Lifting and carrying are power jobs—when you lift and carry the wrong way, you can damage your back. Back injuries are the most common type of injury in the workplace, causing approximately 900,000 disabling injuries in 1995. Over half of these injuries are from lifting.
Back injuries may be difficult to treat and may have lengthy and expensive rehabilitation times.
Whether you are lifting at home or at work, make an effort to take care of your back. The National Safety Council recommends a number of tips to prevent unintentional injuries and keep your back strong and healthy.
Power warm-ups
You will work better if you start each day with slow stretches. These warm-ups let you ease comfortably into your workday and help you avoid injuries.
Leg and back warm-up
Prop one foot on a chair or a stool for support
Take a deep breath
Ease forward slowly—keep your back slightly curved
Blow slowly outward as you ease forward to a seven count
Repeat seven times
Switch and do the same with the other foot
Backbend
Stand with your feet about 12 inches apart
Support the small of your back with your hands
Hold your stomach in firmly and take a deep breath
Arch backward—bend your head and neck as you go, blowing air slowly out for seven counts
Repeat seven times
Power lifting tips
Protect your hands and feet by wearing safety gear
Size up the load—tip it on its side to see if you can carry it comfortably. Get help if the load is too big or bulky for one person. Check for nails, splinters, rough strapping and sharp edges
Lift it right—make sure your footing is solid. Keep your back straight, with no curving or slouching. Center your body over your feet, get a good grip on the object and pull it close to you. Pull your stomach in firmly. Lift with your legs, not your back; if you need to turn, move your feet and don't twist your back
Tough lifting jobs
Oversized loads: do not try to carry a big load alone; ask for help. Work as a team by lifting, walking and lowering the load together. Let one person call the shots and direct the lift. Use proper mechanical devices for heavy loads.
High loads: use a step stool or a sturdy ladder to reach loads that are above your shoulders. Get as close to the load as you can and slide the load toward you. Do all the work with your arms and legs, not your back.
Low loads: loads that are under racks and cabinets need extra care. Pull the load toward you, then try to support it on one knee before you lift. Use your legs to power the lift.
Always use your stomach as a low back support by pulling it in during lifting.
Remember, a strong, healthy, powerful back is vital to your job. It also helps you enjoy life. Take pains to avoid injuries by making it a full-time job to take care of your back!
Thursday, June 21, 2007
BACK CARE FOR SITTING WORK
Professor Alan Hedge, PhD Director Human Factors and Ergonomics Laboratory Cornell UniversityDepartment of Design and Environmental Analysis Ithaca, NY http://ergo.human.cornell.edu
Sitting has become a way of life for many Americans. We sit in cars, buses, trains or planes when we travel, we sit to eat meals, we sit and watch TV, we sit in classrooms, and for many of us, we sit most of the day at work, often in front of a computer all day. Studies of sedentary workers show that low back problems are associated with poor chair design and inappropriate sitting posture.
Although for many activities we could stand just as easily as sit, for example, we could stand to watch TV, stand to eat, and stand in front of a computer all day. There are at least three good reasons why we prefer sitting.
Sitting uses about 20% less energy compared with standing to do the same work, so comfortable sitting helps to relieve fatigue.
Sitting helps to reduce the strain on our back muscles and on the intervertebral discs of the lumbar spine, providing that we sit back in a supported, reclined posture.
Sitting gives us greater postural stability for performing fine manipulative tasks, such as eating with a knife and fork, sewing, writing, etc.
(Image reproduced courtesy of Humanscale)
Anatomical Changes During Sitting
When we change from a standing posture to a sitting posture anatomical changes occur. The lumbar spine changes shape depending on what we sit on and how we sit. If we sit on a flat surface, such as a bench, bleachers or stool, without any back support we tend to hunch the body forwards for support, often resting our arms on our legs to reduce fatigue. As we hunch forwards, the lower back curves outwards into a kyphotic shape. This is generally regarded as an unhealthy posture if sustained for a prolonged period. With nothing to lean back on, the upper body becomes fatigued and we typically regard this as an uncomfortable way to sit. However, this is the way that many people end up sitting over the course of each workday, so it isn't surprising that studies of sedentary workers, such as office workers, have frequently reported high levels of postural discomfort. [2] What we want is to be able to sit and maintain the lumbar spine in a posture called lordosis.
