works the entire spine. Use a slow and
controlled motion, and focus on using the erector spinae to power the movement. This can be
done in the morning in bed and at night in bed.
Instructions
A. Begin lying prone and bring your legs together and extend your arms out past
your head.
B. Lift your torso and legs up as high as you can.
C. Pause at the top, then return to the starting position.
Figure 22 showing how to stretch the erector spinae muscles
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Discussion
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According to the data collected from visiting the clinical site, it was identified that
radiographers pay little attention to their body posture which has caused a lot of body aches
and back pain. Radiographers were seen not using the radiographic equipment properly,
wearing wrong shoes, some knew they had poor body posture which contributed to back pain.
If the identified radiographers were mindful of their interactions with the equipment and their
body posture, the number of case of back pains could be reduced.
With the identified areas which caused radiographers to practice poor body posture while
performing their duty was recorded and this exercise program has targeted the areas of the
body under strain and stress from poor body posture. Due to the work specifications required
of a radiographer, sometimes include their bodies work under stress, which can lead to critical
damages.
Developed muscles can handle the workload while under physical stress more efficiently for
a longer periods of time, reducing the possibility of injuries. Proper stretching of the targeted
muscles can greatly increase muscle flexibilities and durability reducing possible back pain.
Practice of proper body posture will also reduce pain, and these can increase the quality of
the service provided as a radiographer.
Benefits
1. Muscles will develop and handle the workload more efficiently.
2. Reduce the outcry from radiographers having back pain.
3. Reduce critical injuries from occurring, such as fractures.
4. Consistent high quality work and service being provided.
5. Reduce the uses of painkillers which could cause harm to Central Nervous System or
cause kidney failure.
6. Could potentially detect an early case of a kidney stone.
7. Using all radiographic equipment correctly to remove any cause for poor body posture.
8. Wearing the correct shoe to match the foot type to increase the longevity of weight
bearing joints.
Risk
1. Following the exercise program when the cause of pain is more critical than simply
muscle.
2. Muscles can become sore for a day or two causing pain while moving.
3. Poor diet and exercise will result in no improvement.
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Reference
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Asher, A. (2017, March 25). Very Well. Retrieved from Loss of Cervical Curve and Cervical
Kyphosis : https://www.verywell.com/loss-of-cervical-curve-or-military-neck-296649
Back Pain Health Centre. (2016, October 10). Retrieved from WebMD:
http://www.webmd.com/back-pain/guide/back-pain-symptoms-types
Bontrager, K. L., & Lampignano, J. P. (2010). Textbook of radiographic Positioning and
Related Anantomy. St. Louis Missouri: Carol O' Connell.
Carlton, R. R., & Adler, A. M. (January 13, 2012). Principles of Radiographic Imaging .
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Ehrlich, R. A., & Daly, J. A. (2015). Patient Care in Radiography with an Introduction to
Medical Imaging 7th Edition. St. Louis, Missouri 63146: Jeanne Wilke.
GE Medical System Guide for Mobile C-Arm. (July 2003).
Hyde, T. E. (2017, March 30). Spine Health. Retrieved from Spondylolysis and
Spondylolisthesis: http://www.spinehealth.com/conditions/spondylolisthesis/spondylolysis-and-spondylolisthesis
Lower Back Muscles. (2017, April 23). Retrieved from Muscles Uses:
http://www.musclesused.com/erector-spinae-2/
Lumber Herniated Disc. (2017, April 20). Retrieved from WebMD:
http://www.webmd.com/back-pain/tc/herniated-disc-topic-overview#1
Lundberg, U. (2016, October 13). Work Conditions and Back Pain Problems. 1-4. Retrieved
from http://web.b.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=6bc72767-6392-
416b-a769-aef9209dbca1%40sessionmgr106&vid=3&hid=116
Melinda Jaromi, A. N. (2016, October 10). Treatment and ergonomics training of workrelated
lower back pain and body posture problem. Retrieved from Journal of Clinical
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543a-464c-8795-3cea44960bcf%40sessionmgr107&vid=21&hid=116
Pelz, D. M. (2017, April 19). Low Back Pain, Lead Aprons, and the Angiographer. Retrieved
from American Jpurnal of Neuroradiology: http://www.ajnr.org/content/21/7/1364
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http://www.shsu.edu/mgt_ves/mgt481/lesson13/sld009.htm
Searle, A., & Spink. (2016). Exercise interventions for the treatment of chronic low back
pain. CLINICAL REHABILITATION, 29.
Shamus, K. J. (2017, April 27). The wrong kind of shoe can hurt you. Retrieved from Detroit
Free Press: http://www.freep.com/story/sports/marathon/2014/10/15/runningshoes-matter/17269397/
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Sports Injury Clinic. (2017, May 8). Retrieved from Supination of Feet:
http://www.sportsinjuryclinic.net/sport-injuries/foot-heel-pain/supination
Sports Injury Clinic. (2017, May 8). Retrieved from Pronation of Feet:
http://www.sportsinjuryclinic.net/sport-injuries/foot-heel-pain/overpronation
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Stephen Goldberg, M. (1979). Clinical Neuroanatomy made ridiculously simple. Miami :
MedMaster, Inc.
Steven, K. (2017, April 29). Kidney Stones. Retrieved from Health Line:
http://www.healthline.com/health/kidney-stones
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from Live Strong: http://www.livestrong.com/article/142208-pilates-exercises-neck/
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Does a Radiographer Job
Specification Influence Their Body
Posture To Cause Back Pain?
By: Adrian Sampath

