PART 4: ACTIVITIES OF DAILY LIVING
In parts 1 and 2 of the blog series, I reviewed lumbopelvic movement and the pelvic tilt. In part 3, I talked about how to stabilize your core and hold the pelvic tilt where you want it. Today I will talk about how this transfers to everyday activities and movements. If you have back pain or have injured your back, these topics are some of the most practical, easiest ways to help decrease your back pain or reduce your risk for another episode back pain. If you don’t have back pain, these topics will help you understand how to reduce overall stress on your back which will improve recovery. It will also teach you to groove proper stability patterns for a large variety of situations, and it will enhance your positional awareness which will help you tweak your athletic endeavors to improve efficiency.
Throughout the day, we all do thousand things that are second nature to us and we never give a second thought. If you’ve ever experienced significant low back pain, you can appreciate how getting up from a chair or getting out of bed the “correct” way makes the transfer much more comfortable. I put correct in quotations because it is individualized to you specifically and what specifically bothers you (see parts 1 and 2). If you want to reduce your low back pain, reduce the overall stress placed on your low back, and reduce the risk of having an episode of low back pain, then you need to think about every single movement you do throughout the day and how you can make it better for you, i.e. less compression, better position, better stability, etc. How much do you work? I’m guessing the answer lies somewhere in the 40-60hr range. If you are a student or have a desk job, how much are you sitting? If you are a strength coach, how many times are you moving 45lb plates around? There are 168 hours in a week. If you can sleep without pain/discomfort and wake up feeling good, then 42-56 hours of the week are non-stressful hours. If you can take care of the 40-60hrs worth of work activity that is adding stress to your low back, that will add up to 82-116 hours of the week. You will see your back pain decrease, feel less tired by the end of the day, and feel more energized during your workouts. Now for the rest of the hours: the commute, lounging at home, taking the kids to practice and games, family affairs, etc. Identifying all your movements and making them the best they can all be for you will be a lifesaver.
Let’s talk about what exactly I mean. I will review some very common everyday tasks and how to do those best for different preferences. I will then point out other common daily tasks and movements with the goal that from my examples, you will be able to adjust the tasks you complete on a daily basis. First let’s review getting up from lying down. How many of you get out of bed or off the couch or ground by basically doing a sit up? Remember in part 3 that the rectus abdominis adds a lot of compression to the spine, and getting up this way puts you in a flexed position. The combination of compression and flexion adds a ton of unnecessary stress to your low back. Instead get up like this:
You want to roll completely onto your side first. Then let your feet swing off and push yourself up to sitting. If you are on the floor, roll all the way onto your stomach, come up onto all fours, then move into a half kneeling position, then stand up from the lunge position. Transferring this way will keep the stresses very low on your back while keeping your pelvis and lumbar spine in the position that is most comfortable for you. Next, let’s review sit to stand. We do this transfer much more each day than you’d believe. I’ve broken it down two ways, one for flexion bias people and one for extension biased people:
In the first example, you can clearly see this is for those that prefer extension. Each time you get up from a chair, you need to slide all the way to the very edge, bring your feet as close to you as you can (notice position on the left), and have a very wide stance. This will allow you to stand straight up using almost only your legs and thus shifting the stress to the large muscle groups that can handle it and not your low back. Conversely, look at the difference for flexion biased people:
You will still slide all the way to the edge, but your feet will not be as close to you, and you will not have a wide stance. As you stand up, stay leaned forward a little bit (second from the left), and take a few steps before you come all the way upright (third and forth from the left). This will allow the body to comfortably add compression in your preferred position before you end up in lumbar extension. Let’s move on to lifting objects. I like two ways that most of you have probably heard of or seen, the golfer’s lift and the squat lift:
In the golfer’s life (top picture), you are basically doing a single leg RDL. You are keeping your back straight and hinging through your hip. This will allow you to keep your pelvis in your comfortable position. You cannot see it in the picture, but my right hand is stabilizing myself on the table. If you have this option, use it! This will put more force through the shoulder girdle and take more stress off your lower back. On the bottom is the squat lift. You want the object to be as close to you as possible so that you decrease how much compression it adds to your back. With a wide enough stance to accommodate the object, you can put your lower back/pelvic in the position that is best for you (reviewed in part 1), squat down and pick up the object. The lifting might be an obvious one, and maybe even the transfers. So let’s take a look at one option for a not-so-obvious task, tying your shoes:
This shows the way to do it for flexion biased people (left) and extension biased people (right). Please note that if you are flexible enough to sit in the figure-4 position that will be easiest (I am nowhere near flexible enough so this is my go-to option). Also note that for extension biased people, you must bend at the knee on your stance leg and bring your butt closer to your heel in order to maintain slight extension in the lumbar spine and hold your comfortable pelvic position.
Those are just a few tasks we encounter every day, and I hope explaining subtle adjustments in execution of the tasks helps you think about all the tasks and movements you complete throughout the day. Other tasks you may want to think about: Getting in and out of your car, bending down to play with the pet, picking your infant up from the crib, bending down to get files out of the filing cabinet, sitting at your desk, racking/unracking weights, doing laundry, vacuuming, washing your hair, shaving your face or legs. All of those tasks can be stressful to your lower back if you do not think about what your body prefers and how to complete the tasks for you. Next week I will discuss therapeutic exercises and functional stability of the core so you can progress your positional awareness and stability throughout movement.