Nurses’ Use of Chiropractic for Relief of Back and Neck Pain

Nurses’ Use of Chiropractic for Relief of Back and Neck Pain | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Nurses’ Use of Chiropractic for Relief of Back and Neck Pain Regan T Vellan, Laura Gantt This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3931604/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Because of the physical demands of the profession, nurses often experience back and neck pain. Chronic pain can affect productivity at work and push nurses to seek less physically taxing positions. With an increased demand for nurses, the wellbeing of these healthcare workers must be taken into consideration to maximize retention, quality patient care, and job satisfaction. However, few studies exist that describe nurses’ use of chiropractic therapy to manage back and neck pain. This study sought to fill that gap. Methodology The primary investigator obtained permission to recruit patients who were nurses from a chiropractic office in a town in eastern North Carolina. Those sought for this study frequented a chiropractor when dealing with back or other areas of discomfort and had work-related musculoskeletal pain. Narrative inquiry was employed for the study and participants engaged in one face-to-face interview in the chiropractic office. Results Six women ages 45 to 70 were recruited by word of mouth and referrals from the chiropractors. All participants had nursing degrees and experience, but not all were still in nursing practice. From the interviews, nurses’ experiences with back and neck pain before and after chiropractic were revealed. Chiropractic proved to be a beneficial treatment for those suffering pain who were both in and out of work. Nurses described the healing process as gradual, but all participants benefited. The nurses still in practice mentioned that chiropractic care improved their productivity at work; lifting and turning patients became easier. As patients, they received treatments ranging from adjustments to interferential therapy as well as insights into nutrition and stretching. Conclusions Nurses’ self-care is a frequent topic in current literature. However, the use of chiropractic therapy as a strategy for self-care has received limited attention. Future research related to self-care by nurses should include chiropractic among the therapies nurses may find beneficial. Integrative & Complementary Medicine Nursing chiropractic therapy musculoskeletal pain nurses relief Introduction Due to the physical demands of their profession, nurses often experience back and neck pain. A study conducted by Heiden and colleagues ( 1 ) on musculoskeletal disorders in working nurses revealed that individuals aged 35 to 44 are particularly prone to experiencing lower back pain associated with patient handling. Further research found that older nurses and employees in similarly taxing fields suffering from chronic pain had decreased productivity at work ( 2 – 5 ). With the bodily challenges that may arise from a nursing career, both younger and aging nurses may choose to pursue less strenuous positions, retirement, or other professions ( 6 , 2 ). Given the growing demand for nurses, prioritizing the well-being of these healthcare professionals is crucial to enhance retention, quality of patient care, and job satisfaction. Chiropractic care employs a multifaceted strategy to address upper and lower back pain. This approach includes manual adjustments, the use of cervical or intersegmental traction tables, interferential therapy, as well as guidance on physical activity and diet ( 7 ). These chiropractic interventions aim to alleviate symptoms and enhance muscle functionality. During a manual adjustment, a chiropractor applies controlled, sudden force to specific vertebra or joints using either their hands or special instruments to correct misalignments in the spine ( 8 ). Interferential therapy sends electrical currents into the tissue which stimulates endorphins, and therefore results in pain relief, supports healing, and stops muscles spasms. Both cervical and intersegmental traction promote stretching and improve mobility. Additionally, chiropractic facilities may provide other services like cryotherapy, ultrasound, laser therapy, and hydrotherapy. However, it can be difficult to get a consistent picture of the benefits of chiropractic care because the few available studies include a variety of populations, feature small sample sizes, and lack control groups. A larger study of 1853 adults by Hays and colleagues ( 9 ) demonstrated that significant improvements in acute and chronic pain were reported after chiropractic care. Similarly, a Swedish study led by Gedin et al. ( 10 ) showed substantial improvements in 138 patients experiencing acute and chronic back pain after four weeks of chiropractic treatment. Additionally, a qualitative study exploring the outcomes of Complementary and Alternative Medicine (CAM) therapies comprised of 64 adults aged 20 to 70, found high satisfaction levels and positive responses to chiropractic treatment ( 11 ). A scoping review conducted by Mior et al. ( 12 ) concluded that chiropractic treatment was effective in alleviation of pain in active-duty military personnel. Furthermore, research by Corcoran et al. ( 13 ), incorporating 70 episodes of care for female veterans, emphasized the favorable outcomes associated with chiropractic therapy, such as spinal manipulative therapy, spinal mobilization, and myofascial release. Few studies, however, have described the use of chiropractic therapy by nurses or whether it is helpful to nurses in managing back pain. While studies on chiropractic care have indicated that it is beneficial, there is practically no research on nurses and the use of chiropractic treatment, even though nurses are known to have a higher-than-average incidence of back pain. Further research is needed to address this gap in literature. The purpose of this study was to determine if chiropractic therapy could lessen back pain in nurses and improve performance at work. Methods Narrative Inquiry This study utilized narrative inquiry, a technique that recognizes that people use storytelling to make sense of their experiences, communicate their understanding of the world, and assign meaning to their lives ( 14 ). This method delves into the storytelling process to gain a deeper understanding of human experiences. According to Sandelowski, “narratives are understood as stories that include a temporal ordering of events and an effort to make something out of those events” ( 15 , p.162). Additionally, Sandelowski states, “Using such narrative models, researchers can gain insight into the way human beings understand and enact their lives through stories” ( 15 , p.163). It provides a framework for exploring the complexities of individual and collective narratives, allowing researchers to uncover the meanings people attach to their lives. This approach facilitates a deeper understanding of both the individual and their relationship with the act of recounting their stories by analyzing their feelings, intentionality, and perspective ( 14 ). In this study, narrative inquiry related to how nurses manage their acute or chronic back pain with or without chiropractic care allowed exploration of their emotions, reactions to treatment, and meanings behind their stories. Sample Ethical approval was obtained from the Institutional Review Board under the ID number, UMCIRB 22-001398, before the study began. Those sought for this study frequented a chiropractor when experiencing work-related musculoskeletal pain in the back or other areas. A sample of nurses was recruited from one chiropractic office in eastern North Carolina where the primary investigator (R.V.) had permission to recruit subjects. The intent was to recruit five to ten male and/or female nurses ages 21 to 65 by word of mouth and reference from the chiropractors’ office practice. Everyone who was approached for the study agreed to participate. Inclusion criteria were: 1) participants who had some experience in the nursing field and a nursing degree; 2) participants who communicated effectively in English or had a qualified translator; 3) participants who frequented the chiropractor when dealing with back or other areas of discomfort and had work-related musculoskeletal pain. Based on the narrowness and specificity of the research question, the suggested sample size provided sufficient answers for the study. The