A nurse is instructing coworkers about how to minimize lower back pain and avoid repeated episodes of back pain. Which of the following strategies should the nurse include? (Select all that apply.)

Choice A rationale Applying cold packs, or cryotherapy, is primarily indicated for acute soft tissue injuries to induce vasoconstriction, thereby decreasing local blood flow, metabolism, and inflammation, which reduces pain and swelling. For chronic or recurring lower back pain prevention, heat is often more effective, as it promotes vasodilation, increasing blood flow to relax muscles and reduce stiffness, making cold less suitable as a frequent preventative strategy. Choice B rationale Prolonged static postures, like sitting, increase intradiscal pressure and muscle tension in the lumbar region, leading to muscle fatigue and reduced blood flow to the supporting structures, which exacerbates back pain. Regular movement and changing positions is crucial to maintain flexibility, promote circulation, and distribute mechanical stress across different structures, minimizing sustained strain on the spinal ligaments and discs. Choice C rationale Sleeping on a mattress that is too soft fails to provide adequate support for the spine's natural curvature (lumbar lordosis), allowing the trunk to sink, which can lead to spinal misalignment and increased strain on the back muscles and ligaments. A medium-firm mattress is generally recommended to maintain proper spinal alignment during sleep, which reduces mechanical stress and prevents morning stiffness and pain. Choice D rationale Asking for help when moving clients ensures the nurse can use proper body mechanics, which involves keeping the load close to the body, maintaining a wide base of support, and lifting with the legs, not the back. This principle minimizes the mechanical stress and sheer forces applied to the intervertebral discs and paraspinal muscles, significantly lowering the risk of acute muscle strains or chronic cumulative trauma to the lumbar spine. Choice E rationale Partial sit-ups with the knees bent strengthen the abdominal and oblique muscles, which are key components of the body's core musculature. A strong core acts as a stabilizer for the lumbar spine, increasing intra-abdominal pressure to support the vertebral column and reducing the load and mechanical strain on the lower back structures during movement and daily activities, thereby preventing injury recurrence.