4 - Ready, Set, Lift - Information

Goals Information Skills Drills Questions Review

 Information to Master

In Session Three, you learned how spinal stabilization can help protect your spine. You saw how the body's anatomy works to create stability, including the actions of key muscles that stabilize the spine. To lift safely, it is important that you use these muscles every time you lift.

You'll find in this session that doing a lot of lifting, lifting heavy loads, and using improper lifting technique are considered to be risk factors for back pain. However, you'll also discover that there are other factors that may have an even bigger role in how lifting influences back pain. This session will give you an in-depth look at how to protect your back when you lift, including a checklist for safe lifting. You'll practice using your core muscles and safe movement patterns to protect your back when you lift. The same ideas you'll learn from safe lifting can also be practiced when you push, pull, or carry items.

Before jumping ahead, spend time recalling what you learned in Session Three. Review the answers to last session's Questions for Review.

 Answers for Review

In the last session, you were asked four questions. Take a few moments to compare your answers to those given here.

1. Which four tissues in the body must work together to stabilize the spine?

Ligaments protect the spine from unwanted movement. Fascia, such as the TLF (thoracolumbar fascia) in the low back, provides a connecting point for important muscles. It also keeps your back in the power position and amplifies the power that is generated in your low back muscles. Muscles are the dynamic stabilizers of the low back. Nerves send and receive information needed to keep your spine stable. Back pain can interrupt normal nerve function, leading to impaired position sense and muscle activity.

2. Which two core muscles help stabilize the spine, and how do they work?

Lumbar multifidus: The multifidus muscles cross each spinal segment, making them one of the best muscles to stabilize the spine. They work together with the transverse abdominal muscles to prevent shifting between the spinal segments and to guide and control the spine as you move.

Transverse abdominal (TA): The TA works on a feed-forward loop, giving it a split-second advantage to establish spine stability before you actually move, lift, or do other motions. The TA coordinates its actions with the multifidus muscles to grip and hold the spine.

3. What are the basic principles of spinal stabilization exercises?

These exercises start out by engaging the core muscles. Bracing the abdomen causes an increase in abdominal pressure, which gives added stability to the spine. Eventually, the exercises progress to include weights, pulleys, therapy balls, foam rolls, or other methods to challenge your core and improve your spine stability.

4. What methods are available to stabilize the spine?

The most dramatic way to stabilize the spine is lumbar fusion surgery, which often involves bone grafts and metal plates and screws. A less invasive measure is a flexible back brace, though there are some drawbacks that keep most spine practitioners from issuing them routinely. Finally, lumbar stabilization exercises are often prescribed as a way to train the core muscles to hold and protect the spine during activity.

Anatomy of a Safe Lift

Your knowledge of spine anatomy gives you an advantage that can help you lift safely. Recall from Session Three that spine stability starts with optimal posture, the power position. You also learned that the power position is secured by muscles that act on the thoracolumbar fascia (TLF). And you discovered that two key muscle stabilizers, the transverse abdominal and multifidus muscles, coordinate their actions to grip and hold and to guide and control the spine.

You need to keep your low back in the power position when you lift. Setting your core muscles before and during the lift tightens the TLF to your low back. This secures your back in the power position. It allows the TLF to augment the power generated by your back muscles.

Keeping your low back in its power position also requires that you bend your hips and knees when lifting. Bending forward from your hips is different than flexing your low back forward. Flexing your back causes the low back to round forward and to come out of the power position. But if you bend at the hips, you'll find that you can keep your back positioned with a slight inward curve as you bend to lift. To do this you need to hinge forward at the hips, instead of flexing your back forward. This is very similar to the exercise you learned in the last session called the "hinged squat." Done properly, the low back stays in the power position when you bend your hips and knees and as you hinge forward from your hips - not your low back.

Stability during lifting is improved by keeping your feet apart. This posture lowers your center of gravity and gives you a wide base of support. You rarely see a football player tip-toeing on the field. If you do, the player won't be upright very long. An opponent merely has to make contact and the player will be easily knocked down. Instead, players stay low by bending their hips and knees. In this way they are stable and can take a block or hit without getting knocked down. Likewise, your safety improves by keeping your feet apart, bending your knees, and by hinging forward with your hips.

You can give your back another advantage by keeping the load you are lifting close to your body. The further away you hold the item, the greater the forces that are multiplied to your back. Holding a 10-pound box two feet in front of you creates hundreds of pounds of force on your low back. The same box held close to your body produces less than 100 pounds of force.

Finally, avoid twisting your back when you lift, especially if you must bend to lift the object. Twisting and bending at the same time is hazardous to the parts of the back. It places extra strain on the supportive ligaments, and it increases pressure and strain on the discs of the low back.

Checklist for Safe Lifting

Follow the rules in this safety checklist to improve your safety when you lift.

Plan and Prepare

It only takes a moment to make sure your lift will be performed safely. Check to make sure you have a clear path. Remove obstacles, and avoid slippery surfaces. Before you lift, think through the steps you'll take to lift safely.

