Lower back injury is one of the most costly and debilitating of all work-related injuries in the United States today. And EMS personnel are especially susceptible to this injury during patient care. So how do paramedics and EMTs avoid it? The answer is through proper lifting technique and exercise.
Since lower back injuries are so prevalent, many of you may already be in pain, and many of these suggestions and techniques may be unsuitable for your condition. Make sure to discuss any new exercise regimens with your doctor. If you are interested in learning more about self-care of lower back pain, visit www.fireagility.com/articles.php.
Proper Lifting Technique
A majority of on-the-job back injuries stem from lifting patients during a call, injuries that can be avoided with the proper technique. In order to lift heavy objects and people safely, a person must have a very strong awareness of their body and knowledge of the muscles that contract during specific movements. For the purposes of this article, I am going to assume that you are familiar with the major muscle groups of the trunk, pelvis, hips and legs.
The proper lifting technique can be divided into the following points:
- First, proper lifting begins with the proper position. Get yourself as close as possible to the object you are intending to lift. Your feet should be placed apart to provide a stable base. If it’s possible, have your toes underneath the edges of the gurney or your feet as close to the body board as possible.
- Second, tighten your abdominal muscles and keep your back flat. Hold this body position until the lift is complete.
- Third, lift with your legs. Place your body weight on your heels and the balls of your feet. Push up by tightening your hips, hamstrings and gluts as you rise.
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Lastly, some situations involving an immobilized patient may require the use of additional assistance. Dividing the weight amongst a number of rescuers alleviates the chances of overexerting one or two of them. Also, be sure to keep your shoulders aligned with your hips. You may need to shuffle your feet in order to maintain a strong base.
Trunk Stabilization
Support of the lower back is very important in avoiding injury. If you are having trouble with your lower back, it might be due to weak, untrained muscles in your body’s core. Here are some exercises you can do to strengthen your “trunk” and prevent further and future back injuries. Precaution: Do not start this workout if you are currently experiencing lower back pain. Do not continue this workout if it makes you extremely sore or sore for more than 2 days.
In order to protect your lower back from being injured due to awkward or intense positioning, I will detail exercises that will train you in the four ranges of motion: forward flexion, rotation, lateral flexion and extension.
Forward Flexion and Rotation:
I find the best, fastest and most effective way to train in forward flexion and rotation is the bicycle abs exercise. It works the upper and lower abs, as well as the obliques.
You can do these on the floor or on a bench (as shown below). You start the exercise by rotating and lifting the upper body to bring together one elbow with the opposite knee and holding for one second. Make sure to exhale as you touch the elbow to the knee and inhale as you cross the center before alternating to the other side. The elbow not being lifted should be below the level of the bench, allowing for maximum rotation.
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Start out with four sets of 50 repetitions. Aim at a goal of 10 sets of 100 over the next several months. Yep — that’s a lot — But if you do a set of 50 (later working up toward 100) between sets of all your other exercises, it will be easy to accomplish.
Extension:
I find one of the best ways to strengthen your back’s extension motion is through training on an exercise ball (as shown below). Lay on top of the ball with your belly button resting at the highest point on the ball. Your hands should be behind your head and your feet should be placed in the corner of where the wall meets the floor with your toes out. Begin by lightly squeezing the ball with your inner thighs while taking a deep breath. Then lift your torso up until your spine is completely straight, exhaling as you lift and inhaling as you lower. This exercise is difficult, so try six reps during your first attempt. Stop if your lower back starts to hurt. Your target goal should be four sets of 20 spread over several months.
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You can also accomplish the same exercise on a hyperextension bench at the gym (as shown below). Please note that the bench in this photo is being used for lateral flexion. You can alter the exercise by using the bench while facing down. Just hook the backs of your heels under the same area where you see my feet braced. Flex forward with your arms over your chest and raise your torso up only to a straight angle. It is called a hyperextension bench, but DO NOT hyperextend your lumbar spine. Hold for two seconds, and then lower your torso slowly.
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Start with two sets of 10, and take several months to work your way up to four sets of 20. You may then wish to add weights. This exercise can be made much easier by adjusting your bench to an angle and keeping your feet down. Please note that this exercise will make your hamstrings feel sore, so stretch them when you are done!
Lateral Flexion:
Take another look at the picture of lateral flexion on a hyperextension bench. As shown above in this picture, you should begin the exercise by positioning your hip in the middle of the pad toward the caudal end. There should be a split there in the bench for it. Your feet should be wrapped around the post at the end of the bench and your top leg should be back. Keep your range of motion small at first, and make it bigger over months as you get stronger. Start with a set of six on each side of your body when trying this for the first time and see if you are sore the next day. Be very careful! Of all the exercises, this is the toughest one. You can work up to four sets of 12 on each side over several months.
Since I started doing this exercise, I NEVER have lower back pain anymore. The musculature in my trunk simply will not allow my lower back to go past its safe range of motion.
Be sure to give all these exercises a try, but listen to your body and stop if you have pain. If you are having difficulties using the hyperextension bench, most gyms have benches adjusted to a slanted angle, which are easier to use.
These exercises can be pretty tough and should not be done on consecutive days. But they must be done no less than twice a week if you want to achieve strong results. Be sure to stretch out your muscles before and after exercising to avoid injury. And if you get really sore, take a day or two off to let your body heal.
While abdominal and lower back training may seem daunting at first, remember that our bodies are built to support and withstand the daily stresses found on the job. It just takes time and effort to reach that goal. These days, I do 1,000 bicycle ab exercises every day that I can in order to maintain a strong trunk and protect myself from lower back injury. With these preventative measures, you can make sure you live a healthy lifestyle both on and off the job.
