Apart from seating, bending and lifting at work are common problems encountered by patients with low back pain. Examples are floor tiling, carpet laying or welding where the person is at floor level and bending over most of the day. In these situations, it is better for the person to kneel than to squat. The difference is that in kneeling, the knees are lower than the hips and this increases the gap between the ribs and hips thereby reducing the risk of Hip Rib Impingement ( HRI ). in squatting, one or both knees are higher than the hips thereby compressing the hips into the lower rib cage causing HRI and trauma to the lateral abdominal muscles as well as the hip muscles and the intercostal muscles and the diaphragm.
Another situation where the knees are higher than the hips are teachers or carers of young children when the adult sits on the floor cross legged or sits on a child size chair to get down to the child’s level. This definitely causes HRI if not in the sitting position then in the course of getting up from that position. In the last few years some of my patients who work on computers have been provided with foot stools which have actually exacerbated their back pain. These foot stools raise the level of the knees till they are above the height of the hips causing HRI.
Lifting from floor level has the potential to cause or exacerbate lower back pain by causing HRI. The safest way to lift from floor level is again to start by kneeling, then hold the object as close to the body as possible and if the object does not have a handle then to tilt the object so that one hand is under the object and the other is under the tilted side. the next step is to perform the Airbag Technique before lifting and holding the breath in, keeping the torso as vertical as possible and keeping both knees below the level of the hips throughout the lift. Bending straight over at the hips to pick up an object from the floor is high risk as patients have described developing back pain picking up a tissue off the floor or the morning newspaper. Previous recommendations for lifting from the ground level allows one knee to be higher than the level of the hips while lifting and this has been a common cause of back pain for many.
Lifting objects or shopping from the boot of the car is also a high risk situation as people tend to bend over to avoid hitting their head on the boot lid reducing the Hip Rib Gap ( HRG ) and then lifting and twisting at the same time increasing the risk of unilateral HRI. Once again, by using the Airbag Technique, keeping the torso as vertical as possible and twist at the hips and knees instead of the waist will avoid HRI and back pain.
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