Ergonomic Chair Design
If we sit on a good ergonomic chair, the seat pan is curved from back to front to encourage the pelvis to rotate forwards, and this helps the lumbar spine to maintain lordosis. As we sit back the lower back should be well supported by a contoured lumbar support. The average preferred height for a good lumbar support is abut 7.5 -inches above the compressed seat surface (19 cm), and the mean preferred seat depth (horizontal distance from front of seat to lumbar support point) is about 15.25-inches (38.7 cm). Ideally, the chair should have a backrest that is sufficient high to provide support to the thoracic region as well. [3] Also, make sure that the seat is height adjustable (15" - 22"), the backrest angle is adjustable (100° - 120°), the armrests have a minimum 16.1” width and have adjustable height (7.1”-10.6” above compressed seat height). [4] Studies of office chairs show that users often cannot correctly identify or operate chair controls [5], so make sure that the chair has user-friendly controls.
(Image reproduced courtesy of Humanscale)
Safe Sitting
Keeping the spine healthy requires periodic changes in posture, and dynamic movement helps to promote circulation and reduce muscle fatigue. Sitting in any static posture for a prolonged period eventually will become uncomfortable. This means that there isn't a fixed posture that's best for everyone, all of the time, whatever the task at hand. Rather, there is a desirable range of movement that works well for most people doing most of the kinds of tasks performed when sitting.
The preferred way of sitting involves the following:
Make sure that the seat height is correctly adjusted so that your feet are on the ground or on a solid surface like a good footrest.
Recline back in the chair, with the chair backrest angled between 100-110-degrees, so that the chair back can help support the weight of the torso.
Make sure that the chair has good lumbar support in the right area for your shape and size of back. If there is an adjustable support, use this to get the best position. If not, use a rolled towel or a cushion to improve your lower back support.
Make sure that the seat pan is the right size for you and doesn't press behind your knees.
Look for a chair that doesn't tip up the seat pan when you recline because this can put pressure under the thighs and behind the knees.
If the chair has arms, make sure that these are correctly adjusted for height so that your shoulders are relaxed, not hunched or raised when you rest on the armrests.
If the chair has a high neck/headrest make sure that this can be used in different sitting positions.
Now that your body is in a good, supported posture you should be ready to work without any discomfort, but remember to take periodic breaks, and to change posture, get up and move around.
(Image reproduced courtesy of Humanscale)
Tips for Choosing the Best Ergonomic Chair
When choosing a chair ask yourself the following questions:
1. Is the chair comfortable to sit in for the way that you work?
a) Does the shape of the seat fit you and let your legs move freely?
b) Is the cushioning comfortable and made of a breathable material?
c) Do you have at least one-inch free space on either side of your hips and thighs?
d) Do you have at least one-inch free space between the edge of the seat and the back of your knees?
e) Can you sit comfortably with your feet on the floor or a footrest?
2. Can you easily adjust the important features of the chair?
a) Can you adjust seat height while you are sitting in the chair?
b) Is the range of height adjustment of the chair adequate?
c) Can you adjust the position of the lumbar support and is this comfortable?
d) Can you recline the chair back to a comfortable position?
e) Are the controls easy to understand and use?
3. Is the chair stable when you sit on it?
a) Does it have a 5+ pedestal base so it won't easily tip over?
b) Does the chair move easily when you need to?
c) Can you swivel easily so that you don't have to twist your back to turn?
4. Does the chair have comfortable armrests?
a) Are the armrests broad, contoured, and adequately cushioned?
b) While sitting can you adjust the height of the armrests?
c) Can you easily move the arms out of the way if you need to do this?
