Before I became #fitfam, I was a radiographer first. A lot of my opinions here lie within anecdotal evidence from my own experience. I did struggle to find a lot of literature pertaining to Irish/UK radiographers. Which is why this is largely my opinion, as opposed to cold, hard facts. However, as I am rarely wrong and blindly convinced I know everything, why not take this as gospel? (Please don’t).

Common Injuries Radiographers Face

Radiography is a physically demanding job, which is rarely appreciated by those outside the profession. It is tragically not all pushing buttons (although the high levels of repetitive strain injuries amongst radiographers suggest otherwise). It’s transferring and positioning patients, moving heavy equipment into awkward positions and standing in lead all day. You are on your feet more often than not, and on top of that working crazy hours and night shifts. The physical body takes some beating in radiography.

The idea for this article came to me after a week in work where I was working in inpatient x-ray. Inpatients tend to be a lot more physically demanding for the radiographer to examine, often requiring additional positioning aids and advanced manual handling techniques. My body is physically tired from this, and with all the manual handling in the world it is impossible to escape this fatigue. Therefore, I believe it is important that we ensure we are prepared for the physicality of this work.

Literature is generally conclusive that there is a high incidence of workplace related MSK injury amongst radiographers. Indeed, one study reported that 100% of radiographers experience MSK pain during or after their workday at some point in their careers^[2]. One study found that radiographers have a much higher incidence of workplace-related injury (WRI) compared to other occupations^[3]. More than half of these injuries were MSK disorders.

MSK injuries can be chronic (overuse, repetitive strain injuries) or acute (e.g. trauma).

The graphic below shows the most common MSK injuries amongst radiographers.

Sonographers & Injury

Sonography brings a whole other host of physical stressors on the body. Sonographers carry out ultrasound examinations by pushing a heavy transducer probe over a patient, whilst also using a keyboard and monitor simultaneously.

As much as 80-95% of sonographers experience work-related pain or injury^[5]. In addition to the injuries listed above, sonographers frequently sustain shoulder injuries. This can be due to poor scanning technique, workplace ergonomics or a lack of physical strength. Furthermore, scanning overweight patients can increase the risk of muscle injury, as sonographers are required to increase pressure on the probe to visualise structures^[6].

Using appropriate scanning techniques and appropriate workplace environment layout has been shown to reduce injuries amongst sonographers. It’s not all we can do to ensure we decrease injury risk. Literature suggests sonographers focus on building up upper body, core and postural strength to reduce the chance of workplace-related pain^[6].

The Role of Resistance Training in Injury Reduction

With the literature suggesting that as a radiographer you will have sustained some form of injury simply by reading this sentence, we will delve a little deeper into the link between resistance training and injury prevention.

Exercise has long been regarded as vital in maintenance of cardiovascular and muscular health. The American College of Sports Medicine (ACSM) recommend adults perform a variety of resistance exercises 2-3 days a week. Resistance training has been shown to help prevent osteoporosis, sarcopenia and lower back pain^[7].Therefore, it stands to reason that by performing resistance training regularly, you will keep your body in top physical condition, reducing your risk of injury.

Chronic lower back pain is the number one cause of disability amongst the working population, and the likelihood of returning to pre-injury strength decreases with time. Research shows that strengthening the lower back with as little as one set of 8-15 reps per week of lumbar strengthening exercise can positively impact lower back strength^[8]. A study of general hospital personnel found that exercise to improve back muscle, strength and co-ordination reduced the number and complaints of intensity of LBP^[9]. Conversely, one study found resistance training did not affect isokinetic muscle strength of the shoulders and back. This study did use a much smaller sample size, however^[10].

One literature review found that implementing resistance training can help significantly reduce WRI and MSK injuries^[11]. Again, these studies are non-specific to radiographers.

Resistance training can help prepare us for activity. When we are prepared for something, the less likely it will be to cause us stress. Radiography is a very physical job, and can demand a lot of the body. By becoming stronger, you will be less affected by the physicality of work. It is up to you to “get active in your own rescue”, as Marcus Aurelius once said. Be proactive, rather than reactive. Don’t wait until you get a bad back (and you will!) from work to do something about it.

Suggested Exercise To Incorporate Into Your Training

The exercises I suggest you implement into your resistance training programme are based on the principle of specificity. “Specificity” in this context means preparing your body for the activity you intend to do. For example, if a swimmer wanted to swim faster, they would practice swimming technique. Certainly, increasing muscle mass will improve performance, but to get better at something you need to practice at it. Similarly, when it comes to training for injury prevention, exercises need to mimic common movement patterns performed by radiographers. In other words, the training protocol needs to be specific and functional.

Widely regarded as the “king” of all compound movements, the deadlift has the capacity to work your entire body at once. It is widely accepted amongst strength and conditioning coaches as one of the best movements you can perform to develop total body strength^[12]. There are multiple variations of the deadlift, and most people tend to progress quite quickly. Radiographer or not, there are very few reasons why you wouldn’t include it in your training programme.

Including rowing movements in your plan (barbell row, upright row, one-arm row etc.) can be useful, as they mimic a lot of the movements radiographers do throughout their working day (sitting patients forward, pulling equipment etc.) Rowing movements can also help improve core strength, which may help reduce lower back pain^[13].

