How Home Health Clinicians Can Use Body Mechanics to Reduce Personal Injuries

By Donna Cifuni, PT, DPT, LSVT

Physical Therapist

Clinicians spend a large portion of sessions teaching patients the proper way to perform specific activities including education on proper body mechanics to reduce the risk of injury. However, clinicians themselves often suffer throughout the day due to their own poor body mechanics. Studies have shown that up to 94% of healthcare workers report low back pain as a result of their occupation. Many physical and occupational therapists see the long-term effects of poor ergonomics and body mechanics on patients, but don’t frequently step back to look at their own body mechanics throughout the day.

Home health clinicians in particular tend to forget their proper body mechanics due to limitations of treating in a home versus in a clinic. In many cases, a patient’s bed height is not adjustable, leaving clinicians to work with what is in front of them. Similarly, home health clinicians do not always have a desk and are left to rely on a couch or table to complete documentation. These, plus other factors, can lead to a lot of work-related injuries over time including low back pain, cervical neck pain, and other potential long-term effects on the home health clinician’s body.

Starting The Day Off Right

Home health clinicians spend a lot of time driving in their cars, so why not start the day off right?

Due to the natural curvature of the lumbar spine, the muscles are put into excess strain when not properly supported in sitting. This is why utilizing lumbar support is so important when driving for prolonged periods of time, or multiple times a day. Luckily, some newer cars come with adjustable lumbar supports via the electrical controls in the seat. However, not every car provides the right amount of lumbar support. Fortunately, many manufacturers have created ergonomic seat inserts for the driver’s seat which provide increase lumbar and cervical spine support.

Clinicians sometimes sit during patient visits when performing documentation or while patients perform seated exercises. Due to home-environment limitations, clinicians may find themselves sitting on a deep-set couch or a folding chair. In addition to lumbar pillows for the car, a clinician can also bring in a portable lumbar support pillow to utilize while treating to reduce strain on the lower back. Ergonomically, it is also important for clinicians to keep feet flat on the floor with knees bent to 90 degrees to allow for proper body alignment.

Due to a prolonged period of sitting throughout the day, whether in the car or at patient’s houses, it is essential that clinicians keep their bodies moving and their minds relaxed. This article provides many great recommendations for how to keep a healthy body and mind while working full-time including relaxation tips as well as recommended and easy exercises that can be performed in the car!

Setting the Right Example For Caregivers

Caregiver education is a huge part of home health therapy. When educating a patient’s caregiver on transfers, clinicians commonly look for the caregivers to mirror their movements. Not only is it important to reduce the clinician risk of injury, but also to ensure that patients and caregivers perform transfers safely.

When performing transfers with patients on lower surfaces, it is essential that the clinician focus on using leg strength versus back strength to lift the patient. The clinician should also utilize a wide stance with legs positioned appropriately based on the direction of the end-surface of the transfer. Pre-planning will come in handy. Setting up the environment prior to initiating the transfer will prevent making quick decisions in the middle of the transfer and will ensure a reduced risk of clinician-related injury.

After performing a transfer, it is important to educate the caregivers on their personal strategies listed above. Clinicians should also watch the caregiver perform the transfers themselves so that they can provide constructive corrections on caregiver positioning and technique to optimize safety.

Adjusting Your Body Mechanics in a Limited Home Environment

Home health clinicians are limited to the environment of the home in which they are treating. Patients, a majority of the time, will not have adjustable treatment tables, or even adjustable beds, within their homes.

Many patient diagnoses benefit from supine activities including manual therapy and stretching provided by the therapist. This means that the clinician will have to adjust their body height to the pre-set height of the patient’s bed. A very tall clinician, for example, should focus on a wide stance when performing activities such as a hamstring stretch on a supine patient to prevent leaning forward at the spine. A short therapist is even more limited (like myself) and could benefit from using an aerobics step alongside the bed to increase the clinician height while maximizing body mechanics.

Clinicians may also be limited when performing seated stretches and Active-Assist Range of Motion activities when a patient is seated in a wheelchair. Sitting in a high dining room chair when trying to perform a seated hamstring stretch or when trying to assist a patient with an exercise will often lead to a clinician bending forward to assist. Since Home health clinicians are limited to whatever chair is available in a patient’s home, it’s a good idea to bring a portable, adjustable stool to reduce having to lean forward to help a patient through their activities.

Proper Clinician Ergonomics While Documenting

Home health clinicians are also faced with the dilemma of trying to utilize a laptop for documentation at a patient’s home, or even in their car. Unless the clinician is seated at a table, this usually means the clinician’s neck will be strained by looking down at the laptop. Ergonomically, it is recommended that a laptop screen is at eye-level. There are many quick and easy laptop stands that can even be used when sitting on a couch! This angles the laptop and raises the height to make the screen at eye level, thus reducing cervical spine strain.

For clinicians who document in the car between patients, there are also trays that attach to the steering wheel that can be used for holding a light laptop.

Ending The Day On the Right Side of the Bed

When the workday is over, it is still important for clinicians to take care of their bodies and wellbeing. After sitting in the car when commuting home, clinicians should be mindful to stretch their backs and legs. When finishing documentation, clinicians should set the laptop on a table or desk to reduce strain in the cervical spine. If at a desk, clinicians should sit with an ergonomic desk chair with adequate lumbar support. Finally, when going to bed, clinicians should look to utilize a pillow that provides adequate cervical spine support as well as a comfortable mattress.

Long-Term Benefits of Clinician Self Care

With attention to proper body mechanics, implementation of ergonomic devices, and focus on daily stretching, Home health workers should note a decreased amount of cervical and lumbar spine pain. With reduced pain and a healthy body, Home health clinicians will potentially have increased career longevity and will live an overall happier life.

How often do you check your own body mechanics? Comment below with other adaptive ergonomic devices or ideas to reduce the risk of injury.