If you answered "No" to any of the questions then the chair you are considering might not be right for you. If you answered "Yes" to all of the questions, then this chair will work for you. Remember, you will probably sit for a large part of your life, so make sure that your chair is a source of comfort and pleasure, not discomfort and pain.
Professor Alan Hedge, PhD Director Human Factors and Ergonomics Laboratory Cornell UniversityDepartment of Design and Environmental Analysis Ithaca, NY http://ergo.human.cornell.edu
Sitting has become a way of life for many Americans. We sit in cars, buses, trains or planes when we travel, we sit to eat meals, we sit and watch TV, we sit in classrooms, and for many of us, we sit most of the day at work, often in front of a computer all day. Studies of sedentary workers show that low back problems are associated with poor chair design and inappropriate sitting posture.
Although for many activities we could stand just as easily as sit, for example, we could stand to watch TV, stand to eat, and stand in front of a computer all day. There are at least three good reasons why we prefer sitting.
Sitting uses about 20% less energy compared with standing to do the same work, so comfortable sitting helps to relieve fatigue.
Sitting helps to reduce the strain on our back muscles and on the intervertebral discs of the lumbar spine, providing that we sit back in a supported, reclined posture.
Sitting gives us greater postural stability for performing fine manipulative tasks, such as eating with a knife and fork, sewing, writing, etc.
(Image reproduced courtesy of Humanscale)
Anatomical Changes During Sitting
When we change from a standing posture to a sitting posture anatomical changes occur. The lumbar spine changes shape depending on what we sit on and how we sit. If we sit on a flat surface, such as a bench, bleachers or stool, without any back support we tend to hunch the body forwards for support, often resting our arms on our legs to reduce fatigue. As we hunch forwards, the lower back curves outwards into a kyphotic shape. This is generally regarded as an unhealthy posture if sustained for a prolonged period. With nothing to lean back on, the upper body becomes fatigued and we typically regard this as an uncomfortable way to sit. However, this is the way that many people end up sitting over the course of each workday, so it isn't surprising that studies of sedentary workers, such as office workers, have frequently reported high levels of postural discomfort. [2] What we want is to be able to sit and maintain the lumbar spine in a posture called lordosis.
Ergonomic Chair Design
If we sit on a good ergonomic chair, the seat pan is curved from back to front to encourage the pelvis to rotate forwards, and this helps the lumbar spine to maintain lordosis. As we sit back the lower back should be well supported by a contoured lumbar support. The average preferred height for a good lumbar support is abut 7.5 -inches above the compressed seat surface (19 cm), and the mean preferred seat depth (horizontal distance from front of seat to lumbar support point) is about 15.25-inches (38.7 cm). Ideally, the chair should have a backrest that is sufficient high to provide support to the thoracic region as well. [3] Also, make sure that the seat is height adjustable (15" - 22"), the backrest angle is adjustable (100° - 120°), the armrests have a minimum 16.1” width and have adjustable height (7.1”-10.6” above compressed seat height). [4] Studies of office chairs show that users often cannot correctly identify or operate chair controls [5], so make sure that the chair has user-friendly controls.
(Image reproduced courtesy of Humanscale)
Safe Sitting
Keeping the spine healthy requires periodic changes in posture, and dynamic movement helps to promote circulation and reduce muscle fatigue. Sitting in any static posture for a prolonged period eventually will become uncomfortable. This means that there isn't a fixed posture that's best for everyone, all of the time, whatever the task at hand. Rather, there is a desirable range of movement that works well for most people doing most of the kinds of tasks performed when sitting.
The preferred way of sitting involves the following:
Make sure that the seat height is correctly adjusted so that your feet are on the ground or on a solid surface like a good footrest.
Recline back in the chair, with the chair backrest angled between 100-110-degrees, so that the chair back can help support the weight of the torso.
Make sure that the chair has good lumbar support in the right area for your shape and size of back. If there is an adjustable support, use this to get the best position. If not, use a rolled towel or a cushion to improve your lower back support.
Make sure that the seat pan is the right size for you and doesn't press behind your knees.
