Why is it important to lift safely?

The most important reason for lifting safely is to prevent back injuries. Common back injuries include strained muscles and herniated discs and both result in pain that can interfere with work and Activities of Daily Living (ADLs). ADLs include going grocery shopping, vacuuming the living room and doing the dishes.

The anatomy of the back is important to understand because it is designed to work in specific directions. The complex structures of the spine function well if forces are exerted in one direction at a time. Any combination of bending or twisting can cause the back muscles to exert much more force than what is considered safe (Gardner, Cole, 1999). When changing direction from bending forward to backward or from bending left to right, the intervertebral discs located in between the vertebral bodies in the spine are put under pressure. Intervertebral discs are sacs found in between vertebral bodies and are filled with a jelly-like substance and protected by a think membrane. The pressure that the disc is under while the back muscles are contracted can cause the tough membrane to tear. If the tear is large enough, the jelly-like fluid in the disc can bulge out or protrude and result in a herniated disc. If only small tears occur, then the tough membrane can degenerate over time, exposing the jelly-like fluid in the disc (Gardner, Cole, 1999).

To avoid injury while lifting, it is important to have a neutral spine throughout the movement. The neutral spine position of the back is simply the natural inward curve of the spine. If this position is not kept while lifting heavy weights, the muscles in the back have to contract to keep the body upright. The heavier the weight that is being held, the more force the back muscles have to exert to counteract the force of gravity on the body. The more force that is exerted, the bigger the risk is for injury.

Anywhere from 60-80% of the population will experience low back pain (LBP) in their lifetime and 30-40% will have recurrent episodes (Gardner and Cole, 1999). LBP is the most common cause of musculoskeletal afflictions in North America for persons younger than 45 years of age (Hamlyn, Behm and Young, 2007). Not only is LBP painful, but it can also become expensive. Often, time has to be taken off from work and Physical Therapy sessions can become costly. The annual medical cost associated with managing LBP in North America has been estimated to be more than $24 billion (Hamlyn, Behm and Young, 2007). It is important to try and prevent these costly and painful injuries from occurring. One of the best ways to keep your back as healthy and injury free as possible is to ensure you have proper lifting technique.

Lifting for Health Professionals

The lifting and lowering of planks of wood or oversized boxes is challenging, but one of the most difficult objects to lift is the human body. Nurses have an annual incidence rate of low back pain between 40 and 50% and a lifetime incidence rate of 87% (Vierira, Kumar, Courg, Narayan, 2005). Nurses’ most frequent tasks include moving and transferring patients, turning and repositioning patients in bed or chair (pulling/pushing) and holding limbs for dressing changes. This can be especially difficult if patient is intubated (dead weighted) or heavy.

When ready to lift the object manually, there are several lifting techniques that can be used which will be discussed shortly. However, all the lifts have several key techniques that must be followed:

  • Tighten lower abdomen, bringing belly-button to spine. Ensure to breathe throughout the lift.
    • this protects the spine
  • Maintain a “neutral spine” which is the natural inward curve of the back
    • look forward instead of down
    • work with upper body as close to upright as possible
  • Keep object close to the body
    • the farther the object is held from the body, the greater the strain on the back
  • Minimize twisting of the spine
    • move feet instead of neck or waist
    • ensure hips and shoulders are always facing the same direction

Listed below are some patient lifting techniques that will help you prevent injury and back pain.

1. Moving and lifting a patient up and down in bed

A) The safest way to change a patient’s position in bed is to use a low-friction draw sheet. To place a draw sheet under a patient, you will need two nurses on either side of the bed; Nurse #1 and Nurse #2. To roll a person efficiently, ask the person to look in the direction of the roll. Move the arm that will be below the body to the side, creating a 90° angle with their side and place the upper arm across the body in the planned direction of movement. When you move the leg from what will become the upper side in the direction of intended movement, the hips and centre of gravity will easily follow and the patient will be on their side. At this point, Nurse #1 will keep the patient in this position while Nurse #2 will place the draw sheet underneath them. Both nurses will gently return the patient to their original position in lying. Next, both nurses need to roll patient to opposite side. Nurse #2 will keep the patient in this position while Nurse #1 straightens up the draw sheet that was previously laid down. Ensure there is an even amount of sheet on either side of the patient and then return them back to original lying position.