OBJECTIVES
1. To determine if radiographers have a bad posture positioning
clients for general x-ray examinations.
2. To identify causes for bad body posture and determine which
procedure has the highest link to radiographers back pain.
3. To develop a simple exercise routine which may reduce the
likelihood for poor ergonomic.
7/10/2018 2

Data collection
1. Human factor Checklist from Clinical Human Factor Group
2. Clinical observations.
7/10/2018 3

Data Analysis
Table showing analyzed data from field observations
Rooms General Portable Surgical Accident and
Emergency
Total
Percentage
%
12 2 0 32 46 18
88 18 4 108 218 83
100 20 4 140 262 --
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Identified causes of poor posture
Not raising and dropping radiographic table at waist height.
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Identified causes of poor posture
Not wearing the correct shoes.
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Identified causes of poor posture
Moving and Positioning clients into radiographic positions.
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Identified causes of poor posture
1. Wearing Lead Aprons for long periods of time.
2. Moving the x-ray tube.
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Identified causes of poor posture
Wearing Lead Aprons for long periods of time.
Females – Maximum of 8 hours per week
Males – Maximum of 10 hours per week
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Pain!
Upper Back Pain.
Lower Back pain.
Renal System complications.
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Anatomy Under Stress
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Potential Risk Working With Pain!
Upper Back Pain
Military Neck
Stress Fractures
Spondylolisthesis
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Potential Risk Working With Pain!
Lower Back Pain
Herniated Disc
Sciatica
Compression Fractures.
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Exercise Routine Overview
1. Identify muscles under stress and strain.
2. Matching feet type with correct shoes.
3. Exercise to stretch primary muscles to enhance flexibility.
4. Exercise to stretch primary muscles to reduce the likelihood of
muscular pain.
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Exercise Routine Overview
Matching feet type with correct shoes.
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Exercise Routine Overview
Exercise to stretch primary muscles to enhance flexibility.
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Benefits and Risk of the Exercise
Routine.
Benefits
1. Consistent high quality
service provided.
2. Reduce the need of pain
medication.
3. Muscles will develop and
handle the work more
efficiently.
Risk
1. Following the exercise
program when the cause
of pain is more critical
than muscular.
2. Low quality diet will
reduce improvement.
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The End
Thank you
7/10/2018 18

20 th ISRRT WORLD CONGRESS
Certificate
presented to
Adrian Sampath
for the paper entitled
How Does a Radiographer's Job Specification Influence Their Body Posture to Cause Back Pain
20 th International Society of Radiographers & Radiological Technologists World Congress
Held in Hyatt Regency, Trinidad & Tobago
From April 12 th – 15 th 2018.
ALETH BRUCE
President,
Society of Radiographers of
Trinidad and Tobago
ANUSHKA KATTICK-MAHABIRSINGH
Chairperson,
Organizing Committee of
20 t h ISRRT W orld Congress
FOZY PEER
President,
International Society of Radiographers &
Radiological Technologists