suitability of the sample size was assessed repeatedly throughout the interview and research procedure. Once saturation, when all relevant data collection had been completed, no further insights could be gathered, and an understanding of the research had been formed, was thought to have been reached, the sample size was deemed adequate ( 16 ). Data Collection Participants were asked by their chiropractors if they would partake in a brief interview before or after their chiropractic visit between October and December of 2022. All participants listened to an informed consent for the study and the recording of their voice read to them by the investigator. They were informed of the primary investigator’s position as a nursing student in her last semester being mentored in research by the coauthor, who has experience in pediatric, flight, and emergency department nursing along with a PhD and extensive research credentials, including qualitative methods experience. Participants engaged in one face-to-face interview in a consultation room within in the chiropractic office. Interviews were recorded and lasted from fifteen to thirty minutes due to the limited and focused topic. A professional digital recording device, the Olympus DM-720, was used. This is a small, inconspicuous recorder that can be turned off whenever the participant desired. Interview questions were open-ended and further focused based on the individual’s responses. Demographic data including age, gender, years of experience working as nurse, physical activity, diet, and other treatments tried for back pain were collected. The self and prescribed management of back pain by nurses were explored through a series of questions such as: “What made you first visit a chiropractor?” “How has your chiropractic treatment been and what impact has it had on your back pain?” and “How do you feel chiropractic has compared to other treatments you have tried?” At the end of the interview, the interviewer summarized the main points of the interview, so a small clip board and blank paper were with the interviewer. The interviewer wrote down supplemental notes that added context to the recording such as participant facial expressions and body language. The interviewer asked the participant if she (the interviewer) had summarized the main points correctly or would the participant like to add anything. From these inquiries, the nurse’s experiences with back pain before and after chiropractic were revealed. Participant information was kept confidential by removing identifying data from the interview transcripts. Pseudonyms were used to replace participant names. Data was stored on a password protected computer connected to a secure university storage drive. The voice recordings were uploaded directly to the secure storage drive. Data Analysis and Rigor Audio recordings were transcribed word for word and printed. Each interview transcript was reviewed thoroughly. Annotations and highlighting were performed to reveal themes relevant to the topic. Through a thematic narrative analysis of the interviews, similarities and differences between participants’ stories were examined. The audio recordings from the interviews were replayed and common themes were noted to explore the participants’ experiences. After this, the recordings were deleted from the recorder. For this study, back pain, health, nursing, and chiropractic treatment were commonly recognized themes. To uphold rigor in the qualitative approach used, particular attention was given to the reliability and validity of the research. Reliability was maintained through a carefully conducted and systematic research process ( 17 ). For validity and to ensure rigor, the data collection was gathered through questioning participants, analyzing their responses, and developing theories. Additionally, the study demonstrated a commitment to transparency through comprehensive explanations in the methods, results, discussion, and conclusion sections. To ensure the effectiveness of the interview process, practice sessions were conducted with an individual outside of the study before engaging with participants, validating the comprehension of interview questions and the functionality of the digital recorder. Detailed records of the entire research process, including methodologies, results, and conclusions, were meticulously maintained. The research mentor of the principal investigator engaged in transcript analysis, further enhancing the study's objectivity and mitigating potential biases. Continuous checks were conducted during interviews and subsequent research phases to ensure stringent adherence to rigorous criteria. Results Six participants agreed to participate in the study. Table 1 summarizes the demographics of the participants. All six participants were white. Participant ages ranged from 37 to 70; most were over 40 years of age. Participants had experience in the nursing field and a nursing degree, but not all were still in nursing practice. Out of the six participants, five had over 20 years of nursing experience. The lowest number of years of experience as a nurse was 11. Two participants had a Master of Science in Nursing, one had a doctorate in Nursing (PhD), and the remaining three were Bachelor of Science in Nursing (BSN) graduates. All participants reported following an exercise plan throughout the week with activities ranging from walking to strength training to taking workout classes. Four participants mentioned a specific diet plan, but most of the participants mentioned “trying to eat healthy.” Table 1 Demographic characteristics of the study sample Gender Age Highest Degree Nursing Specialty Years of experience working as a nurse Currently employed Exercise plan Diet plan Julia Female 47 BSN RN – emergency medicine, perioperative care, and teaching 21 years Yes Exercise 3–5 days a week Almost never eats fast food Wanda Female 49 MSN FNP - surgery 29 years Yes Walking 3 times per week, strength training without equipment 1–2 days a week Try to eat healthy and count calories Brooke Female 37 BSN Case management – administration 11 years Yes Orange Theory 3–4 times a week N/A Jennifer Female 70 PhD Behavioral health specialty 50 years No Workout with personal trainer twice a week and walk at least three times a week Intermittent fasting / small portions Susan Female 50 BSN Cardiac 29 + years Yes Walking Low fat Claire Female 53 MSN FNP – structural heart 26 years Yes 3 times a week walk 2 miles None Four major themes emerged from the participant’s stories: pain relief, maintenance care, improvement in work performance, and awareness. Pain Relief Chiropractic treatment proved to be beneficial for those suffering back pain both during and outside of work. All of the participants suffered from discomfort and pain ranging from the back to the neck to the jaw that interfered with nursing duties. One participant, Wanda (49 years old), said: Well, when I was having like lower back pain with radiculopathy with it kinda shooting down my legs. Once I had my treatments with the chiropractor then that… that pain would be minimized. I wouldn’t have that pain radiating down my legs. It would just be kind of a dull ache that was bearable at work. And then eventually, it would go away, it just kinda would take some time for that inflammation to get worked out. Another participant, Claire (53 years old), reiterated how chiropractic therapy had contributed to an improvement in her pain: “…anytime I’ve had back pain whether it be from a work injury or I’ve been in a car accident, it [chiropractic] has completely relieved my back pain.” The healing process for the nurses was gradual, and some reported that pain relief began to happen within one to three weeks of starting chiropractic. One nurse, Susan (50 years old), who suffered from temporomandibular joint (TMJ) pain, rheumatoid arthritis, osteoarthritis, and back pain, mentioned her increased mobility and decreased pain after chiropractic treatments: I can tell a big difference after the first visit. And after the second visit, I didn’t see as much of a difference immediately, but within a few days all the symptoms were gone. I had all the mobility back, pain was gone… so that worked out really well. Some participants noted that chiropractic therapy provided maximum pain relief when combined with other self-care strategies including exercise and nutrition. Brooke (37 years old) explained that many factors helped her stay healthy, and that chiropractic treatments played