There is nothing more frustrating than making the effort to get your clients in better shape, only to find them sidelined from your routine by a back injury. While people tend to recognize the risk of injury associated with working out or participating in recreational activities, few recognize the demands placed on their bodies as they move through their daily routines.
 
The Basics:
 
1.       Back injuries occur gradually over time. For most, back injuries are the result of months and years of activity. Prolonged sitting and standing in demanding postures, poor lifting techniques and being in poor physical condition all contribute to the gradual wearing-out process. Most back "injuries" are not the result of a single event. People report that they hurt their backs picking up their kids, getting out of their cars or slipping, when, in fact, they have done these same activities thousands of times in the same manner for years.
2.       The back isn't designed to tell your clients it is wearing out, only that it is worn out. The whole body is designed that way. Hearts generally feel the same before a heart attack, even though the damage has been developing for some time. Your clients don't feel their teeth "developing" a cavity, yet the damage is occurring. The same is true for the back. It is general not until the damage is severe enough that they have the pain. This means that your clients are doing a wide variety of our daily activities in a demanding way and think that it is not causing a problem. Then they do it exactly the same way one more time — and wham, they have a problem.
3.       The back is designed to work best in Power position. The back is well-designed structure, and it is designed to handle a great deal of work. What is also known is that there are positions where the back works best. This means that there are positions where the structures of the back (joints, discs, ligaments, tendons and muscles) are able to do the most work with the least effort. For the most part, this is with the spine in its three natural curves, not bent forward and not rotated. This doesn't mean that people should never bend forward or twist, it just means that some people are bent over and twisted a significant part of their day, and this wears out the back faster, particularly when a task is demanding people need to try to keep their backs as close to the natural curves as possible and avoid twisting.
 
 
We don't give daily activities much thought; we do these all day with little recognition of the impact on the body. Here are some of these activites:
 
Sitting
We've all heard the familiar "sit up straight." One would think that the sheer number of times this mantra has been repeated that we would all be sitting perfectly. Here is where the problem lies: There is no single correct sitting posture. There are simply better and worse or more or less demanding ways to sit. Rather than try and do it perfectly, let's focus on the things that you can mention to your clients to make it less demanding on them:
 
·         Set up for neutral — The body works best when the joints, muscles and tendons are able to work in their most supported position. For the back, this means with the three natural curves of the spine. Have your clients set up their work area so that work encourages them to sit with the natural curves. We all change positions frequently during the day. The point is not to stay in the same position, the point is to have a work environment that encourages clients to return to this neutral position throughout the day rather than pulling them away from it.
·         Find more than one way to perform a sitting job — Regardless of the positions you choose, our bodies want and need variety. If your clients have been sitting for a while, help them find a way to do the work in standing. If they find that after sitting for a while, they stop to think for a minute, have them stand up to do their thinking. Pacing helps this process by not only reducing the demands on the back but insuring that oxygen is being pushed up to the brain.
·         Move — Regardless of what you've heard, fidgeting is a good thing, not to the point where it becomes disruptive but enough to move the demands around. We tend to sit until a leg falls asleep, or we develop a knot in our shoulders. Much of this could be eliminated by doing nothing more than developing the habit of making small changes in posture. We get so focused on what we are doing that we ignore the signals from our bodies until they get so severe that we have no choice but to pay attention. At this point, we will shift our position or do a quick stretch, something that would have been significantly more effective before the pain was present.
 
Standing
While most people associate lifting with back injuries, the fact is that standing is also a risk factor when performed in a demanding way. Ever stood long enough to get a backache? Ever had aching feet or knees by the end of the day? While the surfaces you stand on and the shoes you wear have an impact, the bottom line is the greatest influence is how your clients choose to stand.
 
·         Staggered stance: Simply standing with one slightly forward and one slightly back allows the upper body weight to be placed on the legs rather than on the back.
·         Bend the knees: Keeping a slight bend in your knees activates the muscles in the legs and reduces the pressure on the back.
·         Get a foot up: Elevating one foot slightly moves the legs into more of a staggered stance and moves the hips and back into a more powerful and comfortable position.
·         Move: Standing typically becomes uncomfortable and demanding when we fail to shift positions regularly. Simple changes in your clients' standing postures, shifting their weight or altering leg positions moves the demands around to different parts and makes standing less fatiguing.
 
Lifting
Ask anyone what is the right way to lift and the answer is almost immediate: 
"Bend your knees, and keep your back straight." This sounds good, the only problem is that it is impractical and, in many instances, impossible. How your clients lift is influenced by their height, flexibility, strength and coordination as well as the weight, shape and location of the object. With this many variables, how could there possible be a "right way" to lift? The truth is that there isn't a single correct way to lift. There are, however, better or worse ways or more demanding and less demanding ways to lift. Looking at this way, the goal is to perform each lift the best way that your clients can, and this can be achieved by applying a few basic principles:
 
·         Keep it close, and keep the curves — The closer your clients get to a load before they pick it up, the less pressure it puts on their backs and the more their backs are able to work in the most powerful position.
·         Build a bridge — Anytime your clients start to bend forward, make sure that they support the upper body weight with either a forward arm or a forward leg. If they don't feel the weight of your upper body on an arm or a leg, it's on their back — the one place not designed to feel it!
·         Feet first — The easiest way to reduce reaching and twisting is to make sure that all lifts begin by moving the feet first. When the feet move first, the rest of the body comes along, and reaching and twisting is reduced.
 
Stretching/Warm-up
Most people think that stretching and warming up is an activity associated with exercise. The problem is that most people don't recognize the importance of stretching and warming-up in conjunction with day to day activities. Here are some general rules:
 
·         Let the body know what's coming. This simply means having your client perform a quick warm-up before starting an activity. This moves blood and warmth to the muscles that will be used and lowers the risk of a strain or sprain.
·         Let the body breathe. The number one fuel source for the muscles is oxygen. Letting the body breathe simply means stopping for a few seconds during an activity to stretch and change positions. This opens up the working muscles and lets them "breathe" so that they can continue working with lower risk of fatigue or injury.
·         Remember the rule of opposites. This simply means that if your clients have been bending forward to do something, have them do a simple backward stretch to balance the body. If they have been working with the arms in front of the body, have them stretch them back. Our bodies like balance, and much fatigue and discomfort comes from the absence of this balance.
 
Many regular exercise programs are interrupted by nagging back problems. Few realize that the demands of sitting, standing and lifting build up over time and eventually can lead to a back injury. By applying a few simple principles and developing habits that reduce the risk of back injury, your clients can increase their comfort, decrease the risk of injury and insure that their exercise routines are uninterrupted.
Michael S. Melnik MS, OTR, is an occupational therapist with a Masters degree in exercise physiology. He is the owner and president of Prevention Plus, Inc, where for the last 20 years, he has delivered his high-energy injury prevention message to over a quarter of a million participants in some of the largest companies in the country. He is the author and talent in several award-winning videos, including "Back In Step: The Road to Recovery from Back Pain," which walks those with back pain through the safe performance of a wide variety of daily activities. You can contact Michael at melnik@preventionplusinc.com, or visit his website atwww.preventionplusinc.com.
 

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