Back and Foot Pain on Long Shifts: A Guide for Nurses and Healthcare Workers

The short answer: Back and foot pain on long shifts usually comes from a mix of standing for hours, patient handling, and little recovery time. Short movement breaks, supportive well-fitting shoes, lifting equipment instead of muscle, and a few simple stretches can help. Evidence for each is modest. See a provider if pain is severe, spreading, or persistent.

• In 2017, nursing assistants in the US had 18,090 musculoskeletal injury cases that caused days away from work, a rate of 166.3 per 10,000 workers, more than five times the all-industry rate of 30.5 [1].
• NIOSH calls patient handling "the single greatest" musculoskeletal risk factor for healthcare workers, and advises using assistive lifting devices [2].
• In a review of 49 studies (88,158 people), standing more than 4 hours a day was linked to low back symptoms (odds ratio 1.31). The authors called their conclusions tentative [3].
• Long weekly hours, night work and shift work are linked to musculoskeletal problems in healthcare staff, most strongly low back pain [4].
• Whether extra work breaks prevent musculoskeletal symptoms is uncertain, based on low-certainty evidence, mostly from office workers [5].
• Cushioned footwear and insoles may ease foot pressure and calf fatigue, but few studies were done in nurses [6].

Because several loads stack up over 12 hours. None of them is a mystery, and none means something is "wrong" with you.

• Patient handling. OSHA reports that sprains and strains are the most commonly reported injuries in healthcare, that the shoulders and low back are most affected, and that injuries mainly come from overexertion during repeated patient handling, heavy lifting and awkward postures [1]. NIOSH says patient handling is the single greatest risk factor [2].
• Standing. In a review of 49 studies, mostly cross-sectional (45 of 49), substantial standing (over 4 hours a day) was linked to low back symptoms. Evidence for lower-limb symptoms was judged inconclusive [3].
• Long hours and nights. A 2022 review of 15 studies in healthcare found long weekly hours, night work and shift work were linked to musculoskeletal disorders, with the strongest link for low back pain. The authors said the role of specific schedule features is poorly understood [4].
• Shoes and floors. MedlinePlus lists long periods on your feet and poorly fitting shoes with little cushioning among common causes of foot pain [10].

Most of this evidence shows links, not proof of cause. It fits what many nurses describe: sore low back, tight hips, and aching feet and calves by the end of a shift.

Partly, and equipment matters more. Mayo Clinic's advice for lifting is to avoid heavy lifting when possible; otherwise, let your legs do the work, keep your back straight, bend at the knees and avoid twisting [8].

For patient handling, though, the main message from US agencies is to use equipment. OSHA advises using patient transfer and lifting devices instead of relying on manual lifting, getting training, and explaining planned lifts to patients first [1]. NIOSH says assistive lifting devices can reduce the risk of injury and strain, and that employers should provide them and train workers [2].

The US agency pages we reviewed do not set a safe manual-lift weight for patients, so this guide does not either. In practice:

• Use the hoist, slide sheet or transfer aid your unit provides.
• Ask for help before moving someone you cannot move safely alone.
• Tell the patient what you are about to do and ask for their help.
• Report missing or broken equipment, and ask about the training you should get.

Many US states also have safe patient handling laws [2]. Your employer's occupational health team can tell you what applies where you work.

They are sensible, but the evidence is thin, and it is worth being honest about that.

• Breaks. A Cochrane review looked at work break schedules to prevent musculoskeletal symptoms. Its authors found the evidence too uncertain to draw firm conclusions. The studies were small, mostly of office workers, and relied on self-reported outcomes [5]. No healthcare-specific conclusion can be drawn.
• Stretching. A 2023 randomized trial in 60 healthcare professionals (30 per group) tested whole-body stretching at lunch three times a week for six weeks. The authors reported that stretching may help reduce musculoskeletal pain and fatigue. The comparison group got an education program and also improved, and the abstract does not give the size of the effect [7]. In that group, low back discomfort was the most common problem over the previous 12 months (46.7%) [7].
• Position changes. Mayo Clinic advises changing position frequently, and, if you stand for long periods, placing one foot on a low footstool [8].

So treat breaks as a low-risk habit that may ease stiffness. They do not replace lifting equipment, rest or a proper assessment of pain that will not settle.

Aim for something you will really do. These are clinical suggestions, not tested doses, so take what suits you. Our movement-break planner and movement break timer can help you place them, and our guide to working on your feet has more ideas.

Stop if you feel sharp pain, new numbness or tingling, or pain that travels down a leg. Ease off and see a provider if it persists.

Kai, Loosn's AI physio coach, can help you pick and pace these around your shift pattern. It does not replace advice from your provider or an assessment if your symptoms are severe, getting worse or unusual. Healthcare workers can also find more on our healthcare workers page.

Fit, support with flexibility, and cushioning. A Mayo Clinic orthopedic specialist advises checking the sole, making sure the toe box is large enough to hold your foot comfortably when standing, and choosing a reasonable cushion. He also said people often wear shoes that are not fitted for them [11]. MedlinePlus advises shoes that fit and suit the activity [10].