a part. Brooke said: I think everything’s a holistic approach, so I don’t think one thing is a magic fix to anything. Like I said, I think you need to exercise regularly cuz that just keeps your muscles strong and then… um, it’s just like everyday life; I don’t even know what I do to, like, get knots in my shoulders or get out of alignment. I’m just living my life, but somehow it happens. And so, I feel like I need all these people to help me to stay the best that I can to avoid headaches and neck pain. Maintenance Every participant applauded the benefits of chiropractic care and its reliable delivery of pain relief. Participants scheduled visits from once a week to once a month to manage their pain and to prevent its worsening. When asked how often they frequented the chiropractor or planned on returning, participants often mentioned having maintenance visits to remain pain-free. Susan said: “I will definitely use it when I need it, but I will probably look at going at least once a month or once every couple of weeks just to… especially since it helped my back so much.” Similarly, Wanda, said: I would go for a while and then, you know, and then lapse for a while and then realize I needed to get back in and really since I’ve been here I’ve done more of the maintenance then I… before I would always go when my back would flare up and sometimes it would take a couple weeks to get myself straight again where I could function. Improvement The nurses that were still in practice mentioned that chiropractic improved their productivity at work; lifting, pulling, and turning patients became easier with their back and neck in alignment. Participants mentioned practicing proper body mechanics while undertaking the crucial tasks of patient transport or movement. Furthermore, they highlighted collaborative efforts, mentioning the use of assistance from fellow nurses and specialized equipment in navigating the challenges associated with patient handling. When asked how chiropractic care impacted her performance as a nurse at work, Wanda shared her experience as a bedside nurse before and after back pain. She elaborated on how chiropractic treatments played a pivotal role in enhancing her functionality at work, not only describing the direct benefits on her physical well-being but also emphasizing the positive impact on her overall job performance: …once my back pain was relieved, I was able to function better at work because I’ve had… I’ve had periods of time where I mean I remember as a bedside nurse I had periods of time where my back hurt so bad that I had to get my colleagues to come help me when it came to moving patients and everything, but once I could get that pain eliminated, then I can function and do my job like carry out my daily duties and do what needed to be done. Brooke highlighted the pain relief provided by chiropractic care, expressing how it contributed to a more cheerful disposition during work hours and interactions with patients: “When you don’t have neck pain or headaches you can focus so much more on your tasks and your patients and you’re in a better mood… so it’s definitely… it helps a lot, I’d say.” Awareness After multiple visits to the chiropractic office, numerous nurses attested to a heightened awareness and connection with their bodies. The chiropractic sessions encompassed a diverse range of therapies, including intersegmental traction tables, hydrotherapy, adjustments, and interferential therapy. Beyond these therapeutic interventions, chiropractors also provided valuable guidance on maintaining proper body posture, adhering to a balanced nutrition regimen, and incorporating effective stretching routines. The combined effect of these suggestions and treatments translated into reduced instances of back and other pain, fostering improved body mechanics during work hours. Consequently, this holistic approach not only alleviated physical discomfort but also significantly enhanced overall performance for nurses in their professional roles. Claire who has worked as a nurse for 26 years, mentioned how chiropractic made her advocate for her back more: It’s [chiropractic’s] kind of made me more cognizant of body mechanics, you know, when you’re younger you’ll rush and do things very quickly and as you get a little bit older, you think to yourself, ‘Oh, you know, let’s pause for a minute. Let’s get this patient to move this way or straighten up before I go in and intervene and try to get them to stand. Especially in surgical care, a lot of patients like to grab on to you and use you as the stabilator… like to be their stabilization piece and that will throw your back out in a heartbeat. So, um, I’ve learned to say no to patients. You know, we have equipment for this. Let’s just pause. Let’s everyone be safe.’ When asked how chiropractic impacted how a nurse felt at work, Jennifer (70 years old) responded: I think I tried to be more aware of any symptoms, like if I was starting to feel an ache or starting to feel something… paying better attention to it,” and “I feel physically capable doing just about anything, and I think that’s because I’ve gotten a lot of education from chiropractors and have tried to utilize it. Discussion Every nurse participating in this study encountered back, neck, or other types of pain, and each one discovered relief through chiropractic therapy. These nurses discussed how workplace discomfort and pain had previously resulted in diminished productivity. However, with the assistance of chiropractic care, those nurses who continued to practice reported enhanced performance both on and off the job. One notable strength of the study lies in the varying ages and specialties of the nurses interviewed. This diversity provides a unique perspective on the musculoskeletal pain encountered by each interviewee. However, a limitation of the study stems from the fact that all participants were sourced from a single chiropractic office. Given that different chiropractic care facilities may offer varied treatments based on the provider's clinical assessment and judgment, the potential for differing therapies and, consequently, varying degrees of pain relief exists across different providers. Conclusion Nurses’ self-care is a frequent topic in current literature. Due to musculoskeletal pain, aging, and job dissatisfaction, nurses may retire or switch to different areas of employment ( 6 ). Musculoskeletal pain, specifically back pain, has largely impacted nurse performance and is exacerbated by high workloads and stressful work environments ( 18 , 19 ). Understanding the strategies nurses employ to stay healthy is crucial for cultivating a resilient and productive workforce. Some commonly adopted self-care strategies to address back and other pain areas include limiting work hours, utilizing lifting equipment, and transitioning to less physically demanding work settings ( 6 ). However, the use of chiropractic therapy as a strategy for self-care has received limited attention. In future studies exploring nurse’s self-care practices, chiropractic care can be considered as a potential beneficial therapy among the options available. Investigating chiropractic interventions used in nurses' self-care routines can contribute valuable insights into promoting their overall well-being and optimizing healthcare delivery. Declarations Acknowledgements We would like to acknowledge the chiropractic office that allowed us to conduct our study. We also acknowledge and appreciate the participants who were interviewed for contributing their time to our research. Funding No funding was utilized for this study. Ethics Declaration Ethics approval and consent to participate Ethical approval was obtained from the Institutional Review Board before the study began. All participants were notified of the study’s purpose and verbal consent was provided prior to the interviews. Consent for publication This manuscript does not provide any identifying information about interviewees. All participants provided consent for publication under pseudonyms and all data is anonymous. Availability of data and materials Study data and materials are being securely stored by the authors and are not accessible to the public due to patient informed consent and as approved by the Institutional Review Board. Competing interests All authors declare to have no competing interests. Authors’ Contribution All authors reviewed and approved the final manuscript. RV conducted interviews, transcribed spoken content into a script, and identified recurring themes within the dialogue. RV lead the development and writing of the manuscript. LG played a significant role in formulating research questions, analyzing the data, and drafting the manuscript. Both authors participated in the research and preparing the manuscript. References Heiden B, Weigl M, Angerer P, Müller A. Association of age and physical job demands with musculoskeletal disorders in nurses. Appl Ergon. 