Look for a chair that doesn't tip up the seat pan when you recline because this can put pressure under the thighs and behind the knees.
If the chair has arms, make sure that these are correctly adjusted for height so that your shoulders are relaxed, not hunched or raised when you rest on the armrests.
If the chair has a high neck/headrest make sure that this can be used in different sitting positions.
Now that your body is in a good, supported posture you should be ready to work without any discomfort, but remember to take periodic breaks, and to change posture, get up and move around.
(Image reproduced courtesy of Humanscale)
Tips for Choosing the Best Ergonomic Chair
When choosing a chair ask yourself the following questions:
1. Is the chair comfortable to sit in for the way that you work?
a) Does the shape of the seat fit you and let your legs move freely?
b) Is the cushioning comfortable and made of a breathable material?
c) Do you have at least one-inch free space on either side of your hips and thighs?
d) Do you have at least one-inch free space between the edge of the seat and the back of your knees?
e) Can you sit comfortably with your feet on the floor or a footrest?
2. Can you easily adjust the important features of the chair?
a) Can you adjust seat height while you are sitting in the chair?
b) Is the range of height adjustment of the chair adequate?
c) Can you adjust the position of the lumbar support and is this comfortable?
d) Can you recline the chair back to a comfortable position?
e) Are the controls easy to understand and use?
3. Is the chair stable when you sit on it?
a) Does it have a 5+ pedestal base so it won't easily tip over?
b) Does the chair move easily when you need to?
c) Can you swivel easily so that you don't have to twist your back to turn?
4. Does the chair have comfortable armrests?
a) Are the armrests broad, contoured, and adequately cushioned?
b) While sitting can you adjust the height of the armrests?
c) Can you easily move the arms out of the way if you need to do this?
If you answered "No" to any of the questions then the chair you are considering might not be right for you. If you answered "Yes" to all of the questions, then this chair will work for you. Remember, you will probably sit for a large part of your life, so make sure that your chair is a source of comfort and pleasure, not discomfort and pain.
Sunday, June 17, 2007
Pain
Exercises for pain relief
It is essential that you consult your health professional before commencing these exercises. Robin Mckenzie has written an easy to follow guide called "Treat your own back" and invented the following exercises. Exercise One Lying Face Down Lie face down with your arms beside your body and your head turned to one side Stay in this position, take a few deep breaths and then relax completely for four to five minutes. You must make a conscious effort to remove all tension from the muscles in your lower back; without COMPLETE RELAXATION there is NO CHANCE of ELIMINATING any DISTORTION that may be present in the joint. This exercise is used mainly in the treatment of acute back pain that is pain that is short-lived and is one of the First Aid exercises. It should be done once at the BEGINNING of EACH exercise session, and the sessions are to be spread evenly six to eight times throughout the day. This means that you should repeat the sessions about every two hours. In addition, you must lie face down whenever you are resting. When in acute pain you should avoid sitting, at least during the first few days. Exercise Two Lying Face Down in Extension Remain face down. Place your elbows under your shoulders so that you lean on your forearms. During this exercise you should commence taking in a few deep breaths and allow the muscles in the lower back to relax completely. Again you should stay in this position for about five minutes. You must make a conscious effort to remove all tension from the muscles in your lower back; without COMPLETE RELAXATION there is NO CHANCE of ELIMINATING any DISTORTION that may be present in the joint. This exercise is used mainly in the treatment of severe low back pain and is one of the First Aid exercises it should always follow exercise one and is to be performed once per session. Should you experience severe and increasing pain on attempting this exercise, there are certain measures to be taken before you can continue exercising, these are discussed in the section 'No response or benefit' Exercise Three Extension in Lying Remain face down. Place your elbows under your shoulders in the press-up position. Now you are ready to