The attrition of professional nurses is a sad reality, estimated to be ranging at 24% biennially [1] . Literature has indicated that the leading factors of premature termination of service are poor salaries, long arduous working hours, inadequate in-house training, minimal workplace incentives and rewards, clinical infra-structure and equipment related challenges and personal problems (career dissatisfaction, disgruntled relationships with colleagues and other medical professionals and illness and poor health) [2] [3] [4] . Many of the aforementioned predisposing factors influencing the attrition of nurses are extrinsic in nature, being regarded as hospital management related challenges. This commentary focuses on work-related illness and poor health, more specifically WRMLBP.

WRMLBP is responsible for the increased number of annual sick days and poor health, which contributes to premature retirement of nursing staff [5] [6] . The lower back has been identified as the most susceptible anatomical site of musculoskeletal pain, followed by the shoulders and neck respectively [5] [6] . WRMLBP has high occurrence ranging between 58% and 79% among nursing personnel [6] [7] [8] . Occupational predisposing risk factors cited were awkward habitual working positions unremitting for prolonged periods during patient transfer, strenuous physical stresses of the nursing profession, their poor health and fitness conditioning status as well as obesity [4] [6] [7] [9] (Figure 1).

There has been numerous systematic reviews published concerning WRMLBP among nurses [4] [8] [10] [11] [12] . Yassi and Lockhart and Schlossmacher and Amaral identified a casual association between nursing tasks and WRMLBP [9] [10] . Ellapen and Narsigan’s systematic review described the kinesiology of prolonged vertebral flexion adopted by nurses during patient transfer activities that precipitates lower back pain [12] . Smedley et al. identified the gynoid somatotype (obesity) as a primary intrinsic predisposing risk factor of lower back pain among nurses [13] .

Several empirical investigations examined the efficacy of the different intervention strategies to curb WMSP among nurses [14] . Smedley et al. and Warming

et al. reported that teaching nurses the proper lifting technique during patient transfer reduces lower back pain [13] [15] . Proper et al. and Yuan et al. demonstrated that regular adherence to exercise and physical activity curbs the lower back pain among nurses [16] [17] . Regular flexibility exercises stretch the tight para-spinal muscles of the lower back which, elongates muscle contractures, whilst facilitating the decompression of intervertebral discs and dissipating muscle spasms [18] . Specific strengthening exercise will shorten laxed muscles and increase their strength and endurance when these muscles act as agonists, synergists, fixators and neutralizers to prevent unwanted muscle movement producing lower back pain when performing strenuous physical tasks [18] . Exercise therapists have being prescribing strengthening and stretching exercises to effectively dissipate lower back [18] [19] .

Nelson et al. reported that the primary limitation that prevents nurses from adhering to physical activity programmes is their busy work schedules [5] . This paper briefly reviews the kinesiological association of obesity and WRMLBP. Thereafter an exercise therapeutic intervention has been prescribed to assist in resolving the pain. The authors’ intention is to gently encourage nurses to engage in regular physical activity to curb the incidence of lower back pain.

Nurses should attempt to adopt better ergonomic practises during patient transfers and regularly perform core stabilization exercises [6] . Core stabilization exercises have been successful in decreasing lower back pain by increasing muscle strength and endurance [18] . The ergonomic practices include:

• Adjust patient’s bed height to the nurse’s relative hip (ASIS height), so that the nurse does not need to hyperextend her back when she is transferring the patient onto a bed height higher than her hip.

• Nurses must bend their knees when lifting patients to protect their lower back from injury.

• When lifting patients, nurses should attempt to hold the patients close to their bodies to reduce the stress on their lower back.

• Nurses are encouraged to resume an erect standing posture after continuous prolonged lumbopelvic flexion and/or patient transfers.

• Nurses must refrain from wearing high heel shoes when consulting, as it increases their anterior pelvic tilt.

Core stabilization includes strengthening and stretching exercises. Nurses should seek medical consent from a medical practitioner, exercise therapists (biokineticist and physiotherapist) before engaging in these recommended exercises. The stabilization exercises should include the following;

• All stretching should be performed statically for a minimum of 30 seconds per stretch, twice.

• Muscles that need to be stretched include the iliopsoas, rectus femoris, sartorius, lumbar erector spinae and quadratus lumborum.

• Muscles that need to be strengthened include the gluteus minimus, medius and maximus, hamstrings group and abdominal group (rectus abdominis, external and internal obliques and transverse abdominis).

• Nurses must be encouraged to walk briskly for 20 minutes daily to decrease obesity.

Patients complying with the exercise guidelines will experience a compressive sensation around their lower back (biomechanically known as force closure of the lumbopelvic hip complex), observe better posture (reduction in lordotic curve) and decrease pain sensation leading to no pain. It is important to note that subsequent exercise prescription can serve for prevention and rehabilitation of lower back pain [18] [19] . Physiotherapists and biokineticists are functional exercise therapists who will be invaluable therapeutic practitioners, who may prescribe individualized exercise rehabilitative regimes, demonstrate these exercises and monitor patient progress [12] .

Core stabilization programme

See Table 1 and Table 2.

There is an association between obesity and lower back pain that can be resolved through core stabilization exercises. Therefore, it is recommended that nurses experiencing lower back pain should consider the option of therapeutic exercise.

The authors declare no conflicts of interest regarding the publication of this paper.

Paul, Y., Ellapen, T.J., Swanepoel, M., Hammill, H.V., Barnard, M. and Qumbu, B.T. (2018) An Exercise Rehabilitative Solution to Work-Related Musculoskeletal Lower Back Pain among Nurses. Open Journal of Orthopedics, 8, 322-330. https://doi.org/10.4236/ojo.2018.88035