Are there risks for healthcare workers who are on their feet all day?

Q:

What kind of risks do healthcare workers face from being on their feet during an entire shift?

A:

A large number of studies link sedentary lifestyles to a series of chronic diseases and a shortened life expectancy. Some researchers concluded that having about 11 hours of sedentary activity per day can lead to a 12% increase in the risk of premature death compared to subjects who spend less than 4 hours a day in a sedentary position.

This should be good news for healthcare workers who spend most of their day standing and walking. These jobs maximize your step count and improve cardiovascular health.

That's advantageous to your health. However, too much of a good thing can be a problem, and that includes being on your feet all day. The benefits listed above remain, but there are a series of health symptoms and conditions that can develop from spending too much time standing and even walking.

The Main Hazards of Prolonged Standing and Walking

The most significant hazard for healthcare employees spending most of their time on their feet is gravity. Gravity acts on your body with a force proportionate to your mass, basically pulling our body towards the floor.

The other major hazard in a healthcare setting is impact or compression. The impact is a function of gravity, compounded by the fact that the floors in healthcare facilities are generally made of concrete. That's an advantage from a sanitation perspective, but walking on concrete floors all day creates high impact, which compresses your joints.

The Health Effects of Working on Your Feet

Since gravity is a function of how close two bodies are, the closer a body part is to the ground, the more likely it will be affected by prolonged standing.

The feet are most often affected, followed by the shins and calves, then the knees, thighs, hips, and low back. And since leg, back, and neck muscles are mostly responsible for maintaining our posture, it is no surprise that symptoms from working on your feet will extend (to a lesser degree) to the neck muscles.

The most common symptoms are fatigue and discomfort, but ignoring these preliminary signs will lead to more serious and chronic problems, such as:

  • Low back pain
  • Plantar fasciitis and heel spurs
  • Orthopedic changes in the feet
  • Restricted blood flow
  • Swelling in the feet and legs
  • Varicose veins
  • Increased chance of arthritis in the knees and hips
  • Painful feet and other foot problems

What Causes These Conditions?

Joint Compression

Your body parts are connected by joints, and these joints are compressed and squeezed when the weight of your body acts upon them. In a cumulative effect, each lower body part is compressed by all of the sections of the body above it, hence the higher proportion of conditions afflicting the feet.

Short-term compression has no negative health effects - our bodies are designed to function this way. But over the long run, the body fluids are squeezed out of the space in the joints. This leaves the joints malnourished and reduces their capacity to support the weight of the body.

Those fluids in the joints also act as lubricants. Without the lubrication they provide, wear and tear of body parts is accelerated.

Postural Muscle Fatigue

There are several muscle groups that are responsible for our posturing. These muscle groups are keeping your body from falling over while you are standing or walking. But standing or walking for extended periods of time means that these muscles are under continuous stress, without adequate recovery time. This leads to exhaustion, which in turn leads to pain.

Insufficient Venous Blood Return in the Legs

When standing, gravity encourages your blood to go all the way down to your feet. That same gravity makes it harder for the blood to come back up. The blood will pool down into our feet.

Generally, blood is pushed back up to your heart through cyclic muscle contractions, often called a “muscle pump.” When we are standing we engage these muscles in a continuous contraction and they can’t produce a “muscle pump” effect.

The same continuous contraction becomes an aggravating factor in impeding the replenishing of body fluids in the joints, aggravating the effects of joint compression.

Shock Transmission From Heel Impact on the Floor

The kinetic energy from walking adds supplementary force to the joints, especially the heels. When the heel impacts the floor it has to withstand a force that is the equivalent of one-and-a-half to two times the weight of the body. That impact is further aggravated by the rigidity of the floor.

The impact from this shock transmission can result in microscopic damage to the soft tissue, which in the absence of rest (sitting or lying down) can build up into a repetitive strain musculoskeletal injury.

Conclusion

Despite the health effects of standing and walking, there are also many risks associated with these activities, especially if they're carried out as persistently as they are in healthcare settings.

These risks are compounded by the fact that healthcare workers do not have most of the simple remedies available in other industries. Sitting, resting, or improving the quality of the flooring are not viable options because of the nature of the job.

The available controls are, therefore, mostly limited to:

  • Using insole and orthotics
  • Buying comfortable shoes that don't change the shape of your foot
  • Changing shoes and insoles when their shock absorption has decreased
  • When standing, placing a foot in front of the other, and elevated if possible
  • Stretching when you can
  • Taking care of your feet at home
  • Addressing medical health conditions and behaviors that can increase risks to your feet (diabetes, cardiovascular conditions, smoking, arthritis, scoliosis, gout, preexisting plantar fasciitis)

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Written by Karoly Ban Matei
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Karoly has worked at a senior level (both as an employee and a contractor) for organizations in the construction and manufacturing industries. He has a passion for developing and improving health and safety programs.

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