Back Anatomy and Safe Lifting Techniques

Session Objectives

• Upon completion of this lecture, you should be capable of describing the anatomy and biomechanics of the back and related structures
• Be able to describe and perform various lifting techniques.

Introduction

• Each year, over 1 million workers sustain back injuries, accounting for more than 20% of all workplace injuries and illnesses.
• One-fourth of all compensation claims are related to back injuries that cost employers billions of dollars.
• Back injuries are the second most common reason for lost work time, the first being the common cold.
• Back injuries most frequently occur at home.
• Injured backs are prone to reinjury.
• In addition to missed work, an individual may experience recurring pain
• Two common types of back injuries include soft tissue injuries to muscle or ligaments and injuries to the spinal discs.

Spinal Anatomy 101

• Ligaments hold the spine's vertebrae together.
• Tendons attach muscles to vertebrae.
• Cushions called discs exist between each vertebra.
• The openings in each vertebra line up to form a long hollow canal.
• The spinal cord passes through this canal from the base of the brain.
• Nerves branch out from the spinal cord and exit the spine through the spaces between the vertebrae
• Most of the body's weight is supported by the lower part of the back

Spinal Anatomy 101 - Intervertebral Discs

• Intervertebral discs separate the vertebrae, acting as cushions between the bones
• Each disc is comprised of two parts: the hard, tough outer layer called the annulus and the mushy, moist center termed the nucleus.

Disc Degeneration Factors

• Lifestyle choices, like lack of regular exercise and inadequate nutrition, increase the risk of disc degeneration
• Obesity and drug- and tobacco use can lead to degeneration of the discs
• Natural biochemical changes that occur with age cause the discs to gradually dry out, reducing their strength and resiliency.
• Poor posture and habitual use of incorrect body mechanics can lead to disc degeneration

How To Care for Your Back

• Follow body mechanics
• Apply proper lifting techniques
• Exercise
• Stretch
• Correct Posture

Body Mechanics

• It’s not how much you lift or move, but the way you do it.

Body Mechanics General Rules

• Push rather than pull.
• Keep work within the "strike zone."
• Keep the load close to the body.
• Use abdominal bracing.
• Pivot with feet, avoid twisting.
• Team work vs. Mule work

Principles of Patient Handling

• Start by keeping a wide, stable base.
• Put the bed at the correct height.
• This should be waist level when providing care or hip level when moving a patient.
• Work directly in front of you to avoid rotating the spine.
• Keep the patient as close to your body as possible to minimize reaching.

Preparing for Patient Handling

• Know the equipment operation and if it is available.
• Gather appropriate equipment; get other staff members if needed.
• Lock the wheels of the bed or chair
• Put the the bed or stretcher at the correct height
• Remove clutter
• Ensure charged mobile equipment.
• Team members should know their roles; rehearse if necessary.
• Use the principles of body mechanics for positioning
• Coach the patient by telling them what actions you plan and by showing them, then help and move them.

Types of Patient Handling

• Repositioning: Shifting or adjusting the patient's position in bed, wheelchair, chair, or another supportive surface.
• Transfers: Guiding or helping the patient from one surface to another where the patient is able to bear some weight in the legs and/or arms
• The patient may be able to bear a part of the weight by an assistive device such as a transfer board, walker, or cane.
• Lifts: Actions where the patient's entire body weight is borne by someone or something other than the patient for purposes of repositioning or moving to another surface, e.g., a mechanical lifting device.

Transfers

• Independent Transfers: This is when a client is able to mobilize without risk of injury and the client is comfortable with the use of mobility aids
• Supervised Transfers: This is used when the client is able to mobilize, but may require verbal or minimal physical cueing.
• Transfer belts should be used in all cases.
• One-person Transfer Belt/ Pivot Transfer: This is used when a client can stand unsupported or weight bear with the assistance of one person providing assistance less than 40 pounds (18 kg).
  • This transfer occurs if the physician orders feather, toe-touch, or partial weight bearing.
• A transfer belt must be used for safe handling.
• Two-person Standing Pivot Transfer: Use this transfer when a client can bear weight through legs, but is heavy and unreliable.
• Two health care workers are required, with the tall person behind the patient.
• A transfer belt must be used.

Equipment for Transfers

• Mobility aides, e.g., walker, cane
• A hoist and mechanical lifters
• Transfer belt
• Transfer boards
• Monkey chair

Criticism of lifting techniques in patient handling

• Moving patients makes body mechanics unsuitable for manual handling
• The load is often unstable
• Patients don't have handles
• A patient's weight is distributed unevenly
• A patient may be combative.

Basic Rules for Lifting

• Keep the load as close to you as possible.
• Keep your back straight.
• Turn your feet outward and push your buttocks out
• Picture a professional weight lifter.
• Bend your knees.
• Keep your head forward.
• Your lift will be more balanced and the curves in your spine will stay balanced and aligned.
• Breathe out as you lift.

Standards for Maintaining a Stable Load

• Keep the load close.
• Ensure the placement of a secure hand couple
• Maintain a degree of lumbar lordosis at the initiation and during the lift.
• Choose a lifting technique applicable to the situation
• When lifting on an uneven-sloped surface, face down the slope.
• When lifting, do so as much as possible in the sagittal plane.

