Introduction, definition, purposes of maintaining proper body mechanics,terminology related to body mechanics, factors influencing body mechanics, principles of body mechanics, procedures for moving lifting and positioning of patients, general instructions of moving and lifting patients, after care of the patient, complications of improper body mechanics, conclusion

1. MAINTENANCE OF PROPER
BODY MECHANICS
SWATILEKHA DAS
(RN,MSN)

2. INTRODUCTION
Clinical nursing requires coordinated efforts of musculo-
skeletal and nervous systems and therefore involves body
mechanism. It includes the how and why of using various
muscles of our body in a more coordinated manner so that
it involves integrated functioning and efficient use of the
skeletal system, muscular system and the nervous system
as a machine.

3. To understand the body mechanics, it is important for us to
describe the centre of gravity of an object and various
planes of our body. The centre of gravity of an object may
be defined as the point at which its mass is centres. In the
standing position, the centre of gravity is located in the
centre of pelvis approximately midway between the
umbilicus and the symphysis pubis. The line of gravity is a
vertical line that passes through the centre of gravity. The
constant pull exerted by earth on every object towards its
centre helps to maintain a good posture and balance.
Hence we can say that the key of comfort and efficient use
of energy of an individual is to maintain proper body
mechanics.

4. DEFINITION
Body mechanics is the coordinated effort of the musculo-
skeletal and nervous system to maintain balance, posture
and body alignment during lifting, moving, positioning and
performing activities of daily living.

5. PURPOSES OF MAINTAINING
PROPER BODY MECHANICS
Use of proper body mechanics in terms of posture and alignment
helps in-
• reducing risk of injury to the musculo-skeletal system.
• facilitating body movement without muscle strain and
excessive use of muscle energy.
• maintaining adequate muscle tone; thus contributing to
balance of the body.
• preventing fatigue and deformities e.g. kyphosis, lordosis etc.
• promoting physiological functions of the body as it aids in
circulation and digestion.
• reducing energy expenditure.
• facilitating aesthetic well-being in terms of physical fitness and
shape.

6. TERMINOLOGY RELAED TO BODY
MECHANICS
There are various terms used in relation to body mechanics.
Some of these terms are:
• Body Alignment- Body alignment refers to the positioning of
joints, tendons, ligaments and muscles while in standing,
sitting and lying positions.
• Body Balance- Body balance refers to a state of the body
achieved when the centre of gravity is balanced over a wide,
stable base of support and a vertical line falls from the centre
of gravity through the base of support.
• Posture- Posture refers to the position of the body in relation
to the surrounding space. It is the relationship of various body
parts at rest or any phase of activity.
• Mobility- Mobility is a person’s ability to move about freely
owing to his/her voluntary motor and sensory control of the
body’s regions.

7. • Immobility- Immobility occurs when the individual is confined
to a position and is unable to move or change positions
independently.
• Bed Rest- Bed rest is an intervention in which the client is
restricted to bed for therapeutic reasons.
• Weight- Weight is the force exerted on a body by gravity.
• Friction- Friction is a force that occurs in a direction to
oppose movement.
• Anatomical Position- Anatomical position refers to a position
wherein the individual stands erect (upright position) facing
the observer, with feet on the floor and arms placed at the
sides, and the palms of the hands turned forward.

9. FACTORS INFLUENCING BODY
MECHANICS
• Muscle tone- It is the normal state of balanced muscle tension that is
achieved by alternative contraction and relaxation, without active
movement of neighbouring fibres of a specific muscle group. This helps
a body part to be maintained in a functioning position without muscle
fatigue.
• Muscle groups- The type of muscle group involved in posture and
movement also influence body mechanics. These muscle groups can
be three types:
 Antagonistic muscles work together to bring about movement at the
joint.
 Synergistic muscles contract together to accomplish the same
movement.
 Antigravity muscles continuously oppose the effect of gravity on body
and permit a person to maintain an upright or sitting posture.
• Personality and mood of individual- Posture and movement can be
reflections of personality and mood. For instance, a person with a
dramatic personality gestures with hands; a person who is fatigued or
depressed may show minimum or least movements with a dull posture.

10. PRINCIPLES OF BODY
MECHANICS
• Certain principles underlying body movement can serve as
guide for the patient and the nurse. Correct body mechanics
is necessary for health promotion and prevention of disability.
The principles of body mechanics include:
• The wider the base of support, the greater the stability of the
nurse.
• The lower the centre of gravity, the greater the stability the
nurse.
• The equilibrium of an object is maintained as long as the line
of gravity passes through its base of support.
• The stronger the muscle group, the greater amount of work
that can be safely done by it.
• Facing the direction of movement prevents abnormal twisting
of spine.

11. • Dividing balanced activity between arms legs reduces
the risk of back injury while lifting or moving an object.
• Leverage, rolling, turning or pivoting requires less work
than lifting.
• When friction is reduced between the object to be moved
and the surface on which it is moved, less force is
required to move it.
• Reducing the force of work reduces of injury.
• Maintaining good body mechanics reduces fatigue of the
muscle groups.
• Alternating periods of rest and activity help reduce
fatigue.