Use a Wide Base of Support

Place your feet a minimum of shoulder width apart. This position lowers your center of gravity and helps improve your stability.

Keep the Load Close

Keeping the load close to your body reduces strain on your low back. Holding the load away from your body magnifies the strain on the parts of your low back.

Use the Neutral Spine Position

Align your back in the power position, with the small of the back in a slight inward curve. Your therapist can help you find and feel what the ideal position is for the safety of your low back.

Engage Your Core Muscles

Before lifting, engage the key stabilizers of the low back and abdomen. As these muscles tighten, they'll act as a brace to hold your spine from shifting as you lift. Feel the muscles draw inward as they hold the spine steady and as they guide your spine movements while you lift.

Lift With Your Legs

To lift with your legs, keep your lower back in the power position. Bending at the hips and knees (and not your back) allows you to use the large hip and leg muscles when you lift.

Avoid Twisting

To avoid twisting as you lift, pivot your feet while moving the load from one point to the next. In other words, keep your behind where it belongs - behind you!

Check the List

• Plan and prepare.
• Use a wide base of support.
• Keep the load close.
• Use the neutral spine position.
• Engage your core muscles.
• Lift with your legs.
• Avoid twisting.
• Get help if needed.

Get Help if Needed

If the load is too bulky or too heavy, get help from a friend or co-worker. When needed and available, use a lifting device. Don't get too busy and think you can't wait for help. And don't think you're tough enough to handle an unsafe situation. A strong will does not take the place of a reasonably safe lift.

Do Lifting Belts Help?

Can you lift with greater safety by wearing a lifting support belt? The answer, according to today's leading scientists, is probably not. There simply is no consistent research to show that wearing a lifting belt makes lifting any safer.

Back injuries are most effectively reduced when a complete work safety program is used. Work safety programs improve how the workplace is designed and how work is done. They also include training on how to identify unsafe lifting situations and how to use safe lifting techniques. Simply relying on a lifting support belt is not adequate protection against back injuries in the workplace.

Some doctors may prescribe a lifting support for patients who've had an episode of back pain or injury and who are returning to jobs that involve heavy and repeated lifting. In these cases, the support belt is usually issued in combination with exercises for the back and abdominal muscles, because relying on a lifting belt can cause the trunk muscles to weaken.

There are several drawbacks to using lifting support belts. First, they can create a false sense of security, giving the feeling that more can be lifted than the body can do safely. Second, there is no proof that lifting belts remind workers to keep the back lined up for safe lifting. Third, long-term reliance on lifting supports can lead to inactivity, atrophy, and weakness in the back and abdominal muscles. Fourth, an ill-fitting brace often causes the wearer to loosen the straps or laces, leading to a greater chance of back injury. Finally, lifting belts can produce a sense of psychological dependence in which the person feels he or she can't lift or work safely without wearing a lifting belt.

If your doctor or therapist recommends that you use a lifting support belt:

  • Wear it properly.
  • Be sure to keep all straps and laces secured.
  • Avoid back injuries by making it a habit to use safe lifting techniques whether or not you are wearing a lifting support.

Risks of Lifting and Back Pain

By itself, lifting is not necessarily a risk factor for back pain. It becomes a risk for back pain when other variables are added. For example, lifting with poor technique is a risk, such as lifting when the back is bent and especially when it is twisted.

Lifting a load of unexpected or unknown weight also adds risk to the equation. The lifter may think that the item weighs more or less than it does. Getting the body ready to lift an object depends on knowing how much the item weighs. Using more force than is needed to move materials can increase the risk of falling backwards or of straining the back. The same risk applies to unstable loads or loads that shift suddenly, such as liquids.

Lifting becomes a risk for the person who has to lift over and over during the day. Lifting items for more than half of the work day poses an added risk for back pain. The risk from repetitive lifting also goes up when loads of 50 pounds or more are involved.

For some people who have had a back injury while lifting, their advice for safe lifting is to not lift at all. Yet back pain from lifting is probably somewhat overrated. Scientists do not agree that lifting (all by itself) causes back pain. More likely, lifting may only trigger the problem, making it a target of blame. There is conflicting evidence on whether people in heavy jobs actually report more back pain than people in less physical jobs.

Scientists do agree that other factors are usually involved in the onset of back pain. For example, there is some evidence that people who are overweight or who smoke may have more back pain related to lifting. And there are mental issues that affect peoples' chances of back injury at work. People who worry they'll get injured while lifting at work are at greater risk for back pain or injury. In this instance, the risk goes well beyond the task of lifting. It's the worry that raises the potential dangers of lifting.

Lifting is not always the culprit when it comes to back pain and back injury. The connection between lifting and back pain has something to do with general health, such as maintaining ideal body weight and avoiding tobacco. It also has to do with attitudes about job satisfaction, work stress, and worry about how lifting at work might hurt your back. That's why a healthy work culture reduces time lost from work due to back pain and back injuries. People can improve their back safety by improving the strength in their core muscles and by using these muscles while they lift. Using common sense helps, too.

Goals Information Skills Drills Questions Review

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