start exercise 3. Straighten your elbows and push the top half of your body up as far as the pain permits. It is important that you completely relax the pelvis, hips and legs as you do this. Keep your pelvis, hips and legs hanging limp and allow your back to sag. Once you have maintained this position for a second or two, you should lower yourself to the starting position. Each time you repeat this movement cycle you must try to raise your upper body a little higher, so that in the end your back is extended as much as possible with your arms as straight as possible. Once your arms are straight, remember to hold the sag for a second or two as this is a most important part of the exercise. The sag may be maintained for longer than one or two seconds if you feel the pain reducing or centralizing. This is the most useful and effective first aid procedure in the treatment of acute low back pain. The exercise can also be used to treat stiffness of the low back, and to PREVENT low back pain RECURRING once you are fully recovered. When used in the treatment of either pain or stiffness, the exercise should be performed ten times per session and the sessions are to be spread evenly six to eight times throughout the day. Should you not respond or have increasing pain on attempting this exercise, there are certain measures to be taken before you can continue exercising, these are discussed in the section 'No response or benefit' read it now. Exercise Four Extension in Standing Stand upright with your feet slightly apart. Place your hands in the small of your back with your fingers pointing backwards and your thumbs pointing forwards. You are now ready to start Exercise Four Bend your trunk backwards at the waist as far as you can, using your hands as a fulcrum. It is important that you keep your knees straight as you do this. Once you have maintained this position for a second or two you should return to the starting position. Each time you repeat this movement cycle, you should try to bend backwards a little further so that in the end you have reached the maximum possible degree of extension. When you are in acute pain, this exercise may replace exercise 3 should circumstances prevent you from exercising in the lying position. This exercise however is not as effective as exercise 3. Once you have fully recovered and no longer have low back pain, this exercise is your MAIN TOOL in the PREVENTION of further BACK PROBLEMS As a preventive measure, repeat the exercise every once in a while whenever you find yourself working in a forward bent position. Perform the exercise BEFORE the pain appears. Exercise Five Flexion in Lying Lie on your back with your knees bent and you feet flat on the floor or bed. You are now ready to start Exercise Five Bring both knees up towards the chest. Place both hands around your knees and gently but firmly pull the knees as close to the chest as the pain permits. Once you have maintained this position for a second or two you should lower the legs and return to the starting position. It is important that you DO NOT RAISE YOUR HEAD as you perform this exercise, or STRAIGHTEN YOUR LEGS AS YOU LOWER THEM. Each time you repeat this movement cycle, you should try to pull your knees a little further so that in the end you have reached the maximum possible degree of flexion. At this stage your knees may touch the chest. This exercise is used in the treatment of stiffness in the low back which may have developed since your injury or pain began. While damaged tissues may have now healed, they may have also shortened and become less flexible; it is now necessary to restore their elasticity and full function by performing flexion exercises. These exercises should be commenced with caution. In the beginning you must only do five or six per session, and the sessions are to be repeated three or four times per day. As you have probably realized, this exercise eliminates the lordosis once the knees are bent to the chest, so in order to rectify any distortion that may result, FLEXION EXERCISES MUST ALWAYS BE FOLLOWED BY A SESSION OF EXERCISE 3 - EXTENSION IN LYING. You may stop performing Exercise 4 when you can readily pull the knees to the chest without producing tightness or pain. You may then progress to Exercise 6 Exercise Six Flexion in Sitting Sit on the edge of a steady chair with your knees and feet well apart and let your hands rest between your legs. You are now ready to start Exercise 6 Bend your trunk forwards and touch the floor with your hands. Return immediately to the starting position. Each time you repeat this movement cycle