12. PROCEDURES FOR MOVING,
LIFTIING AND POSITIONING OF
PATIENTS

13. General Instructions in Moving and
Lifting Patients
• Maintaining a good anatomical position of the body.
• Use longest and strongest muscles extremities to provide energy needed in
strenuous activities.
• Keep the objector the patient close to the body to prevent unnecessary
strain on the muscles as this brings the centre of gravity of the object/patient
close to the centre of the gravity of the body.
• Place the feet apart to provide a wide base of support. This facilitates better
body balance.
• Flex knees to come closer to the object/ patient.
• Keep work close to the body.
• Maintain the four body curves of human body and work with their proper
alignment.
• Slide, roll, push or pull an object rather than lift in order to reduce the energy
needed to lift the weight against pull of gravity.
• Keep the body above the object and the use the weight of the body to pull
or push the object.
• Avoid disturbances/ interruptions in the path of movement of patients.
• Move obese patients by sliding them rather than lifting them.

14. • Seek assistance when lifting or moving heavy patients.
• The height of the bed should be adjusted to a height that allows the nurse to
keep her back as erect as possible while moving the patient in the bed. This
reduces the injury to the lower back.
• The patient is moved to the edge of the bed before he is lifted from the bed.
This helps the nurse to keep her trunk more erect.
• When moving a patient by more than one nurse, each nurse assumes the
responsibility for supporting one of the patient’s body sections. The areas to
be supported include head, shoulders, chest, hips, thighs and ankles.
• In order to coordinate the movements of the nurses and to maintain the
patient’s body in correct alignment, the nurse gives the signal by counting
1,2,3 etc. with each activity of the procedure.
• Unless contra-indicated, encourage the patient to use his abilities as much
as possible.
• Observe the patient for symptoms of orthostatic hypotension e.g. fainting,
dizziness, sweating etc.
• Do not support the patient under his armpits, since injury to major nerves
and blood vessels may occur.
• Always lock the wheels of the bed, stretcher or wheel chair while
transferring the patient so as to increase the maximum static friction
between the wheels and floor.

15. Steps of moving patient to one side of
the bed
Steps Rationale
Stand facing the patient at the side of the bed in which he is to be
moved. Stand with a wide base of support with knees and hips
flexed to bring your arms to the level of the bed.
Wide base provides a stable base. Flexed knees,
bring the nurses’ arms to the bed level and place
them in a position to lift with strong leg muscles.
Place the arm of the patient on his/her chest.
Place one arm under the shoulders and neck of the patient and the
other under the patient’s back.
This will help prevent an injury and will not
hinder movement.
Helps to move the patient’s body in unison.
Shift own body weight from your front foot to your back foot as
you ruck backward, bringing the patient towards you to the side of
the bed.
Avoids strain on the patient’s as well as the nurse’s
muscles.
Move the middle part of the patient in the same manner by placing
one arm under his back and one arm under his thighs.
Helps to move the patient’s body in unison.
Then move the feet and lower legs with the same motion. Avoids any musculo-skeletal injury to the patient
and the nurse.

16. Moving patient to one side of the bed

17. Steps of Moving patient in bed
Steps Rationale
Stand at the side of the patient’s bed and face the foot end of the
bed. Stand with a broad stance placing one foot behind the other.
Wide base provides a stable base.
Flex your knees to bring your arms at bed level. Put your arms
under the patient.
Supports the body of the patient.
Helps in easy movement of the patient.
Place one arm under the patient’s head and shoulders and one arm
under his back.
Supports the body of the patient.
Helps in easy movement of the patient.
Move forward and shift your weight from forward foot to her
backward foot with hips flexed.
Avoids strain on muscles of the nurse.
Slide the patient diagonally across the bed towards the head and
side of the bed.
Bringing the patient close to the body prevents
unnecessary strain on his and the nurse’s muscles.
Move the trunk and legs of the patient in the same manner. Helps to maintain a good anatomical position.
Go to the other side of the bed and repeat the above steps till the
patient is positioned satisfactorily.
To be systemic and methodical.

18. Moving a helpless patient in the bed

19. Steps of turning a patient to one side
of the bed
Steps Rationale
Move the patient to the same side of the bed so as to bring him
slightly off the centre of the mattress.
If the patient is not moved to the side of the bed,
he/she may fall to the ground when he/she is turned
on his/her side.
Keep the farthest arm along the side of the head and face, the near
arm across the chest and the near leg flexed over the farthest leg.
Helps to prevent injury.
Helps in easy turning of the patient.
Place your arm under the shoulders and hips of the patient and roll
him gently away. Make the patient comfortable by placing pillows
as in a side lying position.
Supports the body and turns the body as a whole.