2013;44(4):652–8. doi:10.1016/j.apergo.2013.01.001 Letvak S, Ruhm C, Gupta S. Differences in health, productivity and quality of care in younger and older nurses. J Nurs Manag. 2013;21(7):914–21. doi:10.1111/jonm.12181 Ricci JA, Stewart WF, Chee E, Leotta C, Foley K, Hochberg MC. Back pain exacerbations and lost productive time costs in United States workers. Spine. 2006;31(26):3052–60. doi:10.1097/01.brs.0000249521.61813.aa Dressner M, Kissinger S. Occupational injuries and illnesses among registered nurses. Monthly Labor Review. 2018; doi:10.21916/mlr.2018.27 Chappel SE, Verswijveren SJJM, Aisbett B, Considine J, Ridgers ND. Nurses’ occupational physical activity levels: A systematic review. Int J Nurs Stud. 2017;73:52–62. doi:10.1016/j.ijnurstu.2017.05.006 Letvak S. Hurting at work: The lived experience of older nurses. Int J Hum Caring. 2009;13(4):8–16. doi:10.20467/1091-5710.13.4.8 Globe G, Farabaugh RJ, Hawk C, Morris CE, Baker G, Whalen WM, et al. Clinical practice guideline: Chiropractic care for low back pain. J Manipulative Physiol Ther. 2016;39(1):1–22. doi:10.1016/j.jmpt.2015.10.006 National Center for Complementary and Integrative Health. Low-Back Pain and Complementary Health Approaches: What You Need to Know. U.S. Department of Health and Human Services {Internet}. 2020 {cited 2023 Jan 15}.Available from https://www.nccih.nih.gov/health/low-back-pain-and-complementary-health-approaches-what-you-need-to-know Hays RD, Sherbourne CD, Spritzer KL, Hilton LG, Ryan GW, Coulter ID, et al. Experiences with chiropractic care for patients with low back or neck pain. J Patient Exp. 2019;7(3):357–64. doi:10.1177/2374373519846022 Gedin F, Dansk V, Egmar A-C, Sundberg T, Burström K. Patient-reported improvements of pain, disability, and health-related quality of life following chiropractic care for back pain – a national observational study in Sweden. J Bodyw Mov Ther. 2019;23(2):241–6. doi:10.1016/j.jbmt.2018.02.012 Eaves ER, Sherman KJ, Ritenbaugh C, Hsu C, Nichter M, Turner JA, et al. A qualitative study of changes in expectations over time among patients with chronic low back pain seeking four cam therapies. BMC Complement Altern Med. 2015;15(1). doi:10.1186/s12906-015-0531-9 Mior S, Sutton D, Cancelliere C, French S, Taylor-Vaisey A, Côté P. Chiropractic services in the Active Duty Military Setting: A Scoping Review. Chirop Man Therap. 2019;27(1). doi:10.1186/s12998-019-0259-6 Corcoran KL, Dunn AS, Formolo LR, Beehler GP. Chiropractic management for US female veterans with low back pain: A retrospective study of Clinical Outcomes J Manipulative Physiol Ther. 2017;40(8):573–9. doi:10.1016/j.jmpt.2017.07.001 Riessman CK. Narrative methods for the human sciences. Los Ángeles: Sage; 2008. Sandelowski M. Telling stories: Narrative approaches in qualitative research. Image J Nurs Sch. 1991;23(3):161–6. doi:10.1111/j.1547-5069.1991.tb00662.x Hennink MM, Kaiser BN, Marconi VC. Code saturation versus meaning saturation. Quale Health Res. 2016;27(4):591–608. doi:10.1177/1049732316665344 Cypress BS. Rigor or reliability and validity in qualitative research: Perspectives, strategies, reconceptualization, and recommendations. Dimens Crit Care Nurs. 2017;36(4):253–63. doi:10.1097/dcc.0000000000000253 Gabrielle S, Jackson D, Mannix J. Older women nurses: Health, ageing concerns and self‐care strategies. J Adv Nurs. 2008;61(3):316–25. doi:10.1111/j.1365-2648.2007.04530.x Saberipour B, Ghanbari S, Zarea K, Gheibizadeh M, Zahedian M. Investigating prevalence of musculoskeletal disorders among Iranian nurses: A systematic review and meta-analysis. Clin Epidemiol Glob Health. 2019;7(3):513–8. doi:10.1016/j.cegh.2018.06.007 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3931604","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":271189925,"identity":"29f97ba9-a730-481c-99de-ec8dfc48ba81","order_by":0,"name":"Regan T Vellan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyUlEQVRIiWNgGAWjYLCCBwUMDPwgRkIBMcrZQCoNGBgkG6AM4rUYHADxiNFiPr/H8EGCgV2e8fnViR8eGDDI84sdwK9F5hiPsUGCQXKx2Y23myWA1hnOnJ2AX4sEG1saUCVz4rYbZzeAtCQY3CasJf1HgkF94uYZZzf/IFIL8zGgssOJG/h7txFrS/JhoMrjiTNu8G6zSDCQIMIvzAcbP3yoqE7s7z+7+eaPCht5fmkCWpA0g1VKEKscBPgPkKJ6FIyCUTAKRhIAAF82QRWNenhPAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0009-0003-5190-2469","institution":"East Carolina University","correspondingAuthor":true,"prefix":"","firstName":"Regan","middleName":"T","lastName":"Vellan","suffix":""},{"id":271189926,"identity":"158a53b3-d979-46cd-b70a-0f26b26ba567","order_by":1,"name":"Laura Gantt","email":"","orcid":"","institution":"East Carolina University","correspondingAuthor":false,"prefix":"","firstName":"Laura","middleName":"","lastName":"Gantt","suffix":""}],"badges":[],"createdAt":"2024-02-05 17:27:10","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-3931604/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3931604/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":50727424,"identity":"9f02863e-2f73-4ff2-a197-a6a5eb7a570e","added_by":"auto","created_at":"2024-02-06 11:46:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":266433,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3931604/v1/88e0bf5a-453e-4ee3-9d38-4d5e68fe6e32.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eNurses’ Use of Chiropractic for Relief of Back and Neck Pain\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDue to the physical demands of their profession, nurses often experience back and neck pain. A study conducted by Heiden and colleagues (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) on musculoskeletal disorders in working nurses revealed that individuals aged 35 to 44 are particularly prone to experiencing lower back pain associated with patient handling. Further research found that older nurses and employees in similarly taxing fields suffering from chronic pain had decreased productivity at work (\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). With the bodily challenges that may arise from a nursing career, both younger and aging nurses may choose to pursue less strenuous positions, retirement, or other professions (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Given the growing demand for nurses, prioritizing the well-being of these healthcare professionals is crucial to enhance retention, quality of patient care, and job satisfaction.\u003c/p\u003e \u003cp\u003eChiropractic care employs a multifaceted strategy to address upper and lower back pain. This approach includes manual adjustments, the use of cervical or intersegmental traction tables, interferential therapy, as well as guidance on physical activity and diet (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). These chiropractic interventions aim to alleviate symptoms and enhance muscle functionality. During a manual adjustment, a chiropractor applies controlled, sudden force to specific vertebra or joints using either their hands or special instruments to correct misalignments in the spine (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Interferential therapy sends electrical currents into the tissue which stimulates endorphins, and therefore results in pain relief, supports healing, and stops muscles spasms. Both cervical and intersegmental traction promote stretching and improve mobility. Additionally, chiropractic facilities may provide other services like cryotherapy, ultrasound, laser therapy, and hydrotherapy. However, it can be difficult to get a consistent picture of the benefits of chiropractic care because the few available studies include a variety of populations, feature small sample sizes, and lack control groups.