you must bend down a little further so that end you have reached the maximum possible degree of flexion. At this reached the maximum possible degree of flexion and your head is as close as possible to the floor. The exercise can be made more effective by holding on to your ankles with your hands and pulling yourself down further. Exercise 6 SHOULD ONLY BE COMMENCED AFTER THE COMPLETION OF ONE WEEK OF EXERCISE 5, WHETHER EXERCISE 5 HAS BEEN SUCCESSFUL OR NOT IN REDUCING YOUR STIFFNESS OR PAIN. In the beginning you must only do five or six repetitions per session and the sessions are to be repeated three or four times per day. FLEXION EXERCISES MUST ALWAYS BE FOLLOWED BY A SESSION OF EXERCISE 3 - EXTENSION IN LYING. No Response or Benefit after exercising without any relief or benefit for three or four days, you may conclude that the exercises as performed are ineffectual. There are two main causes for lack of response or benefit from these exercises. A lack of response to these exercises is possible in some people when their pain is felt only to one side of the spine, or is felt much more to one side than the other. If your pain during the course of the day is felt only to one side, more to one side as you perform Exercises 1, 2, 3 you may need to modify your body position before commencing them. To achieve this modification, you should: 1. Adopt a position to perform Exercise 1 and allow yourself to relax for a few minutes. 2. Remain face down and now shift your hips AWAY from the PAINFUL side; that is if your pain is usually more on the right side you must move your hips three or four inches to the left, and once more completely relax for a few minutes. 3. While allowing the hips to remain off-centre, lean on the elbows as described in exercise two and relax for a further three or four minutes. You are now ready to commence Exercise 3. With the hips still off-centre, complete one session of Exercise 3 and relax once more. You may need to repeat the exercise several times but before commencing each session of ten you should ensure that the hips are still off centre; remember, away from the painful side. Even with your hips in the off-centre position, you should try with each repetition to move higher and higher. You should reach the maximum amount of extension possible at which time the arms should be completely straight. For the next three or four days you should continue to perform Exercises 1, 2, 3 from the modified starting position. After a few days of practice you may notice that the pain is distributed more evenly across the back or may have centralized. Once this occurs you may stop shifting the hips before exercising and continue exercising as described earlier. Occasionally shifting the hips away from the painful side is sufficient to stop the pain completely. The second cause for lack of response to the exercise arises when Exercise 3 is performed without adequate fixation. Exercise 3 occasionally gives benefit for a few hours only and then the pain returns. The effectiveness of Exercise 3 can be improved by holding the pelvis down using the hands of another person, or by constructing a simple device which can be improvised at home using an ironing board with a seat belt or strong leather strap placed firmly around the waistline. This added fixation frequently makes the difference between the success and failure of the exercise. RECURRENCE Irrespective of what you are doing or where you are, at the first sign of recurrence of low back pain you should immediately start the exercises which previously led to recovery and follow the instructions to relieve acute pain. You should at once commence Exercise 4 - Extension in Standing. If this does not abolish your pain within minutes, you must quickly introduce Exercise 3 - Extension in Lying. The immediate performance of Exercise 3 can so often prevent the onset of a disabling attack. If your pain is already too severe to tolerate these exercises, you should commence Exercises 1 and 2 - Lying face down and lying down in extension. Finally, if you have on sided symptoms which do not centralize with the exercises recommended so far, you should shift your hips away from the painful side before commencing the exercises and hold your hips in the off-centre position while you exercise. In addition to the exercises, you must pay extra attention to your posture and maintain the Lordosis as much as possible. If this episode of low back pain seems to be different from previous occasions and if your pain persists despite the fact that you closely follow the instructions, you should seek advice.