Lifting Techniques

• Basic Lift (Diagonal Lift) involves the most common method of good lifting technique
• Use it for objects small enough to straddle where adequate room enables a wide stance.

To perform a Basic Lift (Diagonal Lift)

• Get close to the object.
• Stand with a wide stance such that one foot is forward and to the side of the object.
• Keep back straight, push buttocks out, and use legs and hips to lower yourself down.
• Move the load as close as possible.
• If the box has handles, grasp the handles firmly, then prepare for the lift by looking forward.
• For objects without handles: put one hand on the side furthest from you, but on the same side as your forward foot.
• Put the other hand on the object on the side closest to you so that your hands are on opposite corners.
• Next, grasp the object firmly with both hands.
• To lift, keep your head and shoulders in line during the lift.
• Hold the load close to your body.
• Lift by extending your legs with your back straight and buttocks out.
• Breathe out while lifting.
• Power Lift*
• This is used for objects too large for you to straddle.
• This lift is very similar to the basic lift.
• However, with the power lift, your centre of gravity shifts forward, requiring using your buttocks to compensate.

To perform a power lift:

• Place one foot in front of the other using a wide stance.
• Keep your back straight, push the buttocks out, and use your legs and hips to lower yourself down.
• Move the load as close as you can.
• Grasp the object and prepare for the lift by looking forward.
• As you lift, keep your head and shoulders in line
• Hold the load close to your body.
• Lift by extending your legs with your back straight and your buttocks out, thus exaggerating the this position.
• Breathe out while you lift.

Tripod Lift

• Useful for objects with uneven weight distribution, for example, sacks of food.
• This lift is recommended for people with decreased arm strength, but not recommended for people with bad knees.

To perform a tripod lift:

• Place one foot next to the object, keeping your back straight.
• Slowly lower yourself down onto one knee, pushing your buttocks out.
• You can also support yourself as you lower yourself down using one hand on a stool or on your thigh.
• Next, position the object close to the knee on the ground.
• Grasp the object firmly with both hands, then slide it from the knee on the ground to mid-thigh.
• Keep your head forward, your back straight, and your buttocks out.
• Lift the object onto the opposite thigh, then place both of your forearms under the object with your palms facing upward.
• Hug the object to your stomach and chest and prepare for the lift by looking forward.
• As you lift, keep your head and shoulders in line,
• Hold the load close to your body, lifting by extending your legs with your back straight and buttocks out
• Then breathe out as you lift.

Partial Squat Lift

• Use this approach for small, light objects with handles at knee height.

To perform a partial squat lift

• Stand with the object close to your side, then place your feet shoulder-width apart with one foot slightly ahead of the other.
• Place one hand on a fixed surface, like a table or stool, or on your thigh.
• Keep your back straight and push your buttocks out, slowly lowering yourself down.
• Reach the object’s handles while preparing for the lift by looking forward.
• As you lift, you can push down on the fixed surface or your thigh for support.
• Keep your head and shoulders in line as you lift.
• Lift by extending your legs with your back straight and your buttocks out, and breathe out.
• Golfers Lift*
• This is to lift for smaller, light objects in deep bins and to pick such off the floor.
• Recommended for people with knee problems or decreased leg strength.

To perform a golfer's lift:

• Place the hand near the edge of a fixed surface, for example, the edge of a table or bin.
• Position the hand so that it supports the upper body during the lift, keeping the back straight while raising one leg straight out behind you.
• Lean down to pick up the object using your leg weight to counterbalance
• Next, grasp the object, prepare for the lift by looking forward, and then keep your leg raised when initiating the lift. To lift, push down on the fixed surface as you lower your leg. Keep your back straight, and breathe out.
• Straight Leg Lift*
• It should be used when lift when obstacles prevent you from bending your knees.

To perform a Straight Leg Lift

• The straight leg lift needs to be avoided if possible
• Lift only when necessary.
• Stand as close to the object as possible with knees slightly bent.
• Push your buttocks out, but not your waist.
• When an obstacle is in the way, lean your legs against a the obstacles is stable enough to support you.
• Use your legs and hips to lower yourself down and grasp the object and prepare for the lift by looking forward.
• While lifting, keep your head and shoulders in line with your body.
• Holding the load close to your body, lift by extending your legs with your back straight and your buttocks out, and breathe out as you lift.
• Overhead Lift*
• Use the overhead lift to place objects on an overhead shelf
• The lift begins with the object in your hands.
• This lift can be difficult and unsafe without proper preparation or assistance

To perform the Overhead Lift

• With an object very close to your body, keep feet shoulder width apart with one foot slightly ahead of the other.
• Prepare for the lift by looking forward then raise the object to shelf height using arm and shoulder muscles while keeping the object close to your body.
• Breathe out as you lift
• As you reach the shelf, shift your weight from your back foot to your forward foot, keeping your back straight.
• Releasing your weight, push the object onto the shelf
• Pivot Technique*
• When lifting an object and then turning to carry it away, it is common to twist the body however twisting while lifting can cause serious damage to the tissues of the back.

To perform the pivot technique to avoid twisting when:

• Lift the load using any of the previous techniques.
• Hold the load very close to your body at waist level.
• Turn the leading foot 90 degrees toward the direction you want to turn.
• Bring the lagging foot next to the leading foot while keeping your body straight.