\u003c/p\u003e \u003cp\u003eA larger study of 1853 adults by Hays and colleagues (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) demonstrated that significant improvements in acute and chronic pain were reported after chiropractic care. Similarly, a Swedish study led by Gedin et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) showed substantial improvements in 138 patients experiencing acute and chronic back pain after four weeks of chiropractic treatment. Additionally, a qualitative study exploring the outcomes of Complementary and Alternative Medicine (CAM) therapies comprised of 64 adults aged 20 to 70, found high satisfaction levels and positive responses to chiropractic treatment (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA scoping review conducted by Mior et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) concluded that chiropractic treatment was effective in alleviation of pain in active-duty military personnel. Furthermore, research by Corcoran et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), incorporating 70 episodes of care for female veterans, emphasized the favorable outcomes associated with chiropractic therapy, such as spinal manipulative therapy, spinal mobilization, and myofascial release.\u003c/p\u003e \u003cp\u003eFew studies, however, have described the use of chiropractic therapy by nurses or whether it is helpful to nurses in managing back pain. While studies on chiropractic care have indicated that it is beneficial, there is practically no research on nurses and the use of chiropractic treatment, even though nurses are known to have a higher-than-average incidence of back pain. Further research is needed to address this gap in literature. The purpose of this study was to determine if chiropractic therapy could lessen back pain in nurses and improve performance at work.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003eNarrative Inquiry\u003c/h2\u003e\n\u003cp\u003eThis study utilized narrative inquiry, a technique that recognizes that people use storytelling to make sense of their experiences, communicate their understanding of the world, and assign meaning to their lives (\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e). This method delves into the storytelling process to gain a deeper understanding of human experiences. According to Sandelowski, \u0026ldquo;narratives are understood as stories that include a temporal ordering of events and an effort to make something out of those events\u0026rdquo; (\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e, p.162). Additionally, Sandelowski states, \u0026ldquo;Using such narrative models, researchers can gain insight into the way human beings understand and enact their lives through stories\u0026rdquo; (\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e, p.163). It provides a framework for exploring the complexities of individual and collective narratives, allowing researchers to uncover the meanings people attach to their lives. This approach facilitates a deeper understanding of both the individual and their relationship with the act of recounting their stories by analyzing their feelings, intentionality, and perspective (\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eIn this study, narrative inquiry related to how nurses manage their acute or chronic back pain with or without chiropractic care allowed exploration of their emotions, reactions to treatment, and meanings behind their stories.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n\u003ch2\u003eSample\u003c/h2\u003e\n\u003cp\u003eEthical approval\u0026nbsp;was obtained from the Institutional Review Board under the ID number, UMCIRB 22-001398, before the study began. Those sought for this study frequented a chiropractor when experiencing work-related musculoskeletal pain in the back or other areas. A sample of nurses was recruited from one chiropractic office in eastern North Carolina where the primary investigator (R.V.) had permission to recruit subjects. The intent was to recruit five to ten male and/or female nurses ages 21 to 65 by word of mouth and reference from the chiropractors\u0026rsquo; office practice. Everyone who was approached for the study agreed to participate. Inclusion criteria were: 1) participants who had some experience in the nursing field and a nursing degree; 2) participants who communicated effectively in English or had a qualified translator; 3) participants who frequented the chiropractor when dealing with back or other areas of discomfort and had work-related musculoskeletal pain.\u003c/p\u003e\n\u003cp\u003eBased on the narrowness and specificity of the research question, the suggested sample size provided sufficient answers for the study. The suitability of the sample size was assessed repeatedly throughout the interview and research procedure. Once saturation, when all relevant data collection had been completed, no further insights could be gathered, and an understanding of the research had been formed, was thought to have been reached, the sample size was deemed adequate (\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n\u003ch2\u003eData Collection\u003c/h2\u003e\n\u003cp\u003eParticipants were asked by their chiropractors if they would partake in a brief interview before or after their chiropractic visit between October and December of 2022. All participants listened to an informed consent for the study and the recording of their voice read to them by the investigator. They were informed of the primary investigator\u0026rsquo;s position as a nursing student in her last semester being mentored in research by the coauthor, who has experience in pediatric, flight, and emergency department nursing along with a PhD and extensive research credentials, including qualitative methods experience. Participants engaged in one face-to-face interview in a consultation room within in the chiropractic office. Interviews were recorded and lasted from fifteen to thirty minutes due to the limited and focused topic. A professional digital recording device, the Olympus DM-720, was used. This is a small, inconspicuous recorder that can be turned off whenever the participant desired. Interview questions were open-ended and further focused based on the individual\u0026rsquo;s responses. Demographic data including age, gender, years of experience working as nurse, physical activity, diet, and other treatments tried for back pain were collected. The self and prescribed management of back pain by nurses were explored through a series of questions such as: \u0026ldquo;What made you first visit a chiropractor?\u0026rdquo; \u0026ldquo;How has your chiropractic treatment been and what impact has it had on your back pain?\u0026rdquo; and \u0026ldquo;How do you feel chiropractic has compared to other treatments you have tried?\u0026rdquo; At the end of the interview, the interviewer summarized the main points of the interview, so a small clip board and blank paper were with the interviewer. The interviewer wrote down supplemental notes that added context to the recording such as participant facial expressions and body language. The interviewer asked the participant if she (the interviewer) had summarized the main points correctly or would the participant like to add anything. From these inquiries, the nurse\u0026rsquo;s experiences with back pain before and after chiropractic were revealed.\u003c/p\u003e\n\u003cp\u003eParticipant information was kept confidential by removing identifying data from the interview transcripts. Pseudonyms were used to replace participant names. Data was stored on a password protected computer connected to a secure university storage drive. The voice recordings were uploaded directly to the secure storage drive.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n\u003ch2\u003eData Analysis and Rigor\u003c/h2\u003e\n\u003cp\u003eAudio recordings were transcribed word for word and printed. Each interview transcript was reviewed thoroughly. Annotations and highlighting were performed to reveal themes relevant to the topic. Through a thematic narrative analysis of the interviews, similarities and differences between participants\u0026rsquo; stories were examined. The audio recordings from the interviews were replayed and common themes were noted to explore the participants\u0026rsquo; experiences. After this, the recordings were deleted from the recorder. For this study, back pain, health, nursing, and chiropractic treatment were commonly recognized themes.