Page1REDUCE RISK OF INJURYWHILE HELPING OTHERS IN NEEDA healthy back has 3 natural curves (cervical curve, thoracic curve & lumbar curve: seeFig 1), strong flexible muscles, flexible joints and healthy discs (Fig 2 & 3). It supportsyour upper body, protects your spinal cord and allows you to move freely.Fig 1 Fig 2 Fig 3Our lower back (lumbar region) is most vulnerable to injury because:-We stand upright.-Lumbar region supports the weight of our entire upper body.-It bears most of the load when we work.-Posterior longitudinal ligament is weaker than the anterior longitudinal ligament.Common Back Problems from Damaged Disc besides Muscle Strains: (Fig 4 & 5)-Degenerative Disc -Thinning Disc -Bulging Disc -Herniated DiscFig 4 Fig 5Majority of back problems are preventable with good posture and body mechanics.
Page2Good posture (Fig 6) and body mechanics (Fig 7) is the safest, most efficient, and mostcomfortable way to move. You will have more energy and less chance of backache,stiffness or injury. Distribute the weight of the load evenly throughout your spine, loweringyour risk of injury.Fig 6 Fig 7 Fig 8Bad Posture (Fig 8) is when the spine is deviated away from the natural curves.Good Posture (Fig 6) is when your ears, shoulders and hips are in a straight line. Keepingall 3 natural curves in their normal alignment; your weight is evenly distributed throughoutthe vertebrae and discs. Your back is least vulnerable to injury when you have good posture.Poor Body Mechanics:-Even a light load held far from body can put excessive strain on low back.-Reaching or bending from the waist forces your back to support your upper body weightplus the load. (Fig 9)Fig 9 Fig 10-Over time can cause back strain, disc damage, pain and lead to a herniated disc. (Fig 10)Good Body Mechanic (Fig 7) is good posture in motion. Whether you are standing, lifting,pushing, pulling, twisting or bending, good body mechanic will provide good backprotection by distribute the weight of the load evenly throughout your spine, lowering yourrisk of injury.How to decrease risk of injury:NEVER STAY IN ONE POSITION FOR A LONG PERIOD OF TIME!-Change positions, stretch and walk.
Page3-Maintain proper posture and spine curvatures in all positions and activities.SLEEPING *use cervical rollPoor Posture…………………………………………………………………………………………………………………………………….………………………………………Good PostureSITTING STANDING WALKING
Page4Poor Good: use Poor Good: rest foot on a low Poor Goodlumbar support stool to relax backLIFTING/MOVING AN OBJECT or A PERSON-When load is heavy, plan ahead and get help. Don’t be shy to ask for help.-Hold loads close to your body & tighten your abdominal muscles.-Keep back straight (neutral spine), feet apart (shoulder width) & your knees bent, lift withyour legs to reduce the stress on your back.-Lift objects only chest-high. Avoid quick, jerky movements.-If you have difficult time tightening your abdominal muscles then you should wear a backsupport when lifting. However, DO NOT wears the support all day because it can weakenyour core muscles that support your back unless you have a condition that your doctor wantsyou to wear it all day.Bad Good Bad Good Bad Good____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________-Avoid bending trunk forward and twisting at the same time. Move your torso-from yourshoulders to your hips-as one solid unit by moving your feet. (Fig 11)Fig 11 Fig 12Bad Good Bad Good
Page5-Avoid reaching out over an obstruction to lift, hold or lower an object as much as possible.If you have to reach across a bed, rest one knee on the bed to support your lower back. Thenbend from hips but keep back straight not hunched over. (Fig 12)____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________-Push, instead of pulling as much as possible. (Fig 13)Fig 13 Fig 14Fair BetterREACHING OVERHEAD (Fig 14)-Store heavy and frequently used items at waist height.-Reach only as high as is comfortable but don’t stretch; use a stool if you need it.-Test the weight of the load before lifting by pushing up on one corner.-Let your arms & legs do the work, not your back. Tighten stomach muscles as you lift.OTHER WAYS TO REDUCE INJURY TO YOUR BACK-Adequate hydration to hydrate the discs to increase disc height.-Stress can tighten your muscles, which in turn narrows your disc space that may cause backpain. Reduce stress by taking a break from providing care every so often. Do things thathelp your muscle relax (i.e. stretching exercises, massages, watch a comedy show…).-Strengthen core muscles & legs: (Do minimum of 3x /week up to everyday 10 to 30x each)Partial Sit Ups: Breathe in 1st. Tuck youchin & belly in. Raise head and shouldersoff the bed one spine segment at a time asyou breathe out slowly for 10 counts then godown in reverse as you breathe in.Bridging:Lift buttocks off the bed. Hold for 10 counts.