The research is less helpful than you might hope. A narrative review of 23 studies (1998 to 2021) on footwear for nurses in standing environments found that:

• viscoelastic insoles and arch support may reduce calf muscle fatigue
• personalized, cushioned footwear may lower peak foot pressure and ease calluses and blisters
• anti-fatigue mats with sports shoes may improve comfort

The authors also said few studies looked at nurses specifically [6]. There is no proof that one brand or type is best, so choose what feels right for your feet, and replace shoes that are worn out. For persistent heel pain, see our post on why plantar fasciitis hurts most with your first steps.

The evidence points to risk with night work and long hours [4], but it does not tell individuals what to change, and many nurses cannot change their schedule. What you can often influence:

• Take the breaks you are entitled to, away from the bedside if you can.
• Keep moving between tasks instead of holding one posture, and change position often [8].
• Move a little before and after a shift to loosen up. Our guide to movement breaks on a busy day can help.
• If sleep after night shifts is a problem, ask your provider.

If your workload or schedule keeps injuring you, raise it with your supervisor or occupational health team. It is a workplace issue, not a personal failing.

Most back pain eases with time and staying active. Mayo Clinic recommends low-impact activity such as walking, bicycling and swimming, and core exercises [8]. See our posts on when lower back pain is serious and our lower back pain page. If your feet hurt, MedlinePlus suggests ice, elevating the foot, cutting back on activity and proper shoes, and says to contact your provider if foot pain does not improve after 1 to 2 weeks of home treatment [10].

If you lift or turn patients, ask your supervisor about modified duties while you recover. Do not push through pain that is getting worse.

Emergency: call 911 (or your local emergency number) or go to the emergency department if [9]:

• back pain starts after trauma, such as a bad fall, a car crash or a patient-handling accident
• you have new bladder or bowel control problems
• back pain comes with a fever
• you notice numbness around your groin, genitals or inner thighs ("saddle numbness"), especially with any of the above

(Other common emergency numbers are 999 in the UK, 112 across the EU and 000 in Australia.)

Get urgent help the same day if:

• you have sudden, severe foot pain, or pain after an injury and you cannot put weight on it [10]
• a foot or joint is red, swollen or hot, or you have an open sore or fever [10]
• your leg weakness is getting worse

See a provider soon if [9][10]:

• back pain has not improved after a week of home treatment [9]
• pain is constant or intense, especially at night or when lying down [9]
• pain spreads down one or both legs, especially below the knee [9]
• you have weakness, numbness or tingling in one or both legs [9]
• you have unintended weight loss with back pain [9]
• foot pain does not improve after 1 to 2 weeks, or you have diabetes or a blood flow problem [10]

Loosn is not a substitute for assessment when symptoms are severe, getting worse or unusual.

Why does my back hurt so much after a 12-hour shift? 

Several things add up. In a review of 49 studies, standing more than 4 hours a day was linked to low back symptoms [3]. Patient handling is described by NIOSH as the single greatest musculoskeletal risk for healthcare workers [2], and long hours and night work are also linked to risk [4]. Most of this evidence is observational.

Why do my feet hurt after a long shift? 

MedlinePlus lists long periods on your feet and poorly fitting, poorly cushioned shoes among common causes of foot pain [10]. A review of 23 studies found cushioned shoes and insoles may ease foot pressure and calf fatigue, but few studies were in nurses [6]. Pain that lingers for one to two weeks should be checked [10].

Do micro-breaks really prevent back pain? 

The evidence is uncertain. A Cochrane review found it too uncertain to say whether extra work breaks prevent musculoskeletal symptoms, mostly in office workers [5]. Short breaks are still a sensible, low-risk habit, and Mayo Clinic advises changing position often [8]. Treat breaks as a way to ease stiffness, not a guaranteed fix.

Can stretching at work help? 

Maybe. In a small trial of 60 healthcare professionals, whole-body stretching at lunch three times a week for six weeks was reported to help musculoskeletal pain and exertion, but the comparison group also had an education program and improved [7]. It is a reasonable, low-risk habit, but not proven to beat other options.

Is lifting technique enough to protect my back? 

Not on its own. Mayo Clinic advises bending at the knees, keeping your back straight and avoiding twisting [8], but NIOSH and OSHA advise using lifting devices instead of manual patient lifting wherever possible [1][2]. If equipment is missing or broken, report it, and ask for the training your employer should provide.

When should I see a doctor about back pain from work? 

Mayo Clinic advises seeing a provider if back pain has not improved after a week of home treatment, is constant or worse at night, spreads below the knee, or comes with leg weakness, numbness or unintended weight loss [9]. Get emergency care for pain after trauma, new bladder or bowel problems, or fever [9].

Use the free Loosn movement-break planner to schedule short breaks around your shift, and ask Kai, Loosn's AI physio coach, to suggest stretches that suit your pain. Try the movement-break planner, or read how Loosn works.