It is essential that you consult your health professional before commencing these exercises. Robin Mckenzie has written an easy to follow guide called "Treat your own back" and invented the following exercises. Exercise One Lying Face Down Lie face down with your arms beside your body and your head turned to one side Stay in this position, take a few deep breaths and then relax completely for four to five minutes. You must make a conscious effort to remove all tension from the muscles in your lower back; without COMPLETE RELAXATION there is NO CHANCE of ELIMINATING any DISTORTION that may be present in the joint. This exercise is used mainly in the treatment of acute back pain that is pain that is short-lived and is one of the First Aid exercises. It should be done once at the BEGINNING of EACH exercise session, and the sessions are to be spread evenly six to eight times throughout the day. This means that you should repeat the sessions about every two hours. In addition, you must lie face down whenever you are resting. When in acute pain you should avoid sitting, at least during the first few days. Exercise Two Lying Face Down in Extension Remain face down. Place your elbows under your shoulders so that you lean on your forearms. During this exercise you should commence taking in a few deep breaths and allow the muscles in the lower back to relax completely. Again you should stay in this position for about five minutes. You must make a conscious effort to remove all tension from the muscles in your lower back; without COMPLETE RELAXATION there is NO CHANCE of ELIMINATING any DISTORTION that may be present in the joint. This exercise is used mainly in the treatment of severe low back pain and is one of the First Aid exercises it should always follow exercise one and is to be performed once per session. Should you experience severe and increasing pain on attempting this exercise, there are certain measures to be taken before you can continue exercising, these are discussed in the section 'No response or benefit' Exercise Three Extension in Lying Remain face down. Place your elbows under your shoulders in the press-up position. Now you are ready to start exercise 3. Straighten your elbows and push the top half of your body up as far as the pain permits. It is important that you completely relax the pelvis, hips and legs as you do this. Keep your pelvis, hips and legs hanging limp and allow your back to sag. Once you have maintained this position for a second or two, you should lower yourself to the starting position. Each time you repeat this movement cycle you must try to raise your upper body a little higher, so that in the end your back is extended as much as possible with your arms as straight as possible. Once your arms are straight, remember to hold the sag for a second or two as this is a most important part of the exercise. The sag may be maintained for longer than one or two seconds if you feel the pain reducing or centralizing. This is the most useful and effective first aid procedure in the treatment of acute low back pain. The exercise can also be used to treat stiffness of the low back, and to PREVENT low back pain RECURRING once you are fully recovered. When used in the treatment of either pain or stiffness, the exercise should be performed ten times per session and the sessions are to be spread evenly six to eight times throughout the day. Should you not respond or have increasing pain on attempting this exercise, there are certain measures to be taken before you can continue exercising, these are discussed in the section 'No response or benefit' read it now. Exercise Four Extension in Standing Stand upright with your feet slightly apart. Place your hands in the small of your back with your fingers pointing backwards and your thumbs pointing forwards. You are now ready to start Exercise Four Bend your trunk backwards at the waist as far as you can, using your hands as a fulcrum. It is important that you keep your knees straight as you do this. Once you have maintained this position for a second or two you should return to the starting position. Each time you repeat this movement cycle, you should try to bend backwards a little further so that in the end you have reached the maximum possible degree of extension. When you are in acute pain, this exercise may replace exercise 3 should circumstances prevent you from exercising in the lying position. This exercise however is not as effective as exercise 3. Once you have fully recovered and no longer have low back pain, this exercise is your MAIN TOOL in the PREVENTION of further BACK PROBLEMS As a preventive measure, repeat the exercise every once in a while whenever you find yourself working in a forward bent position. Perform the exercise BEFORE the pain appears. Exercise Five Flexion in Lying Lie on your back with your knees bent and you feet flat on the floor or bed. You are now ready to start Exercise Five Bring both knees up towards the chest. Place both hands around your knees and gently but firmly pull the knees as close to the chest as the pain permits. Once you have maintained this position for a second or two you should lower the legs and return to the starting position. It is important that you DO NOT RAISE YOUR HEAD as you perform this exercise, or STRAIGHTEN YOUR LEGS AS YOU LOWER THEM. Each time you repeat this movement cycle, you should try to pull your knees a little further so that in the end you have reached the maximum possible degree of flexion. At this stage your knees may touch the chest. This exercise is used in the treatment of stiffness in the low back which may have developed since your injury or pain began. While damaged tissues may have now healed, they