Page6Alternate Arm & Leg Reach:Hold arm & leg up for 10 counts eachtime.Wall Slide:Stand against a wall with your back and buttockstouching the wall. Place both feet about 6 inchesfrom the wall. Tuck your belly in. Slowly loweryour body by bending the knees & slide down thewall until the knees are flexed about 45 degrees.Pause 5 seconds and then slowly slide back up to thestarting position. Keep the hips level and be sureyou are using your knee muscles to perform theexercise.Take care of yourself so you can take care of othersGood posture & body mechanics also apply to the ones that you care for.☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺How to help someone who is not independent:Promote Independence-Do range of motion to keep joints from getting stiff. Encourage the person to range on theirown as much as possible to ↑ circulation & prevent blood clot.-Do weight bearing activities (i.e. standing, walking) as much as possible to prevent loss ofbone density and ability to sense what is up right posture.-Do resistive exercises to keep muscles strong and to prevent bone density loss but mustconsult with your physician & physical therapy first.-Always allow the person to do as much as they are able so they will not become weaker.When they are weaker, it’ll become harder for you.-Provide help only when the person is not capable of doing it.-Use assistive devices (overhead trapeze, sliding board, draw sheet, hand rail, mechanicallift, hospital bed…) if available to make getting around easier for all.-To make sit to stand easier by scooting buttocks forward first, keep feet behind knees. Useboth hands to push down on armrests or bed to assist with standing if able. (Discourage theperson to pull up on the walker for standing as much as possible because the walker can fallback on/with them).
Page7Communication-Always let the person knows what you are going to do & how they can help you.-If the person has dementia, keep instructions simple & meaningful. (i.e. Let’s go eat, let’sgo check the mail or let’s go to the bathroom. Don’t say let’s go for a walk or stand up).Safety-Not to wear socks (unless it is non-slip) or flip flops for walking.-Always remind the person to feel the chair or the bed behind both legs and reach for it withtheir hands prior to sitting down. Always stay close to prevent the person from falling.-Always repeat safety instructions every day to help the person remember. (i.e. don’t get upby themselves, always call for help if they don’t have good balance).-During transfers, use a gait (transfer) belt. If no belt available, use a dress belt with a securebuckle. Place belt around the waist line or pants line. Hold on to the belt and pants. Holdon to the pants if belt is not available; however, the pants should not be elastic.-During walking, stand to the side & slightly behind the person. Hold on to the belt on theback side of the person. The other hand should be ready to grab the shoulder in case theperson loses balance.-If the person loses the balance & you are not able to hold on. Do not strain yourself. Lowerthe person to the ground slowly & safely.-Anything that has wheels should be locked or place against a wall or sturdy furniture.-If the person has breathing problems, keep head elevated at about 45 degrees to allow moreroom for oxygen exchange in the lungs. (A wedge pillow is often helpful).-If the person has a G-tube, make sure head is elevated > 45 degrees.-Not to allow the person to lie down right after meals, wait at least 30 minutes.-Pause after sitting up or standing up to ensure no blackout or dizziness from orthostatichypotension (dropping of blood pressure) before moving on.-If the person’s blood pressure becomes high, help by doing the following relaxationexercises:1. Take a deep breath, pinch shoulder blades together & count to 10 then exhale slowly.2. Take a deep breath then roll shoulders backward slowly 3 times.3. Take a deep breath, bring shoulders to ears & make it very tight then count to 10. Exhaleslowly as you lower both shoulders as low as possible & relax.4. Take a deep breath.5. Close eyes and meditate for 3 minutes as you breathe in and out slowly.
Page8Comfort-Position the person in 3 natural curves as much as possible so the person can be comfortableand able to tolerate a position longer.-Place a small pillow at low back region when sitting.-Use a sit straight pressure relief wheelchair cushion that provides pressure relief on sittingbones & also to assist the person to sit up straight without a hammock effect.Prevent Skin Lesion-Turn and change position every 2 hours if the person is not able to do it on their own toprevent pressure sores.-Do not allow both heels rest against the bed. Place a pillow under legs above the ankles tokeep both heels away from touching the bed.-If has a hospital bed, raise the foot of the bed slightly to prevent the person from slidingdown on the bed in order to reduce sheer force (friction) on the skin.-If the person has tendency of getting swollen limbs, elevate the limb above the heart &encourage the person to move actively such as ankle pumps or finger pumps if able (exceptwhen they have active deep vein thrombosis). Wear compression garment when out of bedto control the edema in order to prevent skin lesion.Moving Up on a Bed-Adjust bed height right below your waist if able. If notable, put one knee on the bed.-Work from side of bed, feet pointed in direction you’llmove the person.-Reach under patient’s shoulders and back and slide,don’t lift.-Ask the person to help by pushing against mattress withfeet and/or elbows.-Keep your feet wide apart, knees bent, back straight.When the person is not able to help at all:-Use a draw sheet & 2 persons lift.-Lift in unison.Turning in Bed-Adjust bed height to mid or upper thigh.-Put bed rail down if safe for the person.-Cross the person’s arms on chest; cross the legs.-Put your knee on bed, near person’s shoulder.-If possible, turn the person toward you.