To move the patient, roll draw sheet on either side so it resembles a cylinder (this makes it easier to grasp). Nurse #1 and Nurse #2 need to grab the draw sheet and one should say 1-2-3-lift. Both nurses should then slide the patient either up or down on the bed. It is important to have their legs bent and backs straight, keeping elbows taught to the body. Remember to keep palms up and elbows down.

B) Nurse #1 and Nurse #2 stand on either side of the bed. Each nurse puts one shoulder behind the patient and places the hand on the same side under their thigh. The hand on the opposite side presses on the bed for balance. Have leg closest to patient kneeling on the bed and the one farthest from the patient planted firmly on the ground. From under the patient’s thighs, the nurses should make a wrist grip with each other. One nurse needs to say 1-2-3-lift. Both nurses press one hand onto the bed and shoulder against patient, gently moving the patient up or down.

2. Moving patients from sitting to lying

Stand on patient’s right side, with left arm around patient’s shoulder. When possible, cross patient’s right foot over the left one but ensure that the patient is comfortable in this position. Bend your knees and put right hand under patient’s legs. Help patient lie down by guiding them towards the pillow and assisting them with lifting their legs onto the bed. Once patient in lying down, move to the other side of the bed. Place forearms under patient’s waist and thighs and gently move patient to the middle of the bed. Always assist the patient from their weaker side. If they need to be repositioned, follow protocol from 1.

3. Moving patients from chair to bed

A) If patient is able to bear their own weight, only one nurse is required. Place wheelchair parallel to the bed. Face patient and wrap arms around them in a shoulder blade grip and have them place their arms around your neck (when possible, have them lock hands together) . Position your feet at ‘ten and two’ to keep patient’s knees together and prevent them slipping forward. Squat slightly and on the command of ‘1-2-3-stand’ straighten your legs while keeping back straight. Make sure you have your balance and together with the patient, pivot towards the bed. Make sure you have your balance and together with the patient, pivot around. Once patient’s legs are against bed, squat down to lower them into a sitting position. If you need to lie patient down, or reposition on bed, follow same protocol as outlined in 1 and 2.

B) If patient is unable to bear own weight or is unpredictable, this lift will require two nurses: nurse #1 and nurse #1. Place wheelchair parallel to the bed with back of chair facing the head of the bed. Nurse #1 stands behind chair with their bedside knee on the bed and the other leg slightly bent. Nurse #1 then wraps arms around patient in an arm-wrist crossed over grip. Nurse #2 is positioned facing the bed, with the legs of the patient in between them and the bed. They then squat, sliding one hand under patient’s thighs and the other hand under heels. Nurse #1 says the command ‘1-2-3-lift’ and straightens their supporting leg and shifts weight over to bent knee. At the same time, nurse #2 stands up from the squat position while keeping their back straight. Together they lift the patient into bed.

4. Moving patients from bed to wheelchair.

A) If patient is able to bear their own weight, only one nurse is required. Place wheelchair parallel to the bed. Face patient and wrap arms around them in a shoulder blade grip and have them place their arms around your neck (when possible, have them lock hands together). Position them into sitting. Stand in front of them with your feet at ‘ten and two’ to keep patient’s knees together and prevent them from slipping forward. Squat slightly and on the command of ‘1-2-3-stand’ straighten your legs while keeping back straight. Make sure you have your balance and together with the patient, pivot towards the wheelchair. Once patient’s legs are against chair, squat down to lower them.

B) If patient is unable to bear own weight or is unpredictable, this lift will require two nurses: nurse #1 and nurse #1. Place wheelchair parallel to the bed with back of chair facing the head of the bed. Nurse #1 stands behind chair with their bedside knee on the bed and the other leg slightly bent. Nurse #1 then wraps arms around patient in an arm-wrist crossed over grip. Nurse #2 is positioned facing the bed, with the legs of the patient in between them and the bed. They then squat, sliding one hand under patient’s thighs and the other hand under heels. Nurse #1 says the command ‘1-2-3-lift’ and straightens their supporting leg and shifts weight over to bent knee. At the same time, nurse #2 stands up from the squat position while keeping their back straight. Together they lift the patient into bed.