may have also shortened and become less flexible; it is now necessary to restore their elasticity and full function by performing flexion exercises. These exercises should be commenced with caution. In the beginning you must only do five or six per session, and the sessions are to be repeated three or four times per day. As you have probably realized, this exercise eliminates the lordosis once the knees are bent to the chest, so in order to rectify any distortion that may result, FLEXION EXERCISES MUST ALWAYS BE FOLLOWED BY A SESSION OF EXERCISE 3 - EXTENSION IN LYING. You may stop performing Exercise 4 when you can readily pull the knees to the chest without producing tightness or pain. You may then progress to Exercise 6 Exercise Six Flexion in Sitting Sit on the edge of a steady chair with your knees and feet well apart and let your hands rest between your legs. You are now ready to start Exercise 6 Bend your trunk forwards and touch the floor with your hands. Return immediately to the starting position. Each time you repeat this movement cycle you must bend down a little further so that end you have reached the maximum possible degree of flexion. At this reached the maximum possible degree of flexion and your head is as close as possible to the floor. The exercise can be made more effective by holding on to your ankles with your hands and pulling yourself down further. Exercise 6 SHOULD ONLY BE COMMENCED AFTER THE COMPLETION OF ONE WEEK OF EXERCISE 5, WHETHER EXERCISE 5 HAS BEEN SUCCESSFUL OR NOT IN REDUCING YOUR STIFFNESS OR PAIN. In the beginning you must only do five or six repetitions per session and the sessions are to be repeated three or four times per day. FLEXION EXERCISES MUST ALWAYS BE FOLLOWED BY A SESSION OF EXERCISE 3 - EXTENSION IN LYING. No Response or Benefit after exercising without any relief or benefit for three or four days, you may conclude that the exercises as performed are ineffectual. There are two main causes for lack of response or benefit from these exercises. A lack of response to these exercises is possible in some people when their pain is felt only to one side of the spine, or is felt much more to one side than the other. If your pain during the course of the day is felt only to one side, more to one side as you perform Exercises 1, 2, 3 you may need to modify your body position before commencing them. To achieve this modification, you should: 1. Adopt a position to perform Exercise 1 and allow yourself to relax for a few minutes. 2. Remain face down and now shift your hips AWAY from the PAINFUL side; that is if your pain is usually more on the right side you must move your hips three or four inches to the left, and once more completely relax for a few minutes. 3. While allowing the hips to remain off-centre, lean on the elbows as described in exercise two and relax for a further three or four minutes. You are now ready to commence Exercise 3. With the hips still off-centre, complete one session of Exercise 3 and relax once more. You may need to repeat the exercise several times but before commencing each session of ten you should ensure that the hips are still off centre; remember, away from the painful side. Even with your hips in the off-centre position, you should try with each repetition to move higher and higher. You should reach the maximum amount of extension possible at which time the arms should be completely straight. For the next three or four days you should continue to perform Exercises 1, 2, 3 from the modified starting position. After a few days of practice you may notice that the pain is distributed more evenly across the back or may have centralized. Once this occurs you may stop shifting the hips before exercising and continue exercising as described earlier. Occasionally shifting the hips away from the painful side is sufficient to stop the pain completely. The second cause for lack of response to the exercise arises when Exercise 3 is performed without adequate fixation. Exercise 3 occasionally gives benefit for a few hours only and then the pain returns. The effectiveness of Exercise 3 can be improved by holding the pelvis down using the hands of another person, or by constructing a simple device which can be improvised at home using an ironing board with a seat belt or strong leather strap placed firmly around the waistline. This added fixation frequently makes the difference between the success and failure of the exercise. RECURRENCE Irrespective of what you are doing or where you are, at the first sign of recurrence of low back pain you should immediately start the exercises which previously led to recovery and follow the instructions to relieve acute pain. You should at once commence Exercise 4 - Extension in Standing. If this does not abolish your pain within minutes, you must quickly introduce Exercise 3 - Extension in Lying. The immediate performance of Exercise 3 can so often prevent the onset of a disabling attack. If your pain is already too severe to tolerate these exercises, you should commence Exercises 1 and 2 - Lying face down and lying down in extension. Finally, if you have on sided symptoms which do not centralize with the exercises recommended so far, you should shift your hips away from the painful side before commencing the exercises and hold your hips in the off-centre position while you exercise. In addition to the exercises, you must pay extra attention to your posture and maintain the Lordosis as much as possible. If this episode of low back pain seems to be different from previous occasions and if your pain persists despite the fact that you closely follow the instructions, you should seek advice.
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