GUIDELINES IN THE PREVENTION OF BACK INJURIES

HOW TO LIFT AN OBJECT

1. Plan your lift: Before picking up any object, you must know where the object is going and how far to carry it. Clear a space to place the object. Size up the object and if there is a chance that you will not manage it on your own, ask for help!
2. Get a firm footing: Keep your feet shoulder width apart for a stable base. An alternative is to keep one foot forward, keeping your weight on the balls of your feet.
3. Bend your knees: It seems a lot easier for us to just bend over at the waist to pick something up but, this puts extreme amounts of force on your back. Rather keep your back straight, bend your knees and use your leg muscles to lift you up.
4. Tighten your stomach muscles: Abdominal muscles are essential in the support of your lumbar spine. Contract your abdominals when you lift as it offsets the force of the load.
5. Keep the load close: Do not hold the load away from your body. The closer it is to your spine, the less force it exerts on your back. Keep the principles of leverage in mind. If you are bending with 1 leg forward (stride standing), you can first lift the object to rest it on your bent knee before standing up.
6. Do not twist: Whether you are lifting an object, carrying it or putting it down, do not twist your spine. If you need to turn, pivot at your feet and not your back.
7. Repeat steps 1 to 6 for every form of lifting, including picking up children.

PUSHING AND PULLING

When pushing an object, bend your knees so that your arms are level with the object. Keep your elbows slightly bent. Lean towards the object while maintaining a neutral spine. Push the object in front of you using your leg muscles REMEMBERINGING to tighten your stomach muscles at all times.

When pulling an object, your arms must also be level with the object. Lean away while maintaining a neutral spine. Pull the object by using your body weight and leg muscles.

WHAT ABOUT ACTIVITIES OF DAILY LIVING?

General Principles

• Maintain a balanced, healthy posture
• Use a rocking motion when using long-handled tools. Shift the body weight onto the leading foot when making a forward stroke and shift weight to the rear foot when making a backward stroke.
• Use long, smooth strokes rather than short, jerky motions.
• Avoid twisting and overreaching- use a pivoting motion instead.
• Move your arms and legs rather than your back.
• Change hand positions continuously.
• Select or adjust a long-handled tool to match your reach.

Vacuum Cleaning

1. Tank-type vacuums are easier to manoeuvre around furniture and can help you reach into the right places. Upright ones require less stooping and light-weight, self-propelled vacuums are less strenuous to use.
2. Use casters under heavy furniture to make them easier to move.

Mopping floors

1. Clean floors with long-handled mops as it is less energy consuming than working on your hands and knees.
2. Fill the bucket half-full to prevent heavy lifting or put the dolly on casters.
3. Use good body mechanics to bend and squat in order to clean those hard- to -reach corners.

Bed changing

1. Position your bed so that 3 sides are away from the wall to give yourself room to squat or kneel. Maintain a healthy posture while squatting or kneeling.
2. When using fitted sheets, tuck in 1 corner, then the diagonal corner, then a 3rd. At the last corner, kneel close to the bed and pull the sheet firmly over the corner and without lifting the mattress, tuck it in with your open hand.
3. Pillowcases: DO NOT hold the pillow under your chin. Sit down and turn the pillowcase inside out. Lay the pillow lengthwise on your bed or lap. Grasp the closed end of the pillowcase and the end of the pillow in the same hand. With your free hand, pull the pillowcase right side out over the pillow.

Ironing

1. Adjust the ironing board to the correct height for use in sitting or standing ie: Table heights should be 2 inches below your elbows, arms should be at your sides with your elbows bent to 90 degrees.
2. If you iron in standing, one should alternate resting one foot on a stool.

Laundry

1. Do laundry on a regular basis to avoid having heavy loads accumulate.
2. Use a laundry basket on wheels.
3. When using a front-loader, squat and kneel correctly in front of it.
4. Put soap, bleach etc at a convenient height.

Shopping

1. Be aware of the amount of parcels you can carry comfortably.
2. Divide up the packages, pack bags half full, carry an equal number of bags in each hand to distribute the weight evenly and also, make extra trips as necessary.
3. Use trolleys ( high rise ones over deeper ones) or delivery services if possible.

Loading and unloading from the boot of your car

1. Place a foot or your knee onto the bumper or use a foot in the boot for balance and support.
2. Lift the object while maintaining normal spinal curves.
3. First lift an object to rest it on the car frame and then lift it to carry it.
4. Use one arm to brace yourself if you need to reach something deep inside the boot.

Gardening

1. Use long-handled tools where possible.
2. For weeding and planting, use kneeling techniques or a hands-and-knees position.
3. For lawn mowing, use a self-propelled mower where possible and then just steer it along.
4. If using a push mower, let the power of your legs do the work. Mow across inclines rather than up and down them.
5. To sweep and rake leaves, use a rocking motion and hold the tools close to the body to avoid bending.
6. Sweep and shovel several smaller loads rather than one large one and avoid twisting by pivoting with your feet.