Page9Getting In/Out of BED-If a person requires a lot of assistance and has a hospital bed, raise head of the bed to makegetting out easier.-Roll the person to their side then have them use elbow & hands to push up to sit.-Do above sequence on reverse when going back to bed.Transfers-Transfer toward the stronger side of the body as much as possible.-Allow the person’s head on the side of the direction where they are heading so they can seewhere they are going in order to help you out as much as possible.-Always lock the wheelchair first.-If coming out from bed to a wheelchair, raise the bed higher than the wheelchair if able tomake transfer & standing up easier.-If going back to bed from the wheelchair, lower the bed than the wheelchair to increase easeof getting into the bed if possible.-Support the person’s weak knee to prevent buckling.-Let the person know, on a count of 3 stand & pivot (i.e. 1, 2, 3 stand & pivot). May userocking motion to gain momentum to stand up if the person is extremely weak.-Make sure you keep your back straight, bend your knees, use legs to lift.-If the person must hold on to you, have they held your waist or shoulder, NOT NECK!Sliding board transfers:-Place wheelchair parallel next to the bed.-Raise the bed slightly higher than the wheelchair if youare getting out of bed.-Lower the bed slightly lower than the wheelchair if youare going back to bed.-Remove arm rest of the side of the bed.- Have the person lean away from the direction they aregoing to place the sliding board under that cheek.-Make sure the sliding board bridge the gap securely.-Have to person to push down with their hands to scootacross the board if they are able. Make sure theirfingers are not under the board.-Have your foot point towards the direction you’re going.Bend your knees. Keep back straight & help slide over.
Page10Bath Tub Transfers Using Transfer Bench:-To transfer from a wheelchair to a bath bench, place the wheelchair so that it faces the front of the tub, nextto the bench. Remove wheelchair armrest of the side of the bench.-Transfer your torso from the wheelchair to the bench then lift each leg into the tub.-Slide over until you are sitting in front of the backrest in the center of the tub. Grab the arm rest to help youslide over, if needed. Move slowly and avoid twisting to prevent injuries.-To transfer back to the wheelchair, slide over to the edge of the bench, lift each leg over the tub wall, andthen transfer your torso into the wheelchair.-To transfer to a bath bench from a standing position, sit down on the side of the bench that is outside thetub. Reach out and grab the arm rest for support, if needed.-Lift each leg over the side of the tub wall.-Slide your body over to the center of the bench, with the backrest behind you.-To get out of the bathtub, slide over to the edge of the bench, lift each leg over the tub wall, and pushyourself up from the bath bench. Move slowly and avoid twisting to prevent injuries.Tub transfer Car transferCar Transfer:-Open the door as wide as possible. (may place a plastic bag on a seat under a towel to make sliding in andout easier.-Place wheelchair next to the car & lock the wheels. (make sure to have enough room for 2).-Stand pivot with then sit on the car seat then swivel legs into the car.-When coming out of the car; reverse the sequence.-If able to walk with an walking aid: walk towards the car seat, turn to back up to the seat then hold on tothe car to sit then bring your legs in. Reverse the sequence when coming out of the car. Make sure not toplace your hand at where it might get jammed.Positioning in a Wheelchair-Lock the wheelchair.-Scooting a person back into a wheelchair: have the person’s arms crossed then put your handsthrough under the armpits then hold onto their wrists or grab their pants to scoot back.
Page11-Place a small pillow at low back area to maintain a natural curve.-Rest feet on foot pedals. Knees should be slightly higher than the hips to increase comfort for lowback area (It the person had recent total hip replacement, the knees will have to be lower than hips).-It is best to lower wheelchair seat height so that the person’s feet can be flat on the floor with kneesat the hip height in order to promote mobility & keep low back in natural curvature. (Should usefoot pedals when moving the person in the wheelchair to prevent leg injuries).-Use leg rest to elevate both legs if has problem with edema in the legs.Falls-If the person is having a lot of pain & not able to move then call 911.-If the person does not have pain or pain is mild, then bring a chair that the person can grabto get up from the floor.How to adjust walking devices:-Elbow should be bending at about 25 to 30 degree angle to be more advantageous.-Or have the person stand with arms resting at his or her sides and adjust it so thatthe handles are at the height of the person’s wrist.-If the person’s posture falls backward then the walking device is too tall; it the person bendforward then the walking device is too low.-Make sure you are wearing the walking shoes when making the measurement.25 to 30 degreesHow to use a rollator or a four wheeled walker with a seat safely-Not to use it like a wheelchair & not to walk with the walker far from you.-Squeeze the brakes like the bicycle brakes when walking down hills/inclines to slow downthe walker. Always keep the wheels locked before sitting in it or standing up from it.-Best to have the walker against a wall or sturdy object to prevent the walker from movingsince the brakes have tendency to fail.-Hold on to both handles & pull it towards your buttocks prior to sitting in it.