Low Back Pain: An Once Of Prevention…

Why It Really Matters - Having Fun!!

(This started as a request for a flyer. Here I will expand on the flyer with more detail and links to other posts where additional context and recommendations will help you in deciding how you can best use the information.) [I will put my additions in brackets – the rest is on the flyer – in case you are interested in picking up a flyer for your work.]

HOW TO BEND & LIFT SAFELY

To bend and lift properly requires movement plus correct alignment (biomechanics). The three keys are Neutral Spine, Hip Crease, and The Knee Rule. [Understanding the need to tense up before lifting, depending on how heavy, how to do that and what to avoid, is also important. Tied to how to breath, this will – like proper body mechanics – insure a safe and strong lift. Tensing is the first of what our patients learn when they begin to transition from the relief stage of care to something that resembles rehabilitation – elementary breathing instruction is usually also necessary and helpful. The importance of breathing will become an increasingly popular subject in the media in coming years. Meanwhile it’s an inherent aspect of traditional movement systems such as Yoga and Tai Chi if you would rather get the benefits now.]

NEUTRAL SPINE: Keeping the spine in a line while maintaining the normal front to back curves in the neck and lower back. Hold a stick behind your back: one hand behind your neck; the other hand behind your lower back. Make sure the stick is touching your head, your mid back and your tailbone. Lengthen your spine along that stick while keeping your chin down. This is the all-important line we talk about in Tai Chi all the time. Violating the Neutral Spine rule means bending forward at the lower back and rounding out that little bit of curve you should have there. Do you do that all day while sitting? Notice.

THE KNEE RULE: When there is weight on the knee and you bend it, it must stay over the front of the foot: a plumb line down from your knee cap should fall right where the toes attach to the feet. Break this rule and the risk of knee injury skyrockets. (Think getting into and out of your car, walking up and down stairs and getting up and down off the ground.) Notice whether you are breaking The Knee Rule, and why it’s hard to not break it. [Maintaining Neutral Spine while not breaking the Knee Rule is a great way to train your “core” muscles as well as reflexes; not maintaining Neutral Spine while breaking the Knee Rule over the course of many years leads to many people telling the following story to their doctor of choice: “All I did was….”]

Notice how faithfully Tai Chi Master Ian Cameron adheres to the Knee Rule while applying self defense techniques.

HIP CREASE: This refers to pulling the hips back and down when you bend and lift. This is the motion that allows you to maintain Neutral Spine while not breaking The Knee Rule. Learn the Hip Crease by practicing Tai chi walking, the Box Squat or by practicing the Modified Chinese Wall Squat. Some refer to “snapping” the hips as you lift to describe the experience of contracting the butt muscles and using the hip hinge as the main lever performing the lift. It is important to train this awareness and the muscle. Learn the Dead Lift motion. Practice makes permanent so learn correctly: technique is everything!

[I put a link to my Biznik profile so you could see a clip of the Tai Chi Hand Form. It demonstrates Tai Chi walking during the form. Tai Chi walking can be an exercise/drill of profound benefit, easy to learn, easy enough to do, and a way to train all kinds of skills, stretch the hip flexors and the ankles, as well as practice Neutral Spine. I haven’t yet found a decent example on YouTube or I would put the link here.]

[Many of the terms used in this post are capitialized. You can Google them. You can YouTube it. You might find outstanding examples and explanations; you might not. Be careful who you listen to. I did Tai Chi wrong for 8 years before finding a teacher who could teach me correctly.]

The #1 thing (aside from awareness) that will stop you from being able to bend and lift properly is tight hamstring muscles: they prevent you from maintaining your lumbar curve while doing the Hip Crease. Stretch the Hamstrings passively and actively. Learn the Good Morning exercise (eccentric stretching.) In order to not break The Knee Rule you need flexible ankles, stretch them with Tai chi walking or by other means.

[Basic mobility is a prerequisite to proper movement. That means joints that move well and muscles that are of adequate length. Get adjusted. Stretch. Hip flexors are usually next in importance, followed by external hip rotators. Tai Chi walking will stretch the Hip Flexors, the Tibetan, and Thai (my labels) Sitting Postures will stretch the Hip External Rotators – these turn the leg/foot out when contracted and tend to have you walk like a duck when overly tight.]

Are You At High Risk For Developing Lower Back Pain?

1. Have you had it before? Yes? Then you will have it again. (#1 predictor)
2. Are you weak? (Failing the 2 min. low back muscle endurance test is #2)
3. Is your quality of movement dysfunctional, limited or asymmetrical (#3)

[There wasn’t room on the flyer but here, of course, is where I would suggest that being out of adjust is a risk factor also. Exercising while you are out of adjustment aint good – risk of injury goes up; benefits go down (there is one exception). Exercising while you are in pain aint good – there is a long list of reasons. Get relief first. Get checked by your Chiropractic doctor, and get adjusted. Then work on the elements of bending and lifting.]

[You know the answer to #1 above. If you want the answer to #2 and #3 find someone who can do the screening test for weakness and the screening test for quality of movement. I can.]

[Ask someone where you work about evaluating your bending and lifting technique: someone there is probably suppose to teach you. If not, have your employer call me – I will teach them so they can teach you. Hint: them being able to check a box that says you have watched a video may not be enough. And having another “safety meeting” after yet another person at your work has injured their back may not be enough to keep you from hurting yours.]

Here is a photo from the recent Snohomish County Business Journal. The gentleman bending over is an Emergency Room doctor. The article is from the Cover Story about the new $460 Million dollar medical facility in Everett.

Dr. Brown demonstrates unsafe bending

The same poor techniques shows up on page 30 of the current issue of Yoga Journal. There a woman is bending over taking cakes out of an oven. To be fair, anyone with a fairly healthy lower back, near normal body weight, who is only lifting themselves (not carrying weight), can get away with breaking the Neutral Spine rule now and then. In fact it’s reasonable to bend forward at the lumbar spine to stretch the posterior muscles, etc. of that area – carefully (and again a reasonably healthy spine and no weight). The problem is thoughtless bending over and lifting. The problem is doing it all the time. The problem is that most people don’t have that healthy of a lower spine. (I use the Yoga Journal example because in the middle of an otherwise fabulous source of all kinds of great advice and information, there can be examples of gaps; I use the ER doctor example for the same reason.)

Dennis Dilday, D.C. (425) 348-5207 DDilday239@aol.com www.doctordilday.com