\u003c/p\u003e\n\u003cp\u003eTo uphold rigor in the qualitative approach used, particular attention was given to the reliability and validity of the research. Reliability was maintained through a carefully conducted and systematic research process (\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e). For validity and to ensure rigor, the data collection was gathered through questioning participants, analyzing their responses, and developing theories. Additionally, the study demonstrated a commitment to transparency through comprehensive explanations in the methods, results, discussion, and \u003cspan class=\"InternalRef\"\u003econclusion\u003c/span\u003e sections. To ensure the effectiveness of the interview process, practice sessions were conducted with an individual outside of the study before engaging with participants, validating the comprehension of interview questions and the functionality of the digital recorder. Detailed records of the entire research process, including methodologies, results, and conclusions, were meticulously maintained. The research mentor of the principal investigator engaged in transcript analysis, further enhancing the study's objectivity and mitigating potential biases. Continuous checks were conducted during interviews and subsequent research phases to ensure stringent adherence to rigorous criteria.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eSix participants agreed to participate in the study. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the demographics of the participants. All six participants were white. Participant ages ranged from 37 to 70; most were over 40 years of age. Participants had experience in the nursing field and a nursing degree, but not all were still in nursing practice. Out of the six participants, five had over 20 years of nursing experience. The lowest number of years of experience as a nurse was 11. Two participants had a Master of Science in Nursing, one had a doctorate in Nursing (PhD), and the remaining three were Bachelor of Science in Nursing (BSN) graduates. All participants reported following an exercise plan throughout the week with activities ranging from walking to strength training to taking workout classes. Four participants mentioned a specific diet plan, but most of the participants mentioned \u0026ldquo;trying to eat healthy.\u0026rdquo;\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eDemographic characteristics of the study sample\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHighest Degree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNursing Specialty\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYears of experience working as a nurse\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCurrently employed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eExercise plan\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDiet plan\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJulia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBSN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRN \u0026ndash; emergency medicine, perioperative care, and teaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eExercise 3\u0026ndash;5 days a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAlmost never eats fast food\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWanda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMSN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFNP - surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eWalking 3 times per week, strength training without equipment 1\u0026ndash;2 days a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTry to eat healthy and count calories\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrooke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBSN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCase management \u0026ndash; administration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eOrange Theory 3\u0026ndash;4 times a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJennifer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePhD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBehavioral health specialty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eWorkout with personal trainer twice a week and walk at least three times a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIntermittent fasting / small portions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSusan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBSN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCardiac\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29\u0026thinsp;+\u0026thinsp;years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eWalking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eLow fat\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClaire\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMSN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFNP \u0026ndash; structural heart\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3 times a week walk 2 miles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFour major themes emerged from the participant\u0026rsquo;s stories: pain relief, maintenance care, improvement in work performance, and awareness.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePain Relief\u003c/h2\u003e \u003cp\u003eChiropractic treatment proved to be beneficial for those suffering back pain both during and outside of work. All of the participants suffered from discomfort and pain ranging from the back to the neck to the jaw that interfered with nursing duties.\u003c/p\u003e \u003cp\u003eOne participant, Wanda (49 years old), said:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWell, when I was having like lower back pain with radiculopathy with it kinda shooting down my legs. Once I had my treatments with the chiropractor then that\u0026hellip; that pain would be minimized. I wouldn\u0026rsquo;t have that pain radiating down my legs. It would just be kind of a dull ache that was bearable at work. And then eventually, it would go away, it just kinda would take some time for that inflammation to get worked out.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAnother participant, Claire (53 years old), reiterated how chiropractic therapy had contributed to an improvement in her pain: \u0026ldquo;\u0026hellip;anytime I\u0026rsquo;ve had back pain whether it be from a work injury or I\u0026rsquo;ve been in a car accident, it [chiropractic] has completely relieved my back pain.\u0026rdquo;\u003c/p\u003e \u003cp\u003eThe healing process for the nurses was gradual, and some reported that pain relief began to happen within one to three weeks of starting chiropractic. One nurse, Susan (50 years old), who suffered from temporomandibular joint (TMJ) pain, rheumatoid arthritis, osteoarthritis, and back pain, mentioned her increased mobility and decreased pain after chiropractic treatments:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI can tell a big difference after the first visit. And after the second visit, I didn\u0026rsquo;t see as much of a difference immediately, but within a few days all the symptoms were gone. I had all the mobility back, pain was gone\u0026hellip; so that worked out really well.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSome participants noted that chiropractic therapy provided maximum pain relief when combined with other self-care strategies including exercise and nutrition. Brooke (37 years old) explained that many factors helped her stay healthy, and that chiropractic treatments played a part. Brooke said:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI think everything\u0026rsquo;s a holistic approach, so I don\u0026rsquo;t think one thing is a magic fix to anything. Like I said, I think you need to exercise regularly cuz that just keeps your muscles strong and then\u0026hellip; um, it\u0026rsquo;s just like everyday life; I don\u0026rsquo;t even know what I do to, like, get knots in my shoulders or get out of alignment. I\u0026rsquo;m just living my life, but somehow it happens. And so, I feel like I need all these people to help me to stay the best that I can to avoid headaches and neck pain.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eMaintenance\u003c/h2\u003e \u003cp\u003eEvery participant applauded the benefits of chiropractic care and its reliable delivery of pain relief. Participants scheduled visits from once a week to once a month to manage their pain and to prevent its worsening. When asked how often they frequented the chiropractor or planned on returning, participants often mentioned having maintenance visits to remain pain-free. Susan said: \u0026ldquo;I will definitely use it when I need it, but I will probably look at going at least once a month or once every couple of weeks just to\u0026hellip; especially since it helped my back so much.