As stated above, a strong core can reduce incidence of lower back pain. This evidence is largely anecdotal, and supporting scientific evidence is minimal. However, there is a lot of evidence to linking lower back pain with poor core muscle stability. Common exercises shown to improve core stability include planks, side bridges and supine bridges. It may be worthwhile implementing these exercises, to ensure you are giving yourself the best chance at maintaining a healthy lower back^[14].

Obviously for these exercises to be beneficial, they need to be carried out correctly and with good form. Incorrect execution of these exercises can put you in a worse position than when you started. If you are unsure, film yourself carrying them out and measure them against tutorials on YouTube from reputable channels (I highly recommend the Buff Dudes for this!).

Conclusion

Resistance training alone will not prevent workplace-related MSK injuries. However, in my opinion, RT can be a factor in reducing the likelihood of MSK injuries. As is the case with everything in life, there will always be those that are the exception to the rule.

Resistance training obviously does not negate the need for proper manual handling techniques and safety procedures. I am by no means suggesting that you start weight training solely for the purpose of being better at your job. It is just one of the benefits of resistance training. Resistance training can help you give yourself the best possible chance at ensuring you maintain your health, particularly your physical health throughout your career. And if you get some abs along the way, sweet.

I would love to hear your thoughts on this, particularly if you are a radiographer. Shoot me an email at michellecarrollpt@gmail.com if you have any comments or feedback on this article. Again, I cannot stress enough that this is entirely my opinion, and open to interpretation based on your own experience.

References

1. CORU (2019) CORU Registration Statistics. Available at: https://coru.ie/news/news-for-health-social-care-professionals/coru-registration-statistics-july-2019.html.
2. Fisher, T.F. (2015)’Radiologic and Sonography Professionals’ Ergonomics: An Occupational Therapy Intervention for Preventing Work Injuries’, Journal of Diagnostic Medical Sonography. Available at: https://journals.sagepub.com/doi/pdf/10.1177/8756479315580020.
3. Hulls, P.M., Money, A., Agius, R.M., de Vocht, F. (2018) ‘Work-related ill-health in radiographers’, Occupational Medicine. Available at: https://academic.oup.com/occmed/article/68/6/354/4998908.
4. Lorusso, A., Bruno, S., L’Abbate, N.L. (2007) ‘Musculoskeletal Complaints among Italian X-ray Technologists’, Industrial Health. Available at: https://www.jstage.jst.go.jp/article/indhealth/45/5/45_5_705/_pdf/-char/ja.
5. Pallotta, O.J. (2016) ‘Musculoskeletal pain and injury in sonographers, causes and solutions’, Sonography. Available at: https://onlinelibrary.wiley.com/doi/full/10.1002/sono.12093.
6. Harrison, G., Harris, A. (2015) ‘Work-related musculoskeletal disorders in ultrasound: Can you reduce risk?”, Ultrasound. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4760593/.
7. Wientt, R., Carpinelli, R. (2001) ‘Potential Health-Related Benefits of Resistance Training’, Preventive Medicine. Available at: https://www.researchgate.net/publication/11675434_Potential_Health-Related_Benefits_of_Resistance_Training.
8. Carpenter, D.M., Nelson, B.W. (1999) ‘Low back strengthening for the prevention and treatment of low back pain’, Medicine & Science in Sports & Exercise. Available at: https://journals.lww.com/acsm-msse/Fulltext/1999/01000/Low_back_strengthening_for_the_prevention_and.5.aspx.
9. Taulaniemi, A., Kankaanpaa, M., Tokola, K., Parkkari, J., Suni, J.H. (2019) ‘Neuromuscular exercise reduces low back pain intensity and improves physical functioning in nursing duties among female healthcare workers; secondary analysis of a randomised controlled trial’, BMC Musculoskeletal Disorders. Available at: https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-019-2678-x.
10. Hamberg-van Reenen, H.H., Visser, B., van der Beek, A.J., Blatter, B.M., van Dieen, J.H., van Mechelen, W. (2009) ‘Applied Ergonomics The effect of a resistance-training program on muscle strength, physical workload, muscle fatigue and musculoskeletal discomfort: An experiment’, Applied Ergonomics. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0003687008001634.
11. Van Eerd, D., Munhall, C., Rempel, D., Irvin, E., Brewer, S., van der Beek, A.J., Dennerlein, J.T., Tullar, J., Skivington, K., Pinion, C., Amick, B. (2015) ‘Effectiveness of workplace interventions in the prevention of upper extremity musculoskeletal disorders and symptoms: an update of the evidence’, Occupational & Environmental Medicine. Available at: https://oem.bmj.com/content/73/1/62.full.
12. Bird, S., Barrington-Higgs, B. (2010) ‘Exploring the Deadlift’, Strength and Conditioning Journal. Available at: https://journals.lww.com/nsca-scj/Fulltext/2010/04000/Exploring_the_Deadlift.4.aspx.
13. Saeterbakken, A., Andersen, V., Brudseth, A., Lund, H., Fimland, M.S. (2015)’The Effect of Performing Bi- and Unilateral Row Exercises on Core Muscle Activation’, International Journal of Sports Medicine. Available at: https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0034-1398646.
14. Huxel Bliven, K.C., Anderson, B.E. (2013) ‘Core Stability Training for Injury Prevention’, Sports Health. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3806175/.