The Low Back Low Down: Pain Prevention

Here's how:

* Feet are shoulder width apart or possibly wider. A wide stance is particularly important if the object to be lifted is very large, bulky or heavy.

* Face the object squarely and get as close to it as possible.

* When lowering the body, hips and knees will flex. The middle third of the body will move posteriorly, or backwards, with the tailbone pointing back.

* This posterior displacement allows he knees to remain over the midfoot, behind the toes. If the knees "overshoot" the toes, a considerable amount of inappropriate joint stress is applied to the knees, increasing the chance of knee injury. Heels remain on the floor (this takes flexibility).

* During hip flexion (while lowering) and the subsequent hip extension (while lifting), a "hip hinge" is performed, meaning that the neutral alignment of the spine (and its four natural curves) is unchanged. The spine is essentially one long, stable, neutral lever that goes along for the ride, but has no independent movement of its own.

* The head and neck simply continue the line of the spine, remaining in neutral alignment.

* The lift is actually performed by the leg muscles (quadriceps, hamstrings, and gluteus maximus) on the way up. The spine is stable and still, with the rectus abdominis, obliques and erector spinae muscle isometrically contracting.

* If the object is particularly heavy or large, it's often helpful to actually brace the elbows against the inner thighs while adjusting the grip and initiating the lift. Widening the feet and practically straddling the object while bracing the elbows works well (especially if adequate hip adductor flexibility exists).

* Always remind yourself and your students/clients to "set" the abdominals prior to actually initiating the lift. Never lift a heavy object with the abdominals loose or "hanging out."

* Reverse this procedure when setting the heavy or large object down.

Sleep

Since approximately one-third of human life is spent in sleep, it makes sense to have the most appropriate spinal alignment possible while sleeping. What would be the best way to keep your spine in neutral alignment throughout the night? Many physicians and physical therapists agree that the most optimal position is on the side. In order to keep the hips stacked and the spine in neutral, it is helpful to place a pillow between the knees. Alternatively, lying supine may be appropriate if a pillow is placed under the knees.

Alignment Maintenance

Evaluate your students/clients during exercise to be sure that they are maintaining a neutral, stable torso at all times (except during specific torso exercises). Clients often "destabilize" their spines during the following common exercises: pushups, lat pull-downs, seated rows, bent-over rows, overhead presses, standing hip extension and abduction, squats, lunges, all fours hip extension, seated and standing hamstring stretches, seated straddle stretch, and standing quadriceps stretch. In all these exercises, extremities are moving, but the spine is held still and in neutral.