20. Turning a patient to one side of the bed

21. Steps of transferring a helpless
patient from bed to stretcher
Steps Rationale
Position the stretcher at right angle to head or foot end of the
bed.
Gives space for nurses to move.
Shortens the distance to carry the patient.
Call helpless to position them at the bedside along the same
side of the bed.
If the patient is heavy,
Call for more helpers.
Move the patient to the edge of the bed. Placing the patient to the edge of the bed prevents over
reaching and sustains injury to the back.
Position yourself(three nurses) at the
i. Head, shoulders and chest
ii. Hips
iii. Thighs and ankles, level of the patient
Facilitates moving of the body as a whole.
Count 1,2,3,4 and 5
i. At count 1, the nurses slide their arms under the patient
to support his body sections.
ii. At count 2, the nurses stand with back erect, holding
the patient as near their body as possible.
iii. At count 3, the nurses take one step backwards and
pivot on their heels towards the stretcher.
iv. At count 4, the nurses move to the side of the stretcher
and stand with a wide base and flexed knees ready to
lower the patient into the stretcher.
v. At count 5, the nurses lower the patient to the stretcher
in a back lying position.
Helps to bring the patient’s body weight within nurse’s base of
support.
A feeling of security to the patient.

22. Steps of transferring a helpless patient from bed to stretcher

23. Steps of assisting the patient to sit on
the side of the bed
Steps Rationale
Assist the patient to move towards the edge of the bed on
the right side.
The patient moves close enough to the edge of the bed to
allow his knees to bend over the edge of the mattress when
sitting.
The nurse stands at the side of the bed at the level of the
patient’s waist.
To protect the patient from rolling out of bed and to assist
him, when needed.
Help the patient to turn to the right side of the bed. The
right hand is kept along the side of the head or face, the
left hand is brought over the chest and the left leg flexed
over the right.
A side lying position enables the patient to assume an
upright position easily.
Ask the patient to slide his heels off the edge of the
mattress, at the same time to raise his head and trunk by
pushing the mattress with the first of the left hand and
grasping the edge of the mattress with the right hand.
Then, roll upwards on elbow till he reaches a sitting
position.
Use of stronger muscle groups helps in moving the patient
easily and safely.
In sitting position, ask the patient to keep both arms
extended backwards with palms supporting on the
mattress. Tell the patient to place both feet flat on the
floor.
Both arms help to maintain the balance of the body in a
sitting position.
Watch for symptoms of orthostatic hypotension such as
faintness, dizziness and sweating.
When bedridden patients assume an upright position, they
develop orthostatic hypotension.

24. Steps of assisting the patient to sit on the side of the
bed

25. Steps of assisting a patient from bed
to chair or wheel chair
Steps Rationale
Place the chair/wheel chair at the right side of the bed,
with the back towards the foot of the bed.
Helps to reduce energy expenditure.
The wheels should be locked or placed against the wall or
another person.
Help the patient to sit on right side of the bed.
To prevent rolling of the wheel chair during transfer of the
patient.
Stand in front of the patient, facing him. To extend help to the patient, when needed.
Slide the patient’s buttocks close to the edge of the bed by
shifting his weight alternatively from right to left buttock
till his feet are placed on the floor.
Rocking motion lifts weight on alternate buttocks and
enhances forward movement.
Instruct the patient to stand on command by
simultaneously leaning forward, pushing with the foot
placed at the back as he straightens his legs. Balance the
patient on the armchair / side rail or mattress.
Do not risk the danger of the patient falling to the floor.
Observe for symptoms of orthostatic hypotension.
Instruct the patient to step back to the chair/ wheel chair
until he/she touches the seat and grasps the other arm of
the chair with his/her right hand.
Facilitates sitting in the chair with ease.
Instruct the patient to lean forward and lower his/her
buttocks slowly to the seat by bending knees and elbows.
Facilitates sitting in the chair with ease.
Check for any discomfort, correct posture of the patient. Helps to check for orthostatic hypotension.

26. Steps of assisting a patient from bed to chair or wheel chair

27. After care of the patient
• Ensure correct body alignment and comfort of the patient.
• Replace pillow and other comfort devices as needed.
• Raise the side rails if necessary for the safety of the patient.
• Check for any discomfort, pain, skin condition etc.
• Check vital signs of the patient after assessing the desired posture
for assessing orthostatic hypotension.
• Remain with the patient during change of position to prevent his/her
falling.
• Return to the supine position in case of any discomfort.
• Record the following aspects:
 Duration of the assumed position of the patient.
 Amount of assistance/instruction needed.
 Vital signs of the patient-temperature, pulse, respiration, blood
pressure.
 Reaction of the patient to activity.
 Observations, if any.
 Recommendations for progressive activity and independence.
• Ensure that the patient is comfortable and safe.

28. COMPLICATIONS OF IMPROPER
BODY MECHANICS
If body mechanics principles are not observed, it may lead
to various complications like:
• Musculo-skeletal injuries
• Complications of immobility, e.g. pressure sores,
contractures, constipation etc.
• Muscle fatigue
• Orthostatic hypotension
• Hypotension bronchopneumonia
• Decreased basal metabolic rate

29. CONCLUSION
The nurses incorporate knowledge of the physiological
factors of movement and principles of transfer and position
their client’s safely. Correct body mechanics protect the
nurse and the patient/ client from musculo-skeletal injuries
and also help in preventing muscle fatigue. Maintaining
good body mechanics by observing the principles and
general rules will certainly help to impart a feeling of well-
being for the patient and a sense of physical fitness and
beauty for the nurse.