\u0026rdquo;\u003c/p\u003e \u003cp\u003eSimilarly, Wanda, said:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI would go for a while and then, you know, and then lapse for a while and then realize I needed to get back in and really since I\u0026rsquo;ve been here I\u0026rsquo;ve done more of the maintenance then I\u0026hellip; before I would always go when my back would flare up and sometimes it would take a couple weeks to get myself straight again where I could function.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eImprovement\u003c/h2\u003e \u003cp\u003eThe nurses that were still in practice mentioned that chiropractic improved their productivity at work; lifting, pulling, and turning patients became easier with their back and neck in alignment. Participants mentioned practicing proper body mechanics while undertaking the crucial tasks of patient transport or movement. Furthermore, they highlighted collaborative efforts, mentioning the use of assistance from fellow nurses and specialized equipment in navigating the challenges associated with patient handling.\u003c/p\u003e \u003cp\u003eWhen asked how chiropractic care impacted her performance as a nurse at work, Wanda shared her experience as a bedside nurse before and after back pain. She elaborated on how chiropractic treatments played a pivotal role in enhancing her functionality at work, not only describing the direct benefits on her physical well-being but also emphasizing the positive impact on her overall job performance:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026hellip;once my back pain was relieved, I was able to function better at work because I\u0026rsquo;ve had\u0026hellip; I\u0026rsquo;ve had periods of time where I mean I remember as a bedside nurse I had periods of time where my back hurt so bad that I had to get my colleagues to come help me when it came to moving patients and everything, but once I could get that pain eliminated, then I can function and do my job like carry out my daily duties and do what needed to be done.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eBrooke highlighted the pain relief provided by chiropractic care, expressing how it contributed to a more cheerful disposition during work hours and interactions with patients: \u0026ldquo;When you don\u0026rsquo;t have neck pain or headaches you can focus so much more on your tasks and your patients and you\u0026rsquo;re in a better mood\u0026hellip; so it\u0026rsquo;s definitely\u0026hellip; it helps a lot, I\u0026rsquo;d say.\u0026rdquo;\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eAwareness\u003c/h2\u003e \u003cp\u003eAfter multiple visits to the chiropractic office, numerous nurses attested to a heightened awareness and connection with their bodies. The chiropractic sessions encompassed a diverse range of therapies, including intersegmental traction tables, hydrotherapy, adjustments, and interferential therapy. Beyond these therapeutic interventions, chiropractors also provided valuable guidance on maintaining proper body posture, adhering to a balanced nutrition regimen, and incorporating effective stretching routines. The combined effect of these suggestions and treatments translated into reduced instances of back and other pain, fostering improved body mechanics during work hours. Consequently, this holistic approach not only alleviated physical discomfort but also significantly enhanced overall performance for nurses in their professional roles.\u003c/p\u003e \u003cp\u003eClaire who has worked as a nurse for 26 years, mentioned how chiropractic made her advocate for her back more:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIt\u0026rsquo;s [chiropractic\u0026rsquo;s] kind of made me more cognizant of body mechanics, you know, when you\u0026rsquo;re younger you\u0026rsquo;ll rush and do things very quickly and as you get a little bit older, you think to yourself, \u0026lsquo;Oh, you know, let\u0026rsquo;s pause for a minute. Let\u0026rsquo;s get this patient to move this way or straighten up before I go in and intervene and try to get them to stand. Especially in surgical care, a lot of patients like to grab on to you and use you as the stabilator\u0026hellip; like to be their stabilization piece and that will throw your back out in a heartbeat. So, um, I\u0026rsquo;ve learned to say no to patients. You know, we have equipment for this. Let\u0026rsquo;s just pause. Let\u0026rsquo;s everyone be safe.\u0026rsquo;\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eWhen asked how chiropractic impacted how a nurse felt at work, Jennifer (70 years old) responded:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI think I tried to be more aware of any symptoms, like if I was starting to feel an ache or starting to feel something\u0026hellip; paying better attention to it,\u0026rdquo; and \u0026ldquo;I feel physically capable doing just about anything, and I think that\u0026rsquo;s because I\u0026rsquo;ve gotten a lot of education from chiropractors and have tried to utilize it.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eEvery nurse participating in this study encountered back, neck, or other types of pain, and each one discovered relief through chiropractic therapy. These nurses discussed how workplace discomfort and pain had previously resulted in diminished productivity. However, with the assistance of chiropractic care, those nurses who continued to practice reported enhanced performance both on and off the job.\u003c/p\u003e \u003cp\u003eOne notable strength of the study lies in the varying ages and specialties of the nurses interviewed. This diversity provides a unique perspective on the musculoskeletal pain encountered by each interviewee. However, a limitation of the study stems from the fact that all participants were sourced from a single chiropractic office. Given that different chiropractic care facilities may offer varied treatments based on the provider's clinical assessment and judgment, the potential for differing therapies and, consequently, varying degrees of pain relief exists across different providers.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eNurses\u0026rsquo; self-care is a frequent topic in current literature. Due to musculoskeletal pain, aging, and job dissatisfaction, nurses may retire or switch to different areas of employment (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Musculoskeletal pain, specifically back pain, has largely impacted nurse performance and is exacerbated by high workloads and stressful work environments (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Understanding the strategies nurses employ to stay healthy is crucial for cultivating a resilient and productive workforce. Some commonly adopted self-care strategies to address back and other pain areas include limiting work hours, utilizing lifting equipment, and transitioning to less physically demanding work settings (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). However, the use of chiropractic therapy as a strategy for self-care has received limited attention. In future studies exploring nurse\u0026rsquo;s self-care practices, chiropractic care can be considered as a potential beneficial therapy among the options available. Investigating chiropractic interventions used in nurses' self-care routines can contribute valuable insights into promoting their overall well-being and optimizing healthcare delivery.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to acknowledge the chiropractic office that allowed us to conduct our study. We also acknowledge and appreciate the participants who were interviewed for contributing their time to our research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was utilized for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics Declaration\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Institutional Review Board before the study began. All participants were notified of the study\u0026rsquo;s purpose and verbal consent was provided prior to the interviews.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis manuscript does not provide any identifying information about interviewees. All participants provided consent for publication under pseudonyms and all data is anonymous.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy data and materials are being securely stored by the authors and are not accessible to the public due to patient informed consent and as approved by the Institutional Review Board.