5. Using a mechanical lift

A lift can be either hydraulic or electric. When patients cannot be safely lifted by a nurse or nurses, a mobile hoist should be used. It can be used to transfer a patient from bed to chair, chair to bed, chair to chair, bed to bed, floor to bed or floor to chair. Hoists can either be mechanical, hydraulic, or electric. The hoists are stable when loaded and have an adjustable base to get a bigger base of support when required. The lifting capacities of hoists vary so ensure that the patient can be lifted by a suitable hoist. The slings have specific weight requirements as well so make sure that a suitable sling is used for the lift.

If patient is in a chair or on a bed, ensure the breaks are on. If they are being moved to a chair or bed, make sure the brakes are on. Insert the sling. If the patient is on the bed, raise the bed to a suitable height and assist them to roll over. Insert the sling along their back and as far under them as possible. Ease patient to return to their back and then roll to the other side. Pull sling through so there is an even amount of the sling on either side. If patient cannot roll, two flat sheets can be positioned underneath and the sling can be positioned in between the two sheets. Once the sling is in place, check to make sure that the lower portion of the sling is under patient’s hips and the top is at the crown of the head. Attach the leg and chest attachments to hoist’s bar and only have the brakes on the hoist when on a sloped surface. Hoist patient up a small distance and check to see if the sling attachments are secure and that the patient is comfortable. Raise patient high enough for clearance of the bed and/or chair; do not raise them as high as the hoist will allow. Observe patient throughout lift and provide encouragement and reassurance to keep them relaxed. Manoeuver hoist and patient to desired position and lower. Once in position, unhook the attachment and move away the hoist and remove the sling. Ensure the patient is comfortable.

Although safe patient handling is important, there are other tasks that are done as a health professional that require proper lifting techniques as well. Anywhere from organizing medicine trays, to carrying equipment, to household chores can trigger back pain if they are done incorrectly. These following lifting tips and techniques will help you lift properly and reduce your risk for back injury.

Recommendations on how to lift safely

The first step for safely lifting an object involves having a safe worksite. Survey the workspace and make any necessary changes:

  • Clear away cluttered space
  • Relocate products and organize storage areas so objects that need to be lifted/carried are between mid-thigh and shoulder height
  • If storage space above shoulder height must be used, place lighter items on top and heavier on bottom to avoid lifting heavy objects above head
  • Check for slippery or damaged floor

Once the area is considered safe, decide if the object should be lifted manually, with the help of another person or if a lift should be used. Ensure that if using a lift, proper training on how to use the equipment has been provided. If not, ask somebody who has been trained for assistance.

When ready to lift the object manually, there are several lifting techniques that can be used which will be discussed shortly. However, all the lifts have several key techniques that must be followed:

  • Tighten lower abdomen, bringing belly-button to spine. Ensure to breathe throughout the lift.
    • this protects the spine
  • Maintain a “neutral spine” which is the natural inward curve of the back
    • look forward instead of down
    • work with upper body as close to upright as possible
  • Keep object close to the body
    • the farther the object is held from the body, the greater the strain on the back
  • Minimize twisting of the spine
    • move feet instead of neck or waist
    • ensure hips and shoulders are always facing the same direction

BE PHYSICALLY ACTIVE! Regular exercise is the first recommendation for the prevention and treatment of LBP (Marshal, Desai, and Robbins, 2011).

Different types of lifts

Every lift is unique. Objects that need to be lifted are not all the same shape, size or weight. They will have to be lifted from different heights and placed on surfaces that are not always the same level. The objects themselves can have different textures; one can be a stiff box while the other can be soft bag of grass seed. Not only do the objects themselves change but individual lifters have different joint problems, muscle strength and muscle flexibility. This is why there is not one ‘absolute’ way to lift. There are different lifts that can be used depending on the object’s size, weight, texture and environment that it is being lifted in.

BASIC LIFT

The basic lift is the most common method of good lifting techniques. Use the basic lift for objects small enough to straddle. Ensure you have enough room to use a wide stance.

