Recovering from low back pain requires first and foremost that further irritation or injury to the spine is avoided. This will create an environment conducive to healing. The most common source of strain to the low back occurs when bending. It is important to learn to hinge from the hips and knees without bending forward at the waist.
What follows are some examples of correct and incorrect technique when performing common activities of daily life (ADL).
The hip hinge
Learning to hinge your trunk from your hips is crucial for avoiding repetitive strain to your lower back or neck. The figure here shows with a stick on your back how it is possible to keep the spine upright by hinging from the hips as you bend your knees. In contrast, if you bend at the waist the spine flexes forward putting the low back and neck in potentially harmful positions. This hip hinge will be used during a variety of ADL’s to protect the spine.
Getting out of a chair
The key to avoiding strain to your spine when rising from a chair or sitting down is to squat up or down using your hips or knees. Stooping forward from the waist should be avoided. A trick to make this simpler is to scoot towards the edge of your chair so that you are perching and move your feet back under your thighs before sitting up.
A foot stool will make it much easier to keep your back upright. Even when you bend forward to rinse your brush or mouth bend from the hips not the waist. A trick to make this simpler is to keep your chest lifted up while you bend forward.
Brushing teeth
Driving
A key to back and neck saving posture when driving is to allow the car seat’s curve to support your lumbar spine’s natural forward curve. A simple trick to encourage this is to increase the lumbar support in the car seat or to sit on small wedge cushion which is higher in the back than the front.
Picking up a bag from the floor
Here it is important to bend from the hips and knees while maintaining the low back’s natural curve by keeping it curved forward.
Putting a baby in a car
One of the most challenging ADL’s involves putting an infant in the back of a car. One tip is to hold the infant as close to your abdomen/chest as possible. Another is to keep your spine upright while avoiding the tendency to bend from the waist.
Changing a baby
The most important means to avoid harming your back while changing a baby is to ensure that you have a changing station of the appropriate height. If it is too low (below your waist) you will be forced to bend forward from the waist. The correct height is approximately waist high and allows you to manoeuvre your baby without having to bend much.
Lifting
The most important aspect of lifting is to keep your spine upright by hinging from the hips and knees. Even if the object is awkwardly placed so that it is not directly in front of you the key is to keep your chest lifted in front while maintaining your lumbar spine’s natural forward curve. Two other key points which will save you from irritating your back are (1) to avoid lifting during the first half hour of the day, and (2) to avoid lifting immediately after sitting for a prolonged period (i.e. over 40 min).
Proper Lifting Techniques
Traditionally, the most important rule in lifting has always been to "keep your back straight" and "bend with the knees – not the back." Recent literature suggests that it is better to maintain the normal curve in your low back at all times and avoid forward bending whenever possible. You should also lightly contract your buttocks and abdominal muscles to help stabilize the spine, and avoid twisting, whenever performing a lift.
It is also important to keep the objects you are lifting as close in to your body as possible. The farther away from your body an object is, the greater is the strain it places on your spine. Also, whenever possible, try to avoid lifting from the floor – place things at knee, waist, or chest height. Finally, plan your lift before its execution to be sure your path is clear, etc.
The most dangerous position for your lower back is the combination of forward bending and twisting – this should be avoided at all costs. Reaching for things above shoulder level is another strenuous activity for your back. Using a foot stool is a good way to reduce the strain. If a foot stool is unavailable, remember to lightly contract your buttocks and abdominal muscles. Pushing and pulling can be yet another source of back strain. If given a choice between the two, pushing is preferred because the legs can be used more effectively.
Recent studies suggest that the back is especially vulnerable to injury immediately following a period of prolonged forward bending or inactivity like sitting for several minutes or sleeping. IN FACT, THE MOST SIGNIFICANT INJURY PREDICTOR IS NOT THE TASK, BUT IN WHAT ACTIVITIES YOU HAVE BEEN PERFORMING OVER THE DAYS AND MINUTES PRIOR! Following times of inactivity, a warm-up should be performed before attempting to lift anything, and even then remember to pay extra-special attention to using proper lifting technique. Furthermore, you should never lift anything shortly after rising from bed.
What about abdominal belts?
A critical review of the current scientific data neither completely supports nor condemns the wearing of abdominal belts for lifting. However, given the available data, the universal prescription of belts is not recommended. Uninjured individuals appear to gain no benefit from wearing belts. However, if certain individuals feel that they benefit from wearing a belt, then they may be allowed to wear it on the following conditions:
1. Given the risks of increased blood pressure and heart rate, those wearing belts should First be
screened for cardiovascular risk.
2. Since belt wearing may provide a false sense of security, those who wear them must also receive education on lifting mechanics. Belts and braces should not be used as a "quick fix," or as the total solution to the problem.
3. Belts should be prescribed only after a complete ergonomic assessment of the individual's worksite.
4. Belts should not be considered for long-term use. More emphasis should be placed on fitness programs, proper lifting techniques, and ergonomics to correct the cause of the problem.
Links to mattress guidelines for sleep comfort
http://www.spine-health.com/topics/cd/mattress/mattress01.html
Adapted from Spine-health.com, this article addresses the importance of selecting a proper mattress.
http://www.spine-health.com/topics/cd/mattress/mattress02.html
Adapted from Spine-health.com, this article discusses best sleep positions to prevent back problems.
http://www.spine-health.com/topics/cd/mattress/mattress03.html
Adapted from Spine-health.com, this article provides tips for selecting the best mattress to prevent spinal injuries and back pain.