Driving

1. Don't drive sitting far back from the steering wheel. Stretching for the pedals and the wheel lessens your lower back curve and strains your back. Use a rolled up towel for a lumbar support.
2. Don't drive with your knees higher than your hips.

Sleeping

1. Do not sleep on soft, sagging, non-supporting mattresses. A mattress should be firm.
2. Sleeping on your side is the chosen position. Use a pillow between your legs for comfort. If you prefer sleeping on your back, put a pillow under your knees. It is not good to sleep on your stomach as you lose the normal curves of your back and your neck is twisted.
3. Use the pillow that helps you maintain the correct curves in your spine. The spine should be in one line when you look at it from the side. With very thick or thin pillows, you will strain your neck due to it being to high up or too low down.

Tips that help you care for your back

A healthy posture and good alignment, combined with stress management, relaxation techniques, regular exercise and weight management are essential in caring for your back.

Stress and relaxation:

• Find frequent periods to relax during the day. Even short breaks more often, can help.
• Relax your shoulders and neck, and allow your arms to hang limply at your sides.
• Frequently change your work position. One should move out of their position every 20 minutes whether it be changing your work station around or just getting up for a quick walk.
• Take frequent breaks when taking long trips. When stopping for a rest, walk around to stretch your legs. On a plane or a train, get up to stretch and move about.

How do I go about practicing relaxation?

1. Take a deep breath in through your nose and out through your mouth, trying to expand your lungs as much as possible. Breath out through pursed lips- this maintains the airways open longer.
2. Shrug your shoulders up, drop them down again and concentrate on relaxing. Close your eyes if you feel it aids relaxation.
3. Tuck your chin in to make a double chin and again-RELAX.
4. Wrinkle your forehead-RELAX.
5. Clench your jaws-RELAX.
6. Make a fist and squeeze-RELAX.
7. Move your wrists clockwise and then anti-clockwise-RELAX.
8. Stretch your arms up, to the sides, behind you-RELAX.
9. Stand up, bend forward, straighten up-RELAX.
10. Stand up and bend to the left and the right-RELAX.

Exercise and weight management

Regular exercise helps to maintain your overall fitness and maintain a weight that is healthy for you. By working the muscles with weights or resistance, you build and maintain strong bones and muscles. Stretching increases flexibility. Besides all the physical improvements, exercise helps you relax and increases your sense of well-being by the release of endorphins ("happy hormones"). People who exercise regularly also mange their stress better and recover from pain and injury more quickly.

Exercise can be one of the best ways to manage back pain. However, if you have severe pain you may need to rest or slow down for a few days. Prolonged rest decreases fitness, weakens bones and muscles and decreases suppleness. This can aggravate a back condition making it harder to get moving again.

If you want to start exercise again after a long time, do so slowly and build up carefully. Your muscles may ache but, this should be temporary. If they ache for 24 hours, this is because they have been worked. If they are painful for longer than 48 hours, you have worked too hard and injured the muscles. Slow down with the next exercise session.

EXERCISES TO DO...........

• Lumbar Extension
  • Stand upright maintaining the natural curves in your back. Put your hands behind your back on either side of your spine to support your lower back. ------While keeping your hips still, lean backwards to the end of your available range and then return to neutral. Repeat this exercise 3-4 times in succession, on the hour, every hour.
• Elbow props (To maintain the normal lumbar curve and strengthen the lower back muscles)
  • Lie flat on your stomach and then prop up on your elbows like a puppy.
  • Hold this for 10-20s, return to the first position and relax.
    (The above 2 exercises are more important to do if your back is normally painful with sitting, driving or bending forward).
• Lower back rotation (helps stretch lower back)
  • Lie on your back with knees bent and arms out to the side.
  • Slowly drop both knees to one side and turn your head to the opposite side.Keep shoulders on the floor.
  • Hold for 5 counts and repeat 10 times to each side- slow and controlled.
• Lower back release
  • While sitting on a chair with your feet firmly placed on the ground, round your back and flop forward towards the floor.
  • Hold this for 10 seconds and then sit up again slowly, rolling through every vertebrae.
  
  (The above 2 exercises are most important if your back is mainly painful while standing or walking).
• Hamstring stretch (To limber and stretch the hamstrings).
  • Lie on your back with knees bent.
  • Raise the right knee to your chest and hold it there with your hands.
  • Straighten this knee while using your hands to pull this outstretched leg towards you. Feel the stretch at the back of your leg.
  • Hold it for 15 counts and then repeat it on the left.
  • Repeat it 5 times on each leg.
• Deep stabilizer strengthening.
  • Lie on your back with your knees bent and feet on the floor.
  • Use the muscles in your lower abdomen to pull your belly- button towards your spine. Or, take a breath in and "hiss" loudly.

Compiled by: Danielle Kloeck
BSc. BSc. Physio (Wits)