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare to have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026rsquo; Contribution\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors reviewed and approved the final manuscript. RV conducted interviews, transcribed spoken content into a script, and identified recurring themes within the dialogue. RV lead the development and writing of the manuscript. LG played a significant role in formulating research questions, analyzing the data, and drafting the manuscript. Both authors participated in the research and preparing the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHeiden B, Weigl M, Angerer P, M\u0026uuml;ller A. Association of age and physical job demands with musculoskeletal disorders in nurses. Appl Ergon. 2013;44(4):652\u0026ndash;8. doi:10.1016/j.apergo.2013.01.001\u003c/li\u003e\n\u003cli\u003eLetvak S, Ruhm C, Gupta S. Differences in health, productivity and quality of care in younger and older nurses. J Nurs Manag. 2013;21(7):914\u0026ndash;21. doi:10.1111/jonm.12181\u003c/li\u003e\n\u003cli\u003eRicci JA, Stewart WF, Chee E, Leotta C, Foley K, Hochberg MC. Back pain exacerbations and lost productive time costs in United States workers. Spine. 2006;31(26):3052\u0026ndash;60. doi:10.1097/01.brs.0000249521.61813.aa\u003c/li\u003e\n\u003cli\u003eDressner M, Kissinger S. Occupational injuries and illnesses among registered nurses. Monthly Labor Review. 2018; doi:10.21916/mlr.2018.27\u003c/li\u003e\n\u003cli\u003eChappel SE, Verswijveren SJJM, Aisbett B, Considine J, Ridgers ND. Nurses\u0026rsquo; occupational physical activity levels: A systematic review. Int J Nurs Stud. 2017;73:52\u0026ndash;62. doi:10.1016/j.ijnurstu.2017.05.006\u003c/li\u003e\n\u003cli\u003eLetvak S. Hurting at work: The lived experience of older nurses. Int J Hum Caring. 2009;13(4):8\u0026ndash;16. doi:10.20467/1091-5710.13.4.8\u003c/li\u003e\n\u003cli\u003eGlobe G, Farabaugh RJ, Hawk C, Morris CE, Baker G, Whalen WM, et al. Clinical practice guideline: Chiropractic care for low back pain. J Manipulative Physiol Ther. 2016;39(1):1\u0026ndash;22. doi:10.1016/j.jmpt.2015.10.006\u003cem\u003e \u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eNational Center for Complementary and Integrative Health. Low-Back Pain and Complementary Health Approaches: What You Need to Know. U.S. Department of Health and Human Services {Internet}. 2020 {cited 2023 Jan 15}.Available from https://www.nccih.nih.gov/health/low-back-pain-and-complementary-health-approaches-what-you-need-to-know \u003c/li\u003e\n\u003cli\u003eHays RD, Sherbourne CD, Spritzer KL, Hilton LG, Ryan GW, Coulter ID, et al. Experiences with chiropractic care for patients with low back or neck pain. J Patient Exp. 2019;7(3):357\u0026ndash;64. doi:10.1177/2374373519846022\u003c/li\u003e\n\u003cli\u003eGedin F, Dansk V, Egmar A-C, Sundberg T, Burstr\u0026ouml;m K. Patient-reported improvements of pain, disability, and health-related quality of life following chiropractic care for back pain \u0026ndash; a national observational study in Sweden. J Bodyw Mov Ther. 2019;23(2):241\u0026ndash;6. doi:10.1016/j.jbmt.2018.02.012\u003c/li\u003e\n\u003cli\u003eEaves ER, Sherman KJ, Ritenbaugh C, Hsu C, Nichter M, Turner JA, et al. A qualitative study of changes in expectations over time among patients with chronic low back pain seeking four cam therapies. BMC Complement Altern Med. 2015;15(1). doi:10.1186/s12906-015-0531-9\u003c/li\u003e\n\u003cli\u003eMior S, Sutton D, Cancelliere C, French S, Taylor-Vaisey A, C\u0026ocirc;t\u0026eacute; P. Chiropractic services in the Active Duty Military Setting: A Scoping Review. Chirop Man Therap. 2019;27(1). doi:10.1186/s12998-019-0259-6\u003c/li\u003e\n\u003cli\u003eCorcoran KL, Dunn AS, Formolo LR, Beehler GP. Chiropractic management for US female veterans with low back pain: A retrospective study of Clinical Outcomes J Manipulative Physiol Ther. 2017;40(8):573\u0026ndash;9. doi:10.1016/j.jmpt.2017.07.001\u003c/li\u003e\n\u003cli\u003eRiessman CK. Narrative methods for the human sciences. Los \u0026Aacute;ngeles: Sage; 2008.\u003c/li\u003e\n\u003cli\u003eSandelowski M. Telling stories: Narrative approaches in qualitative research. Image J Nurs Sch. 1991;23(3):161\u0026ndash;6. doi:10.1111/j.1547-5069.1991.tb00662.x\u003c/li\u003e\n\u003cli\u003eHennink MM, Kaiser BN, Marconi VC. Code saturation versus meaning saturation. Quale Health Res. 2016;27(4):591\u0026ndash;608. doi:10.1177/1049732316665344\u003c/li\u003e\n\u003cli\u003eCypress BS. Rigor or reliability and validity in qualitative research: Perspectives, strategies, reconceptualization, and recommendations. Dimens Crit Care Nurs. 2017;36(4):253\u0026ndash;63. doi:10.1097/dcc.0000000000000253\u003c/li\u003e\n\u003cli\u003eGabrielle S, Jackson D, Mannix J. Older women nurses: Health, ageing concerns and self‐care strategies. J Adv Nurs. 2008;61(3):316\u0026ndash;25. doi:10.1111/j.1365-2648.2007.04530.x\u003c/li\u003e\n\u003cli\u003eSaberipour B, Ghanbari S, Zarea K, Gheibizadeh M, Zahedian M. Investigating prevalence of musculoskeletal disorders among Iranian nurses: A systematic review and meta-analysis. Clin Epidemiol Glob Health. 2019;7(3):513\u0026ndash;8. doi:10.1016/j.cegh.2018.06.007\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"East Carolina University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"chiropractic therapy, musculoskeletal pain, nurses, relief","lastPublishedDoi":"10.21203/rs.3.rs-3931604/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3931604/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eBecause of the physical demands of the profession, nurses often experience back and neck pain. Chronic pain can affect productivity at work and push nurses to seek less physically taxing positions. With an increased demand for nurses, the wellbeing of these healthcare workers must be taken into consideration to maximize retention, quality patient care, and job satisfaction. However, few studies exist that describe nurses\u0026rsquo; use of chiropractic therapy to manage back and neck pain. This study sought to fill that gap.\u003c/p\u003e\u003ch2\u003eMethodology\u003c/h2\u003e \u003cp\u003eThe primary investigator obtained permission to recruit patients who were nurses from a chiropractic office in a town in eastern North Carolina. Those sought for this study frequented a chiropractor when dealing with back or other areas of discomfort and had work-related musculoskeletal pain. Narrative inquiry was employed for the study and participants engaged in one face-to-face interview in the chiropractic office.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSix women ages 45 to 70 were recruited by word of mouth and referrals from the chiropractors. All participants had nursing degrees and experience, but not all were still in nursing practice. From the interviews, nurses\u0026rsquo; experiences with back and neck pain before and after chiropractic were revealed. Chiropractic proved to be a beneficial treatment for those suffering pain who were both in and out of work. Nurses described the healing process as gradual, but all participants benefited. The nurses still in practice mentioned that chiropractic care improved their productivity at work; lifting and turning patients became easier. As patients, they received treatments ranging from adjustments to interferential therapy as well as insights into nutrition and stretching.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eNurses\u0026rsquo; self-care is a frequent topic in current literature. However, the use of chiropractic therapy as a strategy for self-care has received limited attention. Future research related to self-care by nurses should include chiropractic among the therapies nurses may find beneficial.\u003c/p\u003e","manuscriptTitle":"Nurses’ Use of Chiropractic for Relief of Back and Neck Pain","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-06 11:38:25","doi":"10.21203/rs.3.rs-3931604/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"844f3b2a-2886-43c8-9285-be3108898cfc","owner":[],"postedDate":"February 6th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":28584764,"name":"Integrative \u0026 Complementary Medicine"},{"id":28584765,"name":"Nursing"}],"tags":[],"updatedAt":"2024-02-06T11:38:25+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-06 11:38:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3931604","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3931604","identity":"rs-3931604","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}