Lifting Analysis-2 Dr Hafiz Sheraz Arshad

Review of last lecture Stoop lift Squat Lift Semi-Squat Lift Freestyle Lift Trunk Kinetic Lift Load Kinetic Lift Stoop lift for normal individual Lifting technique does not cause back pain In LBP stoops lift may increase pain

It is important for therapists to critically appraise lifting techniques Recommend those that match the client’s capacities to the task that is to be performed

Dependency of lifting The semi-squat lift allows for closer placement of the load to the body, thus creating a smaller moment arm and less compressive force

Frequency & rate of lifting If lighter loads are to be handled but at a higher frequency than four per minute, the stoop lift would be a viable option The rate at which any lift is performed is extremely important Compressive forces increase by 15% when lifting is performed quickly, as compared with using a steady, smooth approach when lifting identical loads

Effective Grasp Effective hand grip and couple in the practice of safe lifting Secure grasp when handling an unstable load Instability resulting from the lack of an effective grasp can adversely affect stability (of the load)  the involuntary increased recruitment of the core-trunk muscle groups (rectus and external and internal obliques)  increased lumbar compressive forces

Other Considerations Compression at the L5/S1 joint was a poor indicator of the potential for injury Lateral shear and torsion (side bending and twisting in coupled and uncoupled movements Velocity Acceleration Worker experience and attitudes toward the job

Slope of surface Lumbosacral moments were considerably larger when lifting from an inclined slope compared with a declined surface Subsequent increase in angulation resulted in an increased moment arm of the trunk, hydrostatic pressure of the disc, and torque at the L5/S1 segment.

Stability of the Load Unstable loads carried significantly higher risks for poor mechanics and low back injury

What Physical Therapist need to concern? A major goal for the therapist is to reduce the risk of lift-related injuries at both the work site and at home The primary concern is to recognize the presence of risk factors and understand how each factor influences the pathologic process

Standards Keep the load close Ensure the placement of a secure hand couple Maintain a degree of lumbar Lordosis at the initiation and during the lift

Standards Techniques Semi –squat ideal lift for heavy loads performed on an occasional basis Squat lift: To be used as an alternative to the semi-squat when space is limited and load size does not allow for foot placement to the side of the object to be lifted This also is the lift preferred by individuals experiencing acute and chronic low back pain

Stoop lift: Lifting scenarios requiring light loads (20 pounds and below) on a frequent basis are more efficiently managed using this technique

Uneven sloped surface When lifting on an uneven-sloped surface, face down the slope to negotiate the lift When lifting, do so as much as is possible in the sagittal plane

Pushing & Pulling Seemingly less menacing and more biomechanically efficient, namely pushing and pulling Resultant vectors changed from the vertical to the horizontal axis, added the component of frictional resistance to the equation when pushing or pulling

Effect on shoulder Net joint torques at the shoulder were minimal during pushing maneuvers but greatly increased during pulling efforts Horizontal force, as opposed to torque, at the shoulder was significant during both activities

Handle height & hand placement Optimal pushing height for the best performance appeared to be at or about waist level Comparing pulling with pushing, the vector of force is substantially higher at the L5/S1 joint when pulling as compared with pushing. This comes as a direct result of the increased moment and flexed posture (at the waist) inherent with pulling as opposed to pushing

What should be preferred: Pushing & Pulling If possible, pushing should be the preferred method of material transport over pulling

Foot Placement The final consideration when evaluating pushing and pulling tasks is foot placement and the avoidance of slippage resulting from a poor coefficient of friction (COF). Injuries secondary to these conditions can be serious and usually result from the loss of balance and uncontrolled acceleration of the whole body

Coefficient of friction Adding water, oil, or other contaminants to the surface, however, greatly decreased the COF and resulted in decreased balance and sway patterns Once the risk factors have been identified, it is the therapist’s mission to control the frequency, severity, and, if possible, the very presence of the risk

THANKS