The third and final part of the series on improving your spinal health focuses on the myriad of activities you do every day from the most basic of getting out bed to the more strenuous vacuuming. You may not have given much thought about how you carry out these activities and what impact that might have on your spine. Hopefully you will find the suggestions given are helpful for you to prevent back pain/injury and enable you to continue doing tasks that you haven’t been able to do without pain.
As a review, the second article in the series explained the importance of abdominal bracing and the ability to maintain a “neutral” spine. These are 2 important skills you should master to protect your spine. Abdominal bracing means stiffening the muscles of the torso to create a girdle around the spine without moving the pelvis. To understand this, imagine someone is about to punch you in the abdomen and you brace for the blow. The contraction is light for most activities and you should be able to breathe normally while doing so.
Secondly, to find your neutral spine, imagine your pelvis is a bucket filled with water. If you keep the bucket level you don’t spill water. If you tip your pelvis forward (by exaggerating the lumbar curve) you spill water in front, and the opposite is true if you allow the pelvis to tip back (by slouching). Stand and/or sit and tip your “bucket” forward and then back, then find the position where you are not “spilling” any water. This is the neutral position and puts the least amount of strain on the lumbar spine.
In this position the spine is more tolerant to withstand compressive forces, the ligaments are not strained, and risk of injuring the discs is minimized. You will notice that the head and torso correct their position over the pelvis when you do this. The goal is to maintain this neutral lumbar curve during daily activities to reduce the load on the spine.
General DO’s and DON’TS
Before you undertake a task, large or small, take a few moments to figure out how you will carry it out or if you can do so by yourself or at all, especially if this task has been problematic for you in the past.
Learn how to squat correctly so you can effectively use the big muscles of the legs rather than those of the back to lift. Correct squatting requires you bend at the hips to allow the body to descend with a neutral spine keeping the knees over the feet. While in the squat posture, you should be able to see the front of your shoes. If the muscles in the back of your thighs (hamstrings) are very tight it will be more difficult for you to squat correctly while still maintaining a neutral pelvis. See Part 2 of this series for information on an exercise to stretch your hamstrings.
Avoid repeated spinal flexion (e.g. picking several objects from the floor with a flexed spine and straight legs) or sustained spinal flexion (i.e. stooping). If you bend over without bending your knees you are flexing your spine. Both can contribute to disc herniation. Sustained spinal flexion strains the ligaments that provide support to the spine.
Build in rest periods and vary tasks to balance accumulated stress on your body and spine. This facilitates the body’s healing and adaptation process. For example, if you have to rake the leaves in your yard don’t spend the entire day doing so. Instead spend, say 30 minutes, then rest or move on to another activity. Assess how your rest/work periods are working for you and adjust as needed.
Although not an exhaustive list, the following information outlines ways to carry out many tasks to avoid back injury/pain.
Getting out of bed: Something we do every morning could be a contributing factor to your back pain. If you are on your back, push with the foot furthest from the side of the bed to initiate rolling onto your side. Push down with the top hand bringing legs over the side of the bed. Free up your bottom hand to push yourself fully into sitting. With practice this movement will become fluid and efficient. Avoid doing a sit-up like motion which, over time, compresses your spine.
Sitting: No matter how ergonomic your chair is sitting for long periods of time is problematic. Avoid long uninterrupted periods of sitting because it loads the discs and elongates the supporting ligaments that provide spinal stability. Change postures while sitting in the chair, stand up frequently and extend your arms overhead, and walk for short distances before sitting down again.
Traveling can present challenges but create opportunities for standing, walking, and stretching throughout your trip. Bucket seats tend to drop your pelvis lower than desirable and tilt your pelvis back. In that case, use the seat control to raise the back of the seat and/or try a wedge cushion if seat adjustments are inadequate to level the seat and bring your pelvis back to neutral.
Lifting: First and foremost, decide before you lift if you think you are capable of doing so without injury. If yes, ask yourself what is the best way to do so. For example, can you push the object you want to move instead of lifting it? (pushing is better than pulling because you can use your legs). Here is a checklist for lifting:
- Stabilize your spine first using abdominal bracing (described above).
- Keep spine neutral, maintaining normal lumbar lordosis (check this by placing one hand on belly, the other on the lumbar spine as you bend your knees to ensure you are hinging at the hips).
- Get as close to object you are about to lift as you can. Reposition the object so you can get it closer. (i.e., a wide laundry basket can be rotated 90 degrees so you’ll be better able to straddle it). Awkward lifting is usually problematic.
- Ensure your feet are wider than shoulder width so you are stable.
- If possible, raise the center of gravity of object you are lifting (i.e., tipping a box up on one corner)
- As you are about to lift, keep the eyes level which helps to maintain the neutral pelvis.
- Pivot your feet to move the object after lifting to avoid twisting.
- Use the “golfer’s lift” if lifting light objects from the floor or even to take clothes out of the washer.
One more difficult task is lifting a laundry basket full of clothes. A few suggestions to make this easier are to purchase a small laundry basket, consider a light, taller hamper, lighten the load by only partially filling the basket, and place the basket on a higher surface to better access the clothes when folding. Apply the lifting steps explained above. For some, you may have to avoid using a laundry basket altogether and just carry a small folded pile of clothing close to your body. As part of laundry tasks, be sure to adjust the height of the ironing board which will allow you to stand tall.
Use proper work height of the ironing board to keep your back straight. Place one foot on a low stool.
When lifting laundry – use your leg muscles to do the work not your back.
Mopping/raking/vacuuming: Stand tall to avoid a flexed spine. Rather than using just your arms, step forward (like a lunge) and back as you work. Square your body to the direction you are working. Stabilize by bracing with your abdominals. Avoid overreaching with your arms to avoid strain. Watch the 3 short videos for helpful pointers.
Washing dishes: One tip that is helpful is to place one foot inside the cupboard under the sink.
Making a bed: Avoid reaching across the bed but instead walk around to the other side to tuck in sheets and blankets. If it isn’t possible to get to the opposite side of the bed try placing one knee on to the bed as pictured. Square your body to the direction you are working. Stabilize by bracing with your abdominals.
Use light bedding such as a down comforter. Place one knee up on a bed to reach when making the bed. Use extra depth fitted sheets and squat down when tucking in corners.
Cleaning tub/shower stall: Avoid standing on the outside and reaching in to clean. You will need to get inside so you can easily reach the surfaces to be cleaned without overreaching. Stabilize by bracing with your abdominals. Square your body to the direction you are working. Avoid bending over (stooping); instead squat and/or pad the knees to be able to kneel without discomfort.
Shoveling: Shoveling snow is a very strenuous activity and not suitable for some. If you are healthy enough for this activity you need a shovel with a handle that is long enough for your height. Adjust the amount of snow you pick up with each shovelful so that you are not overdoing it. Keep up with the storm so you moving less snow at one time. Pay close attention to your body and take frequent breaks.
It needs to be repeated that you need to ensure that your body is balanced and in correct alignment so that abnormal postural stresses on the body are reduced, or eliminated, and the effort required to perform ADLs will be dramatically reduced.
The therapists at BioSynchronistics, using hands-on therapy techniques, assess and help patients correct their posture such that the pelvis is level and not rotated, the weight is correctly over the feet, and the head and trunk are correctly balanced over the pelvis, and the extremities are balanced on the body. Discuss and clarify any concepts explained in this article or previous articles with a physical therapist so that you can incorporate smart practices into you daily life.
McGill, Stuart. Low Back Disorders: Evidence-Based Prevention and Rehabilitation. 2002
McGill, Stuart. Back Mechanic: the secrets to a healthy spine your doctor isn’t telling you. 2015