Many people go to a great deal of effort to follow a rehabilitation program after a back injury, only to reinjure their back by doing something foolish at home or at work. Take a few minutes to go over the information in this chapter with your clients so that they will maintain the back health you’ve helped them achieve.
In the large majority of cases, I have met with mild resistance or even boredom, because most people will say (at least to themselves), "Yes, yes, I know all that, use your legs and not your back, don’t bend over. . . ." Yet a significant number of these same people will end up with an injury simply because they haven’t internalized proper safety procedures. I suggest that you role-play these ideas with your clients. After leading them through the information in this chapter, take just 5 or 10 min to point to various objects and say, "All right, let’s say you have to carry that chair into the next room and set it against the wall. Plan it out for me, explain to me the proper lifting and carrying procedure, and then show me how you would position yourself for the lift." (I don’t suggest letting anyone do a heavy or awkward lift, for reasons of liability.)
Key point: Role-play lifting techniques. Have your client demonstrate the techniques in the setting she will commonly use.
Merely reaching over a table subjects the spine to tremendous leverage forces. Picking up a mug of coffee from the opposite side of a table, for example, can produce more force against the intervertebral discs than lifting a 20 lb (9 kg) weight that is next to one’s body. Remember, torque equals force multiplied by the length of the lever arm. If the spine remains vertical, leverage is minimal. If the spine is allowed to move toward the horizontal, higher leverage forces increase the tendency for the spine to flex, loading the spinal tissues. A simple analogy illustrates this well: When a flexible fishing rod is held vertically, it remains straight; if you tilt it, it bends under its own weight. To keep the rod straight in a tilted or horizontal position, you must support its weight (a fisherman uses a stand). The same principle applies to the back. If you want to move your back away from the vertical, you should support it by placing your hand on a nearby tabletop or chair, or on your knee if nothing else is available. The additional support greatly reduces the stress on the spine and enables you to maintain correct alignment.
Repeated flexion also adds to spinal stress, greatly increasing discal pressure and continually stretching the posterior spinal tissues. Over time, repeated flexion can lead to tissue breakdown. Microtrauma of this type gives rise to classical postural pain syndromes (McKenzie 1981). Instruct your clients to reduce their total amount of bending in any one day by using more effective movements and by improving general back care. Figure 16.1 shows examples of poor general back care, along with alternatives for reducing stress on the spine.
Key point: Support the spine whenever it is not vertical, and reduce the total amount of bending.
Both at home and at work, your clients should follow the principles of good back stability in any lifting or other manual tasks. They must plan their actions carefully and minimize the forces of the lift.
Planning prevents surprises. One of the most common reasons for lifting injuries is failure to assess the entire situation before trying to move an object. Tell your clients they must evaluate three areas:
1. Assess the environment. Note the floor surface. Is it uneven? Is it wet? Are there potential trip hazards? They should plan the entire path over which they will carry the object. Does the path involve going through a doorway? If so, is it accessible and open? Is it wide enough? (It is amazing how often people will carry a couch or desk up to a doorway, only to discover the opening is too small!) Where is the object to be placed? If it is to go on a table, is there room for it or do other items need to be moved first?
2. Assess the object. The distribution of the object’s weight can be even more important than the absolute weight. The heaviest part of the object should be held close to the body to reduce the leverage effect, and people must feel comfortable with the weight lifted in relation to their own health status, training, and capability. They should consider the size and shape of the object: A light object that is very bulky or that may shift (e.g., a container of powder or fluid) offers a greater potential for injury. Your clients must also consider any possible danger from the contents-if a container holds acid or a scalding liquid, what would happen in the event of an accident?
3. Assess themselves. Do they feel confident that a lift is within their capability? People with a knee injury, for example, may not be able to bend their knees sufficiently to lift the object in
a correct manner. Are there any relevant medical conditions? Pregnant women should severely restrict their lifting; and individuals with heart disease, low back pain, or hip pathology will have
Many people injure their backs by trying to lift objects that they suspected were too heavy for them. I often hear something like "I was afraid I couldn’t lift it, but it had to be moved and I
didn’t have time to find help." Machismo is a very common and very dangerous attitude. Emphasize to your clients that it is in no way wimpy to admit they should not lift a given item. Such a decision in fact shows great wisdom and maturity. If special training is needed before a certain kind of lift, and if a person has not received that training, he certainly must not attempt the left.
In general, if people are unsure about any aspect of a lift, they should not attempt it.
Key point: People should not attempt any lift if they have the slightest doubts about their abilities to perform the lift safely.