  1. Get close to the object
  2. Stand with a wide stance
  3. Keep your back straight, and use your legs and hips to lower yourself to the ground.
  4. Move the object as close to you as possible.
  5. If the object has handles go to step 9, if not proceed to next step.
  6. Place one hand on the corner of the object farthest away from you and the other hand on the corner closest to you. Your hands should on opposite corners.
  7. Grasp object firmly with both hands.
  8. Look forward.
  9. Lift upwards, extending your legs with back straight. Breathe out as you lift.

POWER LIFT

The power lift is used for objects too large to be straddled. Where the object is larger and often heavier, it shifts you forward so the buttocks must be pushed out to compensate.

  1. Place one foot slightly ahead of the other and stand in a wide stance.
  2. Keep your back straight, and use your legs and hips to lower yourself to the ground.
  3. Move the object as close to you as possible.
  4. Grasp object firmly with both hands.
  5. Lift upwards, extending your legs with back straight and buttocks out (exaggerate this position). Breathe out as you lift.

TRIPOD LIFT

Use the tripod lift for objects with uneven weight distribution such as sacks of food like rice, topsoil or dog food. This is a good lift for people who may not have great arm strength.

  1. Place one foot next to the object and with your back straight, slowly lower yourself down onto one knee (For support as you lower yourself down, place one hand on stool or thigh).
  2. Position the object close to the knee on the ground.
  3. Grasp the object firmly with both hands.
  4. Slide the object from knee on ground to mid-thigh. While keeping head forward, back straight, lift object onto the opposite thigh.
  5. Put both forearms under the object (with palms facing upwards) and hug item to stomach and chest.
  6. Lift upwards, extending your legs with back straight. Breathe out as you lift.

PARTIAL SQUAT LIFT

The partial squat lift is used for objects at knee height that have handles such as suitcases, briefcases or hockey bags.

  1. Stand with object close to side.
  2. Place feet shoulder width apart, with one foot slightly ahead of the other.
  3. Place one hand on a stable surface (stool, table etc.) or your thigh.
  4. Keeping back straight, slowly lower yourself down to reach the handles.
  5. Grasp the object and look forward.
  6. For support as you lift, push down on the fixed surface or your thigh.
  7. Lift upwards, extending your legs with back straight. Breathe out as you lift.

GOLFER’S LIFT

The Golfer’s lift is used for small, light objects in deep bins and to pick up small objects off of the floor. It is a good lift to use for people who have knee problems or decreased leg strength.

  1. Place hand near the edge of a fixed surface (such as the edge of a table or bin or your thigh). This hand will support your upper body during the lift.
  2. Keep your back straight and lift one leg straight out behind you as you lean down to pick up the object. The weight of your leg will counterbalance the weight of your upper body.
  3. Grasp the object firmly.
  4. When you lift, push down on the fixed surface and lower your leg, returning to an upright position. Keep your back straight and breathe out as you lift.

STRAIGHT-LEG LIFT

Use the straight-leg lift when obstacles prevent you from bending your knees. Examples include lifting groceries out of a grocery cart or boxes out of a car trunk.

Be careful! Lifts over obstacles that prevent you from bending your knees puts you at an increased risk for muscle strain. Only use this lift when necessary! Try to avoid.

  1. Stand as close to object as possible with knees slightly bent.
  2. Push the buttocks out; do not bend at the waist.
  3. If the obstacle (which is preventing your knees) is stable, lean your legs against the obstacle for support. Use your legs and hips to lower yourself down to the object.
  4. Grasp the object firmly with both hands.
  5. With the object as close to you as possible, lift upwards, extending your legs with back straight. Breathe out as you lift.

OVERHEAD LIFT

Use the overhead lift to place an object on an overhead shelf or to take an object off of an overhead shelf.

Be Careful! Overhead lifts put you at an increased risk for muscle strain. It can also be difficult to maintain balance during this lift. Only use this lift when necessary! Try to avoid.

  1. Hold the object very close to your body.
  2. Keep feet shoulder width apart, one foot slightly ahead of the other.
  3. Raise the object to shelf height using the arm and shoulder muscles. Keep object close to body and breathe out as you lift.
  4. As you reach the shelf, slowly shift your weight from the back foot to your forward foot. Keep your back straight.
  5. When the object reaches the shelf, push the object onto the shelf.

