By Ron Salazar, PT, ATC
Jacksonville Orthopedic Institute
Stretch Winter 2009
Proper Lifting Mechanics
Back pain and injury have several causes including trauma, poor body mechanics, poor posture, and decreased strength and flexibility. However, the back is most susceptible to injury when lifting. Having a basic understanding and knowledge of the back and proper lifting technique is essential to prevention of back injury.
The back consists of vertebrae (bones of the spine) and discs which are located between each vertebra. Muscles and ligaments are also present to support the spine and to maintain the position of three natural curves in the neck, upper back, and lower back. This is called the neutral spine position. It is the range between too much arching and too much flattening of the back. The neutral spine position is the most stable and most comfortable position for the back. When this neutral position is lost, increased stresses may cause back pain and injury. Improper lifting mechanics promote this loss of a neutral spine position causing potential injury to the muscles, ligaments, discs, and/or vertebrae.
There are several things to avoid when lifting that will help prevent back injury. First, refrain from lifting objects that are too heavy for one person to safely lift. Second, do not lift in an unsteady, uncontrolled, and unsafe manner. Third, avoid lifting or holding an object away from the body. Fourth, never bend forward (rounding the back) keep the knees extended, and do not extend your trunk to perform the lift. Fifth and most important, do not twist the back when lifting.
Now that common lifting mistakes have been discussed, guidelines for correct, safe lifting mechanics are more clear: 1) Keep a wide base of support to reduce unsteadiness and to maximize leverage – position feet approximately shoulder width apart. 2) Get close to the object you are picking up, and keep it close to your body during the lift. 3) Maintain neutral spine posture – keep your trunk straight, chest out and shoulders back. 4) Let the legs do the work! (not the back) – squat down to pick up the object; slowly lift the object by straightening the hips and knees. In setting down the object, adhere to the same body mechanics/spine posture as when picking up the object – again use the legs, but this time to squat down to set the object down.
In summary, using safe, proper lifting mechanics is the key component to preventing back pain and injury when performing lifting activities. Good lifting technique incorporates maintenance of neutral spine posture, thus reducing potential risk of injury to the muscle, ligaments, bones, and discs of the back
Heat or Ice?
Throughout the course of a formal rehabilitation program, as well as with many day-to-day injuries, one question is almost always asked: Should I use ice or heat? While both modalities have many benefits, there are certain criteria indicating the use of one over the other.
Ice can be used for many different conditions in both chronic and acute injuries. Ice is known to decrease inflammation and swelling, as well as cause vasoconstriction and decrease pain. Cold modalities are typically used for acute (recent) injuries that are still in the inflammation stage of the healing process. This stage typically lasts up to 72 hours following the initial injury and is typically accompanied by pain, swelling, and occasionally bruising, such as an ankle sprain. Cold can also be used for chronic injuries where swelling and inflammation may be present, such as tendonitis. Ice has
relatively few contraindications, or conditions where icing an injury would not be advised. These include use over areas of decreased sensation (nerve injuries) and open wounds.
Heat is typically used for chronic injuries and conditions. Heat is believed to increase circulation, cause vasodilatation, decrease muscle spasm and tightness, and decrease pain. Heat is typically applied following the initial inflammation phase of an injury to increase range of motion and decrease muscle tightness. Heat is particularly beneficial for chronic soft tissue or muscular injuries such as strains and tendonitis. Heat is also helpful for injuries causing muscular tightness or spasm such as low back pain. Heating modalities cannot be used with acute injuries involving inflammation and swelling, as heat dilates the blood vessels and can make these conditions worse. Heat modalities have several other contraindications where heating an injury would not be advised. These include acute inflammation or swelling, areas of decreased sensation, and over open wounds. Hopefully this information is helpful when considering the use of heat or cold on injuries. Contact your local JOI clinician with further questions on this or any topic concerning rehabilitation or injuries
“I Broke My Wrist!” What Does This Mean?
The forearm is made up of two long bones: the radius and the ulna. The portion of the radius at the wrist level is known as the distal radius. A distal radius fracture (broken wrist) is the most commonly broken bone in the arm. The fracture usually occurs when a person falls on their outstretched hand. It can also happen in traumatic situations such a car accidents or during sports. Occasionally, the other bone in the forearm (the ulna) is also broken. When this happens, it is called a distal ulna fracture.
Symptoms & Diagnosis
A distal radius fracture usually causes immediate pain, tenderness, bruising, and swelling. Occasionally, the wrist may look out of alignment if the fracture is severe. An X-ray of the wrist will be taken to visualize the extent of the injury. The fracture almost always occurs about 1 inch from the end of the radius bone (distal portion). A fracture that extends into the joint is called an intra-articular fracture. A fracture that does not extend into the joint is called an extra-articular fracture. The word “articular” means joint. A fracture may also be displaced or nondisplaced. A displaced fracture occurs when the distal piece shifts out of alignment and results in deformity. A non-displaced fracture is when a fracture occurs with no change in alignment of the bone. A fracture that results in the bone breaking the skin is called an open fracture. A fracture in which the bone is broken into two or more pieces is called a comminuted fracture. Intra-articular fractures (fractures within the joints), open fractures (fractures that break through the
skin), displaced fractures (distal portion shifts out of alignment), and comminuted fractures (fracture that shatter the bone into a lot of small pieces) are the more difficult cases to treat.
If the broken bone is in a good position/alignment, a cast or splint may be applied until the bone heals. If the alignment of your bone is not good and likely to cause a functional deficit of the wrist and hand, it may be necessary to correct the deformity. In this case, the bone would be physically re-aligned (reduced) by the doctor. If the bone is straightened (reduced) without having to open the skin (incision), this is called a closed reduction. After the bone is properly aligned, a splint or cast may be placed on your arm. The cast may be changed as the swelling goes down so the cast does not get too loose. Follow-up X-rays may be taken to determine that the bone is staying reduced and to ensure that proper healing is taking place. During this time, the patient may receive physical or occupational therapy to improve the motion in the uninvolved joints such as the fingers. When the bone is healed (usually about 6 weeks), additional therapy may be required to improve the motion and function of the injured wrist and forearm.
If a distal radius has poor alignment and is not able to be properly reduced, a surgical treatment is usually warranted. If left untreated, long-term pain and deformity would prevent good functioning of the arm. There are many surgical options when dealing with a more complex distal radius fracture.
1. Percutaneous pinning (a pin inserted through the skin) may be used after the fracture is reduced to provide additional stability to the reduced fragments.
2. External fixation may be used to stabilize the unstable boney structure. In this kind of reduction, holes are drilled into uninjured areas of bones around the fracture and special bolts or wires are screwed into the holes. Outside the arm, a rod or a curved piece of metal with special ball-and-socket joints joins the bolts to make a rigid support. The fracture can be set in the proper alignment by adjusting the ball-and-socket joints. Since the bolts penetrate the skin, proper cleaning to prevent infection at the site of surgery mustbe performed.
3. Open reduction Internal Fixation (ORIF) may be used in which screws and/or plates are used to stabilize the fracture. Some surgeons use titanium bone plates, screws, and intramedullar nails to rigidly fix fracture.
In the early phases, ice, elevation (holding their arm up above their heart), compression garments to decrease swelling (ace wraps, isotoner gloves) and medications for pain relief are usually recommended. Due to the fracture being stabilized by the surgical hardware, therapy may be recommended days after surgery. Your physical or occupational therapist may work with you on pin care, custom splinting, swelling control, pain control, increasing mobility of the fingers, wrist, forearm, elbow, shoulder and neck and eventually strengthening when the fracture is healed enough.
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