PIVOT TECHNIQUE

When you must lift an object and turn to carry it, instead of twisting the body, shuffle feet in the direction you will be travelling. Ensure hips and shoulders are always facing the same direction.

Lumbar Supports

What is a lumbar brace?

Lumbar braces, also referred to as lumbosacral orthoses, lumbar corsets, and abdominal belts have been used as a method of prevention and management of low back pain for many years (Roelofs, Poppel, Bierma-Zeinstra, and Mechelen, 2010). A lumbar brace is a support which is designed to protect the lower back. It reduces stress on the joints and muscles of the low back during activity. The back brace restricts end-of-range spinal movements and provides stability and support during general movements.

When should you use lumbar braces?

A lumbar brace would be beneficial for people who are suffering from low back pain or have experienced an injury. More specifically, if people are experiencing the acute effects of an injury or have chronic low back pain. Aggravating activities should be avoided but when they are unavoidable, a lumbar brace would help in preventing further injury and reducing pain.

However, a lumbar brace is not going to cure low back pain. Although the lumbar belt does provide support, research has shown that “incidence and severity of lumbar injuries increased after prolonged belt usage had been discontinued” (Ivancic, Cholewicki, and Radebold, 2002, p.502). Because the muscles in the back are not being activated while wearing the brace, they begin to weaken. For this reason, excessive and prolonged use of a lumbar brace is not recommended. When the injury has been healed, weaning off of the brace is the best option when strength, stability and range of motion begin to return to the lower back.

What kind should you use?

Lumbosacral supports range in fit from generic over the counter braces, to custom fit braces, which can be molded to fit the shape and needs of the individual (Agabegi, Asghar, and Herkowitz, 2010).They “can be roughly grouped into three categories based on the material: extensible made of neoprene or rubber, non-extensible made of canvas or nylon, or rigid made of molded hard plastic” (Cholewicki, Lee, Reeves, and Morrisette, 2010, p. 110). It is best to ask your physiotherapist about the options that are available to you and to ensure you choose the right brace for you.

When should lumbar braces be avoided?

One of the most important aspects of a lumbar brace is how comfortable it is, if it is not comfortable, don’t get it. There is better adherence if the possible benefits outweigh the discomfort of wearing a lumbar support (Roelfs, van Poppel, Bierma-Zeinstra, and van Mechelen, 2010). Although, during initial use of the lumbar brace, some discomfort is expected when the injury is in the acute phases and slight movements as well as light touches can evoke pain.

Once an activity can be completed without experiencing any pain, there is no reason to wear the brace any longer.

References

Agabegi, S., Asghar, F., and Herkowitz, H. (2010). Spinal orthoses. Journal of the American Academy of Orthopaedic Surgeons. 18(11), 657-667.

Chloewicki, J., Lee, A., Reeves, P., and Morrisette, D. (2010). Comparison of trunk stiffness provided by different design characteristics of lumbosacral orthoses. Clinical Biomechanics. 25, 110-114.

Gardner, P., Cole, D., 1999. The Stiff-Legged Deadlift. Strength and Conditioning Journal, 21 (5), 7-14.

Hamlyn, N. Behm, D., Young, W., 2007. Trunk-Muscle Activation During Dynamic Weight-Training Exercises and Isometric Instability Exercises. Journal of Strength and Conditioning Research 21(4), 1108-1112.

Ivancic, P., Cholewicki, J., and Radebold, A. (2002). Effects of the abdominal belt on muscle generated spinal stability and L4/L5 joint compression force. Ergonomics. 45(7), 501-513.

Marshal, P., Desai, I., Robbins, D., 2011. Journal of Strength and Conditioning Research. Core Stability in Individuals With and Without Chronic Nonspecific Low Back Pain 25(12), 3404-3411.

Roelfs, P., van Poppel, M., Bierma-Zeinstra, S., and van Mechelen, W. (2010). Determinants of intention for using a lumar support among home care workers with recurrent low back pain. European